Dept Of Anesthesiology & Critical Care, University Of Pennsylvania School Of Medicine

ASA Abstracts 2008 Department of Anesthesiology and Critical Care, UPENN

John G. Augoustides, Wilson Y. Szeto, Brittany Cornelius,  Elizabeth K. Walsh, Joseph E. Bavaria: Does Ischemia on Presentation Stratify Perioperative Outcome after Acute Stanford Type a Dissection? Anesthesiology 2008; A1422

Albert T. Cheung, Neil Singla, Solomon Aronson: Predicting Clevidipine Dose Requirements in Cardiac Surgery Patients with Perioperative Hypertension. Anesthesiology 2008; A1590

Robert D. Gaiser: Faculty Evaluations, Resident Subtest Scores, and Gender on an Obstetric Anesthesia Rotation. Anesthesiology 2008; A1180

Arjunan Ganesh, Travis Foster,  Scott Adzick, Giovanni Cucchiaro: Efficacy of Addition of Fentanyl to Epidural Bupivacaine for Post-Thoracotomy Analgesia in Infants. Anesthesiology 2008; A1610

Raymond Glassenberg, Roderic Eckenhoff, Jin Xi: Bupivacaine Macrocycle Complexes. Anesthesiology 2008; A651

Jeff E. Mandel: Liquid Injection Closed Circuit Administration of Sevoflurane by Waters’ Canister for Cardioversion. Anesthesiology 2008; A1571

Patrick J. Neligan, Guarav Malhotra, Michael Fraser, Maurizio Cereda, Edward A. Ochroch: Boussignac CPAP Immediately Following Extubation Improves Lung Mechanics in Morbidly Obese Patients. Anesthesiology 2008; A1249

Patrick J. Neligan, Guarav Malhotra, Michael Fraser, Maurizio Cereda, Edward A. Ochroch: Immediately Postoperative Non Invasive Ventilation Improves Lung Mechanics Following Bariatric Surgery. Anesthesiology 2008; A849

Raymond S. Roginski,   Phillip P. Santoiemma: GRINL1A Interactors Cluster to Synaptic Function, Transcription Regulation and Neurologic Diseases. Anesthesiology 2008; A1529

Christopher Ward, Huafeng Wei,  Ge Liang,  Shouping Wang, Yifan Zhao: Neonatal Exposure to Isoflurane Does Not Cause Learning Deficits in the Developing Mouse Brain. Anesthesiology 2008; A201

Huafeng Wei,  Ge Liang,  Hui Yang,  Jing Li, : Suppression of IP₃ Receptor Inhibited Isoflurane Neurotoxicity in Rat Primary Cortical Neurons. Anesthesiology 2008; A329

Huafeng Wei, Yifan Zhao,  Ge Liang,  Qianru Chen, Christopher Ward: Isoflurane Induced Apoptosis by Activation of IP₃ Receptors in Developing Rat Brains. Anesthesiology 2008; A25

A proposed mechanism for isoflurane induced apoptosis

Wei and associates continue their investigations into isoflurane toxicity in this paper from Anesthesiology (2008;108:251 – 260).  Using a variety of cultured cell types they showed that isoflurane activates the endoplasmic reticulum membrane inositol 1,4,5-triphosphate (IP3) receptor.  This activation produces excessive calcium first in the cytosol and then in mitochondria.  It is this higher calcium level that triggers apoptosis.  There was considerable variability in the sensitivity of the various cell lines to isoflurane induced apoptosis.  The authors note that certain cases of familial Alzheimer’s or Huntington disease have enhanced IP3 receptor activity and thus may be more sensitive to the toxic effects of isoflurane.  Recognize the difficulty of extrapolating from cell cultures, to organs or whole animals.  Thus, it is my belief, that further work is necessary before clinical practice is altered by findings such as these (DSS comment).

Huafeng Wei, M.D., Ph.D. is Assistant Professor of Anesthesiology and Critical Care at the University of Pennsylvania

David S. Smith, M.D., Ph.D.