ABSTRACT
BACKGROUND: Post-ischemia reperfusion can lead to oxidative stress and an increase in oxidative markers. Employing preventive strategies and antioxidant agents may help mitigate ischemia-reperfusion injury (IRI). The use of a tourniquet in extremity surgery has been associated with IRI. This study aims to investigate the impact of three different approaches- brachial plexus block, total intravenous anesthesia (TIVA), and inhalation anesthesia-on IRI during upper extremity surgery using a tourniquet. METHODS: Patients aged 18 to 45 with American Society of Anesthesiologists (ASA) I-II scores were randomly assigned to one of three groups: Group A received an axillary block with bupivacaine; Group I underwent inhalation anesthesia with sevoflurane; and Group T received TIVA with propofol and remifentanil infusion. Blood samples were collected to measure glucose, lactate, total anti-oxidant status (TAS), total oxidant status (TOS), and ischemia-modified albumin (IMA) levels at various time points: before anesthesia (t1), 1 minute before tourniquet release (t2), 20 minutes after tourniquet release (t3), and 4 hours after tourniquet release (t4). RESULTS: In Group I, lactate levels at t3, and glucose levels at t2 and t3, were higher compared to the other groups. Group A exhibited lower IMA levels at t2, t3, and t4 than the other groups. Additionally, Group I had lower IMA levels at t2, t3, and t4 compared to Group T. TAS levels were higher in Group I at t2, t3, and t4 compared to the other groups. TOS levels at t2 and t3 were lower in Group A than in Group I. CONCLUSION: Axillary anesthesia results in a sympathetic block, promoting better perfusion of the upper extremity. This study demonstrated lower levels of oxidative stress markers with axillary plexus block. Therefore, these results suggest that the axillary block has the potential to mitigate IRI.
Subject(s)
Anesthesia, Intravenous , Brachial Plexus Block , Propofol , Reperfusion Injury , Sevoflurane , Tourniquets , Upper Extremity , Humans , Reperfusion Injury/prevention & control , Reperfusion Injury/etiology , Adult , Male , Female , Anesthesia, Intravenous/methods , Brachial Plexus Block/methods , Middle Aged , Upper Extremity/blood supply , Upper Extremity/surgery , Sevoflurane/administration & dosage , Young Adult , Propofol/administration & dosage , Adolescent , Anesthesia, Inhalation/methods , Anesthetics, Inhalation/administration & dosage , Bupivacaine/administration & dosage , Remifentanil/administration & dosage , Methyl Ethers/administration & dosage , Anesthetics, Local/administration & dosage , Oxidative Stress/drug effects , Anesthetics, Intravenous/administration & dosage , Piperidines/administration & dosageABSTRACT
INTRODUCTION: Postoperative nausea, vomiting, and cough are the most common adverse effects of general anesthesia resulting in high discomfort to the patient resulting in uneasiness during the recovery period. This study aimed to compare the influence of intraoperative use of sevoflurane and isoflurane on postoperative nausea, vomiting, and cough. MATERIALS AND METHODS: After approval from the institutional ethical committee, this quantitative observational institutional study was conducted on all patients aged between 18 and 65 years undergoing surgery under general anesthesia at KMC Hospital, Mangalore. Patients were allocated into the sevoflurane group or isoflurane group. RESULTS: All demographic parameters such as age, sex, American Society of Anesthesiologists physical status, and duration were comparable (P > 0.05). The sevoflurane group had higher number of patients (11 [14.86%]) with postoperative nausea at 0 h as compared isoflurane group (7 [9.45%]). Two patients in the isoflurane group reported postoperative vomiting at 0 h, whereas no patient in the sevoflurane group reported vomiting. For cough, a statistically significant correlation was seen between the two groups (P = 0.000) with majority of patients in the isoflurane group, i.e., 50 (67.6%) patients reporting cough at 0 h while only 15 (20.3%) reported cough in the sevoflurane group. CONCLUSION: Sevoflurane was found to be better than isoflurane in terms of postoperative nausea vomiting and cough immediately after emergence in our study. Isoflurane cause the emergence of cough whereas no significant difference in nausea and vomiting was observed in both groups.
Résumé Introduction:Les nausées, vomissements et toux postopératoires sont les effets indésirables les plus courants de l'anesthésie générale, entraînant un inconfort élevé pour le patient, entraînant un malaise pendant la période de récupération. Cette étude visait à comparer l'influence del'utilisation peropératoire du sévoflurane et de l'isoflurane sur les nausées, vomissements et toux postopératoires.Méthode:Après approbation du comité d'éthique institutionnel, cette étude institutionnelle observationnelle quantitative a été menée sur tous les patients âgés de 18 à 65 ans subissant une intervention chirurgicale sous anesthésie générale à l'hôpital KMC de Mangalore. Les patients ont été répartis dans le groupe sévoflurane ou le groupe isoflurane.Résultats:Tous les paramètres démographiques comme l'âge, le sexe, l'ASA PS et la durée étaient comparables. ( P > 0,05) Le groupe sévoflurane avait un nombre plus élevé de patients [11 (14,86 %)] présentant des nausées postopératoires à 0 heure par rapport au groupe isoflurane [7 (9,45 %)]. 2 patients du groupe Isoflurane ont signalé des vomissements postopératoires à 0 heure alors qu'aucun patient du groupe Sévoflurane n'a signalé de vomissements. Pour la toux, une corrélation statistiquement significative a été observée entre les deux groupes ( P = 0,000) avec une majorité de patients dansle groupe isoflurane, c'est-à-dire 50 (67,6 %) patients signalant une toux à 0 heure, alors que seulement 15 (20,3 %) ont signalé une toux dans le groupe sévoflurane.Conclusion:Le sévoflurane s'est révélé meilleur que l'isoflurane en termes de nausées, vomissements et toux postopératoires immédiatement après l'émergence dans notre étude. L'isoflurane provoque une toux d'émergence alors qu'aucune différence significative en termes de nausées et de vomissements n'a été observée dans les deux groupes.
Subject(s)
Anesthesia, General , Anesthetics, Inhalation , Cough , Isoflurane , Postoperative Nausea and Vomiting , Sevoflurane , Humans , Sevoflurane/adverse effects , Postoperative Nausea and Vomiting/epidemiology , Postoperative Nausea and Vomiting/prevention & control , Female , Anesthetics, Inhalation/adverse effects , Male , Adult , Isoflurane/adverse effects , Isoflurane/administration & dosage , Middle Aged , Anesthesia, General/adverse effects , Young Adult , Adolescent , Aged , Treatment Outcome , Methyl Ethers/adverse effects , Methyl Ethers/administration & dosageABSTRACT
BACKGROUND We aimed to assess the effect of dexmedetomidine (Dex) combined with remifentanil on emergence agitation (EA) during awakening from sevoflurane anesthesia for pediatric liver surgery. MATERIAL AND METHODS Sixty children who underwent liver surgery in our hospital were prospectively selected and randomly allocated into group A (placebo+remifentanil+sevoflurane) or group B (Dex+remifentanil+sevoflurane). Mean arterial pressure (MAP) and heart rate (HR) at different time points, agitation score during awakening, behavioral status, pain level, and the incidence of postoperative adverse effects were compared in both groups. RESULTS Children in group B had lower HR and MAP levels immediately after tracheal extubation and 5 min after tracheal extubation than those in group A. The Aono's scores, PAED agitation scores, and CHIPP scores at 15 min and 30 min of admission to the PACU were lower in group B than in group A. The incidence of agitation during postoperative anesthesia awakening was lower in group B in contrast to group A. There was no significant difference in postoperative adverse reactions between group A and group B. CONCLUSIONS In pediatric liver surgery, the use of Dex+remifentanil+sevoflurane anesthesia can reduce the incidence of EA during the awakening period, stabilize hemodynamic levels, and relieve postoperative pain, and has fewer postoperative adverse effects, which warrants clinical application.
Subject(s)
Anesthetics, Inhalation , Dexmedetomidine , Emergence Delirium , Remifentanil , Sevoflurane , Humans , Dexmedetomidine/administration & dosage , Dexmedetomidine/therapeutic use , Remifentanil/administration & dosage , Remifentanil/therapeutic use , Sevoflurane/administration & dosage , Female , Male , Anesthetics, Inhalation/administration & dosage , Anesthetics, Inhalation/adverse effects , Child, Preschool , Emergence Delirium/prevention & control , Emergence Delirium/etiology , Emergence Delirium/epidemiology , Prospective Studies , Hypnotics and Sedatives/administration & dosage , Hypnotics and Sedatives/therapeutic use , Infant , Child , Psychomotor Agitation/prevention & control , Psychomotor Agitation/etiology , Liver/surgery , Anesthesia Recovery Period , Piperidines/administration & dosage , Piperidines/therapeutic use , Piperidines/adverse effects , Double-Blind Method , Drug Therapy, Combination , Methyl Ethers/administration & dosage , Methyl Ethers/adverse effects , Analgesics, Opioid/administration & dosage , Analgesics, Opioid/therapeutic useABSTRACT
STUDY: Propofol and sevoflurane are two anesthetic agents widely used to induce and maintain general anesthesia (GA). Their intrinsic antinociceptive properties remain unclear and are still debated. OBJECTIVE: To determine whether propofol presents stronger antinociceptive properties than sevoflurane using intraoperative clinical and experimental noxious stimulations and evaluating postoperative pain outcomes. DESIGN: A prospective randomized monocentric trial. SETTING: Perioperative care. PATIENTS: 60 adult patients with ASA status I to III who underwent elective abdominal laparoscopic surgery under GA were randomized either in propofol or sevoflurane group to induce and maintain GA. INTERVENTIONS: We used clinical and experimental noxious stimulations (intubation, tetanic stimulation) to assess the antinociceptive properties of propofol and sevoflurane in patients under GA and monitored using the NOL index, BIS index, heart rate, and mean arterial blood pressure. MEASUREMENTS: We measured the difference in the NOL index alterations after intubation and tetanic stimulation during either intravenous anesthesia (propofol) or inhaled anesthesia (sevoflurane). We also intraoperatively measured the NOL index and remifentanil consumption and recorded postoperative pain scores and opioid consumption in the post-anesthesia care unit. Intraoperative management was standardized by targeting similar values of depth of anesthesia (BIS index), hemodynamic (HR and MAP), NOL index values (below the threshold of 20), same multimodal analgesia and type of surgery. MAIN RESULTS: We found the antinociceptive properties of propofol and sevoflurane similar. The only minor difference was after tetanic stimulation: the delta NOL was higher in the sevoflurane group (39 ± 13 for the propofol group versus 47 ± 15 for sevoflurane; P = 0.04). Intraoperative and postoperative pain outcomes and opioid consumption were similar between groups. CONCLUSIONS: Despite a precise intraoperative experimental and clinical protocol using the NOL index, propofol does not provide a higher level of antinociception during anesthesia or analgesia after surgery when compared to sevoflurane. Anesthesiologists may prefer propofol over sevoflurane to reduce PONV or anesthesia-related pollution, but not for superior antinociceptive properties.
Subject(s)
Anesthesia, General , Anesthetics, Inhalation , Anesthetics, Intravenous , Nociception , Pain, Postoperative , Propofol , Sevoflurane , Humans , Sevoflurane/administration & dosage , Sevoflurane/pharmacology , Propofol/administration & dosage , Male , Anesthesia, General/methods , Female , Middle Aged , Pain, Postoperative/prevention & control , Pain, Postoperative/drug therapy , Prospective Studies , Anesthetics, Intravenous/administration & dosage , Nociception/drug effects , Anesthetics, Inhalation/administration & dosage , Adult , Methyl Ethers/administration & dosage , Laparoscopy/adverse effects , Aged , Remifentanil/administration & dosage , Remifentanil/pharmacology , Analgesics/administration & dosage , Analgesics/pharmacology , Heart Rate/drug effects , Pain Measurement , Analgesics, Opioid/administration & dosage , Monitoring, Intraoperative/methods , Piperidines/administration & dosage , Piperidines/pharmacology , Abdomen/surgeryABSTRACT
BACKGROUND: The effect of sevoflurane on left ventricular diastolic function is not well understood. We hypothesized that parameters of diastolic function may improve under sevoflurane anesthesia in patients with preexisting diastolic dysfunction compared to patients with normal diastolic function. METHODS: This observational study included 60 patients undergoing breast surgery or laparoscopic cholecystectomy. Patients were assigned to diastolic dysfunction (n = 34) or normal (n = 26) groups of septal e' < 8 or ≥ 8.0 cm/s on the first thoracic echocardiography (TTE) performed before anesthesia. During anesthesia, sevoflurane was maintained at 1 to 2 minimum alveolar concentration (MAC) to maintain the bispectral index at 40 to 50. At the end of surgery, the second TTE was performed under 0.8 to 1 MAC of sevoflurane with the patient breathing spontaneously without ventilator support. Primary end point was the percentage change (Δ) of e' on 2 TTEs (Δe'). Secondary end points were ΔE/e', Δleft atrial volume index (ΔLAVI), and Δtricuspid regurgitation maximum velocity (ΔTR Vmax). These percentage changes (Δ) were compared between diastolic dysfunction and normal groups. RESULTS: e' (Δe': 30 [6, 64] vs 0 [-18, 11]%; P < .001), mitral inflow E wave velocity (E), mitral inflow E/A ratio (E/A), and mitral E velocity deceleration time (DT) improved significantly in diastolic dysfunction group compared to normal group. LAVI decreased in diastolic dysfunction group but did not reach statistical significance between the 2 groups (ΔLAVI:-15 [-31, -3] vs -4 [-20, 10]%, P = .091). ΔE/e' was not different between the 2 groups (11 [-16, 26] vs 12 [-9, 22]%, P = .853) (all: median [interquartile range, IQR]). TR was minimal in both groups. CONCLUSIONS: In this study, echocardiographic parameters of diastolic function, including septal e', E, E/A, and DT, improved with sevoflurane anesthesia in patients with preexisting diastolic dysfunction, but remained unchanged in patients with normal diastolic function.
Subject(s)
Anesthetics, Inhalation , Diastole , Sevoflurane , Ventricular Function, Left , Humans , Sevoflurane/administration & dosage , Female , Prospective Studies , Middle Aged , Anesthetics, Inhalation/administration & dosage , Diastole/drug effects , Male , Aged , Ventricular Function, Left/drug effects , Ventricular Dysfunction, Left/physiopathology , Ventricular Dysfunction, Left/diagnostic imaging , Methyl Ethers/administration & dosage , Cholecystectomy, Laparoscopic , AdultABSTRACT
BACKGROUND: The use of methyl-tertiary butyl ether (MTBE) to dissolve gallstones has been limited due to concerns over its toxicity and the widespread recognition of the safety of laparoscopic cholecystectomy. The adverse effects of MTBE are largely attributed to its low boiling point, resulting in a tendency to evaporate. Therefore, if there is a material with a higher boiling point and similar or higher dissolubility than MTBE, it is expected to be an attractive alternative to MTBE. AIM: To determine whether tert-amyl ethyl ether (TAEE), an MTBE analogue with a relatively higher boiling point (102 °C), could be used as an alternative to MTBE in terms of gallstone dissolubility and toxicity. METHODS: The in vitro dissolubility of MTBE and TAEE was determined by measuring the dry weights of human gallstones at predetermined time intervals after placing them in glass containers with either of the two solvents. The in vivo dissolubility was determined by comparing the weights of solvent-treated gallstones and control (dimethyl sulfoxide)-treated gallstones, after the direct infusion of each solvent into the gallbladder in both hamster models with cholesterol and pigmented gallstones. RESULTS: The in vitro results demonstrated a 24 h TAEE-dissolubility of 76.7%, 56.5% and 38.75% for cholesterol, mixed, and pigmented gallstones, respectively, which represented a 1.2-, 1.4-, and 1.3-fold increase in dissolubility compared to that of MTBE. In the in vitro experiment, the 24 h-dissolubility of TAEE was 71.7% and 63.0% for cholesterol and pigmented gallstones, respectively, which represented a 1.4- and 1.9-fold increase in dissolubility compared to that of MTBE. In addition, the results of the cell viability assay and western blot analysis indicated that TAEE had a lower toxicity towards gallbladder epithelial cells than MTBE. CONCLUSION: We demonstrated that TAEE has higher gallstone dissolubility properties and safety than those of MTBE. As such, TAEE could present an attractive alternative to MTBE if our findings regarding its efficacy and safety can be consistently reproduced in further subclinical and clinical studies.
Subject(s)
Ether/administration & dosage , Gallstones/therapy , Methyl Ethers/administration & dosage , Solvents/administration & dosage , Animals , Cell Survival/drug effects , Cholesterol, Dietary/adverse effects , Diet, Carbohydrate Loading/adverse effects , Disease Models, Animal , Ether/adverse effects , Female , Gallstones/diagnostic imaging , Gallstones/etiology , Humans , Mesocricetus , Methyl Ethers/adverse effects , Solvents/adverse effects , Treatment Outcome , UltrasonographyABSTRACT
BACKGROUND: Oxidative stress may be an integral determinant of surgical stress severity. We examined whether the preoperative level of derivatives of reactive oxygen metabolites (d-ROMs), an oxidative stress biomarker based on total hydroperoxides in circulating blood, is predictive of increased risk of delayed recovery and complications after surgery, as well as the effects of anesthesia management on postoperative recovery in light of oxidative stress. METHODS: Patients (American Society of Anesthesiologists physical status I-II) scheduled for a radical esophagectomy (nâ=â186) were randomly selected to receive inhalational sevoflurane (nâ=â94) or intravenous propofol (nâ=â92) anesthesia. Preoperative blood d-ROMs level, as well as pre-and postoperative plasma ferric-reducing ability, were analyzed to assess oxidative stress, with white blood cell (WBC) count, C-reactive protein (CRP) level, incidence of severe postoperative complications, and postoperative recovery process within 30 days after surgery also examined in a double-blind fashion. RESULTS: Postoperative normalization of WBC and CRP was extended in patients with elevated preoperative d-ROMs [WBC versus d-ROMs: correlation coefficient (r)â=â0.58 Pâ<â.001; CRP versus d-ROMs: râ=â0.46 Pâ<â.001]. Receiver operating characteristics analysis of d-ROMs in relation to incidence of severe postoperative complications revealed an optimum d-ROMs threshold value of 410 UCarr and that patients with ≥410 UCarr had a greater risk of complications as compared to those with lower values (odds ratioâ=â4.7). Plasma ferric-reducing ability was decreased by 61â±â185 mmol·l (Pâ<â.001) after surgery, demonstrating development of surgery-related oxidative stress, the magnitude of which was positively correlated with preoperative d-ROMs level (râ=â0.16, Pâ=â.043). A comparison of the 2 anesthesia management protocols showed that patients who received propofol, an antioxidant anesthetic, had no postoperative decrease in ferric-reducing ability, lower incidence of severe postoperative complications (7 of 92 versus 18 of 94, Pâ=â.030, odds ratioâ=â0.35), and faster uneventful recovery time (WBC normalization days 7.1â±â5.2 versus 13.6â±â10.2, Pâ<â.001) as compared to those who received sevoflurane. CONCLUSIONS: Elevated preoperative blood d-ROMs predicts greater intraoperative oxidative stress and increased postoperative complications with prolonged recovery, thus is useful for identifying high-risk patients for delayed and complicated surgical recovery. Reduction of oxidative stress is vital for enhanced recovery, with control by antioxidants such as propofol a possible solution.
Subject(s)
Anesthetics, Inhalation , Anesthetics, Intravenous , Esophagectomy/adverse effects , Oxidative Stress , Postoperative Care , Postoperative Complications/diagnosis , Postoperative Complications/prevention & control , Reactive Oxygen Species/blood , Aged , Biomarkers/blood , C-Reactive Protein/metabolism , Double-Blind Method , Female , Humans , Iron/blood , Leukocyte Count , Male , Methyl Ethers/administration & dosage , Middle Aged , Propofol/administration & dosage , Risk Factors , SevofluraneABSTRACT
RATIONALE: Awareness is the recovery of consciousness during general anesthesia. It occurs when patients under general anesthesia receive inadequate anesthetic medications to maintain unconsciousness during surgery. Equipment failure is a common cause of intraoperative awareness. PATIENT CONCERNS: A 16-year-old boy, 85âkg in weight, was admitted to our hospital for thyroglossal cystectomy under general anesthesia. Six minutes after the intubation, we noted that the Narcotrend index indicated a condition of light anesthesia and the patient was observed to be in tears. DIAGNOSIS: Improper positioning of the syringe fixing clamp on the CP700TCI infusion pump caused equipment failure and light anesthesia. INTERVENTIONS: Bolus of 50âmg propofol and 2âmg midazolam were administered manually by syringe, and inhalation of 2% sevoflurane was supplemented. Infusion pump was replaced. OUTCOMES: The Narcotrend index of the patient returned to state of deep anesthesia following manual administration of the anesthetic medications. Following the surgery, the patient had an uneventful recovery, and did not present with evidence of awareness. LESSONS: Users of the CP700TCI syringe pump should pay attention to the position of the syringe fixing clamp. Anesthesiologists should check all the equipment according to a defined checklist prior to anesthesia. Narcotrend monitor could help to detect light anesthesia and prevent potential awareness.
Subject(s)
Anesthesia, Intravenous/instrumentation , Anesthetics, Intravenous/administration & dosage , Equipment Failure , Infusion Pumps , Intraoperative Awareness/prevention & control , Monitoring, Intraoperative/methods , Adolescent , Anesthetics, Inhalation/administration & dosage , Electroencephalography , Humans , Male , Methyl Ethers/administration & dosage , Midazolam/administration & dosage , Propofol/administration & dosage , SevofluraneABSTRACT
AIM AND BACKGROUND: Sedation is gaining popularity among dental procedures in children. Ketamine and propofol mixture, known as ketofol, is one of the promising choices in sedation protocols; however, there is no consensus on the exact ratio of ketamine plus propofol especially in dental practice. The aim of present study was to compare perioperative side effect profiles, recovery profiles, and satisfaction rates of both parents' and dentists' following three different ratio of ketofol mixtures in children undergoing dental treatment. Materials and. METHODS: Three study groups each containing 30 children scheduled for dental treatment were created. Following anesthesia induction with 5% sevoflurane, 50% nitrous oxide mixture in 50% oxygen, 1 mg/kg bolus ketofol dose was administered. Patients in Group 1 received ketofol as a 1:1 mixture, patients in Group 2 received 1:2 ketofol while in Group 3; 1:4 ketofol was administered at a constant dose of 100 µg/kg/min. Additional doses of the ketofol solution at the same concentration with infused solutions in groups (0.5 mg/kg from either 1:1, 1:2, or 1:4 proportions) were administered if required. Perioperative vital signs, side effects, postoperative side effects, recovery durations, parents' and dentists' satisfaction levels were compared between groups. RESULTS: There were no significant differences between groups in terms of perioperative vital signs and side effects. Depth of sedation, dentists' satisfaction levels and postoperative side effects -myoclonus, hypersalivation and tachycardia were significantly higher in Group 1. Parents' satisfaction was highest in Group 3, however, necessity of additional doses and dissatisfaction of dentists' were found highest in this group. Mean duration of recovery recorded in Group 3 was shortest compared with other groups. CONCLUSION: Decreased ketamine doses in ketofol mixture was related with decreased side effect profile, high parents' satisfaction with fast recovery, however, dentists' satisfaction was lower. In this context, results of present study indicated that ketofol mixture of 1:2 ratio was more reliable choice than others when all investigated parameters evaluated simultaneously.
Subject(s)
Anesthetics, Intravenous/administration & dosage , Conscious Sedation/methods , Dental Care/methods , Dentists/psychology , Ketamine/administration & dosage , Propofol/administration & dosage , Anesthesia , Child , Drug Combinations , Female , Humans , Male , Methyl Ethers/administration & dosage , Outcome and Process Assessment, Health Care , Patient Satisfaction , Postoperative Period , SevofluraneABSTRACT
BACKGROUND: Nonintubated video-assisted thoracic surgery (VATS) has been widely developed during the recent years. Cough reflex is an inevitably encountered problem while approaching lung lesions, and it may induce major bleeding. Sevoflurane anesthesia may attenuate cough reflex by inhibiting the pulmonary irritant receptors. However, the incidence of postoperative nausea and vomiting (PONV) in inhalational anesthesia is higher than in the propofol-based total intravenous anesthesia (TIVA). We investigated the effect of sevoflurane combination with propofol-based TIVA on cough reflex and PONV in nonintubated VATS. METHODS: Ninety patients undergoing nonintubated VATS with laryngeal mask airway (LMA) and spontaneous breathing were randomly assigned for TIVA or propofol/sevoflurane anesthesia. In the TIVA group (nâ=â45), anesthesia was induced and maintained with propofol and fentanyl; in the propofol/sevoflurane (P/S) group (nâ=â45), 1% sevoflurane anesthesia was added to propofol and fentanyl anesthesia. The primary outcome measurements were cough reflex. In addition, the incidence of PONV and extubation time were investigated. RESULTS: Patients with cough reflex were significantly fewer in the P/S group than in the TIVA group (10/45 vs 34/45; Pâ<â.001). The cough severity (35/5/5/0 vs 11/17/17/0; Pâ<â.001) and limb movement (40/5/0/0 vs 28/17/0/0; Pâ<â.001) were lower in the P/S group than in the TIVA group. Besides, incremental fentanyl bolus for cough reflex was 5 (0 [0-1]) in the P/S group and 17 (0 [0-3]) in the TIVA group (Pâ<â.05). And there was no conversion to general anesthesia, postoperative hemorrhage, aspiration pneumonia, or PONV in the 2 groups. Besides, there was no significant difference in extubation time (TIVA: 5.04â±â2.88 vs P/S: 4.44â±â2.98 minutes; Pâ=â.33). CONCLUSION: Sevoflurane attenuated cough reflex under propofol-based TIVA and did not increase the incidence of PONV and extubation time in nonintubated VATS.
Subject(s)
Cough/prevention & control , Methyl Ethers/administration & dosage , Postoperative Complications/prevention & control , Propofol/administration & dosage , Reflex/drug effects , Thoracic Surgery, Video-Assisted/adverse effects , Adult , Aged , Anesthetics, Inhalation/administration & dosage , Anesthetics, Intravenous/administration & dosage , Cough/etiology , Female , Humans , Male , Middle Aged , Postoperative Complications/etiology , Sevoflurane , Thoracic Surgery, Video-Assisted/methods , Treatment OutcomeABSTRACT
OBJECTIVE: To investigate changes in serum cardiac troponin I (cTnI) concentrations in dogs in which medetomidine was used for sedation or for premedication prior to anaesthesia with propofol and sevoflurane. STUDY DESIGN: Prospective clinical study. ANIMALS: A total of 66 client-owned dogs. METHODS: The dogs were sedated with medetomidine (0.04 mg kg-1) intravenously (IV) (group M; n = 20) and left to breath room air or anaesthetized with propofol (6.5 ± 0.76 mg kg-1 IV) and sevoflurane (4.5% vaporizer setting) in oxygen (group P + S; n = 20) or with medetomidine (0.04 mg kg-1 IV), propofol (1.92 ± 0.63 mg kg-1) and sevoflurane (3% vaporizer setting) in oxygen (group M + P + S; n = 26), respectively. After 35 minutes, medetomidine was antagonized with atipamezole (0.1 mg kg-1 intramuscularly). Blood samples for serum cTnI determination were taken before sedation or anaesthesia, 6 and 12 hours and 4 days thereafter. Serum cTnI concentrations were measured with the Architect STAT Troponin-I assay. RESULTS: Before sedation or anaesthesia, cTnI concentrations were above the detection limit in 22 out of 66 (33%) of dogs. Compared to basal values, cTnI concentrations significantly increased at 6 and 12 hours in all groups and at day 4 in group M. There were no differences in cTnI concentration between groups at baseline, at 6 hours and at 4 days. At 12 hours, cTnI concentrations were significantly higher in groups M and P + S, respectively, compared to group M + P + S. CONCLUSIONS AND CLINICAL RELEVANCE: Oxygenation during anaesthesia and reduction of propofol and sevoflurane dose due to the sparing effects of medetomidine might have played a role in alleviation of myocardial hypoxic injury as indicated by the less severe and short-lived increase of cTnI in the M + P + S group.
Subject(s)
Dogs/surgery , Hypnotics and Sedatives/pharmacology , Medetomidine/pharmacology , Methyl Ethers/administration & dosage , Myocardium/metabolism , Propofol/administration & dosage , Troponin I/blood , Animals , Female , Gastroscopy/veterinary , Hypnotics and Sedatives/therapeutic use , Male , Medetomidine/therapeutic use , Oxygen Consumption , Premedication/veterinary , Prospective Studies , Random Allocation , SevofluraneABSTRACT
Clinical studies have shown that total intravenous anesthesia (TIVA) with propofol is associated with better postoperative pain control compared with inhalational anesthesia, while other studies have not shown any benefit. The analgesic effect of TIVA with propofol in colorectal surgery has not been studied. The aim of this study is to evaluate the postoperative analgesic effects of TIVA with propofol versus inhalational sevoflurane in colorectal surgery.This is a retrospective case-control study. Records of patients undergoing colorectal surgery from 2014 to 2016 (36 months) were retrieved. Ninety-five patients who received TIVA with propofol were matched against 95 patients who received inhalational sevoflurane. Acute postoperative numerical rating scale (NRS) pain scores, postoperative morphine consumption, patient satisfaction, and side effects were compared and analyzed for differences between TIVA with propofol and sevoflurane.There were no significant differences in NRS pain scores, incidence of side effects, and patient satisfaction between the 2 groups. Patients receiving TIVA with propofol had significantly reduced total morphine consumption (Pâ<â.001), and daily morphine consumption on postoperative days 1 (Pâ=â.031), 2 (Pâ=â.002), and 3 (Pâ=â.031) compared with those receiving sevoflurane.TIVA with propofol was not associated with improved postoperative analgesia, better patient satisfaction, or reduced side effects. It may reduce postoperative opioid consumption after colorectal surgery.
Subject(s)
Anesthesia/methods , Anesthetics, Inhalation/administration & dosage , Anesthetics, Intravenous/administration & dosage , Intraoperative Care/methods , Methyl Ethers/administration & dosage , Pain, Postoperative/drug therapy , Propofol/administration & dosage , Adult , Case-Control Studies , Colon/surgery , Digestive System Surgical Procedures/adverse effects , Digestive System Surgical Procedures/methods , Female , Humans , Male , Middle Aged , Pain, Postoperative/etiology , Rectum/surgery , Retrospective Studies , Sevoflurane , Treatment OutcomeABSTRACT
We present the case of a 53-year-old man who attended our emergency department with stridor. He had recently undergone investigation for possible glottic cancer. We discuss the airway management of such a case. We believe this to be the first description of propofol target controlled infusion and clonidine to supplement a sevoflurane gas induction, in order to obtund response to intubation while maintaining spontaneous ventilation. We also consider how airway interventions may impact prognosis and need to be considered.
Subject(s)
Airway Management/methods , Airway Obstruction/therapy , Carcinoma, Adenosquamous/surgery , Intubation, Intratracheal/methods , Laryngeal Neoplasms/surgery , Laryngoscopy/methods , Airway Obstruction/diagnostic imaging , Analgesics/administration & dosage , Anesthetics, Inhalation/administration & dosage , Anesthetics, Intravenous/administration & dosage , Carcinoma, Adenosquamous/diagnostic imaging , Carcinoma, Adenosquamous/pathology , Clonidine/administration & dosage , Humans , Laryngeal Neoplasms/diagnostic imaging , Male , Methyl Ethers/administration & dosage , Middle Aged , Propofol/administration & dosage , Sevoflurane , Tomography, X-Ray ComputedABSTRACT
BACKGROUND: Inadvertent coughing and desaturation are the most commonly faced and feared respiratory complications in post-anaesthesia period. The study was done to compare the efficacy of intravenous lignocaine versus sevoflurane in prevention of coughing and desaturation at extubation in children less than 6 years of age. METHODS: This Randomized Control Trial was carried out from May 2013 to May 2016, at Combined Military Hospital Nowshera after obtaining approval from the hospital ethics committee (IREC-0003/5/13/Aneas). Children aged three months to six years undergoing surgical procedures requiring the placement of definitive airway were randomly assigned into two groups. Patients were anaesthetized by standardized balanced anaesthesia technique. In Group A (n=355), three minutes prior to extubation lignocaine 2% was used intravenously. In Group B (n=355), isoflurane was switched off, breathing circuit changed and sevoflurane started at minimum alveolar concentration (MAC 3-4%) for 3 minutes prior to extubation. Assessment for extubation was clinical. Oxygen saturation and severity of coughing were noted for 5 consecutive minutes, after extubation. RESULTS: In group-A, 156 patients were less than 2 years of age while in group-B, 135 patients were less than 2 years old. In group-A, 199 and in group-B, 220 children were 2-6 years of age respectively. Post stratification the p-value for weight was 0.17 (p-value >0.05) and t-statistic was 1.36. Post stratification p-value for gender was 0.12 (p-value>0.05) and chi square statistic was 2.49. Group A had more eventful extubation with 270 cases of cough (76%) as compared to group-B where it was noted in 199 cases (56%). Similarly, desaturation was observed in 85 cases in group-A (24%) as compared to 28 cases (8%) in group-B. The difference between the groups was statistically significant. CONCLUSIONS: Sevoflurane based anaesthetic vapours mixture causes statistical significant prevention from events like coughing episodes and desaturation in post-extubation in children less than six years of age undergoing elective surgery.
Subject(s)
Airway Extubation/adverse effects , Cough , Lidocaine , Methyl Ethers , Administration, Inhalation , Administration, Intravenous , Anesthetics, General/administration & dosage , Anesthetics, General/therapeutic use , Child , Child, Preschool , Cough/etiology , Cough/prevention & control , Humans , Lidocaine/administration & dosage , Lidocaine/therapeutic use , Methyl Ethers/administration & dosage , Methyl Ethers/therapeutic use , Oxygen/blood , SevofluraneABSTRACT
OBJECTIVE: To determine sevoflurane's minimum alveolar concentration (MACSEVO) and its cardiopulmonary effects in sheep. STUDY DESIGN: Prospective experimental study. ANIMALS: A group of 10 female nonpregnant Sardinian milk sheep. METHODS: Anesthesia was induced in each sheep twice with sevoflurane in oxygen. After a 30 minute equilibration at end-tidal sevoflurane concentration (Fe'Sevo) of 2.8%, an electrical stimulus (5 Hz/1 ms/50 mA) was applied to the right thoracic limb for 1 minute or until gross purposeful movement occurred. The Fe'Sevo was then changed using a 0.2% up-and-down protocol, dependent on whether or not the response was positive, and then noxious stimulation was repeated. The MACSEVO was defined as the mean Fe'Sevo between that allowing purposeful movement and that not. The group of 10 sheep were re-anesthetized and MACSEVO was re-determined. Thereafter, Fe'Sevo was maintained for 15 minutes each at concentrations corresponding to 1.0, 1.3, 1.6, 1.9 and 0.75 MACSEVO multiples, and cardiopulmonary, blood gas, acid-base variables and plasma electrolytes were determined. Also, time to induction of anesthesia, extubation and recovery were recorded. RESULTS: The mean ± standard deviation of the MACSEVO was 2.74 ± 0.38%. Median (interquartile range) time to intubation was 3.13 (2.98-3.33) minutes, time to extubation was 6.85 ± 2.65 minutes and time to recovery was 13.4 ± 5.2 minutes. With increasing Fe'Sevo, arterial blood pressures progressively decreased as did minute ventilation, which in turn caused end-tidal carbon dioxide, arterial partial pressure of carbon dioxide and bicarbonate values to steadily increase without significantly affecting arterial partial pressure of oxygen. CONCLUSIONS AND CLINICAL RELEVANCE: The reported MACSEVO agrees with published data in this and other species. Administration of sevoflurane in sheep caused marked hemodynamic and respiratory depression, but soon after turning off the vaporizer, sheep could be extubated and recovered rapidly and event-free.
Subject(s)
Anesthetics, Inhalation/pharmacology , Methyl Ethers/pharmacology , Pulmonary Alveoli/chemistry , Anesthesia, Inhalation/methods , Anesthesia, Inhalation/veterinary , Anesthetics, Inhalation/administration & dosage , Anesthetics, Inhalation/analysis , Animals , Blood Gas Analysis/veterinary , Dose-Response Relationship, Drug , Female , Hemodynamics/drug effects , Methyl Ethers/administration & dosage , Methyl Ethers/analysis , Respiration/drug effects , Sevoflurane , SheepABSTRACT
PURPOSE: Sevoflurane preconditioning (SPC) can provide myocardial protective effects similar to ischemic preconditioning. However, the exact mechanism of SPC remains unclear. Previous studies indicate that vascular endothelial growth factor receptor 1 (VEGFR-1) is involved in ischemic preconditioning-mediated cardioprotection. This study was designed to determine the significance of VEGFR-1 signaling in SPC-mediated cardioprotection. MATERIALS AND METHODS: Myocardial ischemia-reperfusion (I/R) rat model was established using the Langendorff isolated heart perfusion apparatus. Additionally, after 15 min of baseline equilibration, the isolated hearts were pretreated with 2.5% sevoflurane, 2.5% sevoflurane+MF1 10 µmol/L, or 2.5% sevoflurane+placental growth factor 10 µmol/L, and then subjected to 30 min of global ischemia and 120 min of reperfusion. The changes in hemodynamic parameters, myocardial infarct size, and the levels of creatine kinase-MB, lactate dehydrogenase, cardiac troponin-I, tumor necrosis factor-α, and interleukin 6 in the myocardium were evaluated. RESULTS: Compared to the I/R group, pretreatment with 2.5% sevoflurane significantly improved the cardiac function, limited myocardial infarct size, reduced cardiac enzyme release, upregulated VEGFR-1 expression, and decreased inflammation. In addition, the selective VEGFR-1 agonist, placental growth factor, did not enhance the cardioprotection and anti-inflammation effects of sevoflurane, while the specific VEGFR-1 inhibitor, MF1, completely reversed these effects. CONCLUSION: Our data have demonstrated that 2.5% sevoflurane preconditioning alleviates heart I/R injury, which is probably mediated by the anti-inflammatory property and upregulation of VEGFR-1.
Subject(s)
Cardiotonic Agents/pharmacology , Methyl Ethers/pharmacology , Myocardial Reperfusion Injury/prevention & control , Up-Regulation/drug effects , Vascular Endothelial Growth Factor Receptor-1/metabolism , Animals , Cardiotonic Agents/administration & dosage , Male , Methyl Ethers/administration & dosage , Myocardial Reperfusion Injury/metabolism , Rats , Rats, Sprague-Dawley , SevofluraneABSTRACT
Endothelial dysfunction is observed in several cardiovascular diseases, where endothelium-dependent vasodilation is impaired by oxidative stress. However, the time course of endothelial function during the perioperative period of a minor-to-moderate surgery, and the effects of atherosclerotic risk factors and employed general anesthetics on recovery of endothelial function, are unknown. Endothelial function of 30 patients was evaluated as the reactive hyperemia index (RHI) of reactive hyperemia peripheral arterial tonometry. RHI was measured on day before surgery (control), immediately after surgery (Day 0), day after surgery (Day 1), and day 4 after surgery (Day 4) in patients with no functional limitations who were scheduled for oral and maxillofacial surgery of around 3 hours. Sevoflurane- or propofol-based anesthesia supplemented with an opioid analgesic remifentanil was employed. The control RHI was 2.26 ± 0.64. The RHI significantly decreased to the lowest level on Day 0 (1.52 ± 0.28), recovered on Day 1 (2.07 ± 0.58), and improved further on Day 4 (2.55 ± 0.83). Multiple linear regression analysis revealed that recovery of the RHI from Day 0 to Day 4 was impaired by diabetes mellitus (P = 0.0313), obesity (BMI ≥ 25; P = 0.0166), hyperuricemia (uric acid ≥ 6.0 mg/dL; P = 0.0416) and sevoflurane-based anesthesia (P = 0.0308). These findings suggest that endothelial function as evaluated by the RHI is severely suppressed on the day of a minor-to-moderate surgery, and that it improves until the 4th postoperative day on average. Recovery of endothelial function is impaired by diabetes mellitus, obesity, hyperuricemia, and sevoflurane-based anesthesia.
Subject(s)
Anesthetics, Inhalation/adverse effects , Diabetes Mellitus/physiopathology , Endothelium, Vascular/physiopathology , Hyperuricemia/complications , Methyl Ethers/adverse effects , Obesity/complications , Adult , Aged , Anesthesia/adverse effects , Anesthetics, Inhalation/administration & dosage , Atherosclerosis/physiopathology , Female , Humans , Hyperemia/physiopathology , Male , Manometry , Methyl Ethers/administration & dosage , Middle Aged , Oral Surgical Procedures/adverse effects , Prospective Studies , Recovery of Function/drug effects , Risk Factors , SevofluraneABSTRACT
PURPOSE: Visual evoked potentials (VEPs) are a powerful tool to evaluate nervous conduction along the visual pathways, both in humans and in animal models. Traditionally, epidural screw electrodes are used to record VEPs in preclinical research. Here we tested the feasibility in the preclinical setting of the same noninvasive technique used for clinical VEP acquisition, by using epidermal cup electrodes with no surgical procedures. METHODS: Monocular flash VEPs were recorded bilaterally under sevoflurane anesthesia once a week for 6 weeks in 14 dark Agouti rats, 7 with implanted epidural screws and 7 with epidermal 6 mm Ø Ag/AgCl cups. RESULTS: VEP traces obtained with the two techniques were morphologically comparable. There were no significant differences in latency of the main visual component between screw-recorded VEPs (sVEPs) and cup-recorded VEPs (cVEPs). Amplitude values with epidermal cups were significantly lower than those with epidural screws. Both techniques provided latencies and amplitudes which were stable over time. Furthermore, with regard to latency both methods ensured highly repeatable measurements over time, with epidermal cups even providing slightly better results. On the other hand, considering amplitudes, cVEPs and sVEPs provided fairly acceptable repeatability. CONCLUSIONS: Epidermal cup electrodes can provide comparable results to those obtained with the "gold standard" epidural screws, while representing a simpler and less invasive technique to test nervous conduction along the visual pathways in the preclinical setting.
Subject(s)
Epidermis/physiology , Evoked Potentials, Visual/physiology , Visual Pathways/physiology , Anesthetics, Inhalation/administration & dosage , Animals , Electrodes , Electroretinography , Female , Methyl Ethers/administration & dosage , Photic Stimulation/methods , Rats , SevofluraneABSTRACT
Anesthetic preconditioning is a cellular protective approach whereby exposure to a volatile anesthetic renders cardio injury. Sevoflurane preconditioning has been shown to exhibit cardio protective effect on hypoxia/reoxygenation (H/R) injury, but the underlying mechanism is unclear. Syntaxin 1A (STX1A), an important regulator in cardio disease, was predicted to be the target gene of microRNA-34a-5p (miR-34a-5p). The current research was designed to delineate the role of miR-34a-5p in regulating sevoflurane preconditioning in cardiomyocytes injury. In this study, the results demonstrated that the expression of STX1A was significantly increased, while miR-34a-5p was dramatically decreased in sev-preconditioning H9c2 cells as compared with cells only under H/R stimulation. Moreover, miR-34a-5p regulated the protective effect of sev-preconditioning in injured H9c2 cells by mediating cell proliferation and cell apoptosis. Additionally, the luciferase report confirmed the targeting reaction between STX1A and miR-34a-5p. Taken together, our study suggested that miR-34a-5p regulated sev-preconditioning induced inhibition of hypoxia/reoxygenation injury through mediating STX1A, provided a potential therapeutic target for anesthetic protection in cardio disease.
Subject(s)
Methyl Ethers/pharmacology , MicroRNAs/genetics , Myocardial Reperfusion Injury/drug therapy , Myocytes, Cardiac/drug effects , Anesthetics, Inhalation/administration & dosage , Anesthetics, Inhalation/pharmacology , Animals , Apoptosis/drug effects , Cell Line , Cell Proliferation/drug effects , Gene Expression Regulation , Methyl Ethers/administration & dosage , Myocardial Reperfusion Injury/genetics , Myocardial Reperfusion Injury/pathology , Myocytes, Cardiac/pathology , Rats , Sevoflurane , Syntaxin 1/geneticsABSTRACT
BACKGROUND:: Patients with potential difficult mask ventilation (DV) and difficult intubation (DI) are often managed with awake intubation, which can be stressful for patients and anesthesiologists. This prospective randomized study evaluated a new approach, fast difficult airway evaluation (FDAE). We hypothesized that the FDAE approach would reduce the need for awake intubation. METHODS:: After obtaining informed consent, 302 patients with potential DV/DI undergoing elective surgeries were randomly assigned to the FDAE group (Group E) and the control group (Group C). In Group E, patients were gradually sedated, and adequacy of manual mask ventilation during spontaneous breathing was assessed at various sedation levels. Awake intubation was applied in those with inadequate mask ventilation. In Group C, DI was evaluated under local anesthesia. However, the care team could intubate under general anesthesia if the vocal cords were visible. The primary outcome was the rate of awake intubations in both groups and the induction efficiency assessed by the induction time. The secondary outcome was the incidence of serious complications. RESULTS: The rate of awake intubation was significantly lower in Group E than that in Group C (5.81% vs. 36.05%, χ2 = 42.3, P < 0.001). The induction time was much shorter in Group E than in Group C (11.85 ± 4.82 min vs. 18.71 ± 7.85 min, t = 5.39, P < 0.001). There was no significant difference in the incidence of intubation related complications between the two groups. Patients in Group E had a much lower incidence of recall (9.68% vs. 44.90%, χ2 = 47.68, P < 0.001) of the induction process and higher satisfaction levels than patients in Group C (t = 15.36, P < 0.001). CONCLUSIONS: The FDAE significantly reduces the need for awake intubation and improves the efficiency of the intubation process without comprising safety in patients with potential difficult mask ventilation and DI. TRIAL REGISTRATION:: No. ChiCTR-TRC-11001418; http://www.gctr.org/cn/proj/show.aspx?proj=1562.