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1.
Medicine (Baltimore) ; 99(16): e19733, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32311965

RESUMO

RATIONALE: Becker muscular dystrophy (BMD) and Duchenne muscular dystrophy (DMD) are progressive neuromuscular disorders caused by mutations in the dystrophin gene. The management of anesthesia in patients with BMD is complicated because they are highly sensitive to the conventional anesthetics such as volatile anesthetics and muscle relaxants. It is reported that anesthesia in patients with DMD is associated with several complications. However, a few case reports have been published on adult patients with BMD undergoing surgery with general anesthesia. Reports indicate that children with BMD may experience some serious complications with flurane-inhaled anesthesia. However, no study has yet shown that the use of flurane-induced anesthesia in adults with DMD carries high risks. PATIENT CONCERNS: We describe a 56-year-old woman with BMD who was scheduled for laparoscopic hysterectomy and bilateral adnexectomy under general anesthesia due to a mass in the uterus. The patient was diagnosed with BMD 20 years back and reported that during this period, she was able to walk slowly with help during her daily life. Additionally, she also had a history of hypertension since 4 years and type 2 diabetes mellitus since 2 years. DIAGNOSIS: The patient was postmenopausal and presented with abnormal uterine bleeding and elevated CA125. Abdominal ultrasonography revealed diffuse enlargement of the uterus and hypoechoic internal echoes. These findings were suggestive of diffuse adenomyosis with multiple uterine leiomyomas, which would have adverse effects later in her life. Therefore, the patient required surgery to address the symptoms and further confirm the diagnosis. The final diagnosis was confirmed by histopathological analysis. INTERVENTIONS: The patient was scheduled for laparoscopic hysterectomy and bilateral adnexectomy. Anesthesia was induced and maintained by a combination of intravenous and inhalation anesthetic agents, particularly cisatracurium besilate and inhaled. sevoflurane. OUTCOMES: The duration of anesthesia and postoperative period were uneventful. At the end of the operation, the patient had normal vital signs and was fully conscious. The patient was followed up for 8 months and no complications were noted during this period. LESSONS: The combination of sevoflurane and cisatracurium besilate is a safe and effective method for the anesthetic management of adult patients with BMD scheduled for laparoscopic gynecological surgery. On the other hand, it is important to be aware of even rare complications of procedures, so that necessary precautions can be undertaken. Further investigations are necessary to determine the safe dosage of volatile anesthetics specifically for this clinical scenario so that anesthesiologists can use this combination method more accurately and precisely.


Assuntos
Anestesia Geral/métodos , Distrofia Muscular de Duchenne , Anestésicos Inalatórios/administração & dosagem , Atracúrio/administração & dosagem , Atracúrio/análogos & derivados , Feminino , Procedimentos Cirúrgicos em Ginecologia , Humanos , Laparoscopia , Pessoa de Meia-Idade , Bloqueadores Neuromusculares/administração & dosagem , Sevoflurano/administração & dosagem
2.
Rev Med Suisse ; 16(686): 553-556, 2020 Mar 18.
Artigo em Francês | MEDLINE | ID: mdl-32186802

RESUMO

Since 2018, a new analgesic drug has been made available in Switzerland : methoxyflurane. This halogenated gas, controlled by the patient, offers a very effective analgesic effect comparable to opiates. Known since the 1960s and used mainly in pre-hospital emergency medicine in Australia and New Zealand, its use in Europe is increasing alongside standard analgesic treatments in the traumatic setting. Administered by inhalation, it does not require an intravenous access, which is ideal in prehospital emergency situations. This treatment could be used for the management of acute pain of various origins, such as renal lithiasis, or to facilitate different procedures, such as closed fracture reduction or chest tube insertion. Its indications are growing and its use will probably become commonplace with clinicians in a near future.


Assuntos
Dor Aguda/tratamento farmacológico , Anestésicos Inalatórios/uso terapêutico , Metoxiflurano/administração & dosagem , Metoxiflurano/uso terapêutico , Manejo da Dor , Anestésicos Inalatórios/administração & dosagem , Humanos , Suíça
3.
PLoS One ; 15(2): e0223700, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32092080

RESUMO

Emulsified volatile anesthetic can be directly injected into the circulation and eliminated from blood through lungs. Taking advantage of the unique pharmacokinetics of the emulsified volatile anesthetics, we aimed to develop a less traumatic method to differentially deliver them to the spinal cord of rabbit. Sixteen New Zealand White rabbits were randomly assigned to the isoflurane or sevoflurane group. A catheter was placed into the descending aorta, and emulsified isoflurane (8mg/kg/h) or sevoflurane (12mg/kg/h) was given respectively. The concentration and partial pressure of the anesthetics in the jugular and femoral vein were measured. Our results showed that the partial pressure for isoflurane was 3.91±1.11 mmHg and 12.61±1.60 mmHg (1.0MAC), and for sevoflurane was 3.89±1.00 mmHg and 19.92±1.84mmHg (1.0MAC), in the jugular vein and femoral vein, respectively. There was significant difference between jugular and femoral vein partial pressure for both isoflurane and sevoflurane groups (both P < 0.001). In conclusion, a simple and minimally invasive method has been successfully developed to selectively deliver isoflurane and sevoflurane to the spinal cord in the rabbit. Before the anesthetics taking action on the brain, 69% of isoflurane and 81% of sevoflurane were removed through lungs. This method can be used to investigate sites and mechanisms of volatile anesthetic action.


Assuntos
Anestésicos Inalatórios/administração & dosagem , Medula Espinal/metabolismo , Anestésicos Inalatórios/farmacocinética , Animais , Encéfalo/efeitos dos fármacos , Emulsões , Veia Femoral , Isoflurano/administração & dosagem , Veias Jugulares , Pulmão/metabolismo , Métodos , Pressão Parcial , Coelhos , Sevoflurano/administração & dosagem , Volatilização
4.
Medicine (Baltimore) ; 98(48): e18244, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31770287

RESUMO

BACKGROUND: We investigated the effects of propofol vs desflurane on ischemia and reperfusion injury (IRI)-induced inflammatory responses, especially in matrix metalloproteinase-9 (MMP-9) downregulation and heme oxygenase-1 (HO-1) upregulation, which may result in different clinical outcomes in liver transplant recipients. METHODS: Fifty liver transplant recipients were randomized to receive propofol-based total intravenous anesthesia (TIVA group, n = 25) or desflurane anesthesia (DES group, n = 25). We then measured the following: perioperative serum cytokine concentrations (interleukin 1 receptor antagonist [IL-1RA], IL-6, IL-8, and IL-10); MMP-9 and HO-1 mRNA expression levels at predefined intervals. Further, postoperative outcomes were compared between the 2 groups. RESULTS: The TIVA group showed a significant HO-1 level increase following the anhepatic phase and a significant MMP-9 reduction after reperfusion, in addition to a significant increase in IL-10 levels after the anhepatic phase and IL-1RA levels after reperfusion. Compared to DES patients, TIVA patients showed a faster return of the international normalized ratio to normal values, lower plasma alanine aminotransferase concentrations 24 hours after transplantation, and fewer patients developing acute lung injury. Moreover, compared with DES patients, TIVA patients showed a significant reduction in serum blood lactate levels. However, there were no differences in postoperative outcomes between the two groups. CONCLUSION: Propofol-based TIVA attenuated inflammatory response (elevated IL-1RA and IL-10 levels), downregulated MMP-9 response, and increased HO-1 expression with improved recovery of graft function and better microcirculation compared with desflurane anesthesia in liver transplant recipients.


Assuntos
Desflurano , Transplante de Fígado , Propofol , Traumatismo por Reperfusão , Adulto , Anestésicos Inalatórios/administração & dosagem , Anestésicos Inalatórios/efeitos adversos , Anestésicos Intravenosos/administração & dosagem , Anestésicos Intravenosos/efeitos adversos , Desflurano/administração & dosagem , Desflurano/efeitos adversos , Feminino , Heme Oxigenase-1/análise , Humanos , Proteína Antagonista do Receptor de Interleucina 1/análise , Interleucina-10/análise , Transplante de Fígado/efeitos adversos , Transplante de Fígado/métodos , Masculino , Metaloproteinase 9 da Matriz/análise , Período Pós-Operatório , Propofol/administração & dosagem , Propofol/efeitos adversos , Traumatismo por Reperfusão/sangue , Traumatismo por Reperfusão/etiologia , Imunologia de Transplantes
5.
Medicine (Baltimore) ; 98(47): e18088, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31764844

RESUMO

The objective of this study is to compare the effects of paravertebral nerve block-propofol intravenous general anesthesia (PPA) and sevoflurane inhalation general anesthesia (SGA) on the expression of serum vascular endothelial growth factor (VEGF) and transforming growth factor beta (TGF-ß) in patients undergoing radical resection of lung cancer.Patients undergoing radical resection of lung cancer were divided into PPA group and SGA group. In PPA group, thoracic paraspinal nerve block was performed with 0.5% ropivacaine (2 mg/kg) before general anesthesia. Anesthesia was maintained with 2.5-3.5 µg/mL TCI of propofol. In SGA group, anesthesia was maintained with 1.0-1.5 MAC sevoflurane. The dosage of opioids during and 24 h after operation, the pain score at 2, 8, 24, 48, and 72 h after operation, and the concentrations of serum VEGF and TGF-ß before and 24 h after operation were observed in the two groups.The intraoperative dosage of remifentanil in PPA group was significantly less than that in SGA group (P < 0.05). The dosage of sufentanil in SGA group was significantly less than that in SGA group at 24 h after operation (P < 0.05). The VAS score at 2, 8, and 24 h after operation was significantly lower than that in SGA group (P < 0.05). The serum VEGF and TGF-ß concentration in PPA group was significantly lower than that in SGA group (P < 0.05).Thoracic paravertebral nerve block-propofol intravenous general anesthesia can reduce the dosage of opioids, improve the effect of postoperative analgesia, and reduce the serum concentration of tumor angiogenesis-related factors in patients undergoing radical resection of lung cancer.


Assuntos
Anestesia Geral/métodos , Anestésicos Inalatórios/administração & dosagem , Anestésicos Intravenosos/administração & dosagem , Neoplasias Pulmonares/cirurgia , Pneumonectomia , Propofol/administração & dosagem , Sevoflurano/administração & dosagem , Sevoflurano/farmacologia , Fator de Crescimento Transformador beta/efeitos dos fármacos , Fator A de Crescimento do Endotélio Vascular/efeitos dos fármacos , Anestesia por Inalação , Anestesia Intravenosa , Anestésicos Inalatórios/farmacologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Músculos Paraespinais/inervação , Pneumonectomia/métodos , Propofol/farmacologia , Estudos Prospectivos , Tórax
6.
Am J Vet Res ; 80(11): 1007-1009, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31644338

RESUMO

OBJECTIVE: To determine the effect of oral administration of gabapentin (20 mg/kg) on the minimum alveolar concentration (MAC) of isoflurane in dogs. ANIMALS: 6 healthy adult dogs (3 males and 3 females with a mean ± SD body weight of 24.8 ± 1.3 kg). PROCEDURES: Each dog was anesthetized twice. Dogs were initially assigned to 1 of 2 treatments (gabapentin [20 mg/kg, PO] followed 2 hours later by anesthesia maintained with isoflurane or anesthesia maintained with isoflurane alone). A minimum of 7 days later, dogs received the other treatment. The MAC of isoflurane was determined by use of an iterative bracketing technique with stimulating electrodes placed in the maxillary buccal mucosa. Hemodynamic variables and vital parameters were recorded at the lowest end-tidal isoflurane concentration at which dogs did not respond to the stimulus. Effect of treatment on outcome variables was analyzed by use of a paired t test. RESULTS: Mean ± SD MAC of isoflurane was significantly lower when dogs received gabapentin and isoflurane (0.71 ± 0.12%) than when dogs received isoflurane alone (0.91 ± 0.26%). Mean reduction in MAC of isoflurane was 20 ± 14%. Hemodynamic variables did not differ significantly between treatments. Mean time to extubation was significantly less when dogs received gabapentin and isoflurane (6 ± 4 minutes) than when dogs received isoflurane alone (23 ± 15 minutes). CONCLUSIONS AND CLINICAL RELEVANCE: Oral administration of gabapentin 2 hours before anesthesia maintained with isoflurane had a MAC-sparing effect with no effect on hemodynamic variables or vital parameters of dogs.


Assuntos
Anestésicos Inalatórios/farmacocinética , Cães/metabolismo , Gabapentina/farmacologia , Isoflurano/farmacocinética , Alvéolos Pulmonares/efeitos dos fármacos , Administração Oral , Anestésicos Inalatórios/administração & dosagem , Animais , Pressão Sanguínea/efeitos dos fármacos , Feminino , Gabapentina/administração & dosagem , Hemodinâmica/efeitos dos fármacos , Isoflurano/administração & dosagem , Masculino , Alvéolos Pulmonares/metabolismo
7.
Invest Ophthalmol Vis Sci ; 60(12): 3830-3834, 2019 09 03.
Artigo em Inglês | MEDLINE | ID: mdl-31529079

RESUMO

Purpose: To compare the effects of both injectable anesthesia (ketamine/dexmedetomidine versus ketamine/xylazine) and inhalant anesthesia (isoflurane) on IOP using continuous, bilateral IOP telemetry in nonhuman primates (NHP). Methods: Bilateral IOP was recorded continuously using a proven implantable telemetry system in five different sessions at least 2 weeks apart in four male rhesus macaques under two conditions: ketamine (3 mg/kg) with dexmedetomidine (50 µg/kg) or ketamine with xylazine (0.5 mg/kg) for induction, both followed by isoflurane for maintenance. IOP transducers were calibrated via anterior chamber manometry. Bilateral IOP was averaged over 2 minutes after injectable anesthetic induction and again after isoflurane inhalant had stabilized the anesthetic plane, then compared to baseline IOP measurements acquired immediately prior to anesthesia (both before and after initial human contact). Results: When compared to pre-contact baseline measurements, ketamine/dexmedetomidine injectable anesthesia lowers IOP by 1.5 mm Hg on average (P < 0.05), but IOP did not change with ketamine/xylazine anesthesia. IOP returned to baseline levels shortly after isoflurane gas anesthesia was initiated. However, injectable anesthesia lowered IOP by an average of 5.4 mm Hg when compared to that measured after initial human contact (P < 0.01). Conclusions: Anesthetic effects on IOP are generally small when compared to precontact baseline but much larger when compared to IOP measures taken after human contact, indicating that IOP is temporarily elevated due to acute stress (similar to a "white coat effect") and then decreased with anesthetic relaxation. Anesthetic induction with ketamine/xylazine and maintenance with isoflurane gas should be used when IOP is measured postanesthesia.


Assuntos
Anestesia/métodos , Anestésicos Combinados/administração & dosagem , Dexmedetomidina/administração & dosagem , Pressão Intraocular/efeitos dos fármacos , Isoflurano/administração & dosagem , Ketamina/administração & dosagem , Xilazina/administração & dosagem , Anestésicos Dissociativos/administração & dosagem , Anestésicos Inalatórios/administração & dosagem , Animais , Macaca mulatta , Masculino , Telemetria/métodos , Tonometria Ocular
8.
Khirurgiia (Mosk) ; (8. Vyp. 2): 54-59, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31502594

RESUMO

This article deal with method of multimodal, opioid-free anesthesia for colorectal surgery in the perioperative period. AIM: To improve the quality of treatment for patients with colorectal cancer using non-opioid anesthesia and analgesia in the perioperative period. MATERIAL AND METHODS: The study included 47 patients who underwent laparoscopic colon surgery. This anesthesia method consists of epidural anesthesia with sevoflurane during surgery end epidural analgesia after surgery. We describe the method of non-opioid anesthesia technics during colorectal surgery. The pain syndrome was evaluated at various time intervals. Harvard standard for monitoring during anesthesia is presented. RESULTS: Opioid-free anesthesia is safety method for colorectal surgery. It was also possible to reduce the incidence of postoperative nausea and vomiting, pain, intestinal paresis, the duration of hospitalization, and rise quality of medical care for patient with colorectal cancer.


Assuntos
Analgesia Epidural , Anestésicos Inalatórios/administração & dosagem , Colectomia/métodos , Neoplasias Colorretais/cirurgia , Sevoflurano/administração & dosagem , Humanos , Laparoscopia , Período Perioperatório , Resultado do Tratamento
9.
Tidsskr Nor Laegeforen ; 139(12)2019 Sep 10.
Artigo em Norueguês, Inglês | MEDLINE | ID: mdl-31502800

RESUMO

BACKGROUND: In July 2013, the Department of Paediatric and Adolescent Medicine at Østfold Hospital Trust introduced nitrous oxide as an option for procedural sedation of children and adolescents. MATERIAL AND METHOD: During the period 13 July 2013-25 August 2017, 311 procedures were performed with nitrous oxide in 238 patients aged 4-17 years. Age, sex, type and duration of procedure, any supplementary medications, complications and whether the procedure would previously have required general anaesthesia, were recorded in a form. The child rated the effectiveness of nitrous oxide using a graded age-appropriate 10-point pain scale, and the nurse rated it as good, moderate or none. RESULTS: The children reported a median pain score of 2/10 (interquartile range 0-4), and nurses rated effectiveness as good in 247 of 304 (81 %) cases. For 43 % of procedures, the nurse felt that general anaesthesia would have been necessary had the department not had access to nitrous oxide. Adverse effects, most often dizziness, were reported in 110 of 311 procedures (35 %). In 7 of 311 procedures (2 %), the patient experienced adverse effects that resulted in stoppage of the procedure. The procedure was completed in 286 (92 %) children. INTERPRETATION: Nitrous oxide is a useful option for children who require procedural sedation, and means that more procedures can be performed without general anaesthesia.


Assuntos
Anestésicos Inalatórios , Óxido Nitroso , Utilização de Procedimentos e Técnicas , Adolescente , Analgésicos/administração & dosagem , Analgésicos/efeitos adversos , Analgésicos/farmacologia , Anestesia Geral/estatística & dados numéricos , Anestesia Local , Anestésicos Inalatórios/administração & dosagem , Anestésicos Inalatórios/efeitos adversos , Anestésicos Inalatórios/farmacologia , Criança , Pré-Escolar , Contraindicações de Medicamentos , Feminino , Humanos , Masculino , Óxido Nitroso/administração & dosagem , Óxido Nitroso/efeitos adversos , Óxido Nitroso/farmacologia , Noruega , Enfermeiras e Enfermeiros , Medição da Dor , Utilização de Procedimentos e Técnicas/normas , Utilização de Procedimentos e Técnicas/estatística & dados numéricos , Resultado do Tratamento
10.
Vet J ; 251: 105345, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31492389

RESUMO

A constant rate infusion (CRI) of medetomidine is used to balance equine inhalation anesthesia, but its cardiovascular side effects are a concern. This experimental crossover study aimed to evaluate the effects of vatinoxan (a peripheral α2-adrenoceptor antagonist) on cardiorespiratory and gastrointestinal function in anesthetized healthy horses. Six horses received medetomidine hydrochloride 7µg/kg IV alone (MED) or with vatinoxan hydrochloride 140µg/kg IV (MED+V). Anesthesia was induced with midazolam and ketamine and maintained with isoflurane and medetomidine CRI for 60min. Heart rate, carotid and pulmonary arterial pressures, central venous pressure, cardiac output and arterial and mixed venous blood gases were measured. Selected cardiopulmonary parameters were calculated. Plasma drug concentrations were determined. Fecal output was measured over 24h. For statistical comparisons, repeated measures analysis of covariance and paired t-tests were applied. Heart rate decreased slightly from baseline in the MED group. Arterial blood pressures decreased with both treatments, but significantly more dobutamine was needed to maintain normotension with MED+V (P=0.018). Cardiac index (CI) and oxygen delivery index (DO2I) decreased significantly more with MED, with the largest difference observed at 20min: CI was 39±2 and 73±18 (P=0.009) and DO2I 7.4±1.2 and 15.3±4.8 (P=0.014)mL/min/kg with MED and MED+V, respectively. Fecal output or plasma concentrations of dexmedetomidine did not differ between the treatments. In conclusion, premedication with vatinoxan induced hypotension, thus its use in anesthetized horses warrants further studies. Even though heart rate and arterial blood pressures remained clinically acceptable with MED, cardiac performance and oxygen delivery were lower than with MED+V.


Assuntos
Motilidade Gastrointestinal/efeitos dos fármacos , Isoflurano/farmacologia , Medetomidina/farmacologia , Quinolizinas/farmacologia , Antagonistas de Receptores Adrenérgicos alfa 2 , Anestesia por Inalação/veterinária , Anestésicos Inalatórios/administração & dosagem , Anestésicos Inalatórios/farmacologia , Animais , Pressão Sanguínea/efeitos dos fármacos , Fenômenos Fisiológicos Cardiovasculares/efeitos dos fármacos , Estudos Cross-Over , Feminino , Frequência Cardíaca/efeitos dos fármacos , Cavalos , Hipnóticos e Sedativos/administração & dosagem , Hipnóticos e Sedativos/farmacologia , Isoflurano/administração & dosagem , Masculino , Medetomidina/administração & dosagem , Quinolizinas/sangue , Quinolizinas/farmacocinética
11.
Am J Vet Res ; 80(9): 878-884, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31449443

RESUMO

OBJECTIVE: To evaluate the effects of injectable dexmedetomidine-ketamine-midazolam (DKM) and isoflurane inhalation (ISO) anesthetic protocols on selected ocular variables in captive black-tailed prairie dogs (Cynomys ludovicianus; BTPDs). ANIMALS: 9 zoo-kept BTPDs. PROCEDURES: The BTPDs received dexmedetomidine hydrochloride (0.25 mg/kg, IM), ketamine hydrochloride (40 mg/kg, IM), and midazolam hydrochloride (1.5 mg/kg, IM) or inhalation of isoflurane and oxygen in a randomized complete crossover design (2-day interval between anesthetic episodes). Pupil size, globe position, tear production, and intraocular pressure measurements were recorded at 5, 30, and 45 minutes after induction of anesthesia. For each BTPD, a phenol red thread test was performed in one randomly selected eye and a modified Schirmer tear test I was performed in the other eye. Intraocular pressure was measured by rebound tonometry. RESULTS: Compared with findings for the DKM protocol, pupil size was smaller at all time points when the BTPDs underwent the ISO protocol. Globe position remained central during anesthesia with the DKM protocol, whereas it varied among central, ventromedial, and ventrolateral positions during anesthesia with the ISO protocol. Tear production and intraocular pressure decreased significantly over time when the BTPDs underwent either protocol. CONCLUSIONS AND CLINICAL RELEVANCE: Results indicated that ophthalmic examination findings for anesthetized BTPDs can be influenced by the anesthetic protocol used. The DKM protocol may result in more consistent pupil size and globe position, compared with that achieved by use of the ISO protocol. Tear production and intraocular pressure measurements should be conducted promptly after induction of anesthesia to avoid the effect of anesthetic episode duration on these variables.


Assuntos
Anestesia/veterinária , Anestésicos Inalatórios/farmacologia , Olho/efeitos dos fármacos , Sciuridae , Anestésicos Inalatórios/administração & dosagem , Anestésicos Intravenosos/farmacologia , Animais , Animais de Zoológico , Dexmedetomidina/farmacologia , Pressão Intraocular/efeitos dos fármacos , Isoflurano/farmacologia , Ketamina/farmacologia , Masculino , Midazolam/farmacologia , Lágrimas/efeitos dos fármacos
12.
BMC Vet Res ; 15(1): 258, 2019 Jul 24.
Artigo em Inglês | MEDLINE | ID: mdl-31340857

RESUMO

BACKGROUND: Heart rate variability (HRV) provides information about autonomic nervous system (ANS) activity and is therefore a possible tool with which to assess anaesthetic depth. The aim of the present study was to evaluate the effects of isoflurane, remifentanil and dexmedetomidine on HRV before and after nociceptive stimulation at different anaesthetic depths. Seven healthy domestic short-hair cats were used, and each cat was anaesthetized three times - group I with isoflurane alone, group IR with isoflurane and a constant rate infusion (CRI) of remifentanil (18 µg/kg/h), and group ID with isoflurane and a CRI of dexmedetomidine (3 µg/kg/h). Minimum alveolar concentration (MAC) values were determined via electrical supramaximal nociceptive stimulation for each treatment group. Nociceptive stimulation was repeated at 3 different MAC multiples (0.75, 1.0 and 1.5 MAC), and electrocardiographic recordings were performed for 3 min before and after stimulation. Only the 1 min epochs were used for further statistical analysis. Electrocardiographic data were exported for offline HRV analysis. RESULTS: The mean isoflurane MAC ± standard deviation (SD) was 1.83 ± 0.22 vol% in group I, 1.65 ± 0.13 vol% in group IR and 0.82 ± 0.20 vol% in group ID. Nociception was indicated by several HRV parameters, however, with high variability between treatments. The best correlation with MAC was found for the SD of heart rate (STD HR) in group I (rs = - 0.76, p = 0.0001, r2 = 0.46). STD HR was also able to distinguish 0.75 MAC from 1.5 MAC and 1.0 MAC from 1.5 MAC in group I, as well as 0.75 MAC from 1.5 MAC in group ID. CONCLUSIONS: The choice of anaesthetic protocol influences the HRV parameters in cats. Frequency domain parameters respond to nociception at lower MAC levels. The STD HR has the potential to provide additional information for the assessment of anaesthetic depth in isoflurane-anaesthetized cats. The utility of HRV analysis for the assessment of anaesthetic depth in cats is still questionable.


Assuntos
Agonistas de Receptores Adrenérgicos alfa 2/administração & dosagem , Analgésicos Opioides/administração & dosagem , Anestésicos Inalatórios/administração & dosagem , Dexmedetomidina/administração & dosagem , Frequência Cardíaca/efeitos dos fármacos , Isoflurano/administração & dosagem , Remifentanil/administração & dosagem , Anestesia por Inalação/veterinária , Animais , Gatos , Estimulação Elétrica , Eletrocardiografia/veterinária , Feminino , Masculino , Nociceptividade/efeitos dos fármacos
13.
Rhinology ; 57(6): 402-410, 2019 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-31329812

RESUMO

BACKGROUND: Total intravenous anaesthesia (TIVA) with propofol, compared to inhaled anaesthesia (IA), has been proposed to reduce bleeding and improve surgical field quality during endoscopic sinus surgery (ESS), but prior meta-analyses have not been conclusive. We performed an updated meta-analysis to determine the benefit of TIVA versus IA during ESS. METHODOLOGY: PubMed, EMBASE, and Cochrane Library were searched for randomized controlled trials (RCTs) comparing TIVA versus IA. Demographic and outcome data were extracted from articles meeting selection criteria and analysed. RESULTS: We included 12 RCTs for a total of 560 patients. Preoperative characteristics were similar between the two groups. Compared to IA, TIVA improved surgical visibility, estimated blood loss (EBL), and operative time. In a subgroup analysis with remifentanil as the short-acting opioid, TIVA improved surgical visibility, EBL, and operative time. These benefits were not seen with fentanyl as the short-acting opioid. CONCLUSIONS: TIVA with propofol, in comparison to IA, may improve surgical field quality, reduce blood loss, and decrease operative time for ESS. Remifentanil is the preferred short-acting opioid for TIVA in ESS.


Assuntos
Anestesia por Inalação , Anestesia Intravenosa , Cirurgia Endoscópica por Orifício Natural/métodos , Doenças dos Seios Paranasais/cirurgia , Anestésicos Inalatórios/administração & dosagem , Anestésicos Intravenosos/administração & dosagem , Humanos , Propofol/administração & dosagem , Ensaios Clínicos Controlados Aleatórios como Assunto
14.
Br J Anaesth ; 123(3): 288-297, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31279479

RESUMO

BACKGROUND: Minimum alveolar concentration (MAC) and MAC-awake decrease with age. We hypothesised that, in clinical practice, (i) end-tidal MAC fraction in older patients would decline by less than the predicted age-dependent MAC decrease (i.e. older patients would receive relatively excessive anaesthetic concentrations), and (ii) bispectral index (BIS) values would therefore be lower in older patients. METHODS: We examined the relationship between end-tidal MAC fraction, BIS values, and age in 4699 patients > 30 yr in age at a single centre using unadjusted local regression (locally estimated scatterplot smoothing), Spearman's correlation, stratification, and robust univariable and multivariable linear regression. RESULTS: The end-tidal MAC fraction in older patients declined by 3.01% per decade (95% confidence interval [CI]: 2.56-3.45; P<0.001), less than the 6.47% MAC decrease per decade that we found in a meta-regression analysis of published studies of age-dependent changes in MAC (P<0.001), and less than the age-dependent decrease in MAC-awake. The BIS values correlated positively with age (ρ=0.15; 95% CI: 0.12-0.17; P<0.001), and inversely with the age-adjusted end-tidal MAC (aaMAC) fraction (ρ= -0.13; 95% CI: -0.16, -0.11; P<0.001). CONCLUSIONS: The age-dependent decline in end-tidal MAC fraction delivered in clinical practice at our institution was less than the age-dependent percentage decrease in MAC and MAC-awake determined from published studies. Despite receiving higher aaMAC fractions, older patients paradoxically showed higher BIS values. This most likely suggests that the BIS algorithm is inaccurate in older adults.


Assuntos
Envelhecimento/fisiologia , Anestésicos Inalatórios/farmacologia , Eletroencefalografia/efeitos dos fármacos , Adulto , Fatores Etários , Idoso , Envelhecimento/metabolismo , Anestésicos Inalatórios/administração & dosagem , Relação Dose-Resposta a Droga , Esquema de Medicação , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Monitorização Intraoperatória/métodos , Alvéolos Pulmonares/metabolismo , Estudos Retrospectivos
15.
Clin Oral Investig ; 23(9): 3653-3656, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31273527

RESUMO

OBJECTIVE: The recovery after general anesthesia is influenced by the choice of inhalational agent. Stimulations might make patient's agitate. However, the recovery using no touch technique might be safer. In this study, we compared the recovery time, awakening end-tidal concentration, and respiratory complications among inhalational anesthetics in pediatric patients using no touch technique, retrospectively. MATERIAL AND METHODS: The subjects were pediatric patients aged 3 months to 11 years under general anesthesia using sevoflurane, isoflurane, or desflurane. Background, awakening end-tidal concentration, respiratory complications, the time of eye open, body movement, and extubation were recorded. RESULTS: A total of 170 patients were included in the study. There were no respiratory complications during emergence. Awakening end-tidal concentration in desflurane was 0.98%, sevoflurane (0.39%), and isoflurane (0.25%). In patients received desflurane, the time of body movement, eye open, and extubation were significantly shorter than patients who received other anesthetics (p < 0.05). CONCLUSIONS: The recovery from desflurane was significantly shorter among three inhalational anesthetics with no touch technique. In addition, no airway-related complication occurred. CLINICAL RELEVANCE: The recovery from desflurane might be useful to predict emergence by end-tidal inhalational concentration.


Assuntos
Período de Recuperação da Anestesia , Anestésicos Inalatórios , Isoflurano , Anestesia Dentária , Anestésicos Inalatórios/administração & dosagem , Criança , Pré-Escolar , Desflurano/administração & dosagem , Humanos , Lactente , Isoflurano/administração & dosagem , Estudos Retrospectivos
16.
J Coll Physicians Surg Pak ; 29(8): 757-762, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31358099

RESUMO

OBJECTIVE: To describe perioperative anaesthetic management with laparoscopic sleeve gastrectomy (LSG). STUDY DESIGN: An observational study. PLACE AND DURATION OF STUDY: Department of Anesthesiology, Ondokuz Mayis University, Turkey, between January 2012 and December 2017. METHODOLOGY: Patients who underwent LSG at the study centre were considered. Hospital records were retrospectively reviewed. Information was collected on demographic characteristics, comorbidities, haemodynamic parameters, airway and anaesthetic management and complications. RESULTS: The study included 95 patients (mean age, 37.4±12.1 years; mean body mass index, 46 Kg/m2). Despite high airway assessment scores in some patients, 93 patients (98%) were conventionally intubated using our modified ramp position. Anaesthesia induction involved propofol, and anaesthesia maintenance involved inhalation anaesthetics (remifentanil supplementation). Additionally, rocuronium and sugammadex were used. Postoperative pain was managed with multimodal analgesia. Dose calculations were mostly based on lean/ideal body weight. Significant differences were found in the mean arterial pressure, heart rate and arterial oxygen saturation before induction and 5 min after induction. Intraoperatively, 3 patients (3.2%) developed bronchospasm and 1 (1.1%) developed bradycardia. There were no postoperative complications. CONCLUSION: Inhalational anaesthesia with remifentanil and rocuronium-sugammadex is a safe option in bariatric surgery. Although conventional techniques are sufficient to establish the airway in most cases, preparations for difficult intubation should be made. Furthermore, careful patient selection, preoperative anaesthetic management planning and appropriate postoperative monitoring are necessary.


Assuntos
Anestesia Geral/métodos , Gastrectomia/métodos , Obesidade Mórbida/cirurgia , Adulto , Analgésicos/administração & dosagem , Período de Recuperação da Anestesia , Anestésicos Inalatórios/administração & dosagem , Feminino , Humanos , Masculino , Monitorização Intraoperatória , Estudos Retrospectivos
17.
Vet Anaesth Analg ; 46(5): 658-661, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31324455

RESUMO

OBJECTIVE: To characterize the effect of α2-adrenoceptor antagonism on the minimum alveolar concentration of isoflurane (MACISO) in cats. STUDY DESIGN: Prospective experimental study. ANIMALS: A group of five healthy adult male neutered cats. METHODS: Cats were anesthetized with isoflurane in oxygen and instrumented. MACISO was determined in duplicate in five cats, before and during administration of atipamezole (250 µg kg-1 followed by 250 µg kg-1 hour-1) using the bracketing technique and tail clamping. Estimates of MACISO obtained before and during administration of atipamezole were compared using a two-tailed paired t test. RESULTS: MACISO during atipamezole administration (mean ± standard deviation 2.73% ± 0.07%) was significantly larger than before atipamezole administration (1.95% ± 0.13%; p < 0.0001). CONCLUSION AND CLINICAL RELEVANCE: The role of α2-adrenoceptors in inhaled anesthetic-induced immobility may be larger than previously thought. Antagonism of an α2-adrenoceptor agonist during inhalation anesthesia may result in an increase in MAC disproportionate to the MAC reduction induced by the agonist.


Assuntos
Antagonistas de Receptores Adrenérgicos alfa 2/farmacologia , Anestesia por Inalação/veterinária , Anestésicos Inalatórios/farmacocinética , Gatos/fisiologia , Imidazóis/farmacologia , Isoflurano/farmacocinética , Alvéolos Pulmonares/metabolismo , Antagonistas de Receptores Adrenérgicos alfa 2/administração & dosagem , Anestésicos Inalatórios/administração & dosagem , Animais , Gatos/metabolismo , Imidazóis/administração & dosagem , Isoflurano/administração & dosagem , Masculino , Estudos Prospectivos
18.
Nat Commun ; 10(1): 2897, 2019 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-31263107

RESUMO

Multiple areas within the reticular activating system (RAS) can hasten awakening from sleep or light planes of anesthesia. However, stimulation in individual sites has shown limited recovery from deep global suppression of brain activity, such as coma. Here we identify a subset of RAS neurons within the anterior portion of nucleus gigantocellularis (aNGC) capable of producing a high degree of awakening represented by a broad high frequency cortical reactivation associated with organized movements and behavioral reactivity to the environment from two different models of deep pharmacologically-induced coma (PIC): isoflurane (1.25%-1.5%) and induced hypoglycemic coma. Activating aNGC neurons triggered awakening by recruiting cholinergic, noradrenergic, and glutamatergic arousal pathways. In summary, we identify an evolutionarily conserved population of RAS neurons, which broadly restore cerebral cortical activation and motor behavior in rodents through the coordinated activation of multiple arousal-promoting circuits.


Assuntos
Anestésicos Inalatórios/administração & dosagem , Tronco Encefálico/fisiopatologia , Coma/fisiopatologia , Isoflurano/administração & dosagem , Animais , Tronco Encefálico/efeitos dos fármacos , Coma/induzido quimicamente , Eletroencefalografia , Feminino , Humanos , Masculino , Bulbo/efeitos dos fármacos , Bulbo/fisiopatologia , Camundongos , Neurônios/fisiologia , Ratos , Ratos Sprague-Dawley , Vigília
19.
J Insect Physiol ; 117: 103900, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31202852

RESUMO

Imaging of living, intact Drosophila larvae is challenged if normal bodily function must be observed or when healthy larvae must be recovered for subsequent studies. Here, we describe a simple and short protocol that employs transient airborne chloroform or desflurane (1,2,2,2-tetrafluoroethyl difluoromethyl ether) to efficiently immobilize larvae without the use of manipulation devices, vaporizers or imaging chambers. This non-lethal method allows the use of anesthetics while allowing tracking of individual Drosophila into adulthood for follow-up experiments. At dosages sufficient to immobilize larvae, Desflurane, but not chloroform reduced the central nervous system response to auditory stimulus. Desflurane doses were sufficient to arrest the heart, however significant rapid recovery was observed. With our method, chloroform provided more rapid anesthesia but slower recovery than Desflurane. Without specialized hardware, this technique allows for repeated imaging of living Drosophila larvae.


Assuntos
Anestésicos Inalatórios/administração & dosagem , Clorofórmio/administração & dosagem , Desflurano/administração & dosagem , Drosophila/efeitos dos fármacos , Imobilização/métodos , Animais , Sistema Nervoso Central/efeitos dos fármacos , Larva/efeitos dos fármacos , Microscopia Confocal
20.
Rev Bras Anestesiol ; 69(3): 233-241, 2019.
Artigo em Português | MEDLINE | ID: mdl-31076155

RESUMO

BACKGROUND AND OBJECTIVES: Emergence delirium after general anesthesia with sevoflurane has not been frequently reported in adults compared to children. This study aimed to determine the incidence of emergence delirium in adult patients who had anesthesia with sevoflurane as the volatile agent and the probable risk factors associated with its occurrence. DESIGN AND METHODS: A prospective observational study was conducted in adult patients who had non-neurological procedures and no existing neurological or psychiatric conditions, under general anesthesia. Demographic data such as age, gender, ethnicity and clinical data including ASA physical status, surgical status, intubation attempts, duration of surgery, intraoperative hypotension, drugs used, postoperative pain, rescue analgesia and presence of catheters were recorded. Emergence delirium intensity was measured using the Nursing Delirium Scale (NuDESC). RESULTS: The incidence of emergence delirium was 11.8%. The factors significantly associated with emergence delirium included elderly age (>65) (p=0.04), emergency surgery (p=0.04), African ethnicity (p=0.01), longer duration of surgery (p=0.007) and number of intubation attempts (p=0.001). Factors such as gender, alcohol and illicit drug use, and surgical specialty did not influence the occurrence of emergence delirium. CONCLUSIONS: The incidence of emergence delirium in adults after general anesthesia using sevoflurane is significant and has not been adequately reported. Modifiable risk factors need to be addressed to further reduce its incidence.


Assuntos
Anestesia Geral/métodos , Anestésicos Inalatórios/administração & dosagem , Delírio do Despertar/epidemiologia , Sevoflurano/administração & dosagem , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Anestesia Geral/efeitos adversos , Anestésicos Inalatórios/efeitos adversos , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Estudos Prospectivos , Fatores de Risco , Sevoflurano/efeitos adversos , Adulto Jovem
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