The histamine H1 receptor antagonist hydroxyzine enhances sevoflurane and propofol anesthesia: A quantitative EEG study. Issue 9 (September 2021)

• Record Type: Journal Article
• Authors: Tanaka, Ryusuke; Tanaka, Satoshi; Hayashi, Kazuko; Iida, Keisuke; Sawa, Teiji; Kawamata, Mikito
• Is Part Of: Clinical neurophysiology. Volume 132:Issue 9(2021)
• Page Start: 2054
• Page End: 2061
• Publication Date: 2021-09
• Subjects: Hydroxyzine -- Sevoflurane -- Propofol -- Electroencephalogram -- Bicoherence; BIS bispectral index -- CI confidence interval -- EEG electroencephalogram -- GABA γ-aminobutyric acid -- GABAA γ-aminobutyric acid type A -- LORR loss of righting reflex -- PONV postoperative nausea and vomiting -- TMN tuberomammillary nucleus -- VLPO ventrolateral preoptic nucleus; Neurophysiology -- Periodicals; Electroencephalography -- Periodicals; Electromyography -- Periodicals; Neurology -- Periodicals; 612.8
• DOI: 10.1016/j.clinph.2021.05.024
• Languages: English
• ISSNs: 1388-2457

Abstract

Highlights: Hydroxyzine, a histamine H1 receptor antagonist, augmented α and δ bicoherence in both sevoflurane anesthesia and propofol anesthesia. Hydroxyzine augmented θ bicoherence in sevoflurane anesthesia but not in propofol anesthesia. Hydroxyzine enhances both sevoflurane anesthesia and propofol anesthesia at surgical anesthetic depth probably by facilitation of GABAergic neural circuit mechanisms. Abstract: Objective: The aim of this study was to determine the anesthesia-promoting effects of hydroxyzine on electroencephalograms during sevoflurane anesthesia and during propofol anesthesia. Methods: We analyzed 40 patients scheduled for elective surgery under sevoflurane anesthesia (n = 20) or propofol anesthesia (n = 20). Anesthesia was adjusted at a bispectral index value of 50–60, and then 0.5 mg/kg of hydroxyzine was administered intravenously. We analyzed frontal electroencephalograms before and after hydroxyzine injection with power spectral and bicoherence analyses, which are suitable for assessing the anesthetic depth induced by γ-aminobutyric acid (GABA)ergic anesthetics. Results: Hydroxyzine increased the α bicoherence peaks in both sevoflurane anesthesia (mean difference, 11.2%; 95% confidence interval (CI), 7.6 to 14.8; P < 0.001) and propofol anesthesia (mean difference, 5.6%; 95% CI, 1.7 to 9.4; P = 0.008). Hydroxyzine increased the averaged δ bicoherence values in both sevoflurane anesthesia (mean difference, 5.5%; 95% CI, 2.1 to 8.8; P = 0.003) and propofol anesthesia (mean difference, 3.9%; 95% CI, 1.0 to 6.8; P = 0.011). Conclusions: Hydroxyzine enhances both sevoflurane anesthesia and propofol anesthesia probably by facilitation of GABAergic neural circuit mechanisms. Significance: The findings provide a new insight into the role of histaminergic neurons during general anesthesia in humans.