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1.
J Healthc Eng ; 2022: 7677266, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35494523

RESUMO

Objective: To analyze the effect of different doses of propofol on pulmonary function and inflammatory response in patients with lung ischemia reperfusion injury (LIRI) induced by one-lung ventilation (OLV) based on big data analysis. Methods: A retrospective study was performed on 105 patients who underwent lobectomy in our hospital (January 2018 to January 2022). According to the doses of propofol, they were split into low-dose group (LDG), middle-dose group (MDG), and high-dose group (HDG), which received the continuous micropump infusion of propofol at the doses of 2 mg/(kg·h), 5 mg/(kg·h), and 10 mg/(kg·h) after induction, respectively, with 35 cases in each group. The indexes, such as the pulmonary function and inflammatory factors of patients, at different times were compared. The logistic regression analysis was performed according to the occurrence of LIRI. Results: With no notable difference at T0 among the three groups (P > 0.05), the Cdyn levels significantly decreased at T1 (P < 0.05) and gradually increased at T2. The Cdyn levels at T1 and T2 were remarkably higher in HDG and MDG than in LDG (P < 0.05). With no notable differences at T0 and T1 among the three groups (P > 0.05), the PA-aO2 levels and RI values at T2 in MDG and HDG were lower compared with LDG (P < 0.05). The RI values at T1 and T2 in HDG were higher compared with MDG, with no obvious difference (P > 0.05). The OI levels at T1 and T2 in HDG were lower compared with the other two groups (P < 0.05), and the OI levels at T1, T2, and T3 in LDG were higher compared with MDG, with no obvious difference (P > 0.05). The TNF-α and ICAM-1 levels at T1 and T2 in MDG and HDG were lower compared with LDG, with no obvious difference between MDG and HDG (P > 0.05). Compared with LDG, the MDG and HDG at T1 and T2 had lower MDA levels (P < 0.05) and higher SOD levels (P < 0.05). Logistic regression analysis showed that Cdyn, PA-aO2, and OLV time were independent risk factors for LIRI in patients undergoing lobectomy. Conclusion: Propofol has a good protective effect on lung function in patients with OLV-induced LIRI. Appropriately increasing the dose of propofol can effectively improve the local cerebral hypoxia and lung compliance of patients and reduce the inflammatory response and oxidative stress response, with 5 mg/(kg·h) as the clinical reference. Preoperative assessment and preparation should be made for patients, close attention should be paid to risk factors, such as Cdyn and PA-aO2, and OLV time should be controlled.


Assuntos
Ventilação Monopulmonar , Propofol , Traumatismo por Reperfusão , Análise de Dados , Humanos , Pulmão , Propofol/uso terapêutico , Traumatismo por Reperfusão/induzido quimicamente , Estudos Retrospectivos
2.
Comput Intell Neurosci ; 2022: 4911773, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35515499

RESUMO

The aim of this study is to probe the possible molecular mechanisms underlying the effects of propofol on HT22 cells. HT22 cells treated with different concentrations were sequenced, and then the results of the sequencing were analyzed for dynamic trends. Expression pattern clustering analysis was performed to demonstrate the expression of genes in the significant trend modules in each group of samples. We first chose the genes related to the trend module for WGCNA analysis, then constructed the PPI network of module genes related to propofol treatment group, and screened the key genes. Finally, GSEA analysis was performed on the key genes. Overall, 2,506 genes showed a decreasing trend with increasing propofol concentration, and 1,871 genes showed an increasing trend with increasing propofol concentration. WGCNA analysis showed that among them, turquoise panel genes were negatively correlated with propofol treatment, and genes with Cor R >0.9 in the turquoise panel were selected for PPI network construction. The MCC algorithm screened a total of five key genes (CD86, IL10RA, PTPRC, SPI1, and ITGAM). GSEA analysis showed that CD86, IL10RA, PTPRC, SPI1, and ITGAM are involved in the PRION_DISEASES pathway. Our study showed that propofol sedation can affect mRNA expression in the hippocampus, providing new ideas to identify treatment of nerve injury induced by propofol anesthesia.


Assuntos
Biologia Computacional , Propofol , Biologia Computacional/métodos , Hipocampo , Neurônios , Propofol/farmacologia
3.
Dis Markers ; 2022: 4709019, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35521638

RESUMO

The aim of this study was to evaluate the effect of minocycline preadministration on cognitive dysfunction, hippocampal inflammatory response, and hippocampal senile dementia-related proteins induced by propofol anesthesia in aged rats. Sixty male SD rats, aged 20 months and weighing 340-410 g, were randomly divided into three groups: normal saline (NC) group, propofol group (prop), and minocycline (M) group. Prop group rats were injected intraperitoneally with 100 mg/kg propofol. The rats in group M were injected intraperitoneally with 50 mg/kg minocycline 30 minutes before injection of 100 mg/kg propofol, and the rest were the same as prop group. The rats in NC group were received intraperitoneal injection of the same amount of normal saline. The results indicated that compared with group C, the expressions of GSK-3ß, acetyl-NF-κB (Lys310), Tau, and Amlyoid-beta were upregulated, the levels of TNF-α, IL-1ß, and IL-6 were increased, the escape incubation period was prolonged, and the exploration time was shortened in prop group, while the expression of GSK-3ß, acetyl-NF-κB (Lys310), Tau, and Amlyoid-beta in minocycline group was downregulated, the levels of TNF-α, IL-1ß, and IL-6 were decreased, the escape incubation period was shortened, and the exploration time was shortened. In conclusion, preadministration of minocycline can improve cognitive impairment induced by propofol anesthesia in aged rats, and its mechanism of action may be related to minocycline inhibiting hippocampal inflammatory reaction and downregulating the expression of GSK-3ß, acetyl-NF-κB (Lys310), Tau, and Amlyoid-beta proteins in hippocampus.


Assuntos
Doença de Alzheimer , Anestesia , Disfunção Cognitiva , Propofol , Doença de Alzheimer/induzido quimicamente , Doença de Alzheimer/tratamento farmacológico , Doença de Alzheimer/metabolismo , Animais , Disfunção Cognitiva/induzido quimicamente , Disfunção Cognitiva/tratamento farmacológico , Glicogênio Sintase Quinase 3 beta/metabolismo , Hipocampo/metabolismo , Humanos , Interleucina-6/metabolismo , Masculino , Minociclina/metabolismo , Minociclina/farmacologia , NF-kappa B/metabolismo , Propofol/metabolismo , Propofol/farmacologia , Ratos , Ratos Sprague-Dawley , Solução Salina/metabolismo , Solução Salina/farmacologia , Fator de Necrose Tumoral alfa/metabolismo
4.
Crit Care ; 26(1): 122, 2022 05 03.
Artigo em Inglês | MEDLINE | ID: mdl-35505432

RESUMO

BACKGROUND: Current sedatives have different side effects in long-term sedation. The sequential use of midazolam and dexmedetomidine for prolonged sedation may have distinct advantages. We aimed to evaluate the efficacy and safety of the sequential use of midazolam and either dexmedetomidine or propofol, and the use of midazolam alone in selected critically ill, mechanically ventilated patients. METHODS: This single-center, randomized controlled study was conducted in medical and surgical ICUs in a tertiary, academic medical center. Patients enrolled in this study were critically ill, mechanically ventilated adult patients receiving midazolam, with anticipated mechanical ventilation for ≥ 72 h. They passed the spontaneous breathing trial (SBT) safety screen, underwent a 30-min-SBT without indication for extubation and continued to require sedation. Patients were randomized into group M-D (midazolam was switched to dexmedetomidine), group M-P (midazolam was switched to propofol), and group M (sedation with midazolam alone), and sedatives were titrated to achieve the targeted sedation range (RASS - 2 to 0). RESULTS: Total 252 patients were enrolled. Patients in group M-D had an earlier recovery, faster extubation, and more percentage of time at the target sedation level than those in group M-P and group M (all P < 0.001). They also experienced less weaning time (25.0 h vs. 49.0 h; HR1.47, 95% CI 1.05 to 2.06; P = 0.025), and a lower incidence of delirium (19.5% vs. 43.8%, P = 0.002) than patients in group M. Recovery (P < 0.001), extubation (P < 0.001), and weaning time (P = 0.048) in group M-P were shorter than in group M, while the acquisition cost of sedative drug was more expensive than other groups (both P < 0.001). There was no significant difference in adverse events among these groups (all P > 0.05). CONCLUSIONS: The sequential use of midazolam and dexmedetomidine was an effective and safe sedation strategy for long-term sedation and could provide clinically relevant benefits for selected critically ill, mechanically ventilated patients. TRIAL REGISTRATION: NCT02528513 . Registered August 19, 2015.


Assuntos
Dexmedetomidina , Propofol , Adulto , Estado Terminal/terapia , Dexmedetomidina/efeitos adversos , Humanos , Hipnóticos e Sedativos/farmacologia , Hipnóticos e Sedativos/uso terapêutico , Midazolam/efeitos adversos , Propofol/efeitos adversos , Respiração Artificial
5.
Drug Des Devel Ther ; 16: 1199-1209, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35509490

RESUMO

Background: Remimazolam is a new medication with sedative and hypnotic effects. It has been demonstrated non-inferior to propofol in general anesthesia with regard to efficacy and safety. However, whether general anesthesia with remimazolam is better than propofol in terms of patients' recovery quality remains unknown. Patients and Methods: Patients enrolled in this study were randomized to remimazolam or propofol group. In remimazolam group, general anesthesia was induced with remimazolam and sufentanil and maintained with remimazolam and remifentanil. In propofol group, general anesthesia was induced with propofol and sufentanil and maintained with propofol and remifentanil. Neuromuscular blocking agent cisatracurium was also injected during anesthesia. Sedation level was monitored by bispectral index (BIS). Our primary outcome was the quality of patients' postoperative recovery, using the Quality of Recovery-15 (QoR-15) scale. Secondary outcomes included SpO2, HR, MBP and frequency of application of vasoactive drugs during anesthesia, as well as incidences of adverse events in the post anesthesia care unit (PACU). Results: The global scores of QoR-15 scale were lower in remimazolam group at postoperative day 1 and day 3 compared to propofol group, but differences between the two groups only had clinical significance at postoperative day 1. Among the five dimensions of QoR-15 scale, scores for physical comfort and emotional state were lower in remimazolam group than propofol group. MBP and HR were higher in remimazolam group than propofol group after anesthesia induction. SpO2 was similar in the two groups. The frequency of application of vasoactive drugs during anesthesia was higher in propofol group than remimazolam group. There was no statistical difference in the incidences of adverse events between the two groups. Conclusion: General anesthesia with remimazolam can provide more stable hemodynamics but also cause temporary reduction in the quality of recovery in patients undergoing urologic surgery, compared to propofol.


Assuntos
Propofol , Anestesia Geral/efeitos adversos , Anestésicos Intravenosos/efeitos adversos , Benzodiazepinas , Humanos , Hipnóticos e Sedativos , Propofol/efeitos adversos , Remifentanil , Sufentanil
6.
J Cardiothorac Surg ; 17(1): 100, 2022 May 03.
Artigo em Inglês | MEDLINE | ID: mdl-35505367

RESUMO

BACKGROUND: The study was aimed to compare the efficacy and safety of different sedation protocols of dexmedetomidine-remifentanil and propofol-remifentanil for percutaneous closure of atrial septal defects (ASD) under transthoracic echocardiography (TTE) guidance. MATERIAL AND METHODS: From March 2020 to January 2021, of 114 patients screened, 59 ASD patients scheduled for percutaneous closure under TTE guidance were randomly allocated into the dexmedetomidine-remifentanil (D-R) group (n = 29) and the propofol-remifentanil (P-R) group (n = 30). The incidence of hemodynamic and respiratory adverse events, arterial blood gas analysis, induction and recovery time, pain score, infusion rate of remifentanil, satisfaction of the surgeon and patient, additional sedatives were collected for analysis and comparison. RESULTS: The induction time was longer in the D-R group than that in the P-R group (17.66 ± 2.65 min vs 11.43 ± 1.48 min; difference, 6.22 min; 95% CI 5.10 to 7.35; P < 0.001). No differences were observed in the 2 groups in terms of the additional sedatives, infusion rate of remifentanil, pain score, recovery time (P > 0.05). There was no difference between the two groups regarding the incidence of cardiovascular adverse events (6 [20.7%] vs 4 [13.3%]; difference, 7.4%; 95% CI - 11.7 to 26.5%; P = 0.506). Respiratory adverse events occurred in 1 patient (3.4%) in the D-R group, and 8 patients (26.7%) in the P-R group (difference, 23.3%; 95% CI 6.2 to 40.5%; P = 0.026). The incidence of hypercapnia was significantly lower in the D-R group (4 [13.8%]) than in the P-R group (13 [43.3%]; difference, 29.5%; 95% CI 7.8 to 51.2%; P = 0.012). CONCLUSIONS: Except for more rapid the induction time and higher the surgeon satisfaction score in the propofol-remifentanil protocol, the efficacy was similar between two sedation protocols. The hemodynamic stability was comparable, the dexmedetomidine-remifentanil protocol had superior airway security due to fewer hypercapnia and respiratory adverse events.


Assuntos
Comunicação Interatrial , Hipnóticos e Sedativos , Protocolos Clínicos , Dexmedetomidina/efeitos adversos , Combinação de Medicamentos , Comunicação Interatrial/cirurgia , Humanos , Hipercapnia/epidemiologia , Hipnóticos e Sedativos/efeitos adversos , Dor , Propofol/efeitos adversos , Remifentanil/efeitos adversos , Resultado do Tratamento
7.
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
8.
Am J Vet Res ; 83(6)2022 May 08.
Artigo em Inglês | MEDLINE | ID: mdl-35524965

RESUMO

OBJECTIVE: To determine the minimum alveolar concentration (MAC) of isoflurane in donkeys and characterize recovery from anesthesia. ANIMALS: 7 healthy castrated male adult donkeys. PROCEDURES: Anesthesia was induced with propofol and maintained under mechanical ventilation with 1.3% isoflurane end-tidal concentration (ETiso). The MAC of isoflurane was determined after a 60-minute propofol washout period using the bracketing method. A continuous noxious electrical stimulation was applied to the oral mucosa for 1 minute or until the donkey moved. The ETiso was increased or decreased by 10% depending on the response, and MAC was defined as the average of 2 ETiso values allowing and preventing movement in response to stimulation. Arterial blood gases were measured during anesthesia and the recovery period. Unassisted recovery was timed, and a quality score was assigned from 1 (very poor) to 5 (excellent). RESULTS: The mean dose of propofol required for induction was 3.0 ± 0.6 mg/kg. The MAC of isoflurane was 1.44 ± 0.13%. One donkey was excluded from the study because it was still responsive when stimulated at ETiso of 2.8%. Immediately after extubation, the median (range) partial pressure of oxygen in the arterial blood was 63 (minimum to maximum, 46 to 72) mm Hg and 3 donkeys were hypoxemic (partial pressure of arterial oxygen < 60 mm Hg). The median time to standing was 13 (7 to 38) minutes, while the recovery score was 3 (2 to 5). CLINICAL RELEVANCE: The MAC of isoflurane in donkeys is similar to that reported in other species. Oxygen support should be provided to donkeys during recovery from isoflurane anesthesia to prevent hypoxemia.


Assuntos
Anestesia , Anestésicos Inalatórios , Isoflurano , Propofol , Anestesia/veterinária , Anestésicos Inalatórios/farmacologia , Animais , Equidae , Isoflurano/farmacologia , Masculino , Oxigênio , Alvéolos Pulmonares
9.
Medicine (Baltimore) ; 101(10): e28993, 2022 Mar 11.
Artigo em Inglês | MEDLINE | ID: mdl-35451391

RESUMO

OBJECTIVE: The aim of this study was to find the optimum dosage of dexmedetomidine in Spinal Orthopedic Scoliosis Correction Surgery when used in combination with propofol and remifentanil in American Society of Anesthesiologists (ASA) III patients with severe scoliosis undergoing intraoperative wake-up test. MATERIALS AND METHODS: We selected a total of 60 ASA III ≤40 years old patients who underwent Spinal Orthopedic Scoliosis Correction Surgery (SOSCS) and randomized them into groups A, B, and C. Group A was administered 0.2 µg/(kg·h) of dexmedetomidine, group B 0.3 µg/(kg·h), and group C 0.4 µg/(kg·h). The main parameters monitored were: wake-up time; wake-up quality; adverse effects that occur while the patient is awake; postoperative awareness of intraoperative wake-up test; heart rate (HR); mean arterial pressure (MAP); and oxygen saturation (SpO2). Values of these parameters were monitored at 7 timestamps separated by 5 minutes >30 minutes. RESULTS: Group B had a higher MAP at 10 minutes before wake-up (P = .03) and at the moment of wake-up (P = .04) than group A. The Wake-up time of group A was 14.95 ±â€Š7.42 minutes, group B was 14.7 ±â€Š6.52 minutes, which was significantly shorter than that of group C 21.3 ±â€Š10.02 minutes (P = .02). The wake-up quality was excellent. All other parameters had no significant statistical differences. CONCLUSION: Doses of 0.2 to 0.3 µg/(kg·h) have shorter wake-up time and fewer hemodynamic fluctuations compared to 0.4 µg/(kg·h).


Assuntos
Dexmedetomidina , Propofol , Escoliose , Adulto , Estado Terminal , Dexmedetomidina/efeitos adversos , Humanos , Remifentanil , Escoliose/cirurgia
10.
Biomed Environ Sci ; 35(4): 283-295, 2022 Apr 20.
Artigo em Inglês | MEDLINE | ID: mdl-35473893

RESUMO

Objective: Neonatal exposure to propofol has been reported to cause neurotoxicity and neurocognitive decline in adulthood; however, the underlying mechanism has not been established. Methods: SD rats were exposed to propofol on postnatal day 7 (PND-7). Double-immunofluorescence staining was used to assess neurogenesis in the hippocampal dentate gyrus (DG). The expression of p-Akt and p27 were measured by western blotting. The Morris water maze, novel object recognition test, and object location test were used to evaluate neurocognitive function 2-month-old rats. Results: Phosphorylation of Akt was inhibited, while p27 expression was enhanced after neonatal exposure to propofol. Propofol also inhibited proliferation of neural stem cells (NSCs) and decreased differentiation to neurons and astroglia. Moreover, the neurocognitive function in 2-month-old rats was weakened. Of significance, intra-hippocampal injection of the Akt activator, SC79, attenuated the inhibition of p-AKT and increase of p27 expression. SC79 also rescued the propofol-induced inhibition of NSC proliferation and differentiation. The propofol-induced neurocognition deficit was also partially reversed by SC79. Conclusion: Taken together, these results suggest that neurogenesis is hindered by neonatal propofol exposure. Specifically, neonatal propofol exposure was shown to suppress the proliferation and differentiation of NSCs by inhibiting Akt/p27 signaling pathway.


Assuntos
Células-Tronco Neurais , Propofol , Animais , Proliferação de Células , Hipocampo/metabolismo , Propofol/metabolismo , Propofol/toxicidade , Proteínas Proto-Oncogênicas c-akt/genética , Proteínas Proto-Oncogênicas c-akt/metabolismo , Ratos , Ratos Sprague-Dawley , Transdução de Sinais
11.
Asian J Anesthesiol ; 60(1): 33-40, 2022 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-35483678

RESUMO

BACKGROUND: Dexmedetomidine has been used by multiple routes in laparoscopic surgeries to attenuate the hemodynamic response. The present study was done to compare the efficacy of dexmedetomidine nebulization with intravenous dexmedetomidine and fentanyl in laparoscopic surgeries under general anesthesia. METHODS: A prospective, double blind study was conducted, and 90 American Society of Anesthesiologists (ASA) I and II patients of either gender between 18-65 years undergoing laparoscopic surgeries under general anesthesia were randomized into three groups. (1) Group N (n = 30) received dexmedetomidine nebulization 1 mcg/kg in 3 mL of 0.9% saline 15 minutes before induction and 10 mL of intravenous 0.9% saline over 10 minutes at the time of induction of anesthesia. (2) Group I (n = 30) received 0.9% saline nebulization 3 mL and intravenous dexmedetomidine 1 mcg/kg in 10 mL of 0.9% saline. (3) Group F (n = 30) received 0.9% saline nebulization 3 mL and intravenous fentanyl 2 mcg/kg in 10mL of 0.9% saline. Heart rate, blood pressure, propofol requirement, and opioid consumption were monitored throughout surgery and for 1 hour in post-operative period. Statistical analysis was done by using analysis of variance test, chi-square test. P value < 0.05 was considered signifi cant. RESULTS: Suppression of hemodynamic response following intubation and pneumoperitoneum by dexmedetomidine nebulization was compared to intravenous dexmedetomidine and fentanyl. Opioid requirement was significantly lower in dexmedetomidine group than fentanyl group (P < 0.05). Propofol requirement was lower with intravenous and nebulized dexmedetomidine than intravenous fentanyl. CONCLUSIONS: In laparoscopic surgeries, nebulized dexmedetomidine suppresses hemodynamic response when compared to intravenous dexmedetomidine along with dose sparing effect of opioid and propofol.


Assuntos
Dexmedetomidina , Laparoscopia , Propofol , Analgésicos Opioides/farmacologia , Anestesia Geral , Dexmedetomidina/farmacologia , Fentanila/farmacologia , Hemodinâmica , Humanos , Estudos Prospectivos , Solução Salina/farmacologia
12.
Contrast Media Mol Imaging ; 2022: 6027965, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35386725

RESUMO

In order to evaluate the application of EEG intelligent detection in gynecological anesthesia depth, the application of ANGEL-6000 EEG depth monitor in laparoscopic gynecological anesthesia was proposed. This method was applied to 60 patients who underwent elective laparoscopic gynecological surgery in our hospital from February to August 2016. Inclusion criteria were ASA i ∼ ii; the average age was (37.8 ± 6.6) years from 20 to 50 years old; the average body weight was (51.53 ± 3.87) kg; conscious and no communication barriers; and patients without instrument ventilation. The patients were divided into observation group and control group according to the random number table method, with 30 patients in each group. The two groups were anesthetized with the same anesthetic drugs, and their consciousness index was monitored. IoC values were recorded before induction of anesthesia (T0), 5 min after intubation (T1), 5 min after operation (T2), intraoperative exploration (T3), at the end of operation (T4), 1 min before extubation (T5), and 5 min after extubation (T6). The dosage of anesthetic drugs, operation time, extubation time, and operation time of the two groups were statistically analyzed. Compared with the operation time of patients in the two groups, the extubation time, awake time, and time out of the operating room of patients in the control group were longer than the observation group. The IoC values of patients in the control group at T0 and T6 time points were lower than those in the observation group at each time point from T1 to T5. Comparison of perioperative dose of remifentanil and atracurium between the two groups was performed. The control group used more propofol dose in perioperative period. The application of neuroelectric signal in laparoscopic gynecological surgery to detect changes in perioperative IoC value can well reflect the level of consciousness of patients and reflect the effect of perioperative stimulation at different time points on the EEG of patients in real time.


Assuntos
Anestesia Obstétrica , Ginecologia , Obstetrícia , Propofol , Adulto , Humanos , Pessoa de Meia-Idade , Remifentanil , Adulto Jovem
13.
Ann Card Anaesth ; 25(2): 188-195, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35417966

RESUMO

Background: Assessment of myocardial deformation by quantifying peak systolic longitudinal strain (PSLS) is a sensitive and robust index to detect subclinical myocardial dysfunction. We hypothesize that sevoflurane by virtue of anesthetic preconditioning preserves myocardial function better than propofol. Aims: The authors have assessed the effects of sevoflurane and propofol on global longitudinal strain (GLS) as a primary outcome in patients undergoing on-pump coronary artery bypass grafting. Our secondary aim was to assess the pattern of regional distribution of segmental PSLS between the groups. Materials and Methods: Fifty patients with normal left ventricular function undergoing coronary artery bypass grafting were analyzed in this prospective observational study. Consecutive patients received either propofol (P) or sevoflurane (S) anesthesia. Measurements: Trans-esophageal echocardiographic images (mid-esophageal four-chamber, two-chamber, and three-chamber (long-axis)) were recorded during the precardiopulmonary bypass (CPB) and post-CPB period. Strain analysis (GLS/segmental PSLS) was done offline by investigators blinded to the study. The inotropic score, duration of inotropic support, and mechanical ventilation required were recorded. Results: Following cardiopulmonary bypass and coronary revascularization, GLS reduced significantly in both the groups (P < 0.05). In the S-group, significant reduction in segmental strain was observed only in apical segments including apex, whereas in P-group significant reduction in segmental strain was seen in mid- and apical segments. The postoperative VIS, duration of inotropes/vasopressor required, and mechanical ventilation were similar in both the groups. Conclusions: There are no significant differences in global left ventricular function as assessed by GLS between patients anesthetized with sevoflurane or propofol. However, regional PSLS was better preserved in the S-group compared to P-group.


Assuntos
Éteres Metílicos , Propofol , Ponte Cardiopulmonar , Ponte de Artéria Coronária/métodos , Humanos , Éteres Metílicos/farmacologia , Propofol/farmacologia , Sevoflurano/farmacologia
14.
Med Gas Res ; 12(4): 137-140, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35435424

RESUMO

Prevention and management of postoperative nausea and vomiting (PONV) is a fundamental part of anesthesia. Using sevoflurane and propofol in combination for maintenance of anesthesia has been found to reduce PONV compared to sevoflurane alone. However, there are limited studies comparing propofol with a combination of propofol and sevoflurane for the incidence of PONV after laparoscopic surgery. The prospective, randomized, double-blind study was planned to compare propofol and combination of propofol and sevoflurane as maintenance agents for the incidence of PONV. Seventy female patients of 18-60 years, of American Society of Anesthesiologists I or II, undergoing laparoscopic surgery were included. Propofol group (n = 35) included induction with propofol and maintenance with propofol infusion, and propofol + sevoflurane group (n = 35) included induction with propofol and maintenance with a combination of propofol infusion and sevoflurane inhalation. The objectives were to find the incidence of PONV and requirement of rescue antiemetic. In the propofol group, 11 patients (33%) experienced PONV and in the propofol + sevoflurane group, PONV was experienced by 12 patients (38.7%) [0.65]. In the propofol group, 11 patients required ondansetron and out of these 11 patients, 2 patients required metoclopramide. In the propofol + sevoflurane group, Ondansetron was required by 12 patients and 3 patients out of these 12 patients required metoclopramide. In the present study, the incidence of PONV was found to be similar in both groups. So, it can be suggested to add sevoflurane in smaller doses to infusion of propofol for maintenance of anesthesia.


Assuntos
Laparoscopia , Propofol , Adolescente , Adulto , Método Duplo-Cego , Feminino , Humanos , Laparoscopia/efeitos adversos , Metoclopramida , Pessoa de Meia-Idade , Ondansetron , Náusea e Vômito Pós-Operatórios/tratamento farmacológico , Náusea e Vômito Pós-Operatórios/epidemiologia , Náusea e Vômito Pós-Operatórios/prevenção & controle , Propofol/uso terapêutico , Estudos Prospectivos , Sevoflurano , Adulto Jovem
15.
Beijing Da Xue Xue Bao Yi Xue Ban ; 54(2): 289-293, 2022 Apr 18.
Artigo em Chinês | MEDLINE | ID: mdl-35435194

RESUMO

OBJECTIVE: To explore the effectiveness and feasibility of dexamethasone combined with oxybuprocaine hydrochloride gel on the prevention of postoperative sore throat after nasal endoscopy. METHODS: In the study, 60 patients with American Society of Anesthesiologist (ASA) physical statuses Ⅰ to Ⅱ, aged 18 to 72 years, scheduled for elective nasal endoscope surgery under general anesthesia requiring endotracheal intubation were randomly divided into dexamethasone combined with oxybuprocaine hydrochloride gel group (G group, n=30) and control group (C group, n=30). The patients in the G group received dexamethasone 0.1 mg/kg before induction and the oxybuprocaine gel was applied to the endotracheal catheter cuff and the front end within 15 cm. The patients in the C group received the same dose of saline and the saline was applied to the endotracheal catheter cuff and the front end within 15 cm. Then, all the patients in the two groups received the same induction and anesthesia maintainance. The operation time, anesthesia time, emergence time, extubation time and departure time were recorded. The intraoperative infusion volume, blood loss volume, propofol, remifentanil, rocuronium dosage were also recorded. The adverse reactions such as intraoperative hypotension, bradycardia and postoperative agitation were recorded. The postoperative sore throat score was recorded at the end of operation and 4 h, 8 h, 12 h, and 24 h after operation. RESULTS: Compared with the C group, the emergence time [(8.4±3.9) min vs. (10.8±4.7) min], extubation time [(8.8±3.7) min vs. (11.9±4.8) min], and departure time [(20.0±5.3) min vs. (23.0±5.8) min] were significantly shorter, and the propofol dosage [(11.8±1.8) mg/kg vs. (15.9±4.6) mg/kg], remifentanil dosage [(10.9±4.7) µg/kg vs. (14.1±3.6) µg/kg] were significantly less in the G group, and there was no difference of rocuronium dosage in the two groups. Compared with the C group the incidence of intraoperative hypotension [10%(3/30) vs. 30%(9/30)], bradycardia [16.7%(5/30) vs. 20%(6/30)] and postoperative agitation [6.7%(2/30) vs. 23.3%(7/30)] were significantly lower in the C group. The postoperative sore throat score at the end of operation, 4 h, 8 h, 12 h and 24 h after operation in the G group were significantly lower than in the C group respectively [0 (0, 1) vs. 1 (1, 2), 0 (0, 0) vs. 1 (1, 2), 0 (0, 0) vs. 1 (1, 2), 0 (0, 0) vs. 1 (0.75, 1), 0 (0, 0) vs. 1 (0, 1)]. CONCLUSION: Dexamethasone combined with oxybuprocaine hydrochloride gel was effective and feasible on the prevention of postoperative sore throat after nasal endoscopy.


Assuntos
Dexametasona , Endoscopia , Faringite , Adolescente , Adulto , Idoso , Bradicardia/complicações , Bradicardia/tratamento farmacológico , Dexametasona/uso terapêutico , Endoscopia/efeitos adversos , Humanos , Hipotensão/complicações , Hipotensão/tratamento farmacológico , Intubação Intratraqueal/efeitos adversos , Pessoa de Meia-Idade , Dor/tratamento farmacológico , Faringite/etiologia , Faringite/prevenção & controle , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/prevenção & controle , Procaína/análogos & derivados , Propofol , Remifentanil , Rocurônio , Adulto Jovem
16.
BMC Anesthesiol ; 22(1): 109, 2022 04 18.
Artigo em Inglês | MEDLINE | ID: mdl-35436859

RESUMO

BACKGROUND: Direct stimulation of the afferent nerve endings in the venous endothelium is one explanation of propofol injection pain. Previous studies found that ondansetron can also block sodium channels. This effect is similar to that of lidocaine. OBJECTIVE: The primary outcome was the efficacy of ondansetron compared to lidocaine and placebo for the reduction of propofol injection pain. METHOD: This trial was conducted in 240 patients, American Society of Anesthesiologists classification I-III and aged between 18-65 years old, undergoing elective surgery, and having a 20-gauge intravenous catheter at the hand dorsum. Each group of 80 patients received 8 mg. of ondansetron in the O Group, 40 mg. of lidocaine in the L Group and normal saline in the C Group. The study medications were blindly administered to the patients through a 20-gauge intravenous catheter placed on the hand dorsum, and then 1 min later, the small dose of propofol (50 mg.) was infused via the syringe pump at a rate of 600 ml/hr. for 30 s. Following that, the syringe pump of propofol was temporarily stopped, and the patients were asked to rate their pain at the injection site. RESULT: The incidence of pain was lowest in the L group (66.2%) compared with the O (82.5%) and the C groups (85.0%) (P < 0.01). The median pain score in the L, O, and C groups were 2 (0-4), 4 (2-5), and 4.5 (2-6), respectively (P < 0.01). The incidences of no pain, mild, moderate, and severe pain were also significantly different in the L group (33.8%, 37.5%, 21.2%, and 7.5%, respectively) compared with those in the O group (17.5%, 31.2%, 31.2%, and 20.0%, respectively) and the C groups (15.0%, 22.5%, 40.0%, and 22.5%, respectively) (P < 0.01). CONCLUSION: Pretreatment with intravenous lidocaine, rather than ondansetron, can reduce the incidence and intensity of propofol-induced pain.


Assuntos
Lidocaína , Ondansetron , Propofol , Adolescente , Adulto , Idoso , Anestésicos Intravenosos , Anestésicos Locais , Método Duplo-Cego , Humanos , Injeções Intravenosas , Lidocaína/administração & dosagem , Pessoa de Meia-Idade , Ondansetron/administração & dosagem , Dor/tratamento farmacológico , Medição da Dor , Propofol/efeitos adversos , Adulto Jovem
17.
BMC Anesthesiol ; 22(1): 118, 2022 04 23.
Artigo em Inglês | MEDLINE | ID: mdl-35461223

RESUMO

OBJECTIVE: To explore the anesthetic and analgesic effects of remimazolam and propofol in elderly patients undergoing hip replacement and their effects on respiratory and circulatory systems, stress and cognitive function. METHODS: Sixty elderly patients undergoing elective hip replacement in the hospital were selected as the research subjects, and they were divided into the remimazolam group and the propofol group according to the admission sequence of patients. The remimazolam group was anesthetized with remimazolam, and the propofol group was anesthetized with propofol. The anesthesia-related indicators, perioperative pain degree [Visual Analogue Scale (VAS)], circulatory indicators [heart rate, mean arterial pressure (MAP)] before anesthesia (T0), immediately before laryngeal mask insertion (T1), at 5 min after laryngeal mask insertion (T2), at 30 min after laryngeal mask insertion (T3) and at 5 min after laryngeal mask removal (T4), stress response indicators (plasma epinephrine, norepinephrine, cortisol) before anesthesia induction and at 24 h and 72 h after surgery, cognitive function [Mini-Mental State Examination (MMSE)] and adverse reactions were compared between the two groups. RESULTS: Among the 60 enrolled patients, only 1 case was excluded due to withdrawal, thus 30 cases in the remimazolam group and 29 cases in the propofol group were included. There were statistically significant differences in the heart rate, MAP, plasma epinephrine, norepinephrine, cortisol and VAS score in the two groups from the aspects of interaction effect and time-point effect (P < 0.05). The heart rate and MAP at T1, T2 and T3 in the two groups were significantly decreased compared with those at T0, but the heart rate and MAP in the remimazolam group at T1, T2 and T3 were significantly higher than those in the propofol group (P < 0.05). There were no statistical differences in the anesthesia time, awakening time and extubation time between the remimazolam group and the propofol group (P > 0.05). The levels of plasma epinephrine, norepinephrine and cortisol in the two groups were significantly higher at 24 h and 72 h after surgery than those before anesthesia induction, and the above levels were significantly lower in the remimazolam group than those in the propofol group (P < 0.05). The VAS scores at each time point in the two groups were significantly reduced compared to before surgery, but there was no statistically significant difference between the two groups after surgery (P > 0.05). The MMSE scores of the two groups were significantly lower at 1 d and 3 d after surgery compared with those before anesthesia induction, but the score in the remimazolam group was significantly higher than that in the propofol group (P < 0.05). In addition, the incidence rates of adverse reactions were significantly lower in the remimazolam group compared to the propofol group (P < 0.05). CONCLUSION: Compared with propofol, remimazolam can achieve equivalent anesthetic and analgesic effects in elderly patients undergoing hip replacement. However, the latter one can significantly relieve respiratory and circulatory suppression, stress response and cognitive dysfunction, with good safety. TRIAL REGISTRATION: This single-center, prospective, RCT has completed the registration of the Chinese Clinical Trial Center at 31/12/2021 with the registration number ChiCTR2100055039 .


Assuntos
Anestésicos , Propofol , Idoso , Analgésicos , Anestesia Geral , Benzodiazepinas , Epinefrina , Humanos , Hidrocortisona , Norepinefrina , Propofol/efeitos adversos , Estudos Prospectivos
18.
Ulus Travma Acil Cerrahi Derg ; 28(4): 498-507, 2022 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-35485512

RESUMO

BACKGROUND: Intraocular pressure (IOP) increases due to pneumoperitoneum and the Trendelenburg position during laparo-scopic surgery. Apart from ketamine and suxamethonium, anesthetic agents generally reduce IOP by various extents. The present study investigated the effects of combinations of four anesthetic agents on IOP during laparoscopic gynecological surgery. METHODS: Patients (n=100) were assigned to one of the four groups: Group 1 (n=25; pentothal induction + desflurane/remifen-tanil maintenance), Group 2 (n=25; propofol induction + sevoflurane/remifentanil maintenance), Group 3 (n=25; propofol induction + desflurane/remifentanil maintenance), and Group 4 (n=25; pentothal induction + sevoflurane/remifentanil maintenance). The IOPs recorded before anesthesia induction, after intubation, after carbon dioxide insufflation, in the Trendelenburg position, and after ex-tubation were compared among the groups. Hemodynamic parameters were also evaluated. RESULTS: Induction in Group 2 and Group 3 used propofol. When the IOP in the Trendelenburg position was compared with the IOP before induction, there was no statistically significant difference in Groups 2 and 3 (p>0.05). In Groups 1 and 4, pentothal was used for induction. The IOP in Groups 1 and 4 was statistically significantly higher in the Trendelenburg position than it was before induction (0.027-0.001). CONCLUSION: To minimize the variation in IOP in the Trendelenburg position during laparoscopic gynecological surgeries, we recommend the use of propofol for induction, independent of desflurane or sevoflurane use.


Assuntos
Anestésicos , Laparoscopia , Propofol , Desflurano , Feminino , Procedimentos Cirúrgicos em Ginecologia/efeitos adversos , Decúbito Inclinado com Rebaixamento da Cabeça , Humanos , Pressão Intraocular , Laparoscopia/efeitos adversos , Propofol/efeitos adversos , Remifentanil , Sevoflurano , Tiopental
19.
Biomolecules ; 12(4)2022 04 12.
Artigo em Inglês | MEDLINE | ID: mdl-35454159

RESUMO

Propofol is a broadly used intravenous anesthetic agent that can cause cardiovascular effects, including bradycardia and asystole. A possible mechanism for these effects is slowing cardiac pacemaker activity due to inhibition of the hyperpolarization-activated, cyclic nucleotide-gated (HCN) channels. However, it remains unclear how propofol affects the allosteric nature of the voltage- and cAMP-dependent gating mechanism in HCN channels. To address this aim, we investigated the effect of propofol on HCN channels (HCN4 and HCN2) in heterologous expression systems using a whole-cell patch clamp technique. The extracellular application of propofol substantially suppressed the maximum current at clinical concentrations. This was accompanied by a hyperpolarizing shift in the voltage dependence of channel opening. These effects were significantly attenuated by intracellular loading of cAMP, even after considering the current modification by cAMP in opposite directions. The differential degree of propofol effects in the presence and absence of cAMP was rationalized by an allosteric gating model for HCN channels, where we assumed that propofol affects allosteric couplings between the pore, voltage-sensor, and cyclic nucleotide-binding domain (CNBD). The model predicted that propofol enhanced autoinhibition of pore opening by unliganded CNBD, which was relieved by the activation of CNBD by cAMP. Taken together, these findings reveal that propofol acts as an allosteric modulator of cAMP-dependent gating in HCN channels, which may help us to better understand the clinical action of this anesthetic drug.


Assuntos
Anestésicos , Propofol , Anestésicos/farmacologia , AMP Cíclico/metabolismo , Canais Disparados por Nucleotídeos Cíclicos Ativados por Hiperpolarização/química , Canais Disparados por Nucleotídeos Cíclicos Ativados por Hiperpolarização/genética , Canais Disparados por Nucleotídeos Cíclicos Ativados por Hiperpolarização/metabolismo , Ativação do Canal Iônico/fisiologia , Canais de Potássio/metabolismo , Propofol/farmacologia
20.
BMC Anesthesiol ; 22(1): 127, 2022 04 29.
Artigo em Inglês | MEDLINE | ID: mdl-35488192

RESUMO

BACKGROUND: In clinical practice, sufentanil has a stronger sedative effect on patients than fentanyl at equivalent doses. This study hypothesized that, at equivalent doses, patients undergoing gynaecologic laparoscopic surgery (GLS) receiving fentanyl would have an earlier emergence from anaesthesia (EA), a shorter time to extubation (TE), and a better degree of wakefulness. Therefore, this study evaluated the effects of equipotent doses of fentanyl and sufentanil on the quality of emergence in patients undergoing GLS. METHODS: One hundred seven patients scheduled for GLS under general anaesthesia were randomly divided into two groups and were induced with 0.35 µg/kg sufentanil (Group S; n = 55) or 3.5 µg/kg fentanyl (Group F; n = 52). When the GLS was almost over, the patient's abdominal cavity was flushed with warm saline, and 5 µg of sufentanil or 50 µg of fentanyl in a double-blind manner was intravenously injected into the patients. The primary outcomes of the study included EA, TE, the rate of leaving the surgical bed voluntarily and the incidence of endotracheal tube tolerance. The Ramsay Sedation Scale (RSS), and Verbal Rating Scale (VRS) scores at 15 and 30 min in the postanaesthesia care unit (PACU), as well as other adverse events, including nausea and vomiting, itching, delirium, dizziness, chills, and respiratory depression (SpO2 < 95%) in the PACU, were evaluated as secondary outcomes. RESULTS: There were no statistically significant dissimilarities between the two groups with respect to baseline characteristics. For recovery, the EA (9.0 ± 4.8 min vs. 8.9 ± 3.0 min; P = 0. 146), TE (9.5 ± 4.7 min vs. 9.0 ± 3.0 min; P = 0.135), rate of leaving the surgical bed voluntarily (31.18% vs. 38.46%; P = 0.976), and incidence of endotracheal tube tolerance (94.55% vs. 96.15%; P = 0.694) were not significantly different between the two groups. In the PACU, the 15-min RSS score (2.07 ± 0.38 vs. 2.15 ± 0.36; P = 0.125), the 30-min RSS score (2.02 ± 0.13 vs. 2.04 ± 0.19; P = 0.207), the 15-min VRS score (0.50 ± 0.57 vs. 0.67 ± 0.55; P = 0.295), and the 30-min VRS score (0.45 ± 0.50 vs. 0.75 ± 0.52; P = 0.102) were not significantly different between Groups S and F. No adverse events, such as nausea, vomiting, pruritus, delirium, and tremors, occurred in either group. The rates of respiratory depression (1.82% vs. 1.92%; P = 0.968) and dizziness (0.00% vs. 4.85%; P = 0.142) were not different between Groups S and F in the PACU. CONCLUSIONS: The majority of patients scheduled for GLS were able to rapidly and smoothly emerge from anaesthesia. After surgery, similar outcomes, including EA, TE, the incidence of endotracheal tube tolerance, the rate of leaving the surgical bed voluntarily, RSS scores, VRS scores, and adverse events in the PACU, were achieved for the patients between the two anaesthetic protocols.


Assuntos
Anestesia , Delírio , Laparoscopia , Propofol , Insuficiência Respiratória , Tontura/induzido quimicamente , Feminino , Fentanila , Humanos , Náusea/induzido quimicamente , Propofol/efeitos adversos , Remifentanil , Insuficiência Respiratória/induzido quimicamente , Sufentanil , Vômito/induzido quimicamente
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