%0 Journal Article
%T Copper and Anesthesia: Clinical Relevance and Management of Copper Related Disorders
%A Adrian Langley
%A Charles T. Dameron
%J Anesthesiology Research and Practice
%D 2013
%I Hindawi Publishing Corporation
%R 10.1155/2013/750901
%X Recent research has implicated abnormal copper homeostasis in the underlying pathophysiology of several clinically important disorders, some of which may be encountered by the anesthetist in daily clinical practice. The purpose of this narrative review is to summarize the physiology and pharmacology of copper, the clinical implications of abnormal copper metabolism, and the subsequent influence of altered copper homeostasis on anesthetic management. 1. Introduction Copper is an essential trace element whose absorption, distribution, and elimination are highly regulated. In vivo, copper is required for the catalytic activity of several critical enzyme systems. Copper zinc superoxide dismutase (Cu/Zn SOD) acts as a free radical scavenger, cytochrome c oxidase functions in energy production, dopamine ¦Â-hydroxylase catalyzes the conversion of dopamine into noradrenaline, tyrosinase is required for pigment formation, ceruloplasmin is a copper transport protein and anti-oxidant, and lysyl oxidase (LOX) is important for tissue integrity [1]. Copper dependent transcriptions factors may also play an important role in the regulation of cellular proliferation [2]. Clinically defined copper deficiency is rare in western societies; however, altered copper metabolism may influence the conduct and outcome of anesthesia secondary to abnormalities in hemopoietic, cardiovascular, connective tissue, immune and nervous systems. Clinically relevant circumstances predisposing to copper deficiency can include prolonged unsupplemented total parental nutrition (TPN) or enteral nutrition, infants fed with unmodified cow milk based diets, prematurity, gastric bypass and laparoscopic adjustable gastric banding surgery, burns, malabsorption syndromes, and large doses of over the counter vitamins containing zinc and iron [3]. Loss of ceruloplasmin bound copper can also occur in patients undergoing continuous ambulatory peritoneal dialysis for renal failure [4]. Clinical copper toxicity is also rare but is found in genetic overload disorders, occupational exposure, or through ingestion and may also influence anesthetic management through multiorgan failure [5]. 2. Distribution of Total Body Copper Content Copper is the third most abundant trace element in the body. It is readily absorbed from the diet and is found in foods including legumes, potatoes, grains, shellfish, and beef. Minor sources include tap water, jewellery, intrauterine devices, copper containing pesticides, and cooking utensils. Daily intake is approximately 1.5£¿mg depending on dietary copper content and regional
%U http://www.hindawi.com/journals/arp/2013/750901/