With the surge of critically ill COVID-19 patients in China, numerous anesthesiologists from anesthesia intensive care units (AICU) or reallocated to other ICUs were devoted to the treatment of COVID-19. Besides the standard protocols to treat COVID-19 cases, anesthesiologists also have their own experience to treat COVID-19 cases based on professional expertise and practice. Here, we propose some viewpoints to treat critically ill COIVD-19 patients from the perspective of anesthesiologists.
To provide an expert commentary on the impact of prior COVID-19 infection on patient’s surgical outcomes and postoperative recovery. To highlight the need for greater focus on peri-operative care of patients who have recovered from COVID-19.
A narrative review of the literature was conducted by searching Pubmed and EMBASE for relevant articles using keywords such as “COVID-19”, “Coronavirus”, “surgery” and “peri-operative infection”.
Post-COVID-19 condition also known as long COVID has an estimated incidence of between 3.0 to 11.7%. COVID-19 has been shown to cause a series of short and long-term sequelae including cardiopulmonary complications, renal impairment, chronic fatigue and muscular deconditioning. Peri-operative infection with COVID-19 is associated with increased peri-operative mortality. Elective surgery patients who developed COVID-19 were 26 times more likely to die whilst in hospital compared to controls without COVID-19 infection, and for emergency surgery patients with COVID-19 infection were six times more likely to die. A large international prospective cohort study identified that patients who had surgery delayed over 7 weeks from the date of COVID-19 infection had no increased 30-day postoperative mortality, except those with ongoing symptoms.
COVID-19 infection and its complications have been shown to adversely affect surgical outcomes. Further research is required to better characterise long COVID and the long-term sequelae that develop, which should be used to guide comprehensive peri-operative assessment of patients.
Repeated exposures to sevoflurane could induce epigenetic modifications in specific brain regions and cognitive impairments in the immature mice. Conflicting findings make neurobehavioral manifestations intricate and potential mechanisms elusive. Influence of neonatal anesthesia with sevoflurane on the expression of synaptic scaffold proteins and neuronal activity remains to be determined.
C57BL/6 male and female mice in breeding ages were used to produce next generation. The offspring male mice were randomly scheduled to receive 3.0% sevoflurane plus 60% oxygen for 2 h daily at postnatal day (P) 6–8. Three-chambered social paradigm was used to test social affiliation and social memory. Morris water maze was used to test learning and memory. Whole genome bisulfite sequencing (WGBS), differentially methylated regions (DMRs) and KEGG enrichment analysis were performed to screen target gene in sequence context of CG. RT-PCR and immunoblotting analysis were used to assess expression of the Shank gene family, as well as DNA methylases.
The male mice undergoing sevoflurane anesthesia at P6-8 showed diminished preference for novel conspecific and prolonged escape latency and decreased platform-crossing times. The sevoflurane-exposed mice showed reduced mRNA and protein levels of the Shank2 gene. KEGG analysis disclosed the role of DNA hypermethylation of Shank2 gene in the pathway of glutamatergic synapse. In addition, sevoflurane anesthesia reduced mRNA and protein levels of the TET3 enzyme.
Repeated exposures to sevoflurane in neonatal period could impair social recognition memory and spatial reference memory in the male mice. Reduction of hippocampal SHANK2 protein could contribute to sevoflurane-induced neurotoxicity in the immature mice. Reduction of the TET3 enzyme should be responsible for DNA hypermethylation-related silencing of the Shank2 gene.
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