Mode of anesthesia for cesarean delivery with pernicious placenta previa — a retrospective study

Objectives: Anesthesia for cesarean delivery in parturients diagnosed with pernicious placenta previa remains controversial. This study aimed to review pernicious placenta previa cases to evaluate anesthetic management strategies. Material and methods: This retrospective analysis included patients who underwent cesarean delivery (CD) for pernicious placenta previa at the Affiliated Hospital of Zunyi Medical University between December 1, 2012 and November 31, 2017. Patient demographic data, obstetric characteristics, anesthetic management, and maternal outcomes were extracted from the hospital’s computerized database. Results: In all, 61 consecutive cases of pernicious placenta previa were identified among 9512 cesarean deliveries. General anesthesia was performed on 27 of the 61 patients (44.3%). Among GA group, 16 (59.3%) had placenta accreta, 8 of whom required cesarean hysterectomy. Also, 13 of the 27 (48.1%) GA patients required transfer to the intensive care unit. The other 34 patients (55.7%) were given regional anesthesia, 9 of whom were converted to general anesthesia due to excessive bleeding and prolonged operation times. Statistical results indicated that regional anesthesia was associated with a significantly shorter operation time, less perioperative blood loss, fewer intraoperative red blood cell transfusions, and a lower incidence of complications. Conclusions: Anesthetic management is important for parturients with pernicious placenta previa. Although regional anesthesia was our preferred method for these patients, general anesthesia is safe for patients with pernicious placenta previa who experience massive blood loss and prolonged operation times

The effect of epidural analgesia on maternal-neonatal outcomes: a retrospective study

Objectives: Epidural analgesia is commonly used for relieving labor pain in contemporary clinical practice. The rate of pregnant women who request epidural analgesia during labor has been increasing annually, leading to a debate on the effect of epidural analgesia on maternal or neonatal outcomes.Material and methods: The medical records of nulliparous women with a term singleton pregnancy from January to December 2019 at the Affiliated Hospital of Zunyi Medical University were retrospectively reviewed. The women were divided into those who received epidural analgesia during delivery and those who did not receive it. Maternal and neonatal outcomes were assessed.Results: A total of 528 women met the inclusion criteria. The overall labor analgesia rate was 43.0% (227). Women with epidural analgesia had a significantly longer second stage [34.5 (22.8–65.3) vs 27.0 (18.0–41.3) min, p < 0.001] and total duration of labor [698.5 (493.5–875.0) vs 489.5 (344.0-676.3) min, p < 0.001] compared with those without epidural. There were no significant relationships between epidural analgesia and the normal vaginal delivery rate, the incidence of episiotomy, and other adverse maternal or neonatal outcomes (p > 0.05).Conclusions: Epidural analgesia can prolong the second stage of labor, but this is no increased risk for both mother and neonate

Effect of multiple neonatal sevoflurane exposures on hippocampal apolipoprotein E levels and learning and memory abilities

Background: Sevoflurane anesthesia is widely used in pediatric patients. In this study, we investigated whether early multiple exposures to sevoflurane induced cognitive dysfunction by altering the hippocampal expression of ApoE later in development. Methods: Sprague–Dawley rats were exposed to 2.6% sevoflurane at postnatal day 7 (P7), P14, and P21 for 2 h. The ability of learning and memory was assessed using the Morris water maze at P37 and P97. The hippocampal volume was measured by magnetic resonance imaging (MRI) at P37 and P97. The hippocampal expression of ApoE was assessed by immunohistochemical analyses and real-time polymerase chain reaction (PCR). Results: Behavioral testing revealed that the ability of learning and memory in the sevoflurane-exposed rats was decreased compared with the control animals; however, there was no significant difference (P > 0.05). The MRI results showed a significant decrease in the left hippocampal volume, left maximum hippocampal length, and right maximum hippocampal length in the sevoflurane young group compared with the control young group (P  0.05). Among the adult animals, there was no significant difference between the groups in any parameter tested (P > 0.05). Conclusion: Multiple exposures to sevoflurane during the neonatal period decreased the volume of the hippocampus and increased the hippocampal expression of ApoE. The differential expression level of ApoE in different hippocampal subdivisions suggested that the expression of ApoE was regionally specific and reversible. Key Words: sevoflurane, Sprague–Dawley rat, neonatal period, behavior, apolipoprotein E, β-amyloi

NUDT21 relieves sevoflurane-induced neurological damage in rats by down-regulating LIMK2

Postoperative cognitive dysfunction (POCD) is a common complication of cognitive decline after surgery and anesthesia. Sevoflurane, as a commonly used anesthetic, was found to cause POCD. Nudix Hydrolase 21 (NUDT21), a conserved splicing factor, has been reported to exert important functions in multiple diseases’ progression. In this study, the effect of NUDT21 on sevoflurane-induced POCD was elucidated. Results showed that NUDT21 was down-regulated in the hippocampal tissue of sevoflurane-induced rats. Morris water maze test results revealed that overexpression of NUDT21 improved sevoflurane-induced cognitive impairment. In addition, TUNEL assay results indicated that enhanced NUDT21 alleviated sevoflurane-induced apoptosis of hippocampal neurons. Furthermore, overexpression of NUDT21 suppressed the sevoflurane-induced LIMK2 expression. Taken together, NUDT21 alleviates sevoflurane-induced neurological damage in rats by down-regulating LIMK2, providing a novel target for the prevention of sevoflurane-induced POCD

Activation of autophagy inhibits the activation of NLRP3 inflammasome and alleviates sevoflurane-induced cognitive dysfunction in elderly rats

Abstract Aims/introduction As a common complication in elderly patients after surgery/anesthesia, postoperative cognitive dysfunction (POCD) is mainly characterized by memory, attention, motor, and intellectual retardation. Neuroinflammation is one of the most uncontroversial views in POCD. The sevoflurane-induced neurotoxicity has attracted widespread attention in recent years. However, its mechanism has not been determined. This study aimed to observe the effects of sevoflurane on cognitive function and the changes in inflammatory indices and autophagy protein expression in the prefrontal cortex in aged rats. Method Before the experiment, D-galactose was diluted with normal saline into a liquid with a concentration of 125 mg/kg and injected subcutaneously into the neck and back of rats for 42 days to establish the aging rat model. Morris water maze experiments were performed, including positioning navigation (5 days) and space exploration (1 day). The POCD model was established by 3.2% sevoflurane inhalation. The rats were treated with or without MCC950, a potent and selective nucleotide‐binding oligomerization domain‐like receptor protein 3 (NLRP3) inhibitor, followed by autophagy agonists and autophagy inhibitors. The expression levels of inflammasome-related protein NLRP3 and autophagy-related proteins LC3B and P62 were detected to test the behavior of rats with a water maze. Results We found that sevoflurane exposure affected learning and working memory ability in aged rats. We also observed microglia activation in the prefrontal cortex. NLRP3 protein expression was significantly upregulated after sevoflurane inhalation. NLRP3 inflammasome activation induced increased expression and mRNA expression of cleaved Caspase-1 and inflammatory cytokines IL-1β and IL-18, and increased secretion of peripheral proinflammatory cytokines. The inhibitor MCC950 was used to improve cognitive ability and inflammation in rats and inhibit the secretion of cytokines. In addition, we demonstrated that significant inhibition of autophagy (decreased LC3-II/I and increased P62) was accompanied by increased activation of NLRP3 inflammasomes and more severe neural cell damage. However, autophagy inhibitor rapamycin administration to activate autophagy resulted in the inhibition of NLRP3 inflammasomes, ultimately attenuating neuronal injury. Conclusions The activation of autophagy suppressed the formation of NLRP3 inflammasomes. It also alleviated cognitive impairment in aged rats

Comparison of the Efficacy and Safety of Adamgammadex with Sugammadex for Reversal of Rocuronium-Induced Neuromuscular Block: Results of a Phase II Clinical Trial

This current phase II clinical trial was to compare the effect and safety of adamgammadex, a new cyclodextrin-based selective relaxant binding agent, with sugammadex to reverse rocuronium-induced neuromuscular block. Patients were randomised to receive adamgammadex (4 or 6 mg kg−1) or sugammadex (2 mg kg−1, as a positive control group) at the reappearance of the second twitch (T2) in response to TOF stimulation. The standard safety data were collected. The 4 mg kg−1 (n = 16) and 6 mg kg−1 (n = 20) adamgammadex- and 2 mg kg−1 (n = 20) sugammadex-induced recovery time of TOF ratio to 0.9 were 2.3, 1.6, and 1.5 min, respectively (p = 0.49). The 4 mg kg −1 adamgammadex-induced median recovery time was longer than that of 2 mg kg−1 sugammadex (p = 0.01), and there was no difference between the 6 mg kg −1 adamgammadex group and 2 mg kg−1 sugammadex group (p = 0.32). Then, the number of patients who experienced adverse events (AEs) was 6, 11, and 14 for adamgammadex at 4, 6 mg kg−1 and sugammadex at 2 mg kg−1, respectively. The treatment emergent AEs that occurred more than twice were detailed as follows: incision site pain, hypotension, emesis, fever, throat pain, blood bilirubin increase, abnormal T-wave of ECG, dizziness, incision site swelling, postoperative fever, expectoration, and nausea. For drug-related AEs, the increased urine acetone bodies and first-degree atrioventricular block were observed in two patients from sugammadex group. Then, the previously reported AEs were not observed in this study, including anaphylaxis, haemorrhage, recurarization, abnormal basic vital signs, or lengthened QRS intervals and QT intervals. Adamgammadex was found to be effective for reversal of rocuronium-induced neuromuscular block as sugammadex