jueves, 12 de marzo de 2015

Toxicidad de gases halogenados / Halogenated anesthetics toxicity

Toxicidad hepática de los anestésicos halogenados
Hepatotoxicity of halogenated inhalational anesthetics.
Safari S1, Motavaf M2, Seyed Siamdoust SA1, Alavian SM3.
Iran Red Crescent Med J. 2014 Sep 5;16(9):e20153. doi: 10.5812/ircmj.20153. eCollection 2014.
CONTEXT: Halogenated inhalational anesthetics are currently the most common drugs used for the induction and maintenance of general anesthesia. Postoperative hepatic injury has been reported after exposure to these agents. Based on much evidence, mechanism of liver toxicity is more likely to be immunoallergic. The objective of this review study was to assess available studies on hepatotoxicity of these anesthetics. EVIDENCE ACQUISITION: We searched PubMed, Google Scholar, Scopus, Index Copernicus, EBSCO and the Cochrane Database using the following keywords: "inhalational Anesthetics" and "liver injury"; "inhalational anesthetics" and "hepatotoxicity"; "volatile anesthetics" and "liver injury"; "volatile anesthetics" and hepatotoxicity for the period of 1966 to 2013. Fifty two studies were included in this work. RESULTS: All halogenated inhalational anesthetics are associated with liver injury. Halothane, enflurane, isoflurane and desflurane are metabolized through the metabolic pathway involving cytochrome P-450 2E1 (CYP2E1) and produce trifluoroacetylated components; some of which may be immunogenic. The severity of hepatotoxicity is associated with the degree by which they undergo hepatic metabolism by this cytochrome. However, liver toxicity is highly unlikely from sevoflurane as is not metabolized to trifluoroacetyl compounds. CONCLUSIONS: Hepatotoxicity of halogenated inhalational anesthetics has been well documented in available literature. Halothane-induced liver injury was extensively acknowledged; however, the next generation halogenated anesthetics have different molecular structures and associated with less hepatotoxicity. Although anesthesia-induced hepatitis is not a common occurrence, we must consider the association between this disorder and the use of halogenated anesthetics.
KEYWORDS: Anesthesiology; Halothane; Inhalation Anesthesia; Liver Injury Drug-Induced; Sevoflurane
La exposición temprana a los anestésicos volátiles perjudica el aprendizaje asociativo a largo plazo y la memoria de reconocimiento.
Early exposure to volatile anesthetics impairs long-term associative learning and recognition memory. Lee BH1, Chan JT1, Hazarika O1, Vutskits L2, Sall JW1.
PLoS One. 2014 Aug 28;9(8):e105340. doi: 10.1371/journal.pone.0105340. eCollection 2014.
BACKGROUND: Anesthetic exposure early in life affects neural development and long-term cognitive function, but our understanding of the types of memory that are altered is incomplete. Specific cognitive tests in rodents that isolate different memory processes provide a useful approach for gaining insight into this issue. METHODS: Postnatal day 7 (P7) rats were exposed to either desflurane or isoflurane at 1 Minimum Alveolar Concentration for 4 h. Acute neuronal death was assessed 12 h later in the thalamus, CA1-3 regions of hippocampus, and dentate gyrus. In separate behavioral experiments, beginning at P48, subjects were evaluated in a series of object recognition tests relying on associative learning, as well as social recognition. RESULTS: Exposure to either anesthetic led to a significant increase in neuroapoptosis in each brain region. The extent of neuronal death did not differ between groups. Subjects were unaffected in simple tasks of novel object and object-location recognition. However, anesthetized animals from both groups were impaired in allocentric object-location memory and a more complex task requiring subjects to associate an object with its location and contextual setting. Isoflurane exposure led to additional impairment in object-context association and social memory. CONCLUSION:
Isoflurane and desflurane exposure during development result in deficits in tasks relying on associative learning and recognition memory. Isoflurane may potentially cause worse impairment than desflurane.
Anestesia y Medicina del Dolor
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