RESUMO
At clinically relevant concentrations, volatile anaesthetic agents influence neutrophil function. Our hypothesis was that sevoflurane would inhibit neutrophil apoptosis and consequently influence the postoperative pro-inflammatory state. In order to identify selectively the effect of the anaesthetic agent sevoflurane, we studied patients undergoing minimally stimulating (cataract) surgery randomly allocated to receive either sevoflurane (n = 11) or local anaesthesia (n = 12). Venous blood samples were taken immediately prior to anaesthesia and at 1, 8 and 24 h thereafter. The rate of neutrophil apoptosis, plasma concentration of cytokines and differential white cell count were measured. The rates of neutrophil apoptosis and plasma concentrations of IL-1beta, TNF-alpha and IL-8 at each time point were similar in the two groups. IL-6 concentrations increased significantly and to a similar extent compared to preanaesthetic levels at 8 and 24 h. This study demonstrates that sevoflurane does not influence the rate of neutrophil apoptosis, cytokine concentrations and neutrophil count following cataract surgery.
Assuntos
Anestesia por Inalação , Anestesia Local , Anestésicos Inalatórios/administração & dosagem , Anestésicos Locais/administração & dosagem , Apoptose/efeitos dos fármacos , Extração de Catarata , Mediadores da Inflamação/sangue , Bloqueio Nervoso , Neutrófilos/efeitos dos fármacos , Idoso , Análise de Variância , Bupivacaína/administração & dosagem , Feminino , Seguimentos , Humanos , Inflamação/imunologia , Interleucina-1/sangue , Interleucina-6/sangue , Contagem de Leucócitos , Lidocaína/administração & dosagem , Masculino , Éteres Metílicos/administração & dosagem , Procedimentos Cirúrgicos Minimamente Invasivos , Sevoflurano , Fator de Necrose Tumoral alfa/análiseRESUMO
Fiberoptically guided tracheal intubation represents one of the most important advances in airway management to occur in the past thirty years. Perhaps its most important role is in management of the anticipated difficult airway. This is a situation in which the dangers of encountering the life-threatening "can't intubate, can't ventilate" situation can be avoided by placement of an endotracheal tube while the patient is awake. Although skill at the procedure of endoscopy is obviously necessary in this setting, these authors hold that success or failure of the technique frequently depends on the adequacy of preparation. These measures include 1) pre-operative assessment of the patient; 2) careful explanation of what lies in store; 3) "setting the stage"; 4) preparing the equipment to be used; and 5) preparing the patient (antisialogue, sedation, application of topical anesthesia to the upper airway). If these preparatory measures are carried out meticulously, the likelihood of performing a successful and comfortable awake fiberoptic tracheal intubation is greatly increased.