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Desflurane is a volatile anesthetic that allows rapid induction and emergence, reduces cerebral metabolism, and enhances tissue perfusion. We studied the effect of treatment with 4%, 6%, and 12% desflurane on hypoxic neuronal damage by comparing the size of the postsynaptic evoked population spike recorded from the cornu ammonis 1 (CA1) pyramidal cell layer of rat hippocampal slices before and 2 hours after a hypoxic insult. When the tissue was treated with 6% desflurane before, during, and after 3.5 minutes of hypoxia, recovery was significantly better in slices exposed to desflurane (37% +/- 9%) compared with untreated hypoxic slices (15% +/- 5%). A lower (4%) or higher (12%) concentration of desflurane did not significantly improve recovery after 3.5 minutes of hypoxia. In the period before hypoxia, 12% and 6% desflurane significantly increased the latency and decreased the amplitude of the postsynaptic population spike; 4% desflurane had a similar but nonsignificant effect on latency and amplitude. We conclude that 6% desflurane, a clinically useful concentration (1 minimal alveolar concentration), improved the recovery of postsynaptic evoked responses in rat hippocampal slices after 3.5 minutes of hypoxia. In vivo studies must be conducted to assess the potential clinical significance of 6% desflurane's neuroprotective activity.

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This report is the first to correlate data concerning intraoperative somatosensory evoked potentials (SSEPs) and local spinal cord blood flow (ISCBF) in patients with syringomyelia. In a consecutive study, bilateral median nerve SSEPs were recorded intraoperatively in 13 patients undergoing a syrinx shunt to the posterior fossa cisterns (syringocisternostomy). ISCBF was measured in five of these patients using laser doppler flowmetry (LDF) calibrated in arbitrary units (AU). SSEP recordings obtained 30 min after syrinx decompression demonstrated a slight but consistent reduction of N20 latencies (mean change: 0.53 ms right, p < 0.003; 0.58 ms left, p < 0.001) concurrent with a similar but less consistent increase of N20 amplitudes (0.16 mV right, p = 0.256; 0.29 mV left, p = 0.03). Prior to shunting, LDF recordings from the spinal cord overlying syrinxes revealed very low ISCBF values in five of five patients (mean LDF, 13.2 AU +/- 15.3 SD). Immediately after shunting, there was a dramatic rise of ISCBF (mean LDF, 241.2 AU +/- 106.3 SD) associated with visualized hyperemia of the spinal cord and pial vessels. The ISCBF fell to intermediate levels after 2 min (157.2 AU +/- 33.0 SD) and remained at these levels during the interval of recording (5 min). Hyperventilation testing in two patients prior to shunting revealed no change in ISCBF consistent with a loss of CO2 vascular reactivity and a paradoxical increase of ISCBF in one patient 5 min after shunting. Each patient in this study experienced neurological improvement in the immediate postoperative period associated with collapse or disappearance of the syrinx on magnetic resonance imaging scans. Because syrinx shunting results in an acute decompression of the distended spinal cord, it is possible that the rapid improvement of SSEPs reflects a relief of mechanical factors such as stretching and compression of nervous tissue. However, the LDF findings in this study suggest that distended spinal cord cavities are also capable of producing regional ischemia. A significant reduction of ISCBF is a possible contributing cause of neurological injury and SSEP abnormalities. Intraoperative improvement of SSEPs and ISCBF were found to correlate well with neurological recovery following syringocisternostomy. Our results indicate that SSEP monitoring can provide useful information during surgical procedures for syringomyelia and that further experience with LDF monitoring may provide insights into the pathophysiology of this condition.

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The effects of induced hypotension with isoflurane and labetalol on cerebral edema formation were compared following a cryogenic brain injury in dogs. Thirteen dogs received a maintenance anesthetic of 70% N2O, 0.5% isoflurane in O2 and a fentanyl infusion (3 micrograms.kg-1 x hr-1). All dogs were normoventilated (PaCO2 of 35-40 mmHg) and monitored for temperature, arterial blood pressure, central venous pressure (maintained between 7-10 mmHg), end-tidal CO2, end-tidal anesthetic level, and urine output. Following a right parietal craniectomy, a standard sized cryogenic brain lesion was made. The animals were randomly allocated in two groups. Group I (n = 6) received maintenance anesthesia, but within a 30 minute period, mean arterial pressure (MAP) was reduced to 60 mmHg with isoflurane varying in inspired concentration from 2 to 4%. Thereafter, the MAP was maintained at this level for 60 minutes. The inspired concentration of isoflurane was decreased, then discontinued to allow the MAP to return to baseline during the next 30 minutes. Group II (n = 7) received maintenance anesthesia, and MAP was reduced to 60 mmHg during a 30 minute period with intravenous labetalol (20 mg.kg-1). This MAP was maintained for one hour with a continuous labetalol infusion. The infusion was discontinued and the MAP returned to baseline during the next 30 minutes. The wounds were surgically closed. Anesthesia was discontinued, paralysis was reversed, and the animals were extubated and transported to a recovery room. Forty-eight hours postoperatively, all animals were reanesthetized, injected with Evans' blue dye and sacrificed. The brain was removed, fixed in formalin, and sent "blindly" coded for neuropathologic evaluation.(ABSTRACT TRUNCATED AT 250 WORDS)

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The rat hippocampal slice was used as a model system to study the effects of anesthetics on anoxic damage. Thiopental, but not isoflurane, allowed recovery of the postsynaptic population spike evoked from the dentate granule cells. Creatine preincubation protected both dentate granule and CA1 pyramidal cells against anoxic damage. Calcium-free, 10 mM magnesium artificial cerebrospinal fluid (ACSF) was shown to protect CA1 pyramidal cells against anoxic damage. The presynaptic population spike recovered to its preanoxic amplitude after anoxia even under conditions where the postsynaptic population spike demonstrated no recovery. Thus the hippocampal slice is a useful system for studying the effects of anesthetics and other pharmacological agents on anoxic damage.

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Evoked population spikes were recorded from the dentate granule cell layer of hippocampal slices obtained from adult rats. These slices were subjected to short periods of anoxia in the presence of different anesthetics. The recovery of the population spike after anoxia was compared across treatments. Little or no recovery was found after 10 min of anoxia when no anesthetic (4 +/- 4%), 1.5% isoflurane (5 +/- 5%), or 15% isoflurane (0 +/- 0%) was present during the anoxic periods. However, the population spike did recover to 81 +/- 7% of its preanoxic amplitude within 1 h after the anoxia if thiopental 160 mg/liter was present in the perfusate during the anoxia. Fifteen percent isoflurane and 160 mg/liter thiopental were equipotent in reducing the amplitude of the evoked population spike before anoxia but only thiopental protected against the damage after 10 min of anoxia. Our results suggest that the blocking of the evoked population spike by thiopental is not the sole mechanism of its protection against anoxic damage. Isoflurane (1.5%) was able to provide a small degree of protection against shorter periods (7 min) of anoxia.

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