Neurotoxicidad por anestesia / Anesthesia neurotoxicity

Octubre 11, 2016. No. 2475

De la neuroapoptosis inducida por fármacos a la neurotoxicidad pediátrica por anestesia. ¿Dónde estamos ahora? From Drug-Induced Developmental Neuroapoptosis to Pediatric Anesthetic Neurotoxicity-Where Are We Now? Creeley CE1. Brain Sci. 2016 Aug 16;6(3). pii: E32. doi: 10.3390/brainsci6030032. Abstract The fetal and neonatal periods are critical and sensitive periods for neurodevelopment, and involve rapid brain growth in addition to natural programmed cell death (i.e., apoptosis) and synaptic pruning. Apoptosis is an important process for neurodevelopment, preventing redundant, faulty, or unused neurons from cluttering the developing brain. However, animal studies have shown massive neuronal cell death by apoptosis can also be caused by exposure to several classes of drugs, namely gamma-aminobutyric acid (GABA) agonists and N-methyl-d-aspartate (NMDA) antagonists that are commonly used in pediatric anesthesia. This form of neurotoxic insult could cause a major disruption in brain development with the potential to permanently shape behavior and cognitive ability. Evidence does suggest that psychoactive drugs alter neurodevelopment and synaptic plasticity in the animal brain, which, in the human brain, may translate to permanent neurodevelopmental changes associated with long-term intellectual disability. This paper reviews the seminal animal research on drug-induced developmental apoptosis and the subsequent clinical studies that have been conducted thus far. In humans, there is growing evidence that suggests anesthetics have the potential to harm the developing brain, but the long-term outcome is not definitive and causality has not been determined. The consensus is that there is more work to be done using both animal models and human clinical studies. KEYWORDS: cognitive development; drugs; early brain development; neurodevelopment PDF Neurotoxicidad inducida por propofol en el cerebro fetal de animales y avances en la modificación de estos efectos Propofol-Induced Neurotoxicity in the Fetal Animal Brain and Developments in Modifying These Effects-An Updated Review of Propofol Fetal Exposure in Laboratory Animal Studies. Xiong M1, Zhang L2, Li J3, Eloy J4, Ye JH5, Bekker A6. Brain Sci. 2016 Mar 28;6(2). pii: E11. doi: 10.3390/brainsci6020011Abstract In the past twenty years, evidence of neurotoxicity in the developing brain in animal studies from exposure to several general anesthetics has been accumulating. Propofol, a commonly used general anesthetic medication, administered during synaptogenesis, may trigger widespread apoptotic neurodegeneration in the developing brain and long-term neurobehavioral disturbances in both rodents and non-human primates. Despite the growing evidence of the potential neurotoxicity of different anesthetic agents in animal studies, there is no concrete evidence that humans may be similarly affected. However, given the growing evidence of the neurotoxic effects of anesthetics in laboratory studies, it is prudent to further investigate the mechanisms causing these effects and potential ways to mitigate them. Here, we review multiple studies that investigate the effects of in utero propofol exposure and the developmental agents that may modify these deleterious effects. KEYWORDS: apoptosis; in utero; neurotoxicity; propofol PDF Consideraciones del uso de anestésicos en estudios de neurotoxicidad Considerations for the use of anesthetics in neurotoxicity studies. Karmarkar SW1, Bottum KM, Tischkau SA. Comp Med. 2010 Aug;60(4):256-62. Abstract Anesthetics are widely used in experiments investigating neurotoxicity and neuroprotection; however, these agents are known to interfere with the outcome of these experiments. The purpose of this overview is to review these effects and suggest methods for minimizing unintended consequences on experimental outcomes. Information on the neuroprotective and neurotoxic effects of isoflurane, dexmedetomidine, propofol, ketamine, barbiturates, halothane, xenon, carbon dioxide, and nitrous oxide is summarized. The pertinent cell signaling pathways of these agents are discussed. Methods of humane animal euthanasia without anesthetics are considered. Most anesthetics alter the processes of neuronal survival and death. When designing survival surgeries, sham controls subjected to anesthesia but not the surgical intervention should be compared with controls subjected to neither anesthesia nor surgery. Additional controls could include using an anesthetic with a different mechanism of action from the primary anesthetic used. Because the effects of anesthetics lessen with time after surgery, survival surgeries should include later time points until at least 7 d after the procedure. Humane methods of animal euthanasia that do not require anesthetics exist and should be used whenever appropriate. PDF XIII Congreso Virtual Mexicano de Anestesiología Octubre a Diciembre 2016 Información / Information L Congreso Mexicano de Anestesiología Noviembre 2-6, 2016 Información / Information

Anestesiología y Medicina del Dolor 52 664 6848905 vwhizar@anestesia-dolor.org anestesia-dolor.org Copyright © 2015

Hígado y embarazo / Liver and pregnancy

Octubre 13, 2016. No. 2477

Actualización en el diagnóstico y manejo del daño hepático agudo grave en el embarazo Causes and management of severe acute liver damage during pregnancy. Rev Med Chil. 2015 May;143(5):627-36. doi: 10.4067/S0034-98872015000500011. Sepulveda-Martinez A, Romero C, Juarez G, Hasbun J, Parra-Cordero M. Abstract Abnormalities in liver function tests appear in 3% of pregnancies. Severe acute liver damage can be an exclusive condition of pregnancy(dependent or independent of pre-eclampsia) or a concomitant disease. HELLP syndrome and acute fatty liver of pregnancy are the most severeliver diseases associated with pregnancy. Both appear during the third trimester and have a similar clinical presentation. Acute fatty liver may be associated with hypoglycemia and HELLP syndrome is closely linked with pre-eclampsia. Among concomitant conditions, fulminant acutehepatitis caused by medications or virus is the most severe disease. Its clinical presentation may be hyper-acute with neurological involvement and severe coagulation disorders. It has a high mortality and patients should be transplanted. Fulminant hepatic failure caused by acetaminophen overdose can be managed with n-acetyl cysteine. Because of the high fetal mortality rate, the gestational age at diagnosis is crucial. PDF Avances en la comprensión y manejo de las enfermedades hepáticas durante el embarazo. Revisión Advances in understanding and treating liver diseases during pregnancy: A review. Kamimura K1, Abe H1, Kawai H1, Kamimura H1, Kobayashi Y1, Nomoto M1, Aoyagi Y1, Terai S1. World J Gastroenterol. 2015 May 7;21(17):5183-90. doi: 10.3748/wjg.v21.i17.5183. Abstract Liver disease in pregnancy is rare but pregnancy-related liver diseases may cause threat to fetal and maternal survival. It includes pre-eclampsia; eclampsia; haemolysis, elevated liver enzymes, and low platelets syndrome; acute fatty liver of pregnancy; hyperemesis gravidarum; and intrahepatic cholestasis of pregnancy. Recent basic researches have shown the various etiologies involved in this disease entity. With these advances, rapid diagnosis is essential for severe cases since the decision of immediate delivery is important for maternal and fetal survival. The other therapeutic options have also been shown in recent reports based on the clinical trials and cooperation and information sharing between hepatologist and gynecologist is important for timely therapeutic intervention. Therefore, correct understandings of diseases and differential diagnosis from the pre-existing and co-incidental liver diseases during the pregnancy will help to achieve better prognosis. Therefore, here wereview and summarized recent advances in understanding the etiologies, clinical courses and management of liver disease in pregnancy. This information will contribute to physicians for diagnosis of disease and optimum management of patients. KEYWORDS: Acute fatty liver of pregnancy; Haemolysis elevated liver enzymes; Hyperemesis gravidarum; Intrahepatic cholestasis of pregnancy; Liverinjury; Low platelets; Pregnancy PDF Enfermedades hepáticas relacionadas al embarazo Pregnancy-related liver disorders. Goel A1, Jamwal KD1, Ramachandran A2, Balasubramanian KA2, Eapen CE1. J Clin Exp Hepatol. 2014 Jun;4(2):151-62. doi: 10.1016/j.jceh.2013.03.220. Epub 2013 Mar 16. Abstract Pregnancy-related liver disorders accounted for 8% of all maternal deaths at our center from 1999 to 2011. Of the three pregnancy-related liverdisorders (acute fatty liver of pregnancy (AFLP), HELLP (Hemolysis, elevated liver enzymes, low platelets) syndrome and pre-eclamptic liverdysfunction, which can lead to adverse maternal and fetal outcome, AFLP is most typically under - diagnosed. Risk of maternal death can be minimised by timely recognition and early/aggressive multi-specialty management of these conditions. Urgent termination of pregnancy remains the cornerstone of therapy for some of these life threatening disorders, but recent advancements in our understanding help us in better overall management of these patients. This review focuses on various aspects of pregnancy-related liver disorders. PDF XIII Congreso Virtual Mexicano de Anestesiología Octubre a Diciembre 2016 Información / Information L Congreso Mexicano de Anestesiología Noviembre 2-6, 2016 Información / Information 17h World Congress of Anaesthesiologists, WFSA Sep 6-11, 2020 Prague, Czech Republic Informes / Information

Anestesiología y Medicina del Dolor 52 664 6848905 vwhizar@anestesia-dolor.org anestesia-dolor.org Copyright © 2015