martes, 10 de marzo de 2015

Anticuerpos inmunoglobulina CYP2E1 de subclase G4 después de la anestesia con desflurano.

Anticuerpos inmunoglobulina CYP2E1 de subclase G4 después de la anestesia con desflurano.
CYP2E1 immunoglobulin G4 subclass antibodies after desflurane anesthesia.
Batistaki C1, Michalopoulos G1, Matsota P1, Nomikos T1, Kalimeris K1, Riga M1, Nakou M1, Kostopanagiotou G1.  World J Hepatol. 2014 May 27;6(5):340-6. doi: 10.4254/wjh.v6.i5.340.
AIM: To investigate CYP2E1 IgG4 autoantibody levels and liver biochemical markers in adult patients after anesthesia with desflurane. METHODS: Forty patients who were > 18 years old and undergoing elective surgery under general anesthesia with desflurane were studied. Alpha-glutathione-S-transferase (αGST) and IgG4 antibodies against CYP2E1 were measured preoperatively and 96 h postoperatively, as well as complete blood count, prothrombin time (PT), activated partial thromboplastin time (aPTT), international normalized ratio (INR), aspartate aminotransferase (SGOT), alanine aminotransferase (SGPT), g-glutamyl-transpeptidase (gGT), alkaline phosphatase, total serum proteins, albumin and bilirubin. A separate group of 8 patients who received regional anesthesia was also studied for calibration of the methodology used for CYP2E1 IgG4 and αGST measurements. Student's t-test and the Mann-Whitney U test were used for comparison of the continuous variables, and Fisher's exact test was used for the categorical variables. All tests were two-tailed, with statistical significance set as P < 0.05.
RESULTS: None of the patients developed postoperative liver dysfunction, and all patients were successfully discharged from the hospital. No statistically significant difference was observed regarding liver function tests (SGOT, SGPT, γGT, bilirubin, INR), αGST and CYP2E1 IgG4, before and after exposure to desflurane. After dividing patients into two subgroups based on whether or not they had received general anesthesia in the past, no significant difference in the levels of CYP2E1 IgG4 was observed at baseline or 96 h after desflurane administration (P = 0.099 and P = 0.051, respectively). Alpha-GST baseline levels and levels after the intervention also did not differ significantly between these two subgroups (P > 0.1). The mean αGST differences were statistically elevated in men by 2.15 ng/mL compared to women when adjusted for BMI, duration of anesthesia, number of times anesthesia was administered previously and length of hospital stay. No significant difference was observed between patients who received desflurane and those who received regional anesthesia at any time point.
CONCLUSION: There was no difference in CYP2E1 IgG4 or αGST levels after desflurane exposure; further research is required to investigate their role in desflurane-induced liver injury.
KEYWORDS: Anesthesia; CYP2E1 IgG4; Desflurane; Drug-induced-liver injury; Hepatotoxicity

Disfunción cognitiva después de desflurano versus sevoflurano en ancianos. Estudio randomizado controlado
Cognitive dysfunction following desflurane versus sevoflurane general anesthesia in elderly patients: a randomized controlled trial.
Meineke M, Applegate RL 2nd1, Rasmussen T, Anderson D, Azer S, Mehdizadeh A, Kim A, Allard M. Med Gas Res. 2014 Mar 25;4(1):6. doi: 10.1186/2045-9912-4-6.
As life expectancy increases, more patients ≥65 years undergo general anesthesia. Anesthetic agents may contribute to postoperative cognitive dysfunction, and incidence may differ with anesthetic agents or intraoperative anesthesia depth. Responses to anesthetic adjuvants vary among elderly patients. Processed electroencephalography guidance of anesthetic may better ensure equivalent cerebral suppression. This study investigates postoperative cognitive dysfunction differences in elderly patients given desflurane or sevoflurane using processed electroencephalography guidance..... CONCLUSIONS: For elderly patients in whom depth of anesthesia is maintained in the moderate range, both desflurane and sevoflurane are associated with transient decreases in cognitive function as measured by MMSE after anesthesia, with clinically insignificant differences between them in this setting.
Anestesia y Medicina del Dolor
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