Spectral entropy predicts auditory recall in volunteers.

BACKGROUND: From a patient's perspective, intraoperative amnesia is an essential component of general anesthesia. Without specific strategies to reduce recall, its incidence is approximately 0.2% in the general surgical population and may be higher in certain subpopulations. We sought to test the validity for predicting recall of a new spectral entropy-based clinical electroencephalogram monitor. METHODS: We studied 16 volunteers in an unblinded crossover design to assess the correlation of entropy values with behavioral end points during sedation with either propofol or sevoflurane. The end points we considered included word recall, and motor response to verbal command. We also examined the stimulatory effect of verbal commands on electroencephalogram entropy. Logistic regression, receiver operating characteristics, and prediction probability were used to analyze the data. RESULTS: Both State Entropy and Response Entropy were closely correlated with both behavioral end points. The prediction probability of these parameters under a variety of conditions ranged from 0.85 to 0.96. Verbal command to move increased entropy in a dose and drug-dependent fashion. CONCLUSIONS: Entropy parameters in this group of young, healthy volunteers appear to be reliable predictors of recall. These results justify extending these studies to additional anesthetics and to surgical patients.

Isoflurane modulates genomic expression in rat amygdala.

General anesthesia, at a minimum, provides amnesia and unresponsiveness. Although anesthetics have many modulatory effects on neuronal ionophore protein complexes, it is not clear that the resulting electrophysiologic changes are the sole mechanisms of clinical anesthetic action. Cells respond to environmental changes in several ways, including alterations in DNA transcription leading to changes in the cell's proteins. We sought to expose the changes in global genomic expression, seeking potential targets involved in the processes of anesthetic-induced amnesia, and persistent long-term side effects of general anesthesia, including nausea and postoperative cognitive decline. Using Affymetrix GeneChips, we surveyed changes in expression across the entire expressed genome of Sprague-Dawley rat (n = 10 baseline, n = 6 isoflurane) basolateral amygdala 6 h after exposure to 15 min of 2% (1.4 MAC) isoflurane. Isoflurane administration was associated with altered expression in 269 unique genes possessing functional annotation. Affected genes were related to DNA transcription, protein synthesis, metabolism, signaling cascades, cytoskeletal structural proteins, and neural-specific proteins, among others. Even brief exposure to isoflurane leads to widespread changes in the genetic control in the amygdala 6 h after exposure. Gene expression is a dynamic process that may explain some long-term effects of anesthesia and that has the potential to modulate some of those effects using specific molecular therapeutics.

Maternal and fetal 11C-cocaine uptake and kinetics measured in vivo by combined PET and MRI in pregnant nonhuman primates.

UNLABELLED: Cocaine use during pregnancy has been shown to be deleterious to the infant. This may reflect reduction of flow to placenta or effects on the fetal brain. Methods to assess pharmacokinetics of drugs of abuse in vivo would be useful to investigate the mechanisms underlying the fetal adverse effects. We recently reported that combined MRI and PET technology allows the measurement of radioisotope distribution in maternal and fetal organs in pregnant Macaca radiata. Here, we evaluate the utility of PET to measure the uptake and distribution of (11)C-cocaine in the third-trimester fetus. METHODS: Six pregnant M. radiata weighing 3.8-9.0 kg were anesthetized and MR images were acquired on a 4-T MRI instrument. In all 6 animals, dynamic PET scans were subsequently acquired using 148-259 MBq of (11)C-cocaine. Time-activity curves for both maternal and fetal organs were obtained simultaneously with the pregnant animal positioned transverse in the PET scanner. Distribution volume ratios for maternal and fetal brain for (11)C-cocaine were calculated. RESULTS: Coregistration of PET and MR images allowed identification of fetal organs and brain regions and demonstrated that (11)C-cocaine or its labeled metabolites readily cross the placenta and accumulate mainly in fetal liver and to a lesser extent in the brain. Time to reach peak (11)C uptake in brain was shorter for the mother than for the fetus. The distribution volume ratios of the maternal striatum were higher than those of the fetus. Placenta was clearly visible on the early time frames and showed more rapid uptake and clearance than other fetal tissues. CONCLUSION: The pregnant M. radiata model allows the noninvasive measurement of radioisotope pharmacokinetics in maternal and fetal brain and other organs simultaneously. Although the uptake of radioactivity into the fetal brain after the injection of (11)C-cocaine is lower and slower than in the maternal brain, a measurable quantity of (11)C-cocaine (or its labeled metabolites) accumulates in the fetal brain at early times after injection. The highest accumulation of (11)C occurs in the fetal liver. Rapid radioisotope accumulation and clearance in the placenta offer potential as an input function for kinetic modeling for future studies of binding site availability.

Maternal-fetal in vivo imaging: a combined PET and MRI study.

UNLABELLED: An understanding of how drugs are transferred between mother and fetus during the gestational period is an important medical issue of relevance to both therapeutic drugs and drugs of abuse. Though there are several in vitro and in vivo methods to examine this issue, all have limitations. Furthermore, ethical and safety considerations generally preclude such studies in pregnant humans. PET and appropriately labeled compounds have the ability to provide information on both maternal-fetal drug pharmacokinetics and pharmacodynamics. We present here a nonhuman primate animal model and the methodology for combining PET and MRI to identify fetal organs and to measure maternal and fetal isotope distribution using (18)F-FDG and a whole-body imaging protocol to demonstrate proof-of-principle. METHODS: One nonpregnant nonhuman primate was used for determination of the anesthesia protocol and MRI methods and 3 pregnant nonhuman primates (Macaques radiata) weighing 4.5-7 kg were used for the imaging study and anesthetized with propofol (160-300 micro g/kg/min). Anatomic T2-weighted MR images were acquired on a 4-T MR instrument. Subsequently, whole-body PET images were acquired 35 min after injection of (18)F-FDG, and standardized uptake values (SUVs) were calculated. Image processing and coregistration were performed using commercial software. RESULTS: All animals underwent uneventful general anesthesia for a period of up to 7 h. Coregistration of PET and MR images allowed identification of fetal organs and demonstrated that (18)F-FDG readily crosses the placenta and that (18)F accumulates in both maternal and fetal brain, heart, and bladder. Brain SUVs averaged 1.95 +/- 0.08 (mean +/- SD) and 1.58 +/- 0.11 for mothers and fetuses, respectively. Monkeys delivered healthy babies after a normal gestational term of 170 d following the PET/MRI study. CONCLUSION: The pregnant macaque in combination with PET and MRI technology allows the measurement of radioisotope distribution in maternal and fetal organs. This demonstrates the potential for noninvasively measuring the transfer of drugs across the placenta and for measuring the fetal drug distribution. It also opens up the possibility for studying binding and elimination as well as the effects of a drug on specific cellular elements and physiologic processes during the gestational period in a primate model.

Should a patient's gender alter the anesthetic plan?

PURPOSE OF REVIEW: A significant effort has been made in the past few years to determine whether a patient's gender has a significant effect on their anesthetic requirements or outcome. It remains unclear whether there is sufficient evidence to alter an anesthetic regimen based on a patient's gender. RECENT FINDINGS: In well-controlled studies, subtle pharmacokinetic differences between the sexes can be observed. Pharmacodynamic differences have also been observed between the sexes, particularly for muscle relaxants and opioids. Outcome studies have revealed that women are also more likely to experience adverse side-effects such as postoperative nausea. SUMMARY: There are subtle differences between men and women. However, these differences are of a similar magnitude to those that may exist between other commonly encountered factors, such as smoking versus non-smoking, occasional versus regular ethanol consumption, or perhaps, most importantly, the increased age of the patient. If these are combined with pre-existing medical conditions and other patient variables, such as ethnicity, the potential gender effect on anesthesia may easily be overshadowed.