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1.
Medicine (Baltimore) ; 100(6): e23570, 2021 Feb 12.
Artigo em Inglês | MEDLINE | ID: mdl-33578509

RESUMO

ABSTRACT: The Gas Man simulation software provides an opportunity to teach, understand and examine the pharmacokinetics of volatile anesthetics. The primary aim of this study was to investigate the accuracy of a cardiac output and alveolar ventilation matched Gas Man model and to compare its predictive performance with the standard pharmacokinetic model using patient data.Therefore, patient data from volatile anesthesia were successively compared to simulated administration of desflurane and sevoflurane for the standard and a parameter-matched simulation model with modified alveolar ventilation and cardiac output. We calculated the root-mean-square deviation (RMSD) between measured and calculated induction, maintenance and elimination and the expiratory decrement times during emergence and recovery for the standard and the parameter-matched model.During induction, RMSDs for the standard Gas Man simulation model were higher than for the parameter-matched Gas Man simulation model [induction (desflurane), standard: 1.8 (0.4) % Atm, parameter-matched: 0.9 (0.5) % Atm., P = .001; induction (sevoflurane), standard: 1.2 (0.9) % Atm, parameter-matched: 0.4 (0.4) % Atm, P = .029]. During elimination, RMSDs for the standard Gas Man simulation model were higher than for the parameter-matched Gas Man simulation model [elimination (desflurane), standard: 0.7 (0.6) % Atm, parameter-matched: 0.2 (0.2) % Atm, P = .001; elimination (sevoflurane), standard: 0.7 (0.5) % Atm, parameter-matched: 0.2 (0.2) % Atm, P = .008]. The RMSDs during the maintenance of anesthesia and the expiratory decrement times during emergence and recovery showed no significant differences between the patient and simulated data for both simulation models.Gas Man simulation software predicts expiratory concentrations of desflurane and sevoflurane in humans with good accuracy, especially when compared to models for intravenous anesthetics. Enhancing the standard model by ventilation and hemodynamic input variables increases the predictive performance of the simulation model. In most patients and clinical scenarios, the predictive performance of the standard Gas Man simulation model will be high enough to estimate pharmacokinetics of desflurane and sevoflurane with appropriate accuracy.


Assuntos
Débito Cardíaco/efeitos dos fármacos , Desflurano/farmacocinética , Expiração/fisiologia , Ventilação Pulmonar/fisiologia , Sevoflurano/farmacocinética , Adulto , Idoso , Algoritmos , Anestésicos Inalatórios/administração & dosagem , Anestésicos Inalatórios/farmacocinética , Débito Cardíaco/fisiologia , Ensaios Clínicos como Assunto , Simulação por Computador/estatística & dados numéricos , Desflurano/administração & dosagem , Quimioterapia Combinada , Feminino , Humanos , Pulmão/metabolismo , Pulmão/fisiologia , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Alvéolos Pulmonares/efeitos dos fármacos , Alvéolos Pulmonares/metabolismo , Alvéolos Pulmonares/fisiologia , Sevoflurano/administração & dosagem
2.
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
3.
Anaesthesia ; 76(1): 45-53, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33253427

RESUMO

Sleep apnoea is associated with negative outcomes following general anaesthesia. Current recommendations suggest using short-acting anaesthetic agents in preference to standard agents to reduce this risk, but there is currently no evidence to support this. This randomised controlled triple-blind trial tested the hypothesis that a combination of short-acting agents (desflurane-remifentanil) would reduce the postoperative impact of general anaesthesia on sleep apnoea severity compared with standard agents (sevoflurane-fentanyl). Sixty patients undergoing hip arthroplasty under general anaesthesia were randomised to anaesthesia with desflurane-remifentanil or sevoflurane-fentanyl. Respiratory polygraphy was performed before surgery and on the first and third postoperative nights. The primary outcome was the supine apnoea-hypopnoea index on the first postoperative night. Secondary outcomes were the supine apnoea-hypopnoea index on the third postoperative night, and the oxygen desaturation index on the first and third postoperative nights. Additional outcomes included intravenous morphine equivalent consumption and pain scores on postoperative days 1, 2 and 3. Pre-operative sleep study data were similar between groups. Mean (95%CI) values for the supine apnoea-hypopnoea index on the first postoperative night were 18.9 (12.7-25.0) and 21.4 (14.2-28.7) events.h-1 , respectively, in the short-acting and standard anaesthesia groups (p = 0.64). Corresponding values on the third postoperative night were 28.1 (15.8-40.3) and 38.0 (18.3-57.6) events.h-1 (p = 0.34). Secondary sleep- and pain-related outcomes were generally similar in the two groups. In conclusion, short-acting anaesthetic agents did not reduce the impact of general anaesthesia on sleep apnoea severity compared with standard agents. These data should prompt an update of current recommendations.


Assuntos
Anestesia Geral/métodos , Apneia Obstrutiva do Sono/prevenção & controle , Adulto , Idoso , Idoso de 80 Anos ou mais , Anestésicos Inalatórios , Anestésicos Intravenosos , Artroplastia de Quadril , Desflurano , Método Duplo-Cego , Feminino , Fentanila , Humanos , Masculino , Pessoa de Meia-Idade , Oxigênio/sangue , Dor Pós-Operatória/epidemiologia , Complicações Pós-Operatórias/fisiopatologia , Complicações Pós-Operatórias/prevenção & controle , Remifentanil , Sevoflurano , Apneia Obstrutiva do Sono/complicações , Apneia Obstrutiva do Sono/fisiopatologia , Decúbito Dorsal , Resultado do Tratamento
5.
Br J Anaesth ; 125(6): 935-942, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-32958203

RESUMO

BACKGROUND: The perfusion index (PI), calculated from the photoplethysmographic waveform, reflects peripheral vasomotor tone. As such, the PI serves as a surrogate for quantitative measures of drug-induced vasoconstriction or vasodilation. This study aimed to compare the effect on the PI of desflurane and sevoflurane at equi-anaesthetic concentrations in patients undergoing single-agent inhalation anaesthesia, where equi-anaesthetic dose was based on the known minimum alveolar concentration of these agents. METHODS: We randomly allocated patients scheduled for arthroscopic knee surgery to receive either desflurane or sevoflurane general anaesthesia after target-controlled induction of anaesthesia with propofol. Anaesthesia was maintained at age-corrected minimum alveolar concentration 1.0, under neuromuscular block (rocuronium). The PI and haemodynamic data were recorded every minute for 35 min after induction of anaesthesia and after standardised nociceptive stimulation. The primary outcome was PI, compared between the groups over time (repeated-measures analysis of variance). Secondary outcomes included MAP and HR. RESULTS: Sixty-nine participants (mean [range] age: 42 yr [19-65 yr]; 49% females) were assigned to either desflurane (n=34) or sevoflurane (n=35). The PI remained higher under desflurane compared with sevoflurane, both before (mean difference [MD]: 3.3; 95% confidence intervals [CIs]: 2.0-4.7; P<0.001) and after tetanic stimulation (MD: 2.8; 95% CI: 2.0-3.7; P<0.001). Higher PI paralleled lower MAP in participants assigned to desflurane anaesthesia (P<0.001), both before (MD: 8 mm Hg; 95% CI: 4-12) and after nociceptive stimulation (MD: 14 mm Hg; 95% CI: 7-22). HR was similar throughout. CONCLUSIONS: These findings suggest that at equipotent doses, desflurane exerts more potent vasodilatory properties and lowers blood pressure by a magnitude potentially associated with harm. CLINICAL TRIAL REGISTRATION: NCT03570164.


Assuntos
Anestésicos Inalatórios/farmacologia , Desflurano/farmacologia , Hemodinâmica/efeitos dos fármacos , Sevoflurano/farmacologia , Vasodilatadores/farmacologia , Adulto , Idoso , Pressão Sanguínea/efeitos dos fármacos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Adulto Jovem
7.
Anesthesiology ; 133(3): 534-547, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32784343

RESUMO

BACKGROUND: According to the "three-compartment" model of ventilation-perfusion ((Equation is included in full-text article.)) inequality, increased (Equation is included in full-text article.)scatter in the lung under general anesthesia is reflected in increased alveolar deadspace fraction (VDA/VA) customarily measured using end-tidal to arterial (A-a) partial pressure gradients for carbon dioxide. A-a gradients for anesthetic agents such as isoflurane are also significant but have been shown to be inconsistent with those for carbon dioxide under the three-compartment theory. The authors hypothesized that three-compartment VDA/VA calculated using partial pressures of four inhalational agents (VDA/VAG) is different from that calculated using carbon dioxide (VDA/VACO2) measurements, but similar to predictions from multicompartment models of physiologically realistic "log-normal" (Equation is included in full-text article.)distributions. METHODS: In an observational study, inspired, end-tidal, arterial, and mixed venous partial pressures of halothane, isoflurane, sevoflurane, or desflurane were measured simultaneously with carbon dioxide in 52 cardiac surgery patients at two centers. VDA/VA was calculated from three-compartment model theory and compared for all gases. Ideal alveolar (PAG) and end-capillary partial pressure (Pc'G) of each agent, theoretically identical, were also calculated from end-tidal and arterial partial pressures adjusted for deadspace and venous admixture. RESULTS: Calculated VDA/VAG was larger (mean ± SD) for halothane (0.47 ± 0.08), isoflurane (0.55 ± 0.09), sevoflurane (0.61 ± 0.10), and desflurane (0.65 ± 0.07) than VDA/VACO2 (0.23 ± 0.07 overall), increasing with lower blood solubility (slope [Cis], -0.096 [-0.133 to -0.059], P < 0.001). There was a significant difference between calculated ideal PAG and Pc'G median [interquartile range], PAG 5.1 [3.7, 8.9] versus Pc'G 4.0[2.5, 6.2], P = 0.011, for all agents combined. The slope of the relationship to solubility was predicted by the log-normal lung model, but with a lower magnitude relative to calculated VDA/VAG. CONCLUSIONS: Alveolar deadspace for anesthetic agents is much larger than for carbon dioxide and related to blood solubility. Unlike the three-compartment model, multicompartment (Equation is included in full-text article.)scatter models explain this from physiologically realistic gas uptake distributions, but suggest a residual factor other than solubility, potentially diffusion limitation, contributes to deadspace.


Assuntos
Anestésicos Inalatórios/farmacocinética , Desflurano/farmacocinética , Halotano/farmacocinética , Isoflurano/farmacocinética , Alvéolos Pulmonares/metabolismo , Sevoflurano/farmacocinética , Idoso , Artérias/fisiologia , Dióxido de Carbono/metabolismo , Feminino , Humanos , Pulmão/metabolismo , Masculino , Pressão Parcial , Estudos Prospectivos , Estudos Retrospectivos
8.
Zhonghua Yi Xue Za Zhi ; 100(29): 2278-2282, 2020 Aug 04.
Artigo em Chinês | MEDLINE | ID: mdl-32746598

RESUMO

Objective: To analyze the effects of desflurane and sevoflurane anesthesia on postoperative recovery after long lasting tumor surgery. Methods: One hundred and sixty patients undergoing endoscopic radical esophagectomy and gastrectomy (80 cases of each surgical type) from November 2019 to March 2020 at Henan Cancer Hospital, were randomized into 4 groups(n=40): group CS (esophageal cancer+sevoflurane anesthesia), group DS (esophageal cancer+desflurane anesthesia),group CW (stomach cancer+sevoflurane anesthesia) and group DW (gastric cancer+desflurane anesthesia). General anesthesia was induced by intravenous agents in all four groups, which were maintained by inhaled anesthetic during the operation. The mean arterial pressure (MAP), heart rate (HR), and surplus pulse O(2) (SpO(2)) immediately before induction (T(1)), the moment of operation begin (T(2)), operation end (T(3)) and extubation (T(4)) were recorded. Also, the duration required for inhalation anesthetic alveolar concentration reaching 0.5 minimum alveolar concentration (MAC) during induction, the alveolar anesthetic concentration at the beginning of the operation, the duration required for XMAC (patients specific alveolar concentration) declining to 0.5 MAC on recovery period, and the duration of alveolar concentration of 0.5 MAC declining to 0.2 MAC were determined. Additionally, the durations of spontaneous breathing recovery, eyes opening, extubation and recovery of consciousness were recorded. Finally, restlessness score (RS) during recovery period was used to evaluate postoperative agitation. Results: Compared with group CS and group CW, no significant differences in MAP, HR, SpO(2) in group DS and group DW at T(1) to T(4) were found (all P>0.05). The durations required for inhalation anesthetic alveolar concentration reaching 0.5 MAC were (5.6±1.3), (5.8±2.1), (3.5±1.5) and (3.8±1.0) min in group CS, group CW, group DS and group DW, where the durations in group DS and group DW were significantly shorter than those in group CS and group CW (F=32.538, P<0.05). The durations of alveolar concentration of 0.5 MAC declining to 0.2 MAC were (6.4±2.2), (7.0±1.5), (4.2±2.2) and (4.1±1.5) min in group CS, group CW, group DS and group DW, and the durations in group DS and group DW were significantly shortened as compared with group CS and group CW (F=42.113, P<0.05). Compared with group CS and group CW, group DS and group DW required significantly shorter time for spontaneous breathing recovery, eye opening,extubation, and directional force recovery after operation (all P<0.05). Conclusions: Both desflurane and sevoflurane anesthesia can achieve satisfactory anesthesia depth during long lasting tumor surgery. Desflurane can shorten the recovery time and early extubation, and improve the quality of recovery.


Assuntos
Período de Recuperação da Anestesia , Anestésicos Inalatórios , Isoflurano , Éteres Metílicos , Neoplasias , Desflurano , Humanos , Sevoflurano
9.
J Biol Regul Homeost Agents ; 34(3): 935-942, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32693566

RESUMO

The purpose of this study was to investigate the effect of desflurane (Des) pretreatment on sepsisevoked lung injury in rats and its mechanism. The rat model of sepsis-evoked lung injury was prepared using lipopolysaccharide (LPS), while rat lung mesenchymal cell (MSC) model was cultured in vitro, followed by Des pretreatment or inhibitor S31-201 culture. The degree of lung tissue injury was analyzed by Hematoxylin-eosin (HE) staining. The expression levels of interleukin (IL)-6, IL-1ß and tumor necrosis factor (TNF)-α in the serum of rats were detected by enzyme-linked immunosorbent assay (ELISA). One-step terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling (TUNEL) assay was utilized to determine the apoptosis levels of lung tissues and MSCs cultured in vitro. The expressions of the signal transducer and activator of transcription 3 (STAT3) pathway in rat lung tissues and MSCs were detected by Western blotting. After modeling, LPS induced the lung injury in rats, the expression levels of IL-6, IL-1ß and TNF-α were up-regulated (P<0.05), the apoptosis rate was increased (P<0.05), and phosphorylated-Janus kinase 2 (p-JAK2) and phosphorylated-STAT3 (p-STAT3) protein expressions were up-regulated (P<0.05). Des pretreatment can alleviate LPS-induced lung injury, down-regulate IL-6, IL-1ß and TNF-α expression levels (P<0.05), reduce apoptosis (P<0.05), and downregulate p-JAK2 and p-STAT3 protein levels (P<0.05). LPS induced an increase in apoptosis rate of MSCs (P<0.05) and the up-regulation of p-STAT3 protein expression (P<0.05). Both Des pretreatment and S31-201 inhibitor culture could reduce the apoptosis rate (P<0.05) and down-regulate p-STAT3 protein level (P<0.05). Des pretreatment can reduce sepsis-evoked lung injury in rats, which may be related to the inhibition of protein expressions of STAT3 pathway.


Assuntos
Lesão Pulmonar , Sepse , Animais , Desflurano , Interleucina-6 , Ratos , Fator de Transcrição STAT3
10.
Medicine (Baltimore) ; 99(25): e20714, 2020 Jun 19.
Artigo em Inglês | MEDLINE | ID: mdl-32569207

RESUMO

Surgical management of cancer may induce stress and increase the likelihood of cancer metastasis and recurrence. Appropriate surgical and anesthetic techniques may affect the patient's outcome. Although numerous studies have been performed, conflicting results have been obtained regarding the effect of anesthetic techniques on the outcome of patients with cancer. We conducted this study to evaluate the association of anesthetic techniques with overall and recurrence-free survival in patients who had undergone gastric cancer surgery.This retrospective study reviewed the electronic medical records of patients, who had visited our hospital and had been diagnosed with gastric cancer between July 1st, 2006 to June 30th, 2016. Univariate analysis of the potential prognostic factors was performed using the log-rank test for categorical factors, and parameters with a P-value < .05 at the univariate step were included in the multivariate regression analysis. Propensity Score Matching was performed to account for differences in baseline characteristics: propofol or desflurane, in a 1:1 ratio.A total of 408 patients anesthetized with desflurane (218) and propofol (190) were eligible for analysis. After propensity matching, 167 patients remained in each group. The overall mortality rate was significantly higher in the desflurane group (56%) than in the propofol group (34%) during follow-up (P < .001). In addition, a greater percentage of patients in the desflurane group (41%) exhibited postoperative metastasis than those in the propofol group (19%, P < .001).The authors found some association between types of anesthesia used and the long-term prognosis of gastric cancer. Propofol-based total intravenous anesthesia improved survival and reduced the risk of recurrence and metastasis during the 5-year follow-up period after gastric cancer surgery.


Assuntos
Anestesia Intravenosa/métodos , Anestésicos Inalatórios/administração & dosagem , Anestésicos Intravenosos/administração & dosagem , Desflurano/administração & dosagem , Propofol/administração & dosagem , Neoplasias Gástricas/cirurgia , Idoso , Feminino , Humanos , Masculino , Pontuação de Propensão , Estudos Retrospectivos , Neoplasias Gástricas/mortalidade , Taxa de Sobrevida
11.
Medicine (Baltimore) ; 99(19): e20224, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32384519

RESUMO

Remifentanil is the most frequently prescribed opioid for total intravenous anesthesia (TIVA) or balanced anesthesia (BA), due to its favorable pharmacological properties. However, several studies have reported opioid-induced hyperalgesia and/or acute tolerance after intraoperatively using remifentanil. In addition, it is imperative to control postoperative pain with lower doses of opioid anesthetic agents. Therefore, we compared the amount of opioid consumption between TIVA with propofol-remifentanil and BA with desflurane-remifentanil, to control postoperative pain in patients who underwent laparoscopic-assisted distal gastrectomy (LADG) with gastroduodenostomy.We retrospectively evaluated demographic variables (age, gender, height, weight, and smoking habits), the duration of general anesthesia (GA), and intraoperatively administered remifentanil consumption through the electronic medical records of patients who underwent LADG with gastroduodenostomy due to early stomach cancer. The primary outcome was postoperative opioid consumption during postoperative day (POD) 2. The secondary outcomes were the incidence of any rescue opioid analgesics administered, numeric rating scale, and various adverse effects during POD 2. We categorized the data in 2 patient groups to compare TIVA with propofol-remifentanil (TIVA group) to BA with desflurane-remifentanil (BA group) on the postoperative opioid analgesic consumption.We divided 114 patients into the TIVA (46 patients) and BA (68 patients) groups. Opioid consumption as a primary outcome was significantly higher in the BA group than in the TIVA group during POD 2 except in the post-anesthesia care unit. The cumulative opioid consumption was significantly higher in the BA than in the TIVA group. The incidence of rescue analgesic at POD 2 was higher in the BA than in the TIVA group. In the TIVA group, remifentanil consumption was higher, and the duration of GA was shorter than that in the BA group. No statistically significant differences were observed when comparing other variables.Our results indicated that the maintenance of GA with TIVA (propofol-remifentanil) reduces opioid consumption for postoperative pain control compared to BA (desflurane-remifentanil) in patients undergoing LADG with gastroduodenostomy.


Assuntos
Analgésicos Opioides/uso terapêutico , Anestesia Geral/métodos , Gastrectomia/métodos , Laparoscopia/métodos , Dor Pós-Operatória/tratamento farmacológico , Adulto , Fatores Etários , Idoso , Analgésicos Opioides/administração & dosagem , Período de Recuperação da Anestesia , Anestesia Geral/efeitos adversos , Anestesia Intravenosa , Anestésicos Intravenosos/uso terapêutico , Anestesia Balanceada/efeitos adversos , Anestesia Balanceada/métodos , Pesos e Medidas Corporais , Desflurano/uso terapêutico , Feminino , Gastrectomia/efeitos adversos , Humanos , Laparoscopia/efeitos adversos , Masculino , Pessoa de Meia-Idade , Propofol/uso terapêutico , Remifentanil/uso terapêutico , Fatores Sexuais , Fumar/epidemiologia
12.
PLoS One ; 15(5): e0233598, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32437450

RESUMO

BACKGROUND: Previous researches have shown that anesthetic techniques can influence the patient outcomes of cancer surgery. Here, we studied the relationship between type of anesthetic and patient outcomes following elective, open pancreatic cancer surgery. METHODS: This was a retrospective cohort study of patients who received elective, open pancreatic cancer surgery between January 2005 and July 2018. Patients were grouped according to the anesthesia they received, namely desflurane or propofol. A Kaplan-Meier analysis was conducted, and survival curves were presented from the date of surgery to death. Univariable and multivariable Cox regression models were used to compare hazard ratios for death after propensity matching. Subgroup analyses were performed for all-cause mortality, cancer-specific mortality, and disease progression. RESULTS: A total of 68 patients (56 deaths, 82.0%) under desflurane anesthesia, and 72 patients (43 deaths, 60.0%) under propofol anesthesia were included. Fifty-eight patients remained in each group after propensity matching. The propofol anesthesia was associated with improved survival (hazard ratio, 0.65; 95% confidence interval, 0.42-0.99; P = 0.047) in the matched analysis. Subgroup analyses showed significantly better cancer-specific survival (hazard ratio, 0.63; 95% confidence interval, 0.40-0.97; P = 0.037) in the propofol group. Additionally, patients under propofol had less postoperative recurrence, but not fewer postoperative metastases formation, than those under desflurane (hazard ratio, 0.55; 95% confidence interval, 0.34-0.90; P = 0.028) in the matched analysis. CONCLUSIONS: In a limited sample size, we observed that propofol anesthesia was associated with improved survival in open pancreatic cancer surgery compared with desflurane anesthesia. Further investigations are needed to inspect the influences of propofol anesthesia on patient outcomes of pancreatic cancer surgery.


Assuntos
Anestesia Intravenosa , Anestésicos Inalatórios/uso terapêutico , Anestésicos Intravenosos/uso terapêutico , Desflurano/uso terapêutico , Neoplasias Pancreáticas/cirurgia , Propofol/uso terapêutico , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Análise de Sobrevida
13.
Transplant Proc ; 52(4): 1094-1101, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32178928

RESUMO

BACKGROUND: General anesthesia is the conventional management of renal transplant, and its evolution has revolved around the development of new drugs; however, a group of patients meet conditions for neuraxial anesthesia, because of their comorbidities, who are at greater risk of complications with general anesthesia and are not favorable to grafting. METHODS: We conducted a controlled clinical trial of 109 renal transplant recipients where renal function was evaluated at 24, 48, and 72 hours and 3 months after transplant, and we compared regional, general anesthesia with inhaled anesthetic and total intravenous anesthesia. It was performed for 1 year, and serum creatinine, urea nitrogen, and electrolytes were evaluated. During the intraoperative period central venous pressure, mean arterial pressure, vasopressors, fluid therapy, diuretics, surgical time, anesthesia, hot and cold ischemia, immunosuppressants, and antihypertensives were evaluated. They were analyzed with χ2 independence and 1-way and 2-way repeated measures. RESULTS: The type of anesthesia was associated with hemodynamic stability (P = .018), the use of vasopressor (P = .005), and fluid therapy (P = .011). A value of P = .005 was found for central venous pressure at discharge from the operating room, and preincisional mean arterial pressure (P = .015) was among the types of anesthesia. Creatinine, blood urea nitrogen, sodium, and potassium were statistically significant over time (P < .001) but showed no difference between types of anesthesia. CONCLUSION: There is no difference between anesthetic techniques and clinical results over time. The personalized anesthetic technique will improve the neuroendocrine response and surgical stress, decrease the need for vasopressors and analgesics, and reduce complications.


Assuntos
Anestesia Intravenosa/métodos , Raquianestesia/métodos , Anestesia Balanceada/métodos , Transplante de Rim/métodos , Rim/efeitos dos fármacos , Adolescente , Adulto , Anestésicos/administração & dosagem , Bupivacaína/uso terapêutico , Desflurano/administração & dosagem , Feminino , Fentanila/administração & dosagem , Humanos , Masculino , Pessoa de Meia-Idade , Propofol , Sevoflurano/administração & dosagem , Adulto Jovem
14.
PLoS One ; 15(3): e0230290, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32182262

RESUMO

BACKGROUND: Previous researches have shown that anesthetic techniques may influence the patients' outcomes after cancer surgery. Here, we studied the relationship between the type of anesthetic techniques and patients' outcomes following elective robot-assisted radical prostatectomy. METHODS: This was a retrospective cohort study of patients who received elective, robot-assisted radical prostatectomy between January 2008 and December 2018. Patients were grouped according to the anesthesia they received, namely desflurane or propofol. A Kaplan-Meier analysis was conducted, and survival curves were presented from the date of surgery to death. Univariable and multivariable Cox regression models were used to compare hazard ratios for death after propensity matching. Subgroup analyses were performed for tumor-node-metastasis stage and disease progression. The primary outcome was overall survival, and the secondary outcome was postoperative biochemical recurrence. RESULTS: A total of 365 patients (24 deaths, 7.0%) under desflurane anesthesia, and 266 patients (2 deaths, 1.0%) under propofol anesthesia were included. The all-cause mortality rate was significantly lower in the propofol anesthesia than in the desflurane anesthesia during follow-up (P = 0.001). Two hundred sixty-four patients remained in each group after propensity matching. The propofol anesthesia was associated with improved overall survival (hazard ratio, 0.11; 95% confidence interval, 0.03-0.48; P = 0.003) in the matched analysis. Subgroup analyses showed that patients under propofol anesthesia had less postoperative biochemical recurrence than those under desflurane (hazard ratio, 0.20; 95% confidence interval, 0.05-0.91; P = 0.038) in the matched analysis. CONCLUSIONS: Propofol anesthesia was associated with improved overall survival in robot-assisted radical prostatectomy compared with desflurane anesthesia. In addition, patients under propofol anesthesia had less postoperative biochemical recurrence.


Assuntos
Anestésicos Inalatórios/efeitos adversos , Anestésicos Intravenosos/efeitos adversos , Desflurano/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Propofol/efeitos adversos , Prostatectomia/métodos , Anestésicos Inalatórios/administração & dosagem , Anestésicos Intravenosos/administração & dosagem , Desflurano/administração & dosagem , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Propofol/administração & dosagem , Prostatectomia/efeitos adversos , Robótica/métodos , Taxa de Sobrevida
15.
J Anesth ; 34(2): 281-285, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32020373

RESUMO

PURPOSE: The Dräger Perseus A500 (Perseus) anesthetic workstation has been designed with a lower internal volume. We evaluated the recovery time following general anesthesia using the Perseus workstation compared with that using the conventional Dräger Fabius Plus workstation. METHODS: Following approval by our institutional research ethics committee, 50 patients receiving elective surgery under general anesthesia were enrolled in the study. Written informed consent was obtained from each patient. The patients were divided into the Perseus group and a control group. The Perseus anesthesia workstation was used for the Perseus group, and the Fabius Plus was used for the control group. General anesthesia was maintained with a 4.2% end-tidal concentration of desflurane, remifentanil, fentanyl, and regional anesthesia. After the surgical procedure, the administration of desflurane was discontinued. The inspiratory and expiratory desflurane concentration, time taken for patients to open their eyes, and the time taken to extubate the trachea after discontinuation of anesthetics were recorded. RESULTS: The inspiratory and expiratory desflurane concentration after the administration of desflurane was discontinued was lower in the Perseus group. Moreover, the time taken for patients to open their eyes was statistically significantly quicker in the Perseus group when compared with the control group: 284 ± 60 vs 325 ± 43 s, respectively. The time taken for extubation was also statistically significantly quicker in the Perseus group when compared with the control group: 350 ± 67 vs 388 ± 62 s, respectively. CONCLUSIONS: We demonstrate in this study that Perseus enables the faster wash-out of anesthetics and faster recovery of patients after general anesthesia.


Assuntos
Anestésicos Inalatórios , Isoflurano , Período de Recuperação da Anestesia , Anestesia Geral , Anestésicos Intravenosos , Desflurano , Humanos
16.
Anesthesiology ; 132(5): 1080-1090, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32101967

RESUMO

BACKGROUND: Neurocognitive investigations suggest that conscious sensory perception depends on recurrent neuronal interactions among sensory, parietal, and frontal cortical regions, which are suppressed by general anesthetics. The purpose of this work was to investigate if local interactions in sensory cortex are also altered by anesthetics. The authors hypothesized that desflurane would reduce recurrent neuronal interactions in cortical layer-specific manner consistent with the anatomical disposition of feedforward and feedback pathways. METHODS: Single-unit neuronal activity was measured in freely moving adult male rats (268 units; 10 animals) using microelectrode arrays chronically implanted in primary and secondary visual cortex. Layer-specific directional interactions were estimated by mutual information and transfer entropy of multineuron spike patterns within and between cortical layers three and five. The effect of incrementally increasing and decreasing steady-state concentrations of desflurane (0 to 8% to 0%) was tested for statistically significant quadratic trend across the successive anesthetic states. RESULTS: Desflurane produced robust, state-dependent reduction (P = 0.001) of neuronal interactions between primary and secondary visual areas and between layers three and five, as indicated by mutual information (37 and 41% decrease at 8% desflurane from wakeful baseline at [mean ± SD] 0.52 ± 0.51 and 0.53 ± 0.51 a.u., respectively) and transfer entropy (77 and 78% decrease at 8% desflurane from wakeful baseline at 1.86 ± 1.56 a.u. and 1.87 ± 1.67 a.u., respectively). In addition, a preferential suppression of feedback between secondary and primary visual cortex was suggested by the reduction of directional index of transfer entropy overall (P = 0.001; 89% decrease at 8% desflurane from 0.11 ± 0.18 a.u. at baseline) and specifically, in layer five (P = 0.001; 108% decrease at 8% desflurane from 0.12 ± 0.19 a.u. at baseline). CONCLUSIONS: Desflurane anesthesia reduces neuronal interactions in visual cortex with a preferential effect on feedback. The findings suggest that neuronal disconnection occurs locally, among hierarchical sensory regions, which may contribute to global functional disconnection underlying anesthetic-induced unconsciousness.


Assuntos
Anestésicos Inalatórios/farmacologia , Comunicação Celular/efeitos dos fármacos , Comunicação Celular/fisiologia , Córtex Cerebral/efeitos dos fármacos , Córtex Cerebral/fisiologia , Desflurano/farmacologia , Animais , Córtex Cerebral/citologia , Masculino , Ratos , Ratos Sprague-Dawley , Córtex Visual/citologia , Córtex Visual/efeitos dos fármacos , Córtex Visual/fisiologia
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