Can Ayurveda medicine supplement modern medical treatments in chronic disease management?

The editorial highlights the fact that there is limited communication between healthcare providers and patients about complementary and integrative medicine (TCI) like Ayurveda. To address this, healthcare professionals need better education on Ayurveda. Additionally, international collaborations can enhance research and credible information, ensuring safe and effective patient care.

Determining the Target Concentration of Propofol for Sedation in Patients Undergoing Endoscopic Retrograde Cholangiopancreatography: A Target-Controlled Infusion Approach.

Introduction Endoscopic retrograde cholangiopancreatography (ERCP) is vital for diagnosing and treating biliary and pancreatic diseases, necessitating deep sedation typically achieved through total intravenous anesthesia. Propofol, with its favorable pharmacokinetic profile, is the preferred sedative, but conventional administration methods of mg/kg boluses or infusion rates pose challenges. Target-controlled infusion (TCI) systems offer a solution that ensures precise dose delivery of propofol. Despite its widespread use, the literature lacks specific guidance on the target plasma concentration (Cp) of propofol for sedation in patients undergoing ERCP. Methods A prospective interventional study was conducted at the Institute of Liver and Biliary Sciences, Delhi, India to determine the target Cp of propofol for sedation during ERCP. The study enrolled 86 American Society of Anesthesiologists (ASA) grade I and II patients aged 18-70 years. The primary objective was to establish the optimal propofol concentration for sedation as guided by a bispectral index (BIS) value of 60-70. Secondary outcomes included induction time, recovery time, total propofol consumption, and the occurrence of adverse events (if any). The Marsh pharmacokinetic model guided the TCI pump, adjusting Cp until the target sedation was achieved. Results The mean Cp of propofol to maintain the BIS value 60-70 was 2.21 ± 0.42 µg/ml. Age-wise analysis revealed variations, emphasizing the need for individualized dosing. Induction time was 4.21 ± 0.68 minutes; recovery times were seven minutes (median, IQR: 5-10 minutes) for BIS >80 and seven minutes (median, IQR: 5-10 minutes) for achieving a Modified Observer's Assessment of Alertness/Sedation score of ≥5. The mean propofol consumption was 6.24 mg/kg/hr. Side effects were minimal, with 1.16% experiencing transient hypoxia and hypotension. Conclusion The study establishes a mean target propofol concentration of 2.21 ± 0.42 µg/ml for sedation in ASA I and II patients undergoing ERCP.

Study of Two Sedative Protocols for Drug-Induced Sleep Endoscopy: Propofol versus Propofol-Remifentanil Combination, Delivered in Target-Controlled Infusion Mode.

Background and Objectives: Obstructive sleep apnea (OSA) is a prevalent sleep-disordered breathing pathology with significant clinical consequences, including increased cardiovascular risk and cognitive decline. Continuous positive airway pressure (CPAP) is the gold-standard treatment, but alternative strategies are sometimes needed for patients intolerant to CPAP. Drug-induced sleep endoscopy (DISE) is a key diagnostic tool for assessing upper airway obstruction in OSA patients and subsequently tailoring a surgical approach, with sedation protocols playing a crucial role in its efficacy and results accuracy. This study aimed to investigate the effect of adding remifentanil to a propofol target-controlled infusion (TCI) regimen on the sedation parameters and procedural outcomes of DISE. Materials and Methods: The study was conducted at the Central University and Emergency Military Hospital "Dr. Carol Davila" and Ria Clinic in Bucharest between July 2021 and October 2023. Thirty-one patients were enrolled and randomised into two groups: a propofol group (P group, n= 11) and a remifentanil-propofol group (R-P group, n = 20). DISE was performed using standardised protocols, sedative drugs were administered in TCI mode, and data on sedation levels, respiratory and cardiovascular parameters, and procedural incidents were collected. Results: The addition of remifentanil at 1 ng/mL effect-site concentration significantly reduced the effect-site concentration of propofol required for adequate sedation (3.4 ± 0.7 µg/mL in the P group vs. 2.8 ± 0.6 µg/mL in the R-P group, p = 0.035). The time to achieve adequate sedation was also shorter in the R-P group (7.1 ± 2.5 min vs. 9.5 ± 2.7 min, p = 0.017). The incidence of cough, hypoxemia, and cardiovascular events did not significantly differ between the two groups. Conclusions: Adding remifentanil to a propofol TCI regimen for DISE effectively reduces the required propofol effect-site concentration and shortens sedation time without increasing the risk of adverse events. This combination may enhance the safety and efficiency of DISE, offering a promising alternative for patients undergoing this procedure.

Is target-controlled infusion better than manual controlled infusion during TIVA for elective neurosurgery? Results of a single-centre pilot study.

INTRODUCTION: Maintaining optimal systemic circulatory parameters is essential to ensure adequate cerebral perfusion (CPP) during neurosurgery, especially when autoregulation is impaired. AIM OF STUDY: To compare two types of total intravenous anaesthesia i.e. target controlled infusion (TCI) and manually controlled infusion (MCI) with propofol and remifentanil in terms of their control of cardiovascular parameters during neurosurgical resection of intracranial pathology. MATERIAL AND METHODS: Patients with supratentorial intracranial pathology were selected for the study. Patients in ASA grades III and IV and those with diseases of the circulatory system were excluded. Patients were randomly divided into two equal groups according to the method of general anaesthesia used i.e. TCI or MCI. During the neurosurgery, the values of mean arterial pressure (MAP), heart rate (HR), bispectral index (BIS) and central venous pressure were monitored and recorded at the designated 14 relevant (i.e. critical from the anaesthetist's and neurosurgeon's points of view) measurement points. RESULTS: Fifty patients (25 TCI and 25 MCI) were enrolled in the study. The groups did not differ with respect to sex, age and BMI, operation time or volume of removed lesions. TCI-anaesthetised patients had better MAP stability at the respective time points. CONCLUSIONS: Due to the greater stability of MAP, which has a direct effect on CPP, TCI appears to be the method of choice in anaesthesia for intracranial surgery.

Catalyst-free MBE growth of PbSnTe nanowires with tunable aspect ratio.

Topological crystalline insulators (TCIs) are interesting for their topological surface states, which hold great promise for scattering-free transport channels and fault-tolerant quantum computing. A promising TCI is SnTe. However, Sn-vacancies form in SnTe, causing a high hole density, hindering topological transport from the surface being measured. This issue could be relieved by using nanowires with a high surface-to-volume ratio. Furthermore, SnTe can be alloyed with Pb reducing the Sn-vacancies while maintaining its topological phase. Here we present the catalyst-free growth of monocrystalline PbSnTe in molecular beam epitaxy. By the addition of a pre-deposition stage before the growth, we have control over the nucleation phase and thereby increase the nanowire yield. This facilitates tuning the nanowire aspect ratio by a factor of four by varying the growth parameters. These results allow us to grow specific morphologies for future transport experiments to probe the topological surface states in a Pb1-xSnxTe-based platform.

[Effects of Biochar on Growth and Pollutant Accumulation of Lettuce in Soil Co-contaminated with Tetracycline and Copper].

Through lettuce potting experiments, the effects of different types of biochar (apple branch, corn straw, and modified sorghum straw biochar with phosphoric acid modification) on lettuce growth under tetracycline (TC) and copper (Cu) co-pollution were investigated. The results showed that compared with those under CK, the addition of biochar treatment significantly increased the plant height, root length, shoot fresh weight, and root fresh weight of lettuce (P < 0.05). The addition of different biochars significantly increased the nitrate nitrogen, chlorophyll, and soluble protein content in lettuce physiological indicators to varying degrees, while also significantly decreasing the levels of malondialdehyde, proline content, and catalase activity. The effects of biochar on lettuce physiological indicators were consistent during both the seedling and mature stages. Compared with those in CK, the addition of biochar resulted in varying degrees of reduction in the TC and Cu contents of both the aboveground and underground parts of lettuce. The aboveground TC and Cu levels decreased by 2.49%-92.32% and 12.79%-36.47%, respectively. The underground TC and Cu levels decreased by 12.53%-55.64% and 22.41%-42.29%, respectively. Correlation analysis showed that nitrate nitrogen, chlorophyll, and soluble protein content of lettuce were negatively correlated with TC content, whereas malondialdehyde, proline content, and catalase activity were positively correlated with TC content. The resistance genes of lettuce were positively correlated with TC content (P < 0.05). In general, modified biochar was found to be more effective in improving lettuce growth quality and reducing pollutant accumulation compared to unmodified biochar, with modified sorghum straw biochar showing the best remediation effect.

PRESS (Propofol, Remifentanil, Electricity/EEG, Setup and Setting) to Start: Introducing a Total Intravenous Anaesthesia Checklist at a Large Teaching Hospital.

Total intravenous anaesthesia (TIVA) is becoming more widely used, and as of yet there are few safety checks for the use of TIVA when compared to inhaled anaesthesia. This study aims to assess the feasibility and utility of introducing a TIVA checklist at a large teaching hospital. Methods A survey was sent out to all consultant and trainee anaesthetists at our hospital regarding their use of TIVA and errors in practice related to its use. A checklist was created based on common errors reported in the survey, errors described in NAP5 and our hospital's standard operating procedure. The checklist was introduced, and another survey was distributed a month later to assess compliance and utility and to gain feedback. Results In the first survey, there were 39 responses. A total of 64% had seen an error with the use of TIVA. For those using TIVA 70% of the time or more, 31% had seen an error in the last three months. Twelve per cent of those who had seen errors found that the errors led to patient harm. Only 33% used a method to double-check for errors prior to commencing TIVA. In the follow-up survey, 80% of those who used the checklist had found it useful, and 30% had corrected an error while using the checklist. Eighty-seven per cent felt the checklist would prevent errors from being made. Eighty per cent of respondents said they would use the checklist in their future practice. The checklist was found to be more useful for trainees, and for those who use TIVA less often. Discussion The 'PRESS to start TIVA" checklist has been shown to be a useful tool to prevent errors and a majority of anaesthetists at our hospital plan to use it going forward. Our data suggests that anaesthetists who are less experienced with TIVA benefit more from having a checklist. There was a marked increase in the number of anaesthetists who would use a checklist in the future, compared to those who used one in the initial survey. This shows that introducing a checklist is feasible and is likely to reduce errors going forward.

Chitin Deacetylase from Bacillus aryabhattai TCI-16: Heterologous Expression, Characterization, and Deacetylation Performance.

Chitin deacetylase (CDA) removes the acetyl group from the chitin molecule to generate chitosan in a uniform, high-quality deacetylation pattern. Herein, BaCDA was a novel CDA discovered from our previously isolated Bacillus aryabhattai strain TCI-16, which was excavated from mangrove soil. The gene BaCDA was cloned and overexpressed in Escherichia coli BL21 (DE3) to facilitate its subsequent purification. The purified recombinant protein BaCDA was obtained at a concentration of about 1.2 mg/mL after Ni2+ affinity chromatography. The molecular weight of BaCDA was around 28 kDa according to the sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE) analysis. In addition, BaCDA exhibited a significant deacetylation effect on colloidal chitin, and the deacetylation degree was measured from the initial 25.69 to 69.23% by Fourier transform infrared (FT-IR) spectroscopy. Scanning electron microscopy (SEM) observation showed that the surface of colloidal chitin after enzymatic digestion was rough, the crystal fibers disappeared, and the chitin structure was loose and porous with grooves. The results of electrospray ionization mass spectrometry (ESI-MS) showed that BaCDA had full-deacetylation activity against (GlcNAc)4. Molecular docking revealed that BaCDA had an open active pocket capable of binding to the GlcNAc unit. This study not only provides a novel enzymatic resource for the green and efficient application of chitin but also helps to deepen the understanding of the catalytic mechanism of CDA.

Temperament Clusters in Patients With Panic Disorder in Relation to Character Maturity.

OBJECTIVE: This study explored whether temperament profiles are associated with psychological functioning and whether character maturity affects this association in patients with panic disorders (PD). METHODS: A total of 270 patients with PD were enrolled in this study. Measurements included the Temperament and Character Inventory-revised-short (TCI-RS), a self-report version of the Panic Disorder Severity Scale (PDSS-SR), Beck Depression Inventory-II (BDI-II), and Spielberger State-Trait Anxiety Inventory (STAI). Cluster analysis was used to define the patients' temperament profiles, and the differences in discrete variables among temperament clusters were calculated using a one-way analysis of variance. An analysis of covariance was conducted to control for the impact of character maturity on psychological functioning among clusters. RESULTS: We identified four temperament clusters of patients with PD. Significant differences in the PDSS-SR, BDI-II, STAI-state, and STAI-trait scores among the four clusters were detected [F(3, 262)=9.16, p<0.001; F(3, 266)=33.78, p<0.001; F(3, 266)=19.12, p<0.001; F(3, 266)=39.46, p<0.001]. However, after controlling for the effect of character maturity, the effect of cluster type was either eliminated or reduced ([STAI-state] cluster type: F(3, 262)=0.94, p>0.05; SD+CO: F(1, 262)=65.95, p<0.001, ηp2 =0.20). CONCLUSION: This study enabled a more comprehensive and integrated understanding of patients by exploring the configuration of all temperament dimensions together rather than each temperament separately. Furthermore, we revealed that depending on the degree of character maturity, the psychological functioning might differ even within the same temperament cluster. These results imply that character maturity can complement inherently vulnerable temperament expression.

Effects of adding low-dose esketamine to sufentanil and propofol sedation during cervical conization: a single-centre, randomized controlled trial.

BACKGROUND: Cervical conization is a brief but painful procedure that can be performed under sufficient sedation with propofol and opioids. However, this sedation approach comes with a high risk of sedation-related adverse events (SRAEs). Esketamine, an N-methyl-d-aspartate (NMDA) receptor antagonist, causes less cardiorespiratory depression than opioids. The aim of this study was to assess the efficacy and safety of adding a low dose of esketamine to propofol and sufentanil sedation as an opioid-reduced regimen. METHODS: A total of 122 consecutive patients with ASA I-II, body mass index < 30, and STOP-BANG score < 3 who underwent cervical conization were enrolled and randomly divided into Group S and Group ES. Using a closed-loop target-controlled infusion (TCI) pump with a target bispectral index (BIS) value of 60 ± 5, patients in Group S were sedated with 0.2 mcg·kg-1 sufentanil and propofol, while patients in Group ES were sedated with 0.15 mg·kg-1 esketamine, 0.1 mcg·kg-1 sufentanil and propofol. The primary outcome was the incidence and severity of SRAEs, while the secondary outcomes included effectiveness of sedation, awakening time, psychotomimetic side effects, postoperative pain, postoperative nausea and vomiting, and patient and gynaecologist satisfaction. RESULTS: Data from 120 patients were analysed. The incidence of composite SRAEs was significantly higher in Group S than in Group ES (85.0% vs. 56.7%, P < 0.05). Furthermore, the severity of SRAEs was higher in Group S than in Group ES (P < 0.001). There were no significant differences in the effectiveness of sedation, awakening time, psychotomimetic side effects, postoperative pain, postoperative nausea and vomiting, or patient and gynaecologist satisfaction between the two groups. CONCLUSION: Adding low-dose esketamine to propofol and sufentanil sedation reduces the incidence and severity of SRAEs in patients undergoing cervical conization, with equal sedation efficacy, recovery quality, and no additional psychomimetic side effects. TRIAL REGISTRATION: ChiCTR2000040457 , 28/11/2020.

Polygenic risk for depression predicting temperament trajectories over 15 years - A general population study.

BACKGROUND: A great number of case-control and population-based studies have shown that depression patients differ from healthy controls in their temperament traits. We investigated whether polygenic risk for depression predicts trajectories of temperament traits from early adulthood to middle age. METHODS: Participants came from the population-based Young Finns Study (n = 2212). The calculation for Polygenic risk for depression (PRS) was based on the most recent genome-wide association study. Temperament traits of Harm Avoidance, Novelty Seeking, Reward Dependence, and Persistence were assessed with the Temperament and Character Inventory in 1997, 2001, 2007, and 2012 (participants being 24-50-year-olds). As covariates, we used depressive symptoms as assessed by a modified version of the Beck Depression Inventory, psychosocial family environment from parent-filled questionnaires, and socioeconomic factors from adulthood. RESULTS: High PRS predicted higher Persistence from early adulthood to middle age (p = 0.003) when controlling for depressive symptoms, psychosocial family environment, and socioeconomic factors. PRS did not predict trajectories of Novelty Seeking (p = 0.063-0.416 in different models) or Reward Dependence (p = 0.531-0.736). The results remained unaffected when participants with diagnosed affective disorders were excluded. Additionally, we found an interaction between PRS and depressive symptoms when predicting the Harm Avoidance subscale Anticipatory Worry, indicating that the association of Anticipatory Worry with depressive symptoms is stronger in individuals with higher (vs. lower) PRS. LIMITATIONS: There was some attrition due to the long follow-up. CONCLUSIONS: High polygenic risk for major depression may predict differences in temperament trajectories among those who have not developed any severe affective disorders.

Propofol TCI or sevoflurane anesthesia without muscle relaxant for thoracoscopic thymectomy in myasthenia gravis patients: a prospective, observational study.

BACKGROUND: Myasthenia gravis (MG) patients interact unpredictably with anesthetic agents, including neuromuscular blocking agents. Here, we investigate the effectiveness of general anesthesia without muscle relaxants using either propofol via target-controlled infusion systems (TCI) or sevoflurane in MG patients undergoing thoracoscopic thymectomy. METHODS: This prospective, open-label, observational study was conducted in a university hospital. We included 90 myasthenic patients undergoing thoracoscopic thymectomy with general anesthesia. Patients received induction and maintenance anesthesia with propofol TCI (group P, n = 45) or induction with propofol 2-3 mg.kg-1 and maintenance anesthesia with sevoflurane (group S, n = 45). In both groups, the procedure was performed under the guidance of entropy with sufentanil but not a muscle relaxant. Intubation conditions, hemodynamic changes, respiratory function, neuromuscular transmission, arterial blood gas, and complications were evaluated. RESULTS: All patients achieved good intubation conditions. Hemodynamic instability was more frequent in group S than in group P, mostly in the induction stage, and was controllable. The reduction in the intraoperative train-of-four ratio from baseline at 30 min, 60 min, and 90 min in group S was 10.3%, 14.2%, and 14.3%, respectively, significantly higher than that in group P (6.8%, 7.2%, and 8.4%, respectively), which completely recovered at the end of the surgery. All patients were extubated in the operating room without complications. No other significant differences between the groups were observed. CONCLUSIONS: Anesthesia with propofol TCI or sevoflurane without muscle relaxants in MG patients offered safe and effective conditions for thoracoscopic thymectomy. Sevoflurane achieved higher levels of intraoperative muscular relaxation than propofol TCI. Postoperative neuromuscular function was not affected by these anesthetics.

Trend Change Analysis as a New Tool to Complement the Evaluation of Human Body Balance in the Time and Frequency Domains.

Trend change analysis is a tool that complements the assessment of human body stability and provides information on the number and frequency of postural corrections during an examination. The present research aims to determine the possibility of using this method of analysis to investigate postural stability during tests of standing with open eyes (OE) and closed eyes (CE). A total of 118 participants (67 females, 51males) aged 23 (SD 1.3) were assessed. Tests involved standing on a stabilographic platform for 50 s. Trend change analysis was used to evaluate displacement values of the center of pressure (COP). Values for the COP courses as well as values associated with trend change analysis, such as: TCI, MACD_t and MACD_V were determined. Histograms of distribution were plotted for TCI values. The present study provides information on alterations of the strategy used for maintaining balance, which are associated with the number of postural corrections and COP displacement between corrections for measurements taken during the standing test with CE in relation to OE measurements. The strategy demonstrated an ability to detect a smaller number of quick corrections, an increased number of corrections of longer duration, and the elongation of displacement between subsequent postural corrections. Slight standard deviations in TCI and MACD_t values calculated during trend change analysis, for both the OE and CE conditions, made it possible to classify these values as indexes of postural stability with significant sensitivity to slight changes.

Agricultural drought in the Vietnamese Central Highlands at 1-km resolution: Monthly and annual datasets.

Drought is a complex natural hazard which can create significant impacts on society and environment. Given that this phenomenon varies across space and changes over time dependent on various factors (e.g., physical conditions and human activities), the available of spatiotemporal drought data enables a better monitoring and assessment of drought severity This study introduced the integrated multivariate drought index (iMDI) data, a new regional drought index, at 1 km spatial and monthly temporal resolutions for the Vietnamese Central Highlands over a 20-years period. The iMDI was developed recently which is a combination of vegetation condition index (VCI), the temperature condition index (TCI), and the evaporative stress index (ESI) based on the feature of scaling algorithms (i.e., normalisations and standardisation). The data were processed using the median values of MODIS time-series imagery obtained from the Google Earth Engine (GEE) platform. The iMDI datasets are available for monthly and annual drought monitoring between 2001 and 2020. Additionally, the datasets of VCI, TCI, and ESI were provided so that users can apply for their own purposes even though these data can directly obtain from GEE or other sources. Users, especially those without technical expertise, can reap the advantages of having open access to iDMI data. By doing so, they can reduce their expenses and the time required to process data. As such, this accessibility can promote the use of data for diverse applications, such as evaluating the impact of droughts on the environment and human activities and monitoring droughts regionally.

Mediating roles of character traits and parenting in the relationship between maternal effortful control and children's conduct problems.

Background: Parenting practices are crucial to children's development and are important predictors of children's conduct problems. The aim of the current study was to test the mediating role of mothers' character traits on the relationship between their temperamental self-regulation and their parenting practices, and on their children's conduct problems. Method: A representative sample of 387 Israeli mothers of kindergarten children was recruited online. They completed questionnaires about their own effortful control (adult temperament questionnaire; ATQ), character traits (temperament and character inventory-revised (TCI-R), big five inventory (BFI)), and parenting practices (coping with children's negative emotions scale; CCNES), as well as conduct problems of their children (strengths and difficulties questionnaire; SDQ). Structural equation models were fitted, testing for direct and indirect connections, once with character traits drawn from the TCI and once with BFI traits. Results: In both analyses, the first model presented a significant direct effect between mothers' effortful control and children's conduct problems. When including mother's parenting and character (based on the TCI or on the BFI) in the model, the direct path became insignificant and significant mediation effects were found; specifically, the indirect path through the parenting practices, as well as the mediated mediation path through the parenting practices and character. Moreover, mediation effects were found between mothers' effortful control and parenting practices through some character traits. The selected models showed a good fit (e.g., NFI = 0.985; CFI = 0.997; RMSEA = 0.038). Discussion: Our findings emphasize the importance of the mother's mature personality characteristics, the mother's actual parental practices, and the crucial value of this path for predicting child behavior outcomes.

Comparison of Half-Effective Concentration of Propofol in Patients with Parkinson's Disease and Non-Parkinson's Disease.

Objective: This study aimed to compare the half-effective concentration (EC50) of propofol required for the bispectral index (BIS) 50 in patients with Parkinson's disease (PD) and non-PD (NPD) during induction by the Dixon's improved sequential method. Methods: This prospective study recruited 20 patients with PD undergoing deep brain stimulation and 20 patients with NPD accompanied by meningioma or glioma undergoing intracranial surgery from March 2018 to March 2019. The patients were induced by propofol via target-controlled infusion. The target effect-site concentration of propofol was determined by the Dixon's improved sequential method. The results of the pilot experiment showed that the target effect-site concentration for the first patient with PD and NPD was 3.5 µg/mL and 2.8 µg/mL, respectively. BIS values were recorded after achieving a constant effect-site concentration of propofol. The increment or decrement of the target effect-site concentration of the next patient was 0.1 µg/mL. Results: Demographic data, general physical condition, and hemodynamic values were similar between the PD and the NPD groups. The target effect-site concentration of propofol induction doses was significantly higher in the PD group than in the NPD group. The EC50 of propofol required for BIS 50 was 3.213 µg/mL [95% confidence interval (CI), 3.085-3.287 µg/mL] in the PD group and 2.77 µg/mL (95% CI, 2.568-2.977 µg/mL) in the NPD group. Conclusion: The EC50 of propofol required for BIS 50 was higher in patients with PD than in patients with NPD.

Alternatives to remifentanil for the analgesic component of total intravenous anaesthesia: a narrative review.

Propfol-remifentanil-based total intravenous anaesthesia has dominated recent clinical practice due to its favourable pharmacokinetic profile. Interruption in remifentanil supply has presented an opportunity to diversify or even avoid the use of opioids and consider adjuncts to propofol-based total intravenous anaesthesia. Propofol, while a potent hypnotic, is not an effective analgesic. The administration of opioids, along with other adjuncts such as α-2 adrenoceptor agonists, magnesium, lidocaine, ketamine and nitrous oxide provide surgical anaesthesia and avoids large doses of propofol being required. We provide an overview of both target-control and manual infusion regimes for the alternative opioids: alfentanil, sufentanil and fentanyl. The optimal combination of hypnotic-opioid dose, titration sequence and anticipated additional postoperative analgesia required depend on the chosen combination. In addition, we include a brief discussion on the role of non-opioid adjuncts in total intravenous anaesthesia, suggested doses and expected reduction in propofol dose.

Development and optimization of a fentanyl pharmacokinetic model for target-controlled infusion in anaesthetized dogs.

OBJECTIVE: To investigate pharmacokinetics (PK) of fentanyl administered by target-controlled infusion (TCI), and to develop a PK model optimized by covariates for TCI in anaesthetized dogs. STUDY DESIGN: Prospective clinical study. ANIMALS: A group of 20 client-owned dogs with spinal pain undergoing anaesthesia for magnetic resonance imaging. METHODS: Fentanyl was administered as an infusion to 20 anaesthetized dogs using a TCI system incorporating a previously described fentanyl two-compartment PK. Arterial blood samples were collected at specific time points during the infusion and over 60 minutes post-infusion for measurement of fentanyl plasma concentrations. The predictive performance of the Sano PK model was assessed by comparing predicted and measured plasma concentrations. A population PK analysis was then performed using a nonlinear mixed-effect modelling approach, allowing inter- and intra-individual variability estimation. Finally, a quantitative stepwise evaluation of the influence of various covariates such as weight, body condition score, size, size-related age, sex and type of premedication on the PK model was considered. RESULTS: Overall predictive performance of the Sano PK set of variables was not clinically acceptable in anaesthetized dogs. Fentanyl PK was best described by a three-compartment model. Weight and sex were found to affect the volume of distribution of the central compartment. Addition of these two covariate/variable associations resulted in a reduction of the objective function value (OFV) from -340.18 to -448.34, and of the median population weighted residual and the median population absolute weighted residual from 16.1% and 38.6% to 3.9% and 20.3%, respectively. Fentanyl infusions at measured concentrations up to 5.4 ng mL-1 in sevoflurane-anaesthetized dogs resulted in stable anaesthesia and smooth recoveries without complications. CONCLUSIONS AND CLINICAL RELEVANCE: A population three-compartment PK model for fentanyl TCI in anaesthetized dogs was developed. Weight and sex have been detected and incorporated as significant covariates.

Resultados de la anestesia total intra venosa (TIVA) con perfusión controlada por objetivo (TCI) en pacientes sometidos a trasplante renal / Outcomes of Total Intravenous Anesthesia (TIVA) with Goal Controlled Perfusion (TCI) in Kidney Transplant Patients

Introducción: La anestesia total intravenosa (TIVA) con perfusión controlada por objetivo (TCI) es una técnica de anestesia general que usa una combinación de fármacos administrados exclusivamente por vía intravenosa sin usar fármacos por vía inhalatoria. Objetivos: Determinar los resultados del uso de TIVA TCI en los pacientes sometidos a trasplante renal, donantes y receptores, entre noviembre de 2014 y julio de 2018, en el Hospital de Clínicas. Pacientes y métodos: Estudio observacional, analítico transversal, con muestreo no probabilístico a criterio. La serie se agrupó en donantes y receptores. Los datos se expresan en medias y proporciones, se analizó el Odds Rattio y el R2. Se consideró una p< 0,05 como significativa. Resultados: se incluyeron a 198 intervenciones anestésicas, 131 (66,2%) fueron receptores. El rango de edad fue de entre 5 y 66 años (35,8±13 años) y 114 (57%) fueron masculinos. En el post operatorio inmediato, el tiempo en despertar, la PAS, PAD, PAM, frecuencia cardiaca y saturación de oxígeno no tuvieron diferencias significativas, en la comparación de los grupos (donante y receptor). Se observó cefalea en 3 (1,5%) del grupo de donantes y ninguna en los receptores. La diuresis fue tardía en 18 (9,1%) pacientes (p= 0,084 R2=29). Conclusión: La TIVA TCI demostró ser una técnica muy efectiva en el trasplante renal, con pronta recuperación y despertar inmediato tras la extubación, con lucidez absoluta en todos los pacientes.

Introduction: Total intravenous anesthesia (TIVA) with goal-controlled perfusion (TCI) is a general anesthesia technique that uses a combination of drugs administered exclusively intravenously without using inhalational drugs. Objectives: To determine the results of the use of TIVA TCI in kidney transplant patients, donors and recipients, between November 2014 and July 2018, at the Hospital de Clínicas. Patients and methods: Observational, cross-sectional analytical study, with non-probabilistic sampling at the discretion. The series was grouped into donors and recipients. The data is expressed in means and proportions, the Odds Rattio and the R2 were analyzed. A p<0.05 was considered significant. Results: 198 anesthetic interventions were included, 131 (66.2%) were recipients. The age range was between 5 and 66 years (35.8±13 years) and 114 (57%) were male. In the immediate postoperative period, time to awakening, SBP, DBP, MAP, heart rate and oxygen saturation did not show significant differences when comparing the groups (donor and recipient). Headache was observed in 3 (1.5%) of the donor group and none in the recipients. Diuresis was late in 18 (9.1%) patients (p= 0.084 R2=29). Conclusion: TIVA TCI proved to be a very effective technique in kidney transplantation, with prompt recovery and immediate awakening after extubation, with absolute clarity in all patients.