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1.
Nan Fang Yi Ke Da Xue Xue Bao ; 42(4): 591-597, 2022 Apr 20.
Artigo em Chinês | MEDLINE | ID: mdl-35527496

RESUMO

OBJECTIVE: To evaluate the impact of a history of vaginal delivery on anesthesia management of patients undergoing hysteroscopic surgery under intravenous general anesthesia without tracheal intubation. METHODS: Ninety-nine patients undergoing hysteroscopic surgery under intravenous general anesthesia were enrolled in this study, including 43 patients with (VD group) and 56 patients without a history of vaginal delivery (NVD group). For all the patients, blood pressure, heart rate (HR), blood oxygen saturation (SpO2) and bispectral index (BIS) were recorded before anesthesia (T1), after anesthesia (T2), after cervical dilation (T3), and at 3 min after cervical dilation (T4). Propofol and etomidate doses during anesthesia induction, the total dose of propofol administered, additional intraoperative bolus dose and times of propofol, intraoperative body movement, total operation time and surgeons' satisfaction feedback scores were compared between the two groups. The postoperative awake time, recovery time, VAS score at 30 min after operation, and postoperative nausea and vomiting (PONV) were also compared. RESULTS: There was no significant differences in SBP, DBP, HR, SpO2, or BIS between the two groups at T1 and T2, but at T3 and T4, SBP and DBP were significantly higher in NVD group than in VD group (P < 0.01); HR was significantly higher in NVD group only at T3 (P < 0.01). The application of vasoactive drugs did not differ significantly between the two groups. The total dose of propofol, additional intraoperative dose and times of propofol were all greater in NVD group than in VD group (P < 0.01). More body movements of the patients were observed in NVD group (P < 0.01), which also had lower surgeons' satisfaction score for anesthesia (P < 0.01), higher postoperative VAS score (P < 0.05), and shorter postoperative awake time (P < 0.05) and recovery time (P < 0.01). CONCLUSION: A history of vaginal delivery has a significant impact on anesthesia management of patients undergoing hysteroscopic surgery under intravenous general anesthesia without tracheal intubation in terms of hemodynamic changes, anesthetic medication, and postoperative recovery quality, suggesting the necessity of individualized anesthesia management for these patients.


Assuntos
Propofol , Anestesia Geral , Anestesia Intravenosa , Anestésicos Intravenosos , Estudos de Coortes , Parto Obstétrico , Feminino , Humanos , Histeroscopia , Gravidez
2.
Anesth Prog ; 69(1): 18-23, 2022 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-35377932

RESUMO

OBJECTIVE: The incidence of postoperative nausea and vomiting (PONV) after general anesthesia with total intravenous anesthesia (TIVA) was reported to be significantly lower than with volatile inhalational agents (13.3% vs 25%). However, no investigation of PONV risk factors associated with TIVA has ever been reported. This cross-sectional retrospective study aimed to investigate whether known risk factors influenced PONV in intubated general anesthetics utilizing TIVA for dental or oral and maxillofacial surgery. METHODS: Subjects were 761 patients who underwent dental or oral and maxillofacial surgery under TIVA with propofol, fentanyl, and remifentanil. Univariate and multivariable logistic regression analyses were performed using PONV (within 24 hours) as the dependent variable and previously reported risk factors as independent variables. RESULTS: Age (odds ratio [OR]: 1.020 per year decrease; 95% confidence interval [CI]: 1.0002-1.0418; P = .047) and female sex (OR: 2.73; 95% CI: 1.60-4.84; P < .001) were positively associated with PONV. Sagittal split ramus osteotomy (SSRO) (OR: 2.28; 95% CI: 1.21-4.33; P = .011) and bimaxillary osteotomy (OR: 5.69; 95% CI: 2.09-15.99; P < .001) were more likely to be associated with PONV than operations that were neither bimaxillary osteotomy nor SSRO. Late PONV (2-24 hours) had an ∼2.7 times higher incidence than early PONV (0-2 hours). CONCLUSION: These findings suggest further PONV countermeasures, aside from TIVA with propofol and prophylactic antiemetics for orthognathic surgeries especially bimaxillary osteotomy, are needed.


Assuntos
Procedimentos Cirúrgicos Bucais , Cirurgia Bucal , Anestesia Geral/efeitos adversos , Anestesia Intravenosa/efeitos adversos , Estudos Transversais , Feminino , Humanos , Procedimentos Cirúrgicos Bucais/efeitos adversos , Náusea e Vômito Pós-Operatórios/epidemiologia , Náusea e Vômito Pós-Operatórios/etiologia , Náusea e Vômito Pós-Operatórios/prevenção & controle , Estudos Retrospectivos , Fatores de Risco
3.
BMC Vet Res ; 18(1): 134, 2022 Apr 11.
Artigo em Inglês | MEDLINE | ID: mdl-35410207

RESUMO

BACKGROUND: The present study aimed to investigate the effect of endotracheal intubation on nasal and tracheal endogenous NO concentrations, gas exchange and oxygenation in horses undergoing general anaesthesia. In many species a major part of physiological nitric oxide (NO) production takes place in the nasopharynx. Inhaled NO acts as a pulmonary vasodilator and regulates lung perfusion and endotracheal intubation bypasses the nasopharynx. Six horses were randomly assigned to either the "intubated" (INT) or the "non-intubated" (nINT) treatment group. Horses were premedicated with dexmedetomidine (5 µg/kg IV). Anaesthesia was induced with 2.5 mg/kg ketamine and 0.05 mg/kg diazepam IV, and it was maintained by administration of a triple-drip (100 mg/kg/h guaifenesin, 4 mg/kg/h ketamine, 7 µg/kg/h dexmedetomidine). The horses were spontaneously breathing room air. Heart rate, cardiac output, arterial blood pressure, pulmonary arterial blood pressures and respiratory rate were recorded during a 100-min anaesthesia period. Arterial, venous and mixed venous blood samples were taken every 10 minutes and analysed for partial pressure of oxygen (PO2) and carbon dioxide (PCO2), oxygen saturation and haemoglobin content. Standard oxygenation indices were calculated. Nasal and tracheal endogenous NO concentration was determined by chemiluminescence. RESULTS: Cardiovascular variables, respiratory rate, PO2, PCO2, oxygen saturation, haemoglobin content, CaO2, O2ER, P(a-ET)CO2 and Qs/Qt did not differ significantly between the two treatment groups. The P(A-a)O2 was significantly higher in INT (6.1 ± 0.3 kPa) compared to nINT (4.9 ± 0.1 kPa) (p = 0.045), respectively. The nasal (8.0 ± 6.2 ppb) and tracheal (13.0 ± 6.3 ppb) endogenous NO concentration differed significantly in INT (p = 0.036), but not in nINT (nasal: 16.9 ± 9.0 ppb; tracheal: 18.5 ± 9.5 ppb) (p = 0.215). CONCLUSION: Endotracheal intubation reduces the nasal and tracheal endogenous NO concentration. The influence on pulmonary gas exchange and oxygenation is negligible in horses breathing room air.


Assuntos
Dexmedetomidina , Ketamina , Anestesia Geral/veterinária , Anestesia Intravenosa/veterinária , Animais , Dexmedetomidina/farmacologia , Cavalos , Ketamina/farmacologia , Pulmão , Óxido Nítrico , Oxigênio , Respiração
4.
J Healthc Eng ; 2022: 4696128, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35388314

RESUMO

Laparoscopic surgery has the advantages of less trauma and quick recovery, and it is more and more favored by surgeons and patients in clinical practice. However, the impact of carbon dioxide pneumoperitoneum on the body during laparoscopic surgery has attracted the attention of many scholars. Pneumoperitoneum can cause increased cerebral blood flow and increased intracranial pressure, cerebral metabolic rate is highly correlated with blood carbon dioxide partial pressure, and cerebral metabolism without cardiopulmonary bypass is linearly correlated with the depth of anesthesia. Electroencephalographic (EEG) bispectral index (BIS) is a signal analysis method, which can directly measure the effect of drugs on the cerebral cortex and reflect the depth of anesthesia. Based on this, this study takes smart medical treatment as the background and uses the improved BP neural network as a tool to explore the effect of carbon dioxide on EEG bispectral index under intravenous target-controlled anesthesia. The main purpose is to observe the correlation between arterial blood carbon dioxide partial pressure and EEG bispectral index under propofol target-controlled anesthesia during retroperitoneal laparoscopic surgery. The experimental results show that the model proposed in this study can efficiently and accurately obtain the size of the influencing factors, which provides a clinical basis for the anesthesia management and anesthesia depth regulation of carbon dioxide pneumoperitoneum laparoscopic surgery.


Assuntos
Anestesia , Pneumoperitônio , Anestesia Intravenosa , Dióxido de Carbono , Eletroencefalografia/métodos , Humanos
5.
J Healthc Eng ; 2022: 5463986, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35345654

RESUMO

To investigate the effects of dexmedetomidine combined with intravenous anesthesia on oxidative emergency indicators, postoperative sleep quality, and brain function in patients with hypertensive cerebral hemorrhage (HICH), a total of 285 HICH patients admitted to our hospital from February 2020 to February 2021 were selected. The combined anesthesia group (n = 142) and the control group (n = 143) were established by the random number table method. The control group received conventional intravenous anesthesia, and the combined anesthesia group received dexmedetomidine combined intravenous anesthesia. Two groups of patients before and after operation was observed vital signs, oxidative stress index difference, comparing each time, the change of the two groups of brain function index, adverse reactions occurred between observation group, and the postoperative period of Pittsburgh Sleep Quality Index Scale (PSQI) score as a result, the Pearson correlation coefficient analysis of oxidative stress level and the correlation of HICH patients sleep quality. After operation, the mean arterial pressure (MAP) and heart rate (HR) of patients in both groups decreased significantly. The MAP level in the combined anesthesia group significantly increased compared to the control group, and the HR level decreased significantly than the control group (all P < 0.05). The levels of TNF-α, IL-6 and MDA in both groups increased significantly on day 7 after operation compared with before operation, but the indexes in the combined anesthesia group significantly decreased compared with the control group (P < 0.05). The level of superoxide dismutase (SOD) in both groups significantly decreased compared to that before operation, and the index value in combined anesthesia group significantly increased compared to that in the control group (P < 0.05). After surgery, the levels of central nerve specific protein (S100-ß) and neuron specific enolase (NSE) in 2 groups increased with time, and the indexes in the combined anesthesia group significantly decreased compared to the control group (all P < 0.05). The incidence of adr in combined anesthesia group decreased significantly than that in control group (P < 0.05). After surgery, PSQI scores of the two groups showed a downward trend with time extension, and scores of the combined anesthesia group decreased significantly than those of the control group at 24 h, 48 h and 7 d after surgery (all P < 0.05). Pearson's correlation coefficient was used to analyze that TNF-α, IL-6, and MDA levels were positively correlated with PSQI score, while SOD level was negatively correlated with PSQI score (all P < 0.05). Dexmedetomidine combined with intravenous anesthesia can significantly improve the vital signs and oxidative stress response of HICH patients, effectively reduce the risk of adverse reactions, have little impact on the brain function of patients, and can improve the postoperative sleep quality of patients. This operation is worthy of clinical application. In addition, this study further analyzed the influence mechanism of postoperative sleep quality in patients with HICH and showed that TNF-α, IL-6, MDA, and SOD were all correlated with sleep quality in patients with HICH, suggesting that follow-up detection of these indicators has positive significance in improving the prognosis of patients.


Assuntos
Dexmedetomidina , Anestesia Intravenosa , Encéfalo , Dexmedetomidina/uso terapêutico , Humanos , Interleucina-6 , Estresse Oxidativo , Período Pós-Operatório , Superóxido Dismutase , Fator de Necrose Tumoral alfa
6.
Vet Anaesth Analg ; 49(3): 308-312, 2022 May.
Artigo em Inglês | MEDLINE | ID: mdl-35227614

RESUMO

OBJECTIVE: To evaluate alfaxalone for total intravenous anesthesia (TIVA) in rabbits premedicated with dexmedetomidine or dexmedetomidine and buprenorphine. STUDY DESIGN: Crossover study (part 1) with observational study (part 2). ANIMALS: A total of eight New Zealand White rabbits (Oryctolagus cuniculus), four female and four male, aged 12-16 weeks and weighing 2.8-3.5 kg in part 1. Separately, four additional rabbits in part 2. METHODS: Crossover study design with eight rabbits per treatment. Rabbits were administered treatment D, dexmedetomidine (0.2 mg kg-1), or treatment DB, dexmedetomidine (0.1 mg kg-1) and buprenorphine (0.05 mg kg-1) intramuscularly. Anesthesia was induced with alfaxalone intravenously until a supraglottic airway device was placed to deliver 100% oxygen. Anesthesia was maintained with alfaxalone (TIVA). Infusion rates were adjusted to achieve an absent pedal withdrawal reflex. Heart rate, respiratory rate, noninvasive blood pressure, end-tidal carbon dioxide partial pressure and peripheral hemoglobin oxygen saturation (SpO2) were recorded every 5 minutes. Subsequently, four rabbits underwent ovariohysterectomy using treatment DB and alfaxalone TIVA. RESULTS: The mean ± standard deviation alfaxalone infusion rate was 9.6 ± 2.6 and 4.5 ± 1.3 mg kg-1 hour-1 for treatments D and DB, respectively. In both treatments, blood pressure remained within acceptable range and SpO2 was > 95%. Postinduction apnea and respiratory depression were observed in both treatments and managed with manual positive pressure ventilation. Four separate rabbits underwent successful ovariohysterectomy with treatment DB and alfaxalone TIVA. One rabbit required supplementation with inhalant anesthesia; three rabbits were successfully maintained using alfaxalone TIVA alone. CONCLUSIONS AND CLINICAL RELEVANCE: Premedication with dexmedetomidine-buprenorphine combined with alfaxalone TIVA may be a viable alternative for performing abdominal surgery in the rabbit. The use of supplemental oxygen and ability to provide respiratory support are advised.


Assuntos
Buprenorfina , Dexmedetomidina , Pregnanodionas , Anestesia Geral/veterinária , Anestesia Intravenosa/veterinária , Animais , Estudos Cross-Over , Feminino , Masculino , Oxigênio , Coelhos
7.
Comput Biol Med ; 144: 105289, 2022 05.
Artigo em Inglês | MEDLINE | ID: mdl-35247765

RESUMO

During closed-loop induction of anesthesia a closed-loop system will typically administer propofol to bring a patient to a target depth of hypnosis, or reference point, as quickly as possible while minimizing overshoot. Infusion rates are modified in response to patient feedback to maintain the patient at the reference point. In many cases, rapid inductions may be ideal. In some populations and contexts, however, slower inductions may be preferable and result in better patient outcomes. We introduce a framework for explicitly defining and optimizing clinical outcomes of interest during closed-loop inductions. The central innovation is to replace the traditional fixed reference point with a parametric, time-varying reference function. The parameters of the reference function are then selected to minimize an objective function that encapsulates a clinical goal for the population. We consider as objectives 1) combinations of over- and under-shoot of the target depth of hypnosis, 2) time to stably reach the target, and 3) the amount of propofol administered. By incorporating population variability in the objective function, the resulting reference function defines an optimal dosing protocol for a specific outcome in the target population. We illustrate this approach by simulating closed-loop inductions for a constructed population of synthetic patients. The population is split into training and test sets that are used to identify and evaluate optimal reference functions, respectively. Reference function performance is compared to a standard approach of targeting a fixed reference point, corresponding to a rapid-induction strategy. The outcome of interest was almost always minimized in the test set by use of a reference function with less variability between patients. Our simulations suggest that reference functions can be an effective method of achieving clinical goals when induction speed is not the only priority.


Assuntos
Anestesia , Propofol , Anestesia Intravenosa/métodos , Anestésicos Intravenosos , Eletroencefalografia , Humanos
8.
Vet Anaesth Analg ; 49(3): 282-290, 2022 May.
Artigo em Inglês | MEDLINE | ID: mdl-35279356

RESUMO

OBJECTIVE: To determine the effects of intravenous ethyl pyruvate, an anti-inflammatory with putative benefits in horses with endotoxemia, on cardiopulmonary variables during anesthesia and the quality of anesthetic recovery. STUDY DESIGN: Randomized, crossover, blinded experimental design. ANIMALS: A total of six healthy Standardbred geldings, aged 13 ± 3 years and weighing 507 ± 66 kg (mean ± standard deviation). METHODS: Horses were anesthetized for approximately 90 minutes on two occasions with a minimum of 2 weeks apart using xylazine for sedation, ketamine and diazepam for induction, and isoflurane in oxygen for maintenance. Lactated Ringer's solution (LRS; 10 mL kg-1 hour-1) was administered during anesthesia. Treatments were randomized and administered starting approximately 30 minutes after induction of anesthesia and infused over 60 minutes: LRS (1 L) or ethyl pyruvate (150 mg kg-1 in 1 L LRS). Invasive arterial pressures, heart rate, respiratory rate and end-tidal carbon dioxide tensions were recorded every 5 minutes for the duration of anesthesia. Arterial blood gases, glucose and lactate concentrations were measured every 20 minutes. Anesthetic recovery was video recorded, stored, and subsequently rated by two individuals blinded to treatments. Total recovery time, time to extubation, number of attempts and time to sternal recumbency, number of attempts to stand and time to stand were recorded. Quality of recovery was analyzed. Data between treatments and within a treatment were assessed using two-way repeated-measures anova and a Pearson correlation coefficient, significant at p < 0.05. RESULTS: All horses completed the study. No significant differences were detected between the ethyl pyruvate and LRS treatments for either the cardiopulmonary variables or quality of recovery from anesthesia. CONCLUSIONS AND CLINICAL RELEVANCE: The results suggest that intravenous ethyl pyruvate can be administered to healthy anesthetized horses with minimal impact on the cardiopulmonary variables studied or the quality of recovery from anesthesia.


Assuntos
Anestesia , Isoflurano , Anestesia/veterinária , Período de Recuperação da Anestesia , Anestesia Intravenosa/veterinária , Animais , Pressão Sanguínea , Frequência Cardíaca , Cavalos , Masculino , Piruvatos , Xilazina/farmacologia
10.
Bioorg Med Chem Lett ; 60: 128587, 2022 03 15.
Artigo em Inglês | MEDLINE | ID: mdl-35091071

RESUMO

A series of novel procaine derivatives for intravenous anesthesia were prepared and evaluated by physicochemical properties and pharmacodynamic experiments in vivo and in vitro. Systematic optimization of procaine led to the identification of 6f, 6g, 6h, 6o, 6p and 6q with higher TI value and moderate log D. Compared with procaine (TI = 1.65), most procaine derivatives demonstrated better security, among whichcompound 6h (TI = 2.68)was the most notable one and showed fewer adverse events in animals. The result of hNR2B-HEK293 assay indicated that compound 6h suppressed the NMDA receptor 2B subtype channel activity and it showed more than 80% inhibitory effect at the concentration of 500 µM.


Assuntos
Desenho de Fármacos , Procaína/farmacologia , Receptores de N-Metil-D-Aspartato/antagonistas & inibidores , Anestesia Intravenosa , Animais , Relação Dose-Resposta a Droga , Células HEK293 , Humanos , Estrutura Molecular , Procaína/administração & dosagem , Procaína/química , Ratos , Receptores de N-Metil-D-Aspartato/metabolismo , Relação Estrutura-Atividade , Distribuição Tecidual
11.
Ann Card Anaesth ; 25(1): 61-66, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35075022

RESUMO

BACKGROUND: Measurement of biomarkers representing sympathetic tone and the surgical stress response are helpful for objective comparison of anesthetic protocols. AIMS: The primary aim was to compare changes in chromogranin A levels following pump pediatric cardiac surgery between children who received bolus caudal morphine and those who received a conventional intravenous narcotic-based anesthesia regime. The secondary objectives were to compare hemodynamic responses to skin incision and the magnitude of the rise in blood sugar values between the groups. SETTINGS AND DESIGN: A prospective observational study at a tertiary cardiac center. MEASUREMENTS AND METHODS: Sixty pediatric cardiac surgical patients were randomized to Group I [n= 30] to receive intravenous narcotic-based anesthesia and Group II [n = 30] to receive single-shot caudal morphine. Baseline and postoperative chromogranin A levels, the hemodynamic response to skin incision, changes in blood sugar levels, and the total intravenous narcotic dose administered were recorded for each participant. STATISTICAL ANALYSIS: Pearson's Chi-squared test was used for comparison of categorized variables, and Mann-Whitney test was used for the analysis of continuous data. RESULTS: Changes in chromogranin A levels and blood sugar levels were comparable in both groups. Group II received a lower narcotic dosage (P ≤ 0.001), and the response to skin incision as reflected by systolic pressure rise was less (P = 0.006). CONCLUSIONS: Surgical stress response attenuation was similar to caudal morphine as compared with intravenous narcotic-based anesthesia techniques as reflected by a similar increase in chromogranin A levels.


Assuntos
Procedimentos Cirúrgicos Cardíacos , Morfina , Analgésicos Opioides/uso terapêutico , Anestesia Intravenosa , Biomarcadores , Criança , Humanos , Dor Pós-Operatória/tratamento farmacológico , Estudos Prospectivos
12.
Ann Card Anaesth ; 25(1): 112-115, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35075034

RESUMO

Various drugs, including anesthetic agents, can cause parosmia in the perioperative period. There are reported cases of patients with alterations of smell and taste due to local anesthetics, nerve damage, or as a side effect of general anesthesia. We present a case of a 58-year-old male who developed parosmia and dysgeusia in the postoperative period after radical nephrectomy and inferior vena cava thrombectomy. The anesthetics used were fentanyl and propofol for general anesthesia and ropivacaine for epidural analgesia. Clinical examination did not reveal any pathology.


Assuntos
Transtornos do Olfato , Propofol , Anestesia Geral/efeitos adversos , Anestesia Intravenosa , Anestésicos Intravenosos/efeitos adversos , Anestésicos Locais/uso terapêutico , Disgeusia/tratamento farmacológico , Fentanila/efeitos adversos , Humanos , Masculino , Pessoa de Meia-Idade , Transtornos do Olfato/tratamento farmacológico , Dor Pós-Operatória/tratamento farmacológico , Propofol/efeitos adversos
14.
Semina cienc. biol. saude ; 43(1): 167-176, jan./jun. 2022. ilus, tab
Artigo em Português | LILACS | ID: biblio-1354480

RESUMO

Animais presentes em zoológicos frequentemente necessitam de captura e anestesia para a realização de procedimentos clínicos e cirúrgicos. A anestesia total intravenosa apresenta vantagens como redução do estresse cirúrgico e menor depressão cardiovascular e respiratória. Entretanto, ainda são escassas as pesquisas dedicadas dentro deste contexto. Nesse sentido, o objetivo deste relato foi avaliar o protocolo anestésico empregado, visando um procedimento seguro e passível de reversão para a espécie silvestre selecionada. Acompanhou-se a anestesia de um leão (Panthera leo), macho, adulto, proveniente do Zoológico Municipal de Curitiba, submetido a procedimento endodôntico. A medicação pré-anestésica constituiu-se de dexmedetomidina (6 µg/kg), metadona (0,2 mg/kg), midazolam (0,1 mg/kg) e tiletamina-zolazepam (1,2 mg/kg). A indução foi realizada com propofol (1,5 mg/kg) e o animal foi intubado. Visando promover analgesia local, foi realizado bloqueio infraorbitário esquerdo com 5 mL de lidocaína a 2%. A manutenção foi realizada por meio do fornecimento de propofol (0,02-0,1 mg/kg/h), dexmedetomidina (0,5 µg/kg/h) e remifentanil (5 µg/kg/h). O paciente apresentou sedação profunda e foi mantido em plano anestésico cirúrgico; todos os parâmetros fisiológicos monitorados permaneceram estáveis durante todo o procedimento. Após 55 minutos de anestesia o paciente apresentava sustentação espontânea da cabeça, quando foi novamente transportado ao zoológico para soltura no recinto. A ambulação foi considerada normal pelos observadores no zoológico seis horas após a anestesia. Pôde-se concluir que o protocolo realizado se mostrou tanto eficaz quanto seguro para a referida espécie encaminhada ao procedimento em questão.


Zoo animals often require capture and anesthesia in order to undergo clinical and surgical procedures. Total intravenous anesthesia has advantages such as reduced surgical stress and less cardiovascular and respiratory depression. However, specific research on this matter is still scarce. Therefore, the present report aims to evaluate the anesthetic protocol employed, seeking a safe and reversible procedure for the selected wild species. A male adult lion (Panthera leo), from the Zoológico Municipal de Curitiba, was subjected to an endodontic anesthesia, under close monitoring. The pre-anesthetic medication consisted of dexmedetomidine (6 µg/kg), methadone (0.2 mg/kg), midazolam (0.1 mg/kg) and tiletamine-zolazepam (12 mg/kg). Induction was performed with propofol (1 mg/kg) and the animal was intubated. In order to promote local analgesia, a left infraorbital block was implemented with 5 mL of 2% lidocaine. Maintenance was undertaken by supplying propofol (0.02-0.1 mg/kg/min), dexmedetomidine (0.5 µg/kg/h) and remifentanil (5 µg/kg/h). The patient exhibited deep sedation and followed the surgical anesthetic plan; all the monitored physiological parameters remained stable throughout the procedure. After 55 minutes of anesthesia the patient showed spontaneous head support, when it was transported back to the zoo. The ambulation was considered normal by the zoo observers 6 hours after the anesthesia. It was concluded that the protocol was both effective and safe for the referred species undergone the procedure reported.


Assuntos
Animais , Medicação Pré-Anestésica , Tiletamina , Zolazepam , Propofol , Dexmedetomidina , Analgesia , Anestesia , Anestesia Intravenosa , Anestésicos , Animais de Zoológico
15.
Artigo em Inglês | Sec. Est. Saúde SP, Sec. Est. Saúde SP, CONASS, SESSP-IDPCPROD, Sec. Est. Saúde SP | ID: biblio-1359687

RESUMO

OBJECTIVE: To investigate the effect of volatile anesthetics on the rates of postoperative myocardial infarction (MI) and cardiac death after coronary artery bypass graft (CABG). DESIGN: A post hoc analysis of a randomized trial. SETTING: Cardiac surgical operating rooms. PARTICIPANTS: Patients undergoing elective, isolated CABG. INTERVENTIONS: Patients were randomized to receive a volatile anesthetic (desflurane, isoflurane, or sevoflurane) or total intravenous anesthesia (TIVA). The primary outcome was hemodynamically relevant MI (MI requiring high-dose inotropic support or prolonged intensive care unit stay) occurring within 48 hours from surgery. The secondary outcome was 1-year death due to cardiac causes. Measurements and main Results: A total of 5,400 patients were enrolled between April 2014 and September 2017 (2,709 patients randomized to the volatile anesthetics group and 2,691 to TIVA). The mean age was 62 ± 8.4 years, and the median baseline ejection fraction was 57% (50-67), without differences between the 2 groups. Patients in the volatile group had a lower incidence of MI with hemodynamic complications both in the per-protocol (14 of 2,530 [0.6%] v 27 of 2,501 [1.1%] in the TIVA group; p = 0.038) and as-treated analyses (16 of 2,708 [0.6%] v 29 of 2,617 [1.1%] in the TIVA group; p = 0.039), but not in the intention-to-treat analysis (17 of 2,663 [0.6%] v 28 of 2,667 [1.0%] in the TIVA group; p = 0.10). Overall, deaths due to cardiac causes were lower in the volatile group (23 of 2,685 [0.9%] v 40 of 2,668 [1.5%] than in the TIVA group; p = 0.03). CONCLUSIONS: An anesthetic regimen, including volatile agents, may be associated with a lower rate of postoperative MI with hemodynamic complication in patients undergoing CABG. Furthermore, it may reduce long-term cardiac mortality.


Assuntos
Transplantes , Desflurano , Anestesia Intravenosa , Anestésicos
16.
Curr Opin Anaesthesiol ; 35(1): 18-35, 2022 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-34873076

RESUMO

PURPOSE OF REVIEW: Perioperative myocardial injury related to cardiac surgery is associated with organ dysfunction and increased mortality. Volatile anesthetics (VA) have been used during cardiac surgery for decades because of their direct and indirect preconditioning and protection against ischemia-reperfusion injury. The current review provides a summary of the latest literature comparing pharmacological preconditioning and the potential benefits of using VA versus total intravenous anesthesia (TIVA) for general anesthesia to improve outcomes after cardiac surgery. RECENT FINDINGS: Recent literature reports lower mortality and better outcomes when VA is used alone or in combination with remote ischemic preconditioning compared with groups receiving TIVA. However, inconsistent research findings over the years have led to continued debate regarding the anesthetic technique considered more favorable for cardiac surgery. SUMMARY: Research findings regarding the use of volatile anesthetic versus TIVA for better outcomes after cardiac surgery are inconsistent. Variability in timing, duration, dosing, and type of VA as well as surgical and patient-related factors may have influenced these results. Therefore, either technique can reasonably be adopted depending on provider and institutional preference and used safely in patients undergoing cardiac surgery.


Assuntos
Anestésicos Inalatórios , Procedimentos Cirúrgicos Cardíacos , Precondicionamento Isquêmico , Anestesia Geral , Anestesia Intravenosa , Anestésicos Inalatórios/efeitos adversos , Anestésicos Intravenosos/efeitos adversos , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Humanos
17.
Anesth Analg ; 134(3): 615-623, 2022 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-34878412

RESUMO

BACKGROUND: Hypoxemia can occur during gastroscopy under intravenous anesthesia. The aim of this randomized controlled trial was to evaluate whether oxygenation using a nasal mask can reduce the incidence of hypoxemia during gastroscopy under intravenous anesthesia compared with a traditional nasal cannula. METHODS: A total of 574 patients scheduled for gastroscopy under intravenous anesthesia were enrolled and randomly assigned to receive either a nasal mask or a traditional nasal cannula for oxygenation. The primary outcome was the incidence of hypoxemia. The secondary outcomes included the incidence of severe hypoxemia, duration of hypoxemia, minimum oxygen saturation, the proportion of emergency airway management, length of procedure, recovery time, and the satisfaction of the anesthetist and gastroenterologists as well as other adverse events (including cough, hiccups, nausea and vomiting, reflux, aspiration, and laryngospasm). RESULTS: A total of 565 patients were included in the analysis: 282 patients in the nasal cannula group and 283 patients in the nasal mask group. The incidence of hypoxemia was lower in the nasal mask group (18.0%) than in the nasal cannula group (27.7%; relative risk [RR] = 0.65; 95% confidence interval [CI], 0.48-0.89; P = .006), and the hypoxemia lasted a median of 18.0 seconds (interquartile range, 10.0-38.8) in the nasal mask group and 32.5 seconds (20.0-53.5) in the nasal cannula group (median difference -14.50; 95% CI, -22.82 to -1.34; P = .047). The proportion of patients requiring emergency airway management was significantly lower in the nasal mask group (8.8%) than in the nasal cannula group (19.1%; RR, 0.46; 95% CI, 0.30-0.73; P < .001). No difference was found in the overall incidence of other adverse events between the 2 groups (nasal mask 20.8%; nasal cannula 17.0%; RR, 1.23; 95% CI, 0.87-1.73; P = .25). Satisfaction was higher with the nasal mask than with the nasal cannula from the perspective of anesthetists (96.1% for nasal mask versus 84.4% for nasal cannula; RR, 1.14; 95% CI, 1.08-1.20; P < .001) and gastroenterologists (95.4% for mask versus 81.9% for cannula; RR, 1.17; 95% CI, 1.10-1.24; P < .001). There were no significant differences in the incidence of severe hypoxemia, minimum oxygen saturation, length of procedure, or recovery time between the 2 groups. CONCLUSIONS: Nasal mask oxygenation reduced the incidence of hypoxemia during anesthesia for gastroscopy under intravenous anesthesia.


Assuntos
Manuseio das Vias Aéreas/métodos , Anestesia Intravenosa/métodos , Gastroscopia/métodos , Hipóxia/epidemiologia , Máscaras , Nariz , Complicações Pós-Operatórias/epidemiologia , Adulto , Período de Recuperação da Anestesia , Anestesiologistas , Cateterismo , Feminino , Gastroenterologistas , Humanos , Hipóxia/etiologia , Incidência , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Oxigênio/sangue , Resultado do Tratamento
18.
J Med Eng Technol ; 46(2): 95-101, 2022 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-34881660

RESUMO

The use of total intravenous anaesthesia (TIVA) is limited by concerns of disconnections of the tubing, resulting in accidental awareness. We designed a sensor device to detect leakages at the patient end and notify the medical personnel, thereby allowing immediate intervention in preventing awareness. For moisture detection, resistive sensing was selected as the working principle. The prototype was in proximity to the tubing from the TIVA pump and the patient's intravenous cannula, and able to detect leakages in all potential leakage sites and activate an alarm. Our device consists of a disposable bandage (sensor), attached to a reusable clamp that is directly coupled to a central module (SparkFun MicroView, a small microcontroller with built-in Organic Light-Emitting Diode (OLED) display). The disposable bandage is wrapped around the possible leakage sites. Crucially, the disposable bandage is integrated with two separate moisture sensing threads. When moisture is present, the central module detects a drop in resistance across the moisture sensing threads and activates a flashing LED and buzzer. We have successfully created a functional leak detection device, comprising a moisture sensing bandage and an audio and visual alert system, to address the problem of undetected TIVA leakages at the patient end.


Assuntos
Anestesia Intravenosa , Humanos
19.
J Anesth ; 36(1): 96-106, 2022 02.
Artigo em Inglês | MEDLINE | ID: mdl-34739584

RESUMO

PURPOSE: We have developed an automated anesthesia control system that uses biological information to provide closed-loop control of drug administration for total intravenous anesthesia with propofol, remifentanil, and rocuronium. In this study, we investigated whether the control of sedatives, analgesics, and muscle relaxants delivered by this system is non-inferior to that delivered by anesthesiologists. METHODS: During anesthesia management by our automated administration control system and by anesthesiologists, the concentration of each drug at the site of effect (calculated from drug administration history) and biometric information (bispectral index, blood pressure, pulse rate, and single contraction ratio %T1) were tabulated during the period from the start to end of surgery. The primary efficacy endpoint was the ratio of adequate anesthesia time, in which all three factors of sedation, analgesia, and muscle relaxation were maintained within the target range, to the period from the start to end of surgery under total intravenous anesthesia. RESULTS: Percentage of time under appropriate anesthesia was 73.24 ± 17.24 in the automatic group (n = 28) and 59.94 ± 29.06 in the manual group (n = 28). The lower limit of the 97.5% one-sided confidence interval for the difference between the two group means was 0.51%, indicating the non-inferiority of the automatic group to the manual group (p = 0.002). The incidence of adverse events did not differ significantly between the groups. CONCLUSION: The clinical use of our automated anesthesia control system should allow for the maintenance of adequate anesthesia by adjusting the doses of intravenous anesthetics in the same way as anesthesiologists do.


Assuntos
Propofol , Anestesia Intravenosa/efeitos adversos , Anestésicos Intravenosos , Remifentanil , Rocurônio
20.
J Cardiothorac Vasc Anesth ; 36(2): 567-576, 2022 02.
Artigo em Inglês | MEDLINE | ID: mdl-33766470

RESUMO

Postoperative neurologic complications have a significant effect on morbidity, mortality, and long-term disability in patients undergoing cardiac surgery. The etiology of brain injury in patients undergoing cardiac surgery is multifactorial and remains unclear. There are several perioperative causative factors for neurologic complications, including microembolization, hypoperfusion, and systemic inflammatory response syndrome. Despite technologic advances and the development of new anesthetic drugs, there remains a high rate of postoperative neurologic complications. Moreover, despite the strong evidence that volatile anesthesia exerts cardioprotective effects in patients undergoing cardiac surgery, the neuroprotective effects of volatile agents remain unclear. Several studies have reported an association of using volatile anesthetics with improvement of biochemical markers of brain injury and postoperative neurocognitive function. However, there is a need for additional studies to define the optimal anesthetic drug for protecting the brain in patients undergoing cardiac surgery.


Assuntos
Anestesia , Anestésicos Inalatórios , Anestésicos , Procedimentos Cirúrgicos Cardíacos , Anestesia Intravenosa , Anestésicos Intravenosos , Encéfalo , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Humanos
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