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2.
J Med Case Rep ; 15(1): 201, 2021 Apr 17.
Artigo em Inglês | MEDLINE | ID: mdl-33863374

RESUMO

BACKGROUND: Malignant hyperthermia (MH) is a rare genetic disease characterized by the development of very serious symptoms, and hence prompt and appropriate treatment is required. However, postoperative MH is very rare, representing only 1.9% of cases as reported in the North American Malignant Hyperthermia Registry (NAMHR). We report a rare case of a patient who developed sudden postoperative hyperthermia after mastectomy, which was definitively diagnosed as MH by the calcium-induced calcium release rate (CICR) measurement test. CASE PRESENTATION: A 61-year-old Japanese woman with a history of stroke was hospitalized for breast cancer surgery. General anesthesia was introduced by propofol, remifentanil, and rocuronium. After intubation, anesthesia was maintained using propofol and remifentanil, and mastectomy and muscle flap reconstruction surgery was performed and completed without any major problems. After confirming her spontaneous breathing, sugammadex was administered and she was extubated. Thereafter, systemic shivering and masseter spasm appeared, and a rapid increase in body temperature (maximum: 38.9 °C) and end-tidal carbon dioxide (ETCO2) (maximum: 59 mmHg) was noted. We suspected MH and started cooling the body surface of the axilla, cervix, and body trunk, and administered chilled potassium-free fluid and dantrolene. After her body temperature dropped and her shivering improved, dantrolene administration was ended, and finally she was taken to the intensive care unit (ICU). Body cooling was continued within the target range of 36-37 °C in the ICU. No consciousness disorder, hypotension, increased serum potassium level, metabolic acidosis, or cola-colored urine was observed during her ICU stay. Subsequently, her general condition improved and she was discharged on day 12. Muscle biopsy after discharge was performed and provided a definitive diagnosis of MH. CONCLUSIONS: The occurrence of MH can be life-threatening, but its frequency is very low, and genetic testing and muscle biopsy are required to confirm the diagnosis. On retrospective evaluation using the malignant hyperthermia scale, the present case was almost certainly that of a patient with MH. Prompt recognition and immediate treatment with dantrolene administration and body cooling effectively reversed a potentially fatal syndrome. This was hence a valuable case of a patient with postoperative MH that led to a confirmed diagnosis by CICR.


Assuntos
Anestesia Geral/efeitos adversos , Anestésicos Inalatórios/efeitos adversos , Neoplasias da Mama/cirurgia , Dantroleno/administração & dosagem , Hipertermia Maligna/tratamento farmacológico , Mastectomia/efeitos adversos , Relaxantes Musculares Centrais/administração & dosagem , Cálcio , Dantroleno/uso terapêutico , Feminino , Humanos , Hipertermia Maligna/diagnóstico , Hipertermia Maligna/etiologia , Pessoa de Meia-Idade , Relaxantes Musculares Centrais/uso terapêutico , Estudos Retrospectivos , Tremor por Sensação de Frio , Resultado do Tratamento
3.
J Zoo Wildl Med ; 52(1): 327-331, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33827194

RESUMO

Respiratory depression from isoflurane seems to be greater in birds than in mammals. Isoflurane respiratory anesthetic index (AI) has only been evaluated in ducks (Anas platyrhynchos), which indeed showed a lower AI compared to mammals, but the isoflurane AI for other avian species is not known. The aim of this study was to evaluate the isoflurane AI in chickens (Gallus gallus domesticus). Six adult hens were anesthetized with isoflurane for determination of the minimum anesthetic concentration (MAC) using the bracketing method. During a second anesthetic event, the isoflurane AI was determined by progressively increasing the expired fraction of isoflurane by 0.5 times MAC until apnea was achieved (ETiso-apnea). The isoflurane AI was considered the ratio between the ETiso-apnea and the MAC. Heart rate, systolic arterial pressure, respiratory rate, and end-tidal carbon dioxide were continuously monitored throughout both anesthetic events. Data were analyzed using a mixed-effect model with Greenhouse-Geisser correction, followed by Tukey's test. The MAC for isoflurane was 1.18% ± 0.09% (mean ± SD). The ETiso-apnea was 3.31% ± 0.34% and the isoflurane AI was 2.80 ± 0.26. In chickens, isoflurane AI is similar to that measured in mammals, which is in contrast with published data in other avian species.


Assuntos
Anestesia por Inalação/veterinária , Anestésicos Inalatórios/efeitos adversos , Galinhas/fisiologia , Isoflurano/efeitos adversos , Insuficiência Respiratória/veterinária , Anestesia por Inalação/efeitos adversos , Anestésicos Inalatórios/administração & dosagem , Animais , Feminino , Isoflurano/administração & dosagem , Insuficiência Respiratória/induzido quimicamente
5.
Medicine (Baltimore) ; 100(4): e23753, 2021 Jan 29.
Artigo em Inglês | MEDLINE | ID: mdl-33530174

RESUMO

ABSTRACT: To evaluate the utility of low-concentration nitrous oxide (N2O) anesthesia in ptosis surgeryThis study was a retrospective consecutive case series that included 54 successive patients with blepharoptosis who underwent bilateral levator aponeurosis advancement and on whom skin resection performed by the same surgeon between August 2016 and July 2017. Among these patients, 27 were operated with a local anesthesia injection (air group) and 27 with a local anesthesia injection and low-concentration N2O anesthesia (N2O group). All N2O cases used a total of 6 L of gas comprising 70% oxygen and 30% N2O. Preoperative and postoperative blood pressure (BP) and heart rate (HR) and intraoperative pain, anxiety, nausea, and memory were measured immediately after surgery using visual analog scale score (VASS). Additionally, perioperative side effects were examined.There was no significant difference in age, sex, and preoperative and postoperative margin reflex distance (MRD) between the 2 groups (all P > .05). The intraoperative mean peripheral oxygen saturation was significantly higher (97.5% ±â€Š1.6% vs 99.5% ±â€Š.6%, P < .001), intraoperative HR was significantly lower (78.2 ±â€Š12.8 vs 70.7 ±â€Š11.6 bpm, P = .02), and operation time was significantly shorter (33.1 ±â€Š8.1 vs 29.4 ±â€Š10.3 minutes, P = .03) in the N2O group than in the air group.Difference between intraoperative and preoperative systolic BP (BPs) (+15.8 ±â€Š18.0 vs + 3.1 ±â€Š21.7 mm Hg, P = .02), diastolic BP (BPd) (+7.0 ±â€Š17.4 vs -2.3 ±â€Š13.6 mm Hg, P = .04), and HR (3.2 ±â€Š8.5 vs -3.9 ±â€Š9.4 bpm, P = .01) was significantly lower in the N2O group than in the air group.VASS of intraoperative pain was significantly lower in the N2O group than in the air group (49.5 ±â€Š24.7 vs 22.6 ±â€Š14.9, P < .001), whereas intraoperative anxiety and memory did not present significant differences between the groups (P = .09 and P = .45, respectively). Intraoperative nausea score was 0 for all cases in both groups. There was no other side effect.Ptosis surgery with anesthesia using 30% N2O may effectively suppress intraoperative BP and HR along with pain and shorten the operation time without side effects such as nausea.


Assuntos
Anestésicos Inalatórios/administração & dosagem , Anestésicos Inalatórios/efeitos adversos , Blefaroplastia/métodos , Blefaroptose/cirurgia , Óxido Nitroso/administração & dosagem , Óxido Nitroso/efeitos adversos , Idoso , Idoso de 80 Anos ou mais , Anestésicos Locais/administração & dosagem , Ansiedade/prevenção & controle , Pressão Sanguínea/efeitos dos fármacos , Feminino , Frequência Cardíaca/efeitos dos fármacos , Humanos , Período Intraoperatório , Masculino , Memória/efeitos dos fármacos , Pessoa de Meia-Idade , Náusea/induzido quimicamente , Duração da Cirurgia , Manejo da Dor , Estudos Retrospectivos , Sinais Vitais
6.
Medicine (Baltimore) ; 100(4): e24495, 2021 Jan 29.
Artigo em Inglês | MEDLINE | ID: mdl-33530271

RESUMO

RATIONALE: Sevoflurane-induced seizures are most often caused by high concentrations of sevoflurane during anesthesia induction. However, in this case, we found a rare case of seizure-like movements caused by residual sevoflurane inside the anesthesia machine. Therefore, we propose that the detection of residual anesthesia-inhaled drugs should be included in pre-anesthesia checkout procedures. PATIENT CONCERNS: An 11-year-old girl with a history of epilepsy was scheduled for emergency appendectomy under general anesthesia. The patient presented with seizure-like movements caused by residual sevoflurane inside the anesthesia machine after pre-oxygenation during rapid sequence induction. DIAGNOSES: Based on the clinical presentation and previous history of seizures, sevoflurane-induced seizures were diagnosed. INTERVENTIONS: A washout procedure was performed by turning the oxygen flow up to 10L/min to wash out the residual sevoflurane from the anesthesia machine. OUTCOMES: The seizures ceased spontaneously, and the vital signs of the patient were stable during the washout procedure. Rapid sequence anesthesia induction and total intravenous anesthesia maintenance were uneventful. Surgery was performed as planned, and there were no postoperative problems. The patient was discharged after 4 days without complications and was well on follow-up. LESSONS: The check-up procedure of residual anesthesia-inhaled drugs inside the anesthesia machine should be included in the checkout design guidelines, or else the washout procedure should be performed in the pre-anesthesia checkout procedures.


Assuntos
Anestésicos Inalatórios/efeitos adversos , Convulsões/induzido quimicamente , Sevoflurano/efeitos adversos , Anestesia Geral/efeitos adversos , Anestesia Geral/instrumentação , Criança , Feminino , Humanos
8.
J Anesth ; 35(1): 112-121, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33389161

RESUMO

PURPOSE: The effect of anesthetic types on postoperative acute kidney injury (AKI) remains unclear particularly in patients undergoing non-cardiac surgery. The purpose of this retrospective study was to compare total intravenous anesthesia (TIVA) and inhalation anesthesia in terms of the risk of AKI after open major abdominal surgery (MAS). METHODS: Adult patients who underwent open MAS (gastrectomy, hepatectomy, colectomy, or pancreatectomy) at our institute from 2016 to 2018 were included. Using the multivariable logistic regression, the risk of postoperative AKI was compared among patients who underwent TIVA (TIVA group) and inhalation anesthesia (inhalation group) both in the total cohort and in the propensity score-matched cohort. Additional multivariable logistic regression analysis was performed with inverse probability of treatment weighting (IPTW) using the propensity score. RESULTS: In total, 3616 patients were analyzed. The incidence of postoperative AKI was 5.0% (77/1546) and 7.8% (161/2070) in the TIVA and inhalation groups, respectively. The risk of AKI was significantly higher in the inhalation group [adjusted odds ratio (aOR) 1.72; 95% confidence interval (CI) 1.27-2.35; P = 0.002] than the TIVA group. In the matched cohort (n = 1518 in each group), the inhalation group also had a higher risk of AKI (aOR 1.66; 95% CI 1.20-2.31; P = 0.002). The multivariable logistic regression with IPTW showed similar results (aOR 1.59; 95% CI 1.30-1.95; P < 0.001). CONCLUSIONS: The risk of AKI after open MAS differed significantly according to the anesthetic used. Patients receiving inhalation anesthesia may have a greater risk of postoperative AKI than those undergoing TIVA.


Assuntos
Lesão Renal Aguda , Anestésicos Inalatórios , Lesão Renal Aguda/induzido quimicamente , Lesão Renal Aguda/epidemiologia , Adulto , Anestesia por Inalação/efeitos adversos , Anestesia Intravenosa/efeitos adversos , Anestésicos Inalatórios/efeitos adversos , Anestésicos Intravenosos , Humanos , Pontuação de Propensão , Estudos Retrospectivos
9.
Anesthesiology ; 134(3): 381-394, 2021 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-33439974

RESUMO

BACKGROUND: Delayed neurocognitive recovery after surgery is associated with poor outcome. Most surgeries require general anesthesia, of which sevoflurane and propofol are the most commonly used inhalational and intravenous anesthetics. The authors tested the primary hypothesis that patients with laparoscopic abdominal surgery under propofol-based anesthesia have a lower incidence of delayed neurocognitive recovery than patients under sevoflurane-based anesthesia. A second hypothesis is that there were blood biomarkers for predicting delayed neurocognitive recovery to occur. METHODS: A randomized, double-blind, parallel, controlled study was performed at four hospitals in China. Elderly patients (60 yr and older) undergoing laparoscopic abdominal surgery that was likely longer than 2 h were randomized to a propofol- or sevoflurane-based regimen to maintain general anesthesia. A minimum of 221 patients was planned for each group to detect a one-third decrease in delayed neurocognitive recovery incidence in propofol group compared with sevoflurane group. The primary outcome was delayed neurocognitive recovery incidence 5 to 7 days after surgery. RESULTS: A total of 544 patients were enrolled, with 272 patients in each group. Of these patients, 226 in the propofol group and 221 in the sevoflurane group completed the needed neuropsychological tests for diagnosing delayed neurocognitive recovery, and 46 (20.8%) in the sevoflurane group and 38 (16.8%) in the propofol group met the criteria for delayed neurocognitive recovery (odds ratio, 0.77; 95% CI, 0.48 to 1.24; P = 0.279). A high blood interleukin-6 concentration at 1 h after skin incision was associated with an increased likelihood of delayed neurocognitive recovery (odds ratio, 1.04; 95% CI, 1.01 to 1.07; P = 0.007). Adverse event incidences were similar in both groups. CONCLUSIONS: Anesthetic choice between propofol and sevoflurane did not appear to affect the incidence of delayed neurocognitive recovery 5 to 7 days after laparoscopic abdominal surgery. A high blood interleukin-6 concentration after surgical incision may be an independent risk factor for delayed neurocognitive recovery.


Assuntos
Abdome/cirurgia , Anestésicos Inalatórios/efeitos adversos , Anestésicos Intravenosos/efeitos adversos , Complicações Cognitivas Pós-Operatórias/epidemiologia , Propofol/efeitos adversos , Sevoflurano/efeitos adversos , Idoso , Anestésicos Inalatórios/sangue , Anestésicos Intravenosos/sangue , Biomarcadores/sangue , China/epidemiologia , Método Duplo-Cego , Feminino , Avaliação Geriátrica/métodos , Avaliação Geriátrica/estatística & dados numéricos , Humanos , Laparoscopia , Masculino , Pessoa de Meia-Idade , Testes Neuropsicológicos/estatística & dados numéricos , Complicações Cognitivas Pós-Operatórias/sangue , Propofol/sangue , Sevoflurano/sangue
10.
Eur J Anaesthesiol ; 38(5): 477-486, 2021 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-33399382

RESUMO

BACKGROUND: The glycocalyx plays an important physiological role and may be damaged during cardiopulmonary bypass. Sevoflurane can protect the glycocalyx; however, its relevance in a clinical setting is unknown. OBJECTIVE: Glycocalyx degradation during cardiopulmonary bypass in patients was investigated. On the basis of the available experimental data, we hypothesised that sevoflurane-based anaesthesia would confer additional protection against cardiopulmonary bypass-induced glycocalyx damage. DESIGN: Randomised controlled study. SETTING: Clinical study at The First Affiliated Hospital of Wenzhou Medical University between June 2018 and March 2019. PATIENTS: Fifty-one patients. INTERVENTIONS: After intubation and mechanical ventilation, patients undergoing elective heart valve surgery were maintained under general anaesthesia with either propofol or sevoflurane during surgery. MAIN OUTCOME MEASURES: Glycocalyx markers (such as syndecan-1, heparan sulphate and hyaluronan), sheddases responsible for the degradation of the endothelial glycocalyx (such as matrix metalloproteinase-9 and cathepsin-B), urine albumin-to-creatinine ratio and levels of lactic acid and myocardial enzymes were all measured. Postoperative mechanical ventilation time and length of stay in the cardiac care unit and hospital were also measured. Morbidity and mortality after 30 days and 1 year were evaluated. RESULTS: The vascular endothelial glycocalyx was damaged during cardiopulmonary bypass. The glycocalyx damage in the sevoflurane group was less extensive than that in the propofol group. The urine albumin-to-creatinine ratio increased in both groups but was lower in the sevoflurane group. Enzymes including matrix metalloproteinase-9 and cathepsin-B were positively correlated with glycocalyx marker concentrations. After operation, the sevoflurane group showed lower levels of lactic acid and myocardial enzyme, as well as shorter duration of postoperative mechanical ventilation than the propofol group. CONCLUSION: Sevoflurane can decrease glycocalyx degradation in patients undergoing heart valve surgery under cardiopulmonary bypass. TRIAL REGISTRATION: Chinese Clinical Trial Registry, chictr.org.cn, identifier: ChiCTR1800016367.


Assuntos
Anestésicos Inalatórios , Procedimentos Cirúrgicos Cardíacos , Éteres Metílicos , Propofol , Anestésicos Inalatórios/efeitos adversos , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Glicocálix , Valvas Cardíacas , Humanos , Éteres Metílicos/efeitos adversos , Sevoflurano
11.
Environ Sci Pollut Res Int ; 28(9): 10436-10449, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33415631

RESUMO

Occupational exposure to inhalational anesthetics has been associated with health problems, including reproductive issues. Considering the scarcity and outdated nature of reviews concerning this relevant topic, which has implications for indoor pollution/environmental science/public health, this critical review aimed to systematically evaluate whether exposure to inhalational anesthetics is associated with abortion. Seven databases were searched with no language or year restrictions. Of the 3881 search results, 18 observational studies were included. Some studies demonstrated a significant association between occupational exposure to inhalational anesthetics and spontaneous abortion, especially among professionals who work for longer periods and/or in an environment without gas scavenging/ventilation systems, which may favor the occurrence of abortion in this population. Due to considerable heterogeneity and limitations, it cannot be concluded whether an association exists between occupational exposure to anesthetics and the occurrence of abortion. However, more well-designed studies should be performed, especially in less economically developed countries that do not have access to quality anesthetic gas scavenging/ventilation systems, thereby bringing this issue into sharp focus. This review highlights the need for scientific knowledge in this area and the extensive use of scavenging equipment and in the workplace to minimize exposure and reduce the risk of abortion.


Assuntos
Aborto Espontâneo , Anestésicos Inalatórios , Exposição Ocupacional , Aborto Espontâneo/induzido quimicamente , Aborto Espontâneo/epidemiologia , Ar Condicionado , Anestésicos Inalatórios/efeitos adversos , Feminino , Humanos , Gravidez
12.
Anesthesiology ; 134(2): 202-218, 2021 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-33433619

RESUMO

BACKGROUND: Nitrous oxide produces non-γ-aminobutyric acid sedation and psychometric impairment and can be used as scientific model for understanding mechanisms of progressive cognitive disturbances. Temporal complexity of the electroencephalogram may be a sensitive indicator of these effects. This study measured psychometric performance and the temporal complexity of the electroencephalogram in participants breathing low-dose nitrous oxide. METHODS: In random order, 20, 30, and 40% end-tidal nitrous oxide was administered to 12 participants while recording 32-channel electroencephalogram and psychometric function. A novel metric quantifying the spatial distribution of temporal electroencephalogram complexity, comprised of (1) absolute cross-correlation calculated between consecutive 0.25-s time samples; 2) binarizing these cross-correlation matrices using the median of all channels as threshold; (3) using quantitative recurrence analysis, the complexity in temporal changes calculated by the Shannon entropy of the probability distribution of the diagonal line lengths; and (4) overall spatial extent and intensity of brain complexity, was quantified by calculating median temporal complexity of channels whose complexities were above 1 at baseline. This region approximately overlay the brain's default mode network, so this summary statistic was termed "default-mode-network complexity." RESULTS: Nitrous oxide concentration correlated with psychometric impairment (r = 0.50, P < 0.001). Baseline regional electroencephalogram complexity at midline was greater than in lateral temporal channels (1.33 ± 0.14 bits vs. 0.81 ± 0.12 bits, P < 0.001). A dose of 40% N2O decreased midline (mean difference [95% CI], 0.20 bits [0.09 to 0.31], P = 0.002) and prefrontal electroencephalogram complexity (mean difference [95% CI], 0.17 bits [0.08 to 0.27], P = 0.002). The lateral temporal region did not change significantly (mean difference [95% CI], 0.14 bits [-0.03 to 0.30], P = 0.100). Default-mode-network complexity correlated with N2O concentration (r = -0.55, P < 0.001). A default-mode-network complexity mixed-effects model correlated with psychometric impairment (r2 = 0.67; receiver operating characteristic area [95% CI], 0.72 [0.59 to 0.85], P < 0.001). CONCLUSIONS: Temporal complexity decreased most markedly in medial cortical regions during low-dose nitrous oxide exposures, and this change tracked psychometric impairment.


Assuntos
Disfunção Cognitiva/induzido quimicamente , Disfunção Cognitiva/fisiopatologia , Eletroencefalografia/métodos , Óxido Nitroso/efeitos adversos , Lobo Temporal/efeitos dos fármacos , Lobo Temporal/fisiopatologia , Adulto , Anestésicos Inalatórios/efeitos adversos , Estudos Cross-Over , Relação Dose-Resposta a Droga , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Psicometria , Método Simples-Cego , Adulto Jovem
13.
Medicine (Baltimore) ; 100(1): e24160, 2021 Jan 08.
Artigo em Inglês | MEDLINE | ID: mdl-33429798

RESUMO

ABSTRACT: Postoperative delirium (PODE) can be associated with severe clinical complications; therefore, preventive measures are important. The objective of this trial was to elucidate whether haemodynamic or electroencephalographic (EEG) monitoring parameters during general anaesthesia or sevoflurane dosage correlate with the incidence of PODE. In addition, sevoflurane dosages and EEG stages during the steady state of anaesthesia were analyzed in patients of different ages.Eighty adult patients undergoing elective abdominal surgery received anaesthesia with sevoflurane and sufentanil according to the clinical routine. Anaesthesiologists were blinded to the EEG. Haemodynamic parameters, EEG parameters, sevoflurane dosage, and occurrence of PODE were analyzed.Thirteen patients (4 out of 33 women, 9 out of 47 men) developed PODE. Patients with PODE had a greater mean arterial pressure (MAP) variance (267.26 (139.40) vs 192.56 (99.64) mmHg2, P = .04), had a longer duration of EEG burst suppression or suppression (27.09 (45.32) vs 5.23 (10.80) minutes, P = .03), and received higher minimum alveolar sevoflurane concentrations (MAC) (1.22 (0.22) vs 1.09 (0.17), P = .03) than patients without PODE. MAC values were associated with wide ranges of EEG index values representing different levels of hypnosis.The results suggest that, in order to prevent PODE, a great variance of MAP, higher doses of sevoflurane, and deep levels of anaesthesia should be avoided. Titrating sevoflurane according to end-tidal gas monitoring and vital signs can lead to unnecessarily deep or light hypnosis. Intraoperative EEG monitoring may help to prevent PODE.


Assuntos
Delírio/classificação , Delírio/etiologia , Monitorização Intraoperatória/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Anestésicos Inalatórios/efeitos adversos , Anestésicos Inalatórios/uso terapêutico , Estudos Transversais , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Monitorização Intraoperatória/estatística & dados numéricos , Complicações Pós-Operatórias/classificação , Complicações Pós-Operatórias/fisiopatologia , Estudos Prospectivos , Sevoflurano/efeitos adversos , Sevoflurano/uso terapêutico , Sufentanil/efeitos adversos , Sufentanil/uso terapêutico
14.
Environ Mol Mutagen ; 62(2): 155-164, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33341964

RESUMO

Considering the importance and lack of data of toxicogenomic approaches on occupational exposure to anesthetics, we evaluated possible associations between waste anesthetic gases (WAGs) exposure and biological effects including oxidative stress, DNA damage, inflammation, and transcriptional modulation. The exposed group was constituted by anesthesia providers who were mainly exposed to the anesthetics sevoflurane and isoflurane (10 ppm) and to a lesser degree to nitrous oxide (150 ppm), and the control group was constituted by physicians who had no exposure to WAGs. The oxidative stress markers included oxidized DNA bases (comet assay), malondialdehyde (high-performance liquid chromatography [HPLC]), nitric oxide metabolites (ozone-chemiluminescence), and antioxidative markers, including individual antioxidants (HPLC) and antioxidant defense marker (ferric reducing antioxidant power by spectrophotometry). The inflammatory markers included high-sensitivity C-reactive protein (chemiluminescent immunoassay) and the proinflammatory interleukins IL-6, IL-8 and IL-17A (flow cytometry). Telomere length and gene expression related to DNA repair (hOGG1 and XRCC1), antioxidant defense (NRF2) and inflammation (IL6, IL8 and IL17A) were evaluated by real-time quantitative polymerase chain reaction. No significant differences (p > .0025) between the groups were observed for any parameter evaluated. Thus, under the conditions of the study, the findings suggest that occupational exposure to WAGs is not associated with oxidative stress or inflammation when evaluated in serum/plasma, with DNA damage evaluated in lymphocytes and leucocytes or with molecular modulation assessed in peripheral blood cells in university anesthesia providers. However, it is prudent to reduce WAGs exposure and to increase biomonitoring of all occupationally exposed professionals.


Assuntos
Anestesia/efeitos adversos , Anestésicos Inalatórios/efeitos adversos , Dano ao DNA/efeitos dos fármacos , Expressão Gênica/efeitos dos fármacos , Inflamação/induzido quimicamente , Exposição Ocupacional/efeitos adversos , Estresse Oxidativo/efeitos dos fármacos , Adulto , Idoso , Poluentes Ocupacionais do Ar/efeitos adversos , Antioxidantes/metabolismo , Reparo do DNA/efeitos dos fármacos , Feminino , Hospitais , Humanos , Inflamação/metabolismo , Isoflurano/efeitos adversos , Masculino , Pessoa de Meia-Idade , Óxido Nitroso/efeitos adversos , Sevoflurano/efeitos adversos
15.
Anaesthesia ; 76(1): 36-44, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32743803

RESUMO

Sevoflurane and desflurane are the most commonly used volatile anaesthetics for maintenance of anaesthesia. In this study, we aimed to evaluate the relationship between choice of volatile anaesthetic and early postoperative respiratory complications, and to address a critical knowledge gap in safety outcomes between these two commonly used agents. We performed a retrospective analysis of adult (non-cardiac surgery) patients who received sevoflurane or desflurane for the maintenance of general anaesthesia at our institution between 2005 and 2018. We evaluated the association between desflurane exposure (when compared with sevoflurane) and the primary outcome of postoperative respiratory complications, defined by early post-extubation desaturation (Sp O2  < 90%) or re-intubation within 7 days postoperatively. Multivariable regression analyses were performed and adjusted for confounding factors, including patient, anaesthetic and surgical factors. Propensity matched, interaction and sub-group analyses were performed to assess outcomes in high-risk groups: morbidly obese (BMI > 35 kg.m-2 ); elderly (age > 65 years); and high risk of respiratory complications as well as the primary outcome at 24 h. Desflurane was used for 23,830 patients and sevoflurane for 84,608 patients. Patients exposed to desflurane did not demonstrate a reduced risk of postoperative respiratory complications when compared with sevoflurane (adjusted odds ratio 0.99, 95%CI 0.94-1.04, p = 0.598). These findings were consistent across all sub-groups of high-risk patients and in the propensity score matched cohort. In summary, desflurane use was not associated with reduced postoperative respiratory complications when compared with sevoflurane. In the context of environmental and cost concerns with volatile anaesthetic agents, our study provides important data to support organisational decisions regarding the use of desflurane.


Assuntos
Anestésicos Inalatórios/efeitos adversos , Desflurano/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Transtornos Respiratórios/epidemiologia , Sevoflurano/efeitos adversos , Adulto , Fatores Etários , Idoso , Extubação , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Obesidade Mórbida/complicações , Complicações Pós-Operatórias/terapia , Pontuação de Propensão , Transtornos Respiratórios/terapia , Fatores de Risco , Resultado do Tratamento
16.
Eur J Paediatr Dent ; 21(4): 277-282, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-33337902

RESUMO

AIM: The aim of this study was to evaluate the features of inhalation conscious sedation for urgent dental treatments in uncooperative paediatric patients during COVID-19 outbreak. MATERIALS AND METHODS: Forty-two uncooperative patients, attending primary and secondary schools, were submitted to emergency dental treatments with inhalation conscious sedation using nitrous oxide and oxygen during COVID-19 pandemic. Collected data included: number of working sessions, success/failure, adverse events, side effects, number of teeth treated; type of dental procedure. Parents filled in an e-mailed questionnaire on post-discharge children status to evaluate: pain; crying; fever; vomiting; headache; drowsiness; excitability; irritability; ability to eat; need for drugs. RESULTS: One working session was carried out in 29 patients, 2 working sessions were carried out in 6 patients and 3 working sessions were carried out in 7 patients. Success rate was 87.1%. In relation to success, there was no statistically significant difference between males and females, healthy and disabled patients, respectively; while there was a statistically significant difference between patients attending primary and secondary schools (p=0.023). No adverse events occurred. The most frequent side effect was nausea. In relation to side effects, there was no statistically significant difference between males and females, healthy and disabled patients, patients attending primary and secondary schools, respectively. In relation to e-mailed questionnaires on post-discharge children status, 29.6% of the patients had pain, 22.2% vomited, 14.8% had headache, 18.5% experienced drowsiness, 29.6% failed to eating normally, 35.2% needed to take drugs. None of the patients cried, had a fever, exhibited irritability and excitability. CONCLUSION: Inhalation conscious sedation is a safe, practical and effective procedure with minimal side effects to perform emergency dental treatments in uncooperative paediatric patients during COVID-19 outbreak.


Assuntos
Anestesia Dentária , Anestésicos Inalatórios , Assistência ao Convalescente , Anestésicos Inalatórios/efeitos adversos , Criança , Comportamento Infantil , Sedação Consciente , Feminino , Humanos , Masculino , Óxido Nitroso/efeitos adversos , Oxigênio , Pandemias , Alta do Paciente , Resultado do Tratamento
17.
J Anesth Hist ; 6(3): 164-165, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32921489

RESUMO

Famous for pioneering the oxygenation of nitrous-oxide anesthetics, Chicago surgeon Edmund Andrews trusted the Manhattan-based Colton Dental Association's claim that they had conducted 75,000 nitrous-oxide anesthetics without a single mortality. Those statistics were cited in Andrews' 1870 journal article on anesthetic risks and then, remarkably, advertised on the business cards of dentist James M. Spencer, Jr., of Gouverneur, New York.


Assuntos
Publicidade/história , Anestesia Dentária/história , Anestésicos Inalatórios/história , Óxido Nitroso/história , Anestésicos Inalatórios/efeitos adversos , História do Século XIX , Humanos , Óxido Nitroso/efeitos adversos , Publicações Periódicas como Assunto/história , Estados Unidos
18.
Anesth Analg ; 131(4): 1291-1299, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32925350

RESUMO

BACKGROUND: Neonatal exposure to sevoflurane induces neurobehavioral and neuroendocrine abnormalities in exposed male rats (generation F0) and neurobehavioral, but not neuroendocrine, abnormalities in their male, but not female, offspring (generation F1). These effects of sevoflurane are accompanied by a hypermethylated neuron-specific K-2Cl (Kcc2) Cl exporter gene in the F0 spermatozoa and the F1 male hypothalamus, while the gene's expression is reduced in the F0 and F1 hypothalamus. We investigated whether inhibition of deoxyribonucleic acid methyltransferases (DNMTs) before paternal sevoflurane exposure could alleviate the anesthetic's F0 and F1 effects. METHODS: Sprague-Dawley male rats were anesthetized with 2.1% sevoflurane for 5 hours on postnatal day (P) 5 and mated with control females on P90 to generate offspring. The nonselective DNMT inhibitor decitabine (0.5 mg/kg, intraperitoneally) was administered 30 minutes before sevoflurane exposure. The F0 and F1 male rats were evaluated in in vivo and in vitro tests in adulthood. RESULTS: Paternal exposure to sevoflurane induced impaired prepulse inhibition of the acoustic startle response and exacerbated corticosterone responses to stress in F0 males and impaired prepulse inhibition of the startle responses in F1 males. These effects were accompanied in both generations by reduced and increased expressions of hypothalamic Kcc2 and Dnmt3a/b, respectively. Decitabine deterred the effects of paternal exposure to sevoflurane in F0 and F1 males. CONCLUSIONS: These results suggest that similar decitabine-sensitive mechanisms regulating expression of multiple genes are involved in the mediation of neurobehavioral abnormalities in sires neonatally exposed to sevoflurane and in their future unexposed male offspring.


Assuntos
Anestesia por Inalação/efeitos adversos , Anestésicos Inalatórios/efeitos adversos , Antimetabólitos Antineoplásicos/uso terapêutico , Decitabina/uso terapêutico , Exposição Paterna/efeitos adversos , Sevoflurano/efeitos adversos , Animais , Animais Recém-Nascidos , Corticosterona/metabolismo , Metilases de Modificação do DNA/antagonistas & inibidores , Feminino , Masculino , Ratos , Ratos Sprague-Dawley , Reflexo de Sobressalto/efeitos dos fármacos , Estresse Psicológico/metabolismo , Simportadores/antagonistas & inibidores
20.
Khirurgiia (Mosk) ; (8): 69-74, 2020.
Artigo em Russo | MEDLINE | ID: mdl-32869618

RESUMO

OBJECTIVE: To substantiate the advisability of using cytoflavin to correct postoperative cognitive dysfunction (POCD) in patients undergoing video laparoscopic cholecystectomy (VLCE) under conditions of inhalation anesthesia with sevoflurane. MATERIAL AND METHODS: The data of two representative groups of patients (n=60) who underwent video-laparoscopic cholecystectomy under the conditions of inhalation anesthesia with sevoflurane were analyzed. At the stages of the perioperative period, in order to monitor the state of higher mental functions, neuropsychological testing was performed: anxiety and depression scales (HADS), the Montreal scale of cognitive dysfunction (MoCA), and frontal dysfunction batteries (FAB). Patients of the first group (n=19) were not corrected for POKD. For the correction of cognitive impairment, patients of the second group (n=41) were treated with Cytoflavin according to the 20 ml regimen per 250 ml of 0.9% sodium chloride solution intravenously once before the operation, then within 4 days of the postoperative period. RESULTS: Neuropsychological testing in group I patients revealed the development of moderate POCD. The inclusion of Cytoflavin in the treatment regimen in the II group of patients contributed to an improvement in the state of HMF, accompanied by a decrease in the level of anxiety and depression. CONCLUSION: The inclusion of Cytoflavin in treatment regimens helps prevent the development of POKD and is accompanied by an improvement in the state of higher mental functions, which is manifested by a decrease in the level of anxiety and depression, favorably affecting the emotional background of patients.


Assuntos
Anestésicos Inalatórios/efeitos adversos , Colecistectomia Laparoscópica , Transtornos Cognitivos/terapia , Mononucleotídeo de Flavina/administração & dosagem , Inosina Difosfato/administração & dosagem , Fármacos Neuroprotetores/administração & dosagem , Niacinamida/administração & dosagem , Sevoflurano/efeitos adversos , Succinatos/administração & dosagem , Anestesia por Inalação/efeitos adversos , Anestesia por Inalação/métodos , Colecistectomia Laparoscópica/efeitos adversos , Colecistectomia Laparoscópica/métodos , Transtornos Cognitivos/induzido quimicamente , Transtornos Cognitivos/diagnóstico , Transtornos Cognitivos/etiologia , Combinação de Medicamentos , Humanos , Cirurgia Vídeoassistida
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