Enzymatic Evaluation of General Anesthesia-Induced Neurotoxicity in Aneurysmal Subarachnoid Hemorrhage Patients (original) (raw)

Prospective randomized double-blind study-from January 2016 to May 2017. Thirty-two patients with good grade aneurysm-clipping and endovascular coiling were recruited and randomized to four groups for the maintenance of anesthesia-propofol, isoflurane, sevoflurane, and desflurane. Lumbar drain preoperatively was inserted for CSF sampling. Standard monitors and induction techniques were used. Concentrations of anesthetic agents were compared using state entropy-maintained bet ween 40 and 60. CSF and serum samples collected at base line, 1 hour after exposure to anesthesia, after the cessation of anesthesia. Samples were centrifuged, stored and later analyzed using ELISA. Results: CSF caspase-3 levels significantly decreased from baseline to 1 hour after exposure to anesthetic agents, which then reached to baseline levels after the cessation of anesthesia. These changes were statistically significant and comparable between all the groups. Serum caspase-3 levels significantly increased from baseline to 1 hour after exposure to anesthetic agents, which then reached to baseline levels after the cessation of anesthesia. These changes were statistically significant and comparable between all the groups. Conclusion: Intravenous and inhalational anesthetic agents have same effect on the serum and CSF caspase-3 levels. The reduction in CSF caspase-3 levels suggests the role of anesthesia in reduction of apoptotic mechanism. Increase in serum caspase-3 levels after exposure may be due to caspase-dependent apoptosis in peripheral mononuclear cells secondary to inflammatory stress response.