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1.
J Korean Med Sci ; 35(11): e70, 2020 03 23.
Artigo em Inglês | MEDLINE | ID: mdl-32193901

RESUMO

BACKGROUND: Previously, a linked pharmacokinetic-pharmacodynamic model (the Kim model) of propofol with concurrent infusion of remifentanil was developed for children aged 2-12 years. There are few options for pharmacokinetic-pharmacodynamic model of propofol for children under two years old. We performed an external validation of the Kim model for children under two years old to evaluate whether the model is applicable to this age group. METHODS: Twenty-four children were enrolled. After routine anesthetic induction, a continuous infusion of 2% propofol and remifentanil was commenced using the Kim model. The target effect-site concentration of propofol was set as 2, 3, 4, and 5 µg/mL, followed by arterial blood sampling after 10 min of each equilibrium. Population estimates of four parameters-pooled bias, inaccuracy, divergence, and wobble-were used to evaluate the performance of the Kim model. RESULTS: A total of 95 plasma concentrations were used for evaluation of the Kim model. The population estimate (95% confidence interval) of bias was -0.96% (-8.45%, 6.54%) and that of inaccuracy was 21.0% (15.0%-27.0%) for the plasma concentration of propofol. CONCLUSION: The pooled bias and inaccuracy of the pharmacokinetic predictions are clinically acceptable. Therefore, our external validation of the Kim model indicated that the model can be applicable to target-controlled infusion of propofol in children younger than 2 years, with the recommended use of actual bispectral index monitoring in clinical settings that remifentanil is present. TRIAL REGISTRATION: Clinical Research Information Service Identifier: KCT0001752.


Assuntos
Anestésicos Intravenosos/farmacocinética , Propofol/farmacocinética , Remifentanil/farmacocinética , Monitores de Consciência , Feminino , Humanos , Lactente , Recém-Nascido , Infusões Intravenosas , Masculino , Modelos Biológicos
2.
Medicine (Baltimore) ; 99(5): e19043, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32000452

RESUMO

BACKGROUND: Propofol has been used widely as an anesthetic for elderly patients; however, the drug instructions only indicate that the need for maintenance of general anesthesia in elderly patients is reduced, and not the extent of the reduction. This study has summarized the usage of propofol in total intravenous anesthesia under bispectral index (BIS) monitoring and determined the optimum dosage of propofol for elderly patients. METHODS: The study comprised 156 patients undergoing elective surgery under general anesthesia divided into 2 groups according to their age: the elderly group (O group) and nonelderly group (Y group). BIS monitoring was used in both groups during the operation, and propofol and remifentanil were used to maintain anesthesia. The preoperative special conditions, intraoperative maintenance of propofol, remifentanil, fentanyl, cis-atracurium, vasoactive drug use, and hemodynamic changes were summarized. RESULTS: Propofol maintenance in the O group was 3.372 ±â€Š0.774 mg/(kg h), which was significantly lesser than that in Y group (P < 0.05). The incidence of cardiovascular and cerebrovascular diseases and the use rate of vasoactive drugs in the O group were significantly higher than in the Y group (P < 0.05). CONCLUSION: Propofol maintenance in the O group was significantly lower than that in the nonelderly group; this indicates that the anesthetic drug delivery rate for elderly patients should be reduced.


Assuntos
Anestésicos Intravenosos/administração & dosagem , Monitores de Consciência , Propofol/administração & dosagem , Idoso , Humanos
3.
N Engl J Med ; 382(12): 1103-1111, 2020 03 19.
Artigo em Inglês | MEDLINE | ID: mdl-32068366

RESUMO

BACKGROUND: In critically ill, mechanically ventilated patients, daily interruption of sedation has been shown to reduce the time on ventilation and the length of stay in the intensive care unit (ICU). Data on whether a plan of no sedation, as compared with a plan of light sedation, has an effect on mortality are lacking. METHODS: In a multicenter, randomized, controlled trial, we assigned, in a 1:1 ratio, mechanically ventilated ICU patients to a plan of no sedation (nonsedation group) or to a plan of light sedation (i.e., to a level at which the patient was arousable, defined as a score of -2 to -3 on the Richmond Agitation and Sedation Scale [RASS], on which scores range from -5 [unresponsive] to +4 [combative]) (sedation group) with daily interruption. The primary outcome was mortality at 90 days. Secondary outcomes were the number of major thromboembolic events, the number of days free from coma or delirium, acute kidney injury according to severity, the number of ICU-free days, and the number of ventilator-free days. Between-group differences were calculated as the value in the nonsedation group minus the value in the sedation group. RESULTS: A total of 710 patients underwent randomization, and 700 were included in the modified intention-to-treat analysis. The characteristics of the patients at baseline were similar in the two trial groups, except for the score on the Acute Physiology and Chronic Health Evaluation (APACHE) II, which was 1 point higher in the nonsedation group than in the sedation group, indicating a greater chance of in-hospital death. The mean RASS score in the nonsedation group increased from -1.3 on day 1 to -0.8 on day 7 and, in the sedation group, from -2.3 on day 1 to -1.8 on day 7. Mortality at 90 days was 42.4% in the nonsedation group and 37.0% in the sedated group (difference, 5.4 percentage points; 95% confidence interval [CI], -2.2 to 12.2; P = 0.65). The number of ICU-free days and of ventilator-free days did not differ significantly between the trial groups. The patients in the nonsedation group had a median of 27 days free from coma or delirium, and those in the sedation group had a median of 26 days free from coma or delirium. A major thromboembolic event occurred in 1 patient (0.3%) in the nonsedation group and in 10 patients (2.8%) in the sedation group (difference, -2.5 percentage points; 95% CI, -4.8 to -0.7 [unadjusted for multiple comparisons]). CONCLUSIONS: Among mechanically ventilated ICU patients, mortality at 90 days did not differ significantly between those assigned to a plan of no sedation and those assigned to a plan of light sedation with daily interruption. (Funded by the Danish Medical Research Council and others; NONSEDA ClinicalTrials.gov number, NCT01967680.).


Assuntos
Sedação Consciente , Estado Terminal/terapia , Hipnóticos e Sedativos/administração & dosagem , Respiração Artificial , Idoso , Idoso de 80 Anos ou mais , Coma/complicações , Sedação Consciente/métodos , Estado Terminal/mortalidade , Delírio/complicações , Feminino , Humanos , Infusões Intravenosas , Unidades de Terapia Intensiva , Análise de Intenção de Tratamento , Estimativa de Kaplan-Meier , Tempo de Internação , Masculino , Midazolam/administração & dosagem , Pessoa de Meia-Idade , Propofol/administração & dosagem , Respiração Artificial/efeitos adversos , Tromboembolia/etiologia
4.
Beijing Da Xue Xue Bao Yi Xue Ban ; 52(1): 181-186, 2020 Feb 18.
Artigo em Chinês | MEDLINE | ID: mdl-32071484

RESUMO

OBJECTIVE: To analyze the clinical data of patients undergoing intravenous sedation in oral and maxillofacial surgery, to understand the epidemiological characteristics, to evaluate the efficacy and safety of intravenous sedation for oral surgery, and to summarize our experience. METHODS: We retrospectively reviewed the clinical data of patients undergoing intravenous sedation between January 2010 and December 2018 in the Department of Oral and Maxillofacial Surgery, Peking University School of Stomatology. The gender, age, source, disease types, the values of perioperative vital signs, the use of sedatives and analgesics, duration of surgery and sedation, effect of sedation during the operation and the postoperative anterograde amnesia were analyzed. RESULTS: A total of 2 582 patients experienced oral surgery by intravenous sedation. The peak age was 3.5 to 10 years and between 21 to 40 years. Supernumerary teeth (38%, 981/2 582) and impacted third molars (30%, 775/2 582) were the major disease types, and other types of disease accounted for 32 percent (826/2 582). The values of heart rate(HR), mean arterial pressure(MAP), respiration rate(RR) and bispectral index(BIS) showed statistically significant differences at the time of before sedation, local anesthesia injection, surgical incision, 10 min after operation and the end of operation. In the study, 69%(1 781/2 582) cases received midazolam alone, 7%(181/2 582) cases received propofol alone, and 24% (620/2 582) cases received midazolam and propofol combined for intravenous sedation. Fentanyl (33%, 852/2 582)was the most common intravenous analgesic we used, followed by flurbiprofen axetil (23%, 594/2 582) and ketorolac tromethamine (6%, 157/2 582). Besides, 35% (907/2 582) patients didn't use any intravenous analgesic during the surgery. The average operation time was (31.2±20.8) min, and the average sedation time was (38.4±19.2) min. During the surgery procedure, most of the patients scored on a scale of 2 to 4 according to the Ramsay sedation score (RSS). The postoperative anterograde amnesia rates of local anesthesia injection, surgical incision and dental drill during surgery were 94% (2 431/2 582), 92% (2 375/2 582) and 75% (1 452/1 936). CONCLUSION: Intravenous sedation on the oral and maxillofacial surgery is effective and safe, can make the patients more comfortable, and should be further promoted and applied.


Assuntos
Anestesia Dentária , Cirurgia Bucal , Anestésicos Intravenosos , Humanos , Hipnóticos e Sedativos , Midazolam , Propofol , Estudos Retrospectivos
5.
Oncology ; 98(3): 161-167, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31962315

RESUMO

BACKGROUND: The effect of anesthetic techniques on cancer recurrence has been the subject of intensive research in the past years, as it affects a large proportion of the population. The use of opioids and halogenated agents in cancer patients during the perioperative period may be related to higher rates of cancer recurrence and reduced disease-free survival. METHODS: This was a prospective study. The sample was composed of 100 patients who underwent a radical cystectomy for infiltrating bladder cancer in a reference center. We compared disease-free survival associated with combined anesthesia versus opiate-based analgesia. The relationship between the administered hypnotic and disease-free survival was also investigated. RESULTS: The median disease-free survival of the patients who received combined anesthesia was 585 (240-1,005) days versus 210 (90-645) days in the other group. A significant difference was observed between the two groups (p = 0.01). Combined analysis of all groups revealed significant differences in disease-free survival between patients who received combined anesthesia with propofol (510 [315-1,545] disease-free days) and those who received sevoflurane and opioids (150 [90-450] disease-free days) (p = 0.02). CONCLUSIONS: Anesthesia may play a crucial role in tumor relapse, as it is administered at the moment of the greatest risk of dissemination: surgical handling of the tumor. Opioids and volatile agents have been related to an increased risk for cancer recurrence. We compared the use of propofol + local anesthesia versus sevoflurane + opioids and also found that disease-free survival was longer among patients who received propofol + local anesthesia. Disease-free survival increases with the use of propofol in combination with epidural anesthesia in patients who undergo surgery for infiltrating bladder cancer.


Assuntos
Analgésicos Opioides/administração & dosagem , Anestesia por Inalação , Anestesia Intravenosa , Anestésicos Intravenosos/administração & dosagem , Cistectomia , Propofol/administração & dosagem , Neoplasias da Bexiga Urinária/cirurgia , Analgésicos Opioides/efeitos adversos , Anestesia por Inalação/efeitos adversos , Anestesia por Inalação/mortalidade , Anestesia Intravenosa/efeitos adversos , Anestesia Intravenosa/mortalidade , Anestésicos Intravenosos/efeitos adversos , Cistectomia/efeitos adversos , Cistectomia/mortalidade , Intervalo Livre de Doença , Humanos , Metástase Neoplásica , Recidiva Local de Neoplasia , Propofol/efeitos adversos , Estudos Prospectivos , Fatores de Proteção , Medição de Risco , Fatores de Risco , Fatores de Tempo , Neoplasias da Bexiga Urinária/mortalidade , Neoplasias da Bexiga Urinária/patologia
6.
Life Sci ; 244: 117280, 2020 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-31926239

RESUMO

AIMS: Recently, chemoresistance has been recognized as an obstacle in the treatment of gastric cancer (GC). The aim of this study was to investigate the biological functions and underlying mechanisms of propofol in GC chemoresistance. MAIN METHODS: CCK-8 assay, flow cytometry and immunofluorescent staining were performed to assess the IC50 concentration, cell apoptosis and autophagy activity of cisplatin in both GC chemosensitive cells (SGC7901) and chemoresistant cells (SGC7901/CDDP). The expression pattern of MALAT1 in GC cells was detected by qRT-PCR. The shRNAs and overexpressing plasmids were employed for the loss or gain-of-function. Dual-luciferase reporter assay was subjected to verify the binding relationship between MALAT1 and miR-30e. Besides, ATG5 mRNA and protein levels were determined using qRT-PCR and western blot analysis. Furthermore, GC xenograft mice model was established to validate the in vitro findings. KEY FINDINGS: Chemoresistant GC cells presented higher IC50 of cisplatin, increased autophagy activity and stronger expression of MALAT1. The application of propofol promoted cell apoptosis and reduced the activity of autophagy through downregulating MALAT1. Silencing of MALAT1 inhibited chemo-induced autophagy, whereas MALAT1 overexpression promoted autophagy in GC cells. Mechanistic researches demonstrated that MALAT1 could bind with miR-30e to regulate ATG5 expression, thus causing the suppression of autophagy. In vivo GC xenograft model treated with both propofol and cisplatin also showed significantly decreased tumor size and weight, which was enhanced by knockdown of MALAT1. SIGNIFICANCE: Altogether, our study revealed a novel mechanism of propofol of lncRNA MALAT1/miR-30e/ATG5 mediated autophagy-related chemoresistance in GC, casting new lights on the understanding of propofol.


Assuntos
MicroRNAs/genética , Propofol/metabolismo , RNA Longo não Codificante/metabolismo , Animais , Apoptose/efeitos dos fármacos , Autofagia/genética , Proteína 5 Relacionada à Autofagia/genética , Proteína 5 Relacionada à Autofagia/metabolismo , Linhagem Celular Tumoral , Proliferação de Células/efeitos dos fármacos , China , Cisplatino/metabolismo , Cisplatino/farmacologia , Resistencia a Medicamentos Antineoplásicos/efeitos dos fármacos , Regulação Neoplásica da Expressão Gênica/efeitos dos fármacos , Humanos , Camundongos , Camundongos Nus , MicroRNAs/metabolismo , Propofol/farmacologia , RNA Longo não Codificante/genética , Neoplasias Gástricas/genética , Neoplasias Gástricas/metabolismo , Ensaios Antitumorais Modelo de Xenoenxerto
7.
Anaesthesia ; 75 Suppl 1: e90-e100, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31903578

RESUMO

Propofol-based total intravenous anaesthesia is well known for its smooth, clear-headed recovery and anti-emetic properties, but there are also many lesser known beneficial properties that can potentially influence surgical outcome. We will discuss the anti-oxidant, anti-inflammatory and immunomodulatory effects of propofol and their roles in pain, organ protection and immunity. We will also discuss the use of propofol in cancer surgery, neurosurgery and older patients.


Assuntos
Anestesia Intravenosa/métodos , Anestésicos Intravenosos , Avaliação de Resultados da Assistência ao Paciente , Período Perioperatório , Propofol , Humanos
8.
Medicine (Baltimore) ; 99(1): e18669, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31895833

RESUMO

In ophthalmic surgery, coughing during emergence from general anesthesia may have a detrimental effect on intraocular pressure. Tracheal suction during emergence may elicit this reflex. The optimal effect-site concentration (EC) of propofol to prevent triggering of the cough reflex during tracheal suctioning is unknown. The aim of this study is to assess the optimal EC of propofol for tracheal suctioning during emergence in patients undergoing ophthalmic surgery.Twenty-one patients were enrolled, all of them American Society of Anesthesiologists (ASA) physical status I or II non-smokers undergoing ophthalmic surgery. Anesthesia was induced and maintained under total intravenous anesthesia using target-controlled infusion. During emergence from general anesthesia, tracheal suction was performed at different propofol concentrations as required for Dixon's up-and-down method with a step size of 0.2 µg/ml. A propofol concentration at which the cough reflex was not triggered during tracheal suctioning was considered successful.The EC50 of propofol for tracheal suction without cough was 1.4 µg/ml and the EC95 was 1.6 µg/ml.Tracheal suction may be accomplished without triggering the cough reflex when the propofol effect-site concentration is higher than 1.6 µg/ml.


Assuntos
Anestésicos Intravenosos/administração & dosagem , Tosse/prevenção & controle , Intubação Intratraqueal/efeitos adversos , Procedimentos Cirúrgicos Oftalmológicos , Propofol/administração & dosagem , Idoso , Tosse/etiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Sucção/efeitos adversos
9.
Toxicol Lett ; 322: 98-103, 2020 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-31954869

RESUMO

Patients intoxicated with organophosphorous compounds may need general anaesthesia to enable mechanical ventilation or for control of epileptiform seizures. It is well known that cholinergic overstimulation attenuates the efficacy of general anaesthetics to reduce spontaneous network activity in the cortex. However, it is not clear how propofol, the most frequently used intravenous anaesthetic today, is affected. Here, we investigated the effects of cholinergic overstimulation induced by soman and acetylcholine on the ability of propofol to depress spontaneous action potential activity in organotypic cortical slices measured by extracellular voltage recordings. Cholinergic overstimulation by co-application of soman and acetylcholine (10 µM each) did not reduce the relative inhibition of propofol (1.0 µM; mean normalized action potential firing rate 0.49 ± 0.06 of control condition, p < 0.001, Wilcoxon signed rank test) but clearly reduced its efficacy. Co-application of atropine (10 nM) did not improve the efficacy. Propofol preserved its relative inhibitory potential but did not produce a degree of neuronal depression which can be expected to assure hypnosis in humans. Since a combination with atropine did not improve its efficacy, an increase in dosage will probably be necessary when propofol is used in victims suffering from organophosphorous intoxication.


Assuntos
Acetilcolina/toxicidade , Potenciais de Ação/efeitos dos fármacos , Anestésicos Intravenosos/farmacologia , Rede Nervosa/efeitos dos fármacos , Propofol/farmacologia , Soman/toxicidade , Acetilcolina/administração & dosagem , Anestesia Geral , Anestésicos Intravenosos/administração & dosagem , Animais , Camundongos Endogâmicos C57BL , Neocórtex/efeitos dos fármacos , Neocórtex/fisiologia , Rede Nervosa/fisiologia , Neurônios/efeitos dos fármacos , Neurônios/fisiologia , Técnicas de Cultura de Órgãos , Intoxicação por Organofosfatos , Propofol/administração & dosagem , Soman/administração & dosagem
10.
Br J Anaesth ; 124(3): 271-280, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31902588

RESUMO

BACKGROUND: Preclinical data suggest suppression of cancer proliferation by propofol, and retrospective studies suggest improved survival after cancer surgery with propofol-based anaesthesia. METHODS: To determine whether propofol dose administered for anaesthesia is associated with 1-yr mortality in patients with and without a diagnosis of solid cancer, we analysed adult patients undergoing monitored anaesthesia care or general anaesthesia at two academic medical centres in Boston, MA, USA. Logistic regression with interaction term analysis was applied with propofol dose (mg kg-1) as primary and diagnosis of solid cancer as co-primary exposure, and 1-yr mortality as the primary outcome. RESULTS: Of 280 081 patient cases, 10 744 (3.8%) died within 1 yr. Increasing propofol dose was associated with reduced odds of 1-yr mortality (adjusted odds ratio [aOR] 0.93 per 10 mg kg-1; 95% confidence interval [CI]: 0.89-0.98; absolute risk reduction fifth vs first quintile 0.5%; 95% CI: 0.2-0.7). This association was modified by a diagnosis of solid cancer (P<0.001 for interaction). Increasing propofol dose was associated with reduced odds of 1-yr mortality in patients without solid cancer (aOR: 0.78; 95% CI: 0.71-0.85), but not in patients with solid cancer (0.99; 0.94-1.04), a finding that was replicated when examining 5-yr mortality. CONCLUSIONS: Increasing propofol dose is associated with lower 1-yr mortality in patients without, but not in patients with, a diagnosis of solid cancer. We found evidence for competing effects, modifying the association between propofol dose and mortality.


Assuntos
Anestesia Geral/métodos , Anestésicos Intravenosos/administração & dosagem , Neoplasias/mortalidade , Complicações Pós-Operatórias/prevenção & controle , Propofol/administração & dosagem , Adulto , Idoso , Relação Dose-Resposta a Droga , Feminino , Seguimentos , Humanos , Masculino , Massachusetts/epidemiologia , Pessoa de Meia-Idade , Complicações Pós-Operatórias/mortalidade , Estudos Retrospectivos , Análise de Sobrevida
11.
Int Heart J ; 61(1): 60-66, 2020 Jan 31.
Artigo em Inglês | MEDLINE | ID: mdl-31956143

RESUMO

Transcatheter aortic valve implantation (TAVI) using a transfemoral approach under local anesthesia with conscious sedation (LACS) is becoming an increasingly common TAVI strategy. However, patients who are awake during the TAVI procedure can experience stress, anxiety, and pain, even when LACS is used. Clinical hypnotherapy is an anxiolytic intervention that can be beneficial for patients undergoing invasive surgery. This study aimed to assess the perioperative outcomes of adjunctive hypnotherapy undergoing transfemoral TAVI with LACS.Consecutive patients (n = 143) with symptomatic severe aortic stenosis who underwent transfemoral TAVI with LACS only (n = 107) or with LACS and hypnotherapy (n = 36) between January 2015 and April 2016 were retrospectively included in the study. The clinical outcomes were compared between the two groups. The LACS with hypnotherapy group had a significantly shorter length of stay in the intensive care unit (ICU; LACS only versus LACS with hypnotherapy: 4.0 (4.0-5.5) days versus 3.0 (3.0-5.0) days, P < 0.01). Moreover, the use of anesthetics (propofol and remifentanil) and norepinephrine was significantly lower in the LACS with hypnotherapy group (e.g., for propofol, LACS only versus LACS with hypnotherapy: 96.4 ± 104.7 mg versus 15.0 ± 31.8 mg, P < 0.001). The multiple regression analysis showed that being male, hypnotherapy, and the composite complication score were independently associated with the length of stay in the ICU.The adjunctive hypnotherapy on LACS among transfemoral TAVI patients may facilitate perioperative management. However, a prospective randomized study is necessary to confirm the efficacy of hypnotherapy among TAVI patients.


Assuntos
Estenose da Valva Aórtica/cirurgia , Sedação Consciente/métodos , Hipnose/métodos , Substituição da Valva Aórtica Transcateter/métodos , Idoso , Idoso de 80 Anos ou mais , Anestesia Local , Feminino , Humanos , Masculino , Norepinefrina/administração & dosagem , Período Perioperatório , Complicações Pós-Operatórias , Propofol/administração & dosagem , Estudos Prospectivos , Análise de Regressão , Remifentanil/administração & dosagem , Estudos Retrospectivos , Resultado do Tratamento
13.
Anaesthesia ; 75(2): 196-201, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31788791

RESUMO

Mechanisms underlying loss of consciousness following propofol administration remain incompletely understood. The objective of this study was to compare frontal lobe electroencephalography activity and brainstem reflexes during intravenous induction of general anaesthesia, in patients receiving a typical bolus dose (fast infusion) of propofol compared with a slower infusion rate. We sought to determine whether brainstem suppression ('bottom-up') predominates over loss of cortical function ('top-down'). Sixteen ASA physical status-1 patients were randomly assigned to either a fast or slow propofol infusion group. Loss of consciousness and brainstem reflexes were assessed every 30 s by a neurologist blinded to treatment allocation. We performed a multitaper spectral analysis of all electroencephalography data obtained from each participant. Brainstem reflexes were present in all eight patients in the slow infusion group, while being absent in all patients in the fast infusion group, at the moment of loss of consciousness (p = 0.010). An increase in alpha band power was observed before loss of consciousness only in participants allocated to the slow infusion group. Alpha band power emerged several minutes after the loss of consciousness in participants allocated to the fast infusion group. Our results show a predominance of 'bottom-up' mechanisms during fast infusion rates and 'top-down' mechanisms during slow infusion rates. The underlying mechanisms by which propofol induces loss of consciousness are potentially influenced by the speed of infusion.


Assuntos
Anestésicos Intravenosos/administração & dosagem , Estado de Consciência/efeitos dos fármacos , Eletroencefalografia/métodos , Lobo Frontal/efeitos dos fármacos , Propofol/administração & dosagem , Adulto , Feminino , Humanos , Infusões Intravenosas , Masculino , Pessoa de Meia-Idade , Método Simples-Cego , Fatores de Tempo , Adulto Jovem
14.
Odontology ; 108(1): 102-108, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31562580

RESUMO

The propofol dose requirement and the emergence time are affected by antiepileptic use. The effects on anesthesia of the number and kind of antiepileptic agents have not been reported. We investigated the relationship between the kind and number of antiepileptic agents and the propofol dose requirement for anesthesia and emergence time in intravenous general anesthesia for dental treatment for patients with neurological disorders. We studied 247 patients with neurological disorders who underwent dental treatment under intravenous general anesthesia. Patients were categorized according to the number of antiepileptics (none, single agent, two kinds, and three or more kinds of antiepileptics) and the kind of antiepileptic (carbamazepine, valproate, phenobarbital, phenytoin, zonisamide, clobazam, or topiramate) being received. The propofol dose requirement for anesthesia, emergence time, and predicted blood propofol concentration at emergence were evaluated. Patients on three or more kinds of antiepileptics had significantly lower propofol dose requirement (reduction in 25%, compare with no use) and predicted blood propofol concentration at emergence (reduction in 41%) and significantly longer emergence time (extension in 50%) (P < 0.05). Valproate and clobazam reduced the propofol dose (valproate 9% and clobazam 19%) and predicted blood propofol concentration at emergence (valproate 18% and clobazam 33%), while phenobarbital increased these parameters (30% and 125%) (P < 0.05). The number and kind of antiepileptics effects propofol dose requirement. In particular, valproate and clobazam reduce the propofol dose requirement, while phenobarbital increases this.Clinical trial registration UMIN No. UMIN000014179.


Assuntos
Anticonvulsivantes , Propofol , Humanos , Fenobarbital , Fenitoína , Ácido Valproico
15.
Forensic Sci Int ; 306: 110070, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31786517

RESUMO

Propofol abuse has been reported worldwide, suggesting the need to establish analytical methods for human biological samples to investigate the abuse of propofol. This study aimed to investigate the relationship between dose and hair concentration using a simple and rapid analytical method developed and validated in this study. In the sample preparation, hair samples were washed with distilled water and methanol and extracted in methanol during 16h at room temperature. After centrifugation and evaporation, the residue was reconstituted and filtered through a 0.22µm membrane filter before LC-MS/MS analysis. The precursor-to-product ion transitions were 353 → 175, 113 for propofol glucuronide and m/z 370 → 175, 113 for internal standard(propofol glucuronide-d17). The calibration curves were satisfactory (R2=0.9997) and the limits of detection and quantification were 2 and 5pg/mg, respectively. In addition, this study collected the history of propofol use from subjects using a questionnaire and analyzed subjects' hair samples using a validated analytical method. As a result, the concentrations of propofol glucuronide ranged from 7 to 122pg/mg (mean : 51pg/mg). There were cases of positive relationships, but generally there was no correlation between dose and hair concentration.


Assuntos
Glucuronídeos/análise , Cabelo/química , Hipnóticos e Sedativos/análise , Propofol/análise , Detecção do Abuso de Substâncias/métodos , Adulto , Cromatografia Líquida , Feminino , Toxicologia Forense , Glucuronídeos/administração & dosagem , Humanos , Hipnóticos e Sedativos/administração & dosagem , Masculino , Pessoa de Meia-Idade , Propofol/administração & dosagem , Transtornos Relacionados ao Uso de Substâncias/diagnóstico , Espectrometria de Massas em Tandem , Adulto Jovem
16.
Life Sci ; 241: 117143, 2020 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-31811855

RESUMO

AIM: To investigate the effect of propofol on the migration and invasion of oral squamous cell carcinoma (OSCC) cells and explore the underlying mechanism. MAIN METHODS: Cal-27 and SCC-25 cells treated with or without propofol, then the cells metastasis were determined. The levels of SNAI1 mRNA and protein were detected by real-time PCR and western blot. Cell migration ability was evaluated by wound healing assay, and the invasion of cells was measured using transwell assay. KEY FINDINGS: Propofol treatment significantly promoted cell migration and invasion of OSCC. Further mechanistic studies of the stimulating effects of propofol on OSCC cell metastasis revealed that propofol treatment dose-dependently upregulated the expression of SNAI1, a member of the Snail superfamily of zinc-finger transcription factors. Additionally, the inhibition of endogenous SNAI1 expression reversed the effect of propofol on cell migration and invasion in Cal-27 and SCC-25 cells. SIGNIFICANCE: Our results demonstrate that propofol at clinically relevant concentrations facilitates cell migration and invasion through up-regulation of SNAI1 in OSCC cells, and suggest propofol may not be suitable for anesthesia management in OSCC patients.


Assuntos
Carcinoma de Células Escamosas/patologia , Movimento Celular/efeitos dos fármacos , Regulação Neoplásica da Expressão Gênica/efeitos dos fármacos , Hipnóticos e Sedativos/farmacologia , Neoplasias Bucais/patologia , Propofol/farmacologia , Fatores de Transcrição da Família Snail/metabolismo , Apoptose/efeitos dos fármacos , Carcinoma de Células Escamosas/tratamento farmacológico , Carcinoma de Células Escamosas/metabolismo , Proliferação de Células/efeitos dos fármacos , Humanos , Neoplasias Bucais/tratamento farmacológico , Neoplasias Bucais/metabolismo , Invasividade Neoplásica , Fatores de Transcrição da Família Snail/genética , Células Tumorais Cultivadas
19.
Braz J Med Biol Res ; 53(1): e8645, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31859910

RESUMO

Data about the feasibility and safety of thoracoscopic surgery under non-intubated anesthesia and regional block are limited. In this prospective study, 57 consecutive patients scheduled for thoracoscopic surgery were enrolled. Patients were sedated with dexmedetomidine and anesthetized with propofol and remifentanil. Ropivacaine was used for intercostal nerve and paravertebral block. Lidocaine was used for vagal block. The primary outcomes were mean arterial pressure (MAP), heart rate (HR), oxygen saturation, and end-tidal carbon dioxide partial pressure (ETCO2) at T0 (pre-anesthesia), T1 (immediately after laryngeal mask/nasopharyngeal airway placement), T2 (immediately after skin incision), T3 (10 min after opening the chest), T4 (end of surgery), and T5 (immediately after laryngeal mask/nasopharyngeal airway removal). One patient required conversion to intubation, 15 developed intraoperative hypotension, and two had hypoxemia. MAP at T0 and T5 was higher than at T1-T4; MAP at T3 was lower (P<0.05 vs other time points). HR at T0 and T5 was higher (P<0.05 vs other time points). ETCO2 at T2 and T3 was higher (P<0.05 vs other time points). Arterial pH, PCO2, and lactic acid at T1 differed from values at T0 and T2 (P<0.05). The Quality of Recovery-15 (QoR-15) score at 24 h was lower (P<0.05). One patient experienced dysphoria during recovery. Thoracoscopic surgery with regional block under direct thoracoscopic vision is a feasible and safe alternative to conventional surgery under general anesthesia, intubation, and one-lung ventilation.


Assuntos
Anestesia Geral/métodos , Máscaras Laríngeas , Bloqueio Nervoso/métodos , Toracoscopia/métodos , Adolescente , Adulto , Pressão Sanguínea/efeitos dos fármacos , Pressão Sanguínea/fisiologia , Dexmedetomidina/administração & dosagem , Estudos de Viabilidade , Feminino , Frequência Cardíaca/efeitos dos fármacos , Frequência Cardíaca/fisiologia , Humanos , Masculino , Pessoa de Meia-Idade , Propofol/administração & dosagem , Estudos Prospectivos , Remifentanil/administração & dosagem , Adulto Jovem
20.
DNA Cell Biol ; 39(2): 197-209, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31880481

RESUMO

Propofol is a widely used intravenous agent for the induction and maintenance of anesthesia. An increasing number of studies have shown that propofol modulates autophagy, which is an evolutionarily conserved catabolic process that maintains cellular homeostasis by degrading long-lived proteins and damaged cellular proteins or organelles. Extensive studies have been performed to better understand the regulation of autophagy by propofol, the majority of which have demonstrated that the effects of propofol on autophagy are beneficial to organs and tissues. In this review, we retrospectively analyzed studies to assess the effects of propofol on autophagy in different diseases and evaluated the underlying mechanisms.


Assuntos
Autofagia/efeitos dos fármacos , Sistema Nervoso Central/efeitos dos fármacos , Homeostase/efeitos dos fármacos , Propofol/farmacologia , Animais , Autofagia/fisiologia , Sistema Nervoso Central/lesões , Humanos , Estudos Retrospectivos , Transdução de Sinais/efeitos dos fármacos
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