Methylphenidate can reverse the general anesthesia of propofol and isoflurane

The ability of common stimulant methylphenidate (Ritalin) to accelerate recovery after general anesthesia seems to be applicable to both inhaled isoflurane and intravenous propofol. Members of the research team of Massachusetts General Hospital (MGH) reported the study of isoflurane. They published similar research results of propofol in the May issue of Anesthesiology, and their papers have been published online.

“Propofol is the most widely used intravenous general anesthesia, and there is no way to reverse its effect at present,” said Ken Souter, MD, director of the Department of Anesthesia, Intensive Care and Pain Medicine of MGH and the corresponding author of this paper. “By finding that methylphenidate can reverse the general anesthesia of propofol and isoflurane, we show that it may be widely applicable to awakening patients from different general anesthesia drugs.”

The previous research published by MGH team in the journal Anesthesiology in October 2011 showed that methylphenidate, which is known to affect the arousal pathway in the brain and is usually used to treat attention deficit hyperactivity disorder, significantly shortened the recovery time of rats from isoflurane anesthesia. The current research has carried out very similar experiments, in which propofol, as an anesthetic, has a different mechanism of action from isoflurane.

In the initial experiment, the animals that lost consciousness after a single dose of propofol were injected with methylphenidate or normal saline intravenously. Those animals injected with methylphenidate recovered nearly 5 minutes faster than those injected with normal saline. The administration of methylphenidate also caused the rats to show signs of excitement – exercise or stand up – by intravenous injection of a constant dose of propofol, while the rats given normal saline remained motionless. During the continuous injection of high doses of propofol, the EEG reading of the animal brain showed that methylphenidate turned the brain activity to a conscious state. This change lasted for 10 minutes, during which the animals showed signs of excitement, such as opening their eyes and kicking their legs, although they did not stand up.

“Propofol can be a very dangerous drug because it can cause patients to stop breathing and lower their blood pressure,” Salter explained. “It is usually used for sedation during colonoscopy, etc. If the patient is excessively sedated, methylphenidate may help them wake up, resume breathing and restore blood pressure.” In the operating room, propofol can be used for several hours, and patients may need up to an hour to recover. The ability to use methylphenidate to induce recovery can make general anesthesia safer and more effective. We hope to conduct clinical trials on patients in the near future. ”

Salter is an assistant professor of anesthesiology at Harvard Medical School. Other authors of the anesthesiology report are Jessica Chemali, the main author, and Dr. Christa Van Dort and Dr. Emery Brown, the co authors, both from the MGH Department of Anesthesia, Critical Care and Pain Medicine. This study was funded by the National Institutes of Health.

Founded in 1811, Massachusetts General Hospital is the predecessor of Harvard Medical School and the largest teaching hospital. MGH carries out the largest hospital based research project in the United States, with an annual research budget of more than 750 million dollars. Its main research centers include AIDS, cardiovascular research, cancer, computational and comprehensive biology, skin biology, human genetics, medical imaging, neurodegenerative diseases, regenerative medicine, systems biology, transplantation biology and photoelectric medicine.

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