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1.
Nat Commun ; 11(1): 642, 2020 01 31.
Artigo em Inglês | MEDLINE | ID: mdl-32005799

RESUMO

Metastasis can occur following surgical resection of solid tumors and metastasis is the main cause of cancer death. The role of anesthetics used during surgery in cancer metastasis and the underlying mechanism remains largely unknown. Here we show that surgical dissection of primary tumors in mice under anesthesia with sevoflurane leads to significantly more lung metastasis than with propofol in both syngeneic murine 4T1 and xenograft human MDA-MB-231 breast cancer models. Sevoflurane increases the level of serum IL-6, which activates STAT3 and the infiltration of CD11b+ myeloid cells into the lung. Interruption of IL-6/JAK/STAT3 pathway by a JAK inhibitor AZD1480 reverses the pro-metastatic effect of sevoflurane and the associated increase of both activated STAT3 and infiltrated CD11b+ cells in 4T1 model. Our study provides the preclinical evidence informing the distinct effects of anesthetics on metastasis of breast cancers through change of cytokines and the tumor microenvironment.


Assuntos
Anestésicos Gerais/efeitos adversos , Neoplasias da Mama/cirurgia , Interleucina-6/metabolismo , Janus Quinases/metabolismo , Neoplasias Pulmonares/secundário , Fator de Transcrição STAT3/metabolismo , Anestésicos Gerais/administração & dosagem , Animais , Neoplasias da Mama/patologia , Linhagem Celular Tumoral , Modelos Animais de Doenças , Feminino , Humanos , Interleucina-6/genética , Janus Quinases/genética , Neoplasias Pulmonares/etiologia , Neoplasias Pulmonares/genética , Neoplasias Pulmonares/metabolismo , Camundongos , Camundongos Endogâmicos BALB C , Propofol/administração & dosagem , Propofol/efeitos adversos , Fator de Transcrição STAT3/genética , Sevoflurano/administração & dosagem , Sevoflurano/efeitos adversos
2.
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
3.
Medicine (Baltimore) ; 98(48): e18244, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31770287

RESUMO

BACKGROUND: We investigated the effects of propofol vs desflurane on ischemia and reperfusion injury (IRI)-induced inflammatory responses, especially in matrix metalloproteinase-9 (MMP-9) downregulation and heme oxygenase-1 (HO-1) upregulation, which may result in different clinical outcomes in liver transplant recipients. METHODS: Fifty liver transplant recipients were randomized to receive propofol-based total intravenous anesthesia (TIVA group, n = 25) or desflurane anesthesia (DES group, n = 25). We then measured the following: perioperative serum cytokine concentrations (interleukin 1 receptor antagonist [IL-1RA], IL-6, IL-8, and IL-10); MMP-9 and HO-1 mRNA expression levels at predefined intervals. Further, postoperative outcomes were compared between the 2 groups. RESULTS: The TIVA group showed a significant HO-1 level increase following the anhepatic phase and a significant MMP-9 reduction after reperfusion, in addition to a significant increase in IL-10 levels after the anhepatic phase and IL-1RA levels after reperfusion. Compared to DES patients, TIVA patients showed a faster return of the international normalized ratio to normal values, lower plasma alanine aminotransferase concentrations 24 hours after transplantation, and fewer patients developing acute lung injury. Moreover, compared with DES patients, TIVA patients showed a significant reduction in serum blood lactate levels. However, there were no differences in postoperative outcomes between the two groups. CONCLUSION: Propofol-based TIVA attenuated inflammatory response (elevated IL-1RA and IL-10 levels), downregulated MMP-9 response, and increased HO-1 expression with improved recovery of graft function and better microcirculation compared with desflurane anesthesia in liver transplant recipients.


Assuntos
Desflurano , Transplante de Fígado , Propofol , Traumatismo por Reperfusão , Adulto , Anestésicos Inalatórios/administração & dosagem , Anestésicos Inalatórios/efeitos adversos , Anestésicos Intravenosos/administração & dosagem , Anestésicos Intravenosos/efeitos adversos , Desflurano/administração & dosagem , Desflurano/efeitos adversos , Feminino , Heme Oxigenase-1/análise , Humanos , Proteína Antagonista do Receptor de Interleucina 1/análise , Interleucina-10/análise , Transplante de Fígado/efeitos adversos , Transplante de Fígado/métodos , Masculino , Metaloproteinase 9 da Matriz/análise , Período Pós-Operatório , Propofol/administração & dosagem , Propofol/efeitos adversos , Traumatismo por Reperfusão/sangue , Traumatismo por Reperfusão/etiologia , Imunologia de Transplantes
4.
Medicine (Baltimore) ; 98(46): e17957, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31725655

RESUMO

BACKGROUND: Although surgical field visualization is important in functional endoscopic sinus surgery (FESS), the complications associated with controlled hypotension for surgery should be considered. Intraoperative hypotension is associated with postoperative stroke, leading to subsequent hypoxia with potential neurologic injury. We investigated the effect of propofol and desflurane anesthesia on S-100ß and glial fibrillary acidic protein (GFAP) levels which are early biomarkers for cerebral ischemic change during controlled hypotension for FESS. METHODS: For controlled hypotension during FESS, anesthesia was maintained with propofol/remifentanil in propofol group (n = 30) and with desflurane/remifentanil in desflurane group (n = 30). For S-100ß and GFAP assay, blood samples were taken at base, 20 and 60 minutes after achieving the target range of mean arterial pressure, and at 60 minutes after surgery. RESULTS: The base levels of S-100ß were 98.04 ±â€Š78.57 and 112.61 ±â€Š66.38 pg/mL in the propofol and desflurane groups, respectively. The base levels of GFAP were 0.997 ±â€Š0.486 and 0.898 ±â€Š0.472 ng/mL in the propofol and desflurane groups, respectively. The S-100ß and GFAP levels were significantly increased in the study period compared to the base levels in both groups (P ≤ .001). There was no significant difference at each time point between the 2 groups. CONCLUSION: On comparing the effects of propofol and desflurane anesthesia for controlled hypotension on the levels of S-100ß and GFAP, we noted that there was no significant difference in S-100ß and GFAP levels between the 2 study groups. CLINICAL TRIAL REGISTRATION: Available at: http://cris.nih.go.kr, KCT0002698.


Assuntos
Proteína Glial Fibrilar Ácida/sangue , Hipotensão Controlada/métodos , Propofol/uso terapêutico , Subunidade beta da Proteína Ligante de Cálcio S100/sangue , Sinusite/cirurgia , Adulto , Anestésicos Intravenosos , Pressão Arterial/efeitos dos fármacos , Dióxido de Carbono/sangue , Doença Crônica , Desflurano/administração & dosagem , Desflurano/efeitos adversos , Desflurano/uso terapêutico , Endoscopia , Feminino , Proteína Glial Fibrilar Ácida/biossíntese , Humanos , Hipotensão Controlada/efeitos adversos , Masculino , Pessoa de Meia-Idade , Propofol/administração & dosagem , Propofol/efeitos adversos , Estudos Prospectivos , Remifentanil/administração & dosagem , Subunidade beta da Proteína Ligante de Cálcio S100/biossíntese , Fatores de Tempo
5.
Trials ; 20(1): 534, 2019 Aug 28.
Artigo em Inglês | MEDLINE | ID: mdl-31455386

RESUMO

BACKGROUND: Accidental Accidental awareness during general anesthesia (AAGA) occurs in 1-2% of high-risk practice patients and is a cause of severe psychological trauma, termed post-traumatic stress disorder (PTSD). However, no monitoring techniques can accurately predict or detect AAGA. Since the first reflex for a patient during AAGA is to move, a passive brain-computer interface (BCI) based on the detection of an intention of movement would be conceivable to alert the anesthetist. However, the way in which propofol (i.e., an anesthetic commonly used for the general anesthesia induction) affects motor brain activity within the electroencephalographic (EEG) signal has been poorly investigated and is not clearly understood. For this reason, a detailed study of the motor activity behavior with a step-wise increasing dose of propofol is required and would provide a proof of concept for such an innovative BCI. The main goal of this study is to highlight the occurrence of movement attempt patterns, mainly changes in oscillations called event-related desynchronization (ERD) and event-related synchronization (ERS), in the EEG signal over the motor cortex, in healthy subjects, without and under propofol sedation, during four different motor tasks. METHODS: MOTANA is an interventional, prospective, exploratory, physiological, monocentric, and randomized study conducted in healthy volunteers under light anesthesia, involving EEG measurements before and after target-controlled infusion of propofol at three different effect-site concentrations (0 µg.ml -1, 0.5 µg.ml -1, and 1.0 µg.ml -1). In this exploratory study, 30 healthy volunteers will perform 50 trials for the four motor tasks (real movement, motor imagery, motor imagery with median nerve stimulation, and median nerve stimulation alone) in a randomized sequence. In each conditions and for each trial, we will observe changes in terms of ERD and ERS according to the three propofol concentrations. Pre- and post-injection comparisons of propofol will be performed by paired series tests. DISCUSSION: MOTANA is an exploratory study aimed at designing an innovative BCI based on EEG-motor brain activity that would detect an attempt to move by a patient under anesthesia. This would be of interest in the prevention of AAGA. TRIAL REGISTRATION: Agence Nationale de Sécurité du Médicament (EUDRACT 2017-004198-1), NCT03362775. Registered on 29 August 2018. https://clinicaltrials.gov/ct2/show/NCT03362775?term=03362775&rank=1.


Assuntos
Anestésicos Intravenosos/administração & dosagem , Eletroencefalografia , Consciência no Peroperatório/prevenção & controle , Monitorização Neurofisiológica Intraoperatória/métodos , Atividade Motora , Córtex Motor/efeitos dos fármacos , Propofol/administração & dosagem , Adolescente , Adulto , Anestésicos Intravenosos/efeitos adversos , Sincronização Cortical , França , Voluntários Saudáveis , Humanos , Consciência no Peroperatório/diagnóstico , Consciência no Peroperatório/fisiopatologia , Masculino , Córtex Motor/fisiopatologia , Valor Preditivo dos Testes , Propofol/efeitos adversos , Estudos Prospectivos , Ensaios Clínicos Controlados Aleatórios como Assunto , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
7.
Mediators Inflamm ; 2019: 7651383, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31281228

RESUMO

Many patients experience excellent physical recoveries after surgery; however, there are some of them who from suffer mood fluctuation, even depression. Postoperative depression may be resulted from cognitive dysfunction, pain, and a compromised immune system during the surgery. But there is a higher possibility that general anaesthesia may be responsible for the development of depression. Here, we employed one of the most used anaesthetics, propofol, in a mouse model to investigate whether this intravenous anaesthetic compound could cause depressive-like behavioural performance in mice. We found a single dose of propofol caused significant abnormal behavioural performance in tail suspension, forced swimming, and open field tests. We also examined the brain section of these mice and revealed that there was significant reduced expression of the CD11b protein, which demonstrated an inhibition of propofol on microglial function. We investigated the effect of propofol on synaptic protein, SYP, and found there was no notable influence on the protein expression. These above results suggested that propofol treatment might promote the depressive-like behaviours in mice via influencing the microglial cell function. Furthermore, we found the level of the IL-6 cytokine was significantly increased in the brain tissue, which might subsequently cause the activation of the transcriptional factor, STAT3. Our finding may provide a new perspective of further understanding the mechanism of anaesthetic drugs and deciphering the underlying mechanism of postoperative depression.


Assuntos
Depressão/induzido quimicamente , Microglia/efeitos dos fármacos , Microglia/fisiologia , Propofol/efeitos adversos , Anestesia Intravenosa , Animais , Ansiedade/induzido quimicamente , Ansiedade/metabolismo , Encéfalo/efeitos dos fármacos , Encéfalo/metabolismo , Antígeno CD11b/metabolismo , Depressão/metabolismo , Modelos Animais de Doenças , Ensaio de Imunoadsorção Enzimática , Interleucina-6/metabolismo , Masculino , Camundongos , Camundongos Endogâmicos C57BL , Fator de Transcrição STAT3/metabolismo , Sinaptofisina/metabolismo
8.
Medicine (Baltimore) ; 98(27): e16257, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31277145

RESUMO

RATIONALE: Benign epilepsy with centrotemporal spikes (BECTS) is one of the most common forms of childhood epilepsy, which is expected to resolve before 16 years of age, with mild effects on the cognitive or behavioral functions in adulthood. This study aims to report the first propofol-induced refractory status epilepticus (SE) in patients with BECTS after 16 years of age, and to review SE in BECTS or induced by propofol. PATIENT CONCERN: A 16-year-old Chinese girl, who was diagnosed with BECTS at the age of 2 years, developed refractory SE induced by propofol administered during the maintenance stage of general anesthesia during a plastic surgery procedure. DIAGNOSES: Considering her medical history, EEG, and magnetic resonance images, and brain computed tomography, a diagnosis of refractory SE in BECTS was confirmed. INTERVENTIONS: The patient had been seizure-free for 3 years from treatment with 2 anti-epileptic drugs (AEDs) valproate acid (VPA) and oxcarbazepine (OXC), and had started monotherapy with OXC for 3 months before the seizure incidence. She had undergone blepharoplasty under local anesthesia prior to receiving general anesthesia. During the maintenance state she developed convulsive SE, which was uncontrolled seizure and lasted for 14 hours. The treatment for which included midazolam, diazepam, propofol, VPA, OXC, and levetiracetam (LEV). OUTCOMES: The prolonged seizure was controlled by diazepam (4 mg/h), propofol (6 mg/kg/h), VPA (2400 mg/d intravenous injection). Subsequently, she was administered VPA (800 mg/d po), OXC (600 mg/d po), and LEV (1000 mg/d po). Finally, on the 17th day she was discharged, and did not have any seizure recurrence and EEG results were normal as noted during the 3-month follow-up. LESSONS: This was the first report of an SE in BECTS patient past the remission age. This report implied that interventions of sedation or analgesia in a patient after remission age of BECTS might still be at risk of refractory SE and therefore, should be carefully evaluated and monitored during such procedures, especially when an AED medication has been withdrawn or altered.


Assuntos
Epilepsia Rolândica/fisiopatologia , Propofol/efeitos adversos , Estado Epiléptico/induzido quimicamente , Adolescente , Eletroencefalografia , Feminino , Humanos , Hipnóticos e Sedativos/efeitos adversos , Hipnóticos e Sedativos/uso terapêutico , Imagem por Ressonância Magnética , Propofol/uso terapêutico , Estado Epiléptico/diagnóstico , Tomografia Computadorizada por Raios X
9.
Afr Health Sci ; 19(1): 1736-1744, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31149004

RESUMO

Background: The aim of this study was to compare the effect of propofol and ketofol (ketamine-propofol mixture) on EA in children undergoing tonsillectomy. Method: In this randomized clinical trial, 87 ASA class I and II patients, aged 3-12 years, who underwent tonsillectomy, were divided into two groups to receive either propofol 100 µg/kg/min (group p, n=44) or ketofol : ketamine 25 µg/kg/min + propofol 75 µg/kg/min (group k, n= 43). Incidence and severity of EA was evaluated using the Pediatric Anesthesia Emergence Delirium (PAED) scales on arrival at the recovery room, and 10 and 30 min after that time. Results: There was no statistically significant difference in demographic data between the two groups. In the ketofol group, the need for agitation treatment and also mean recovery duration were lower than in the propofol group (30 and 41%, and 29.9 and 32.7 min), without statistically significant difference (P value=0.143 and P value=0.187). Laryngospasm or bronchospasm occurred in 2 patients in each group and bleeding was observed in only one individual in the ketofol group. Conclusion: Infusion of ketofol in children undergoing tonsillectomy provides shorter recovery time and lower incidence of EA despite the non significant difference with propofol.


Assuntos
Anestésicos Dissociativos/administração & dosagem , Anestésicos Intravenosos/administração & dosagem , Delírio do Despertar/induzido quimicamente , Ketamina/administração & dosagem , Propofol/administração & dosagem , Tonsilectomia/métodos , Anestesia/efeitos adversos , Anestésicos Dissociativos/efeitos adversos , Anestésicos Intravenosos/efeitos adversos , Espasmo Brônquico/induzido quimicamente , Criança , Pré-Escolar , Delírio do Despertar/epidemiologia , Feminino , Humanos , Incidência , Ketamina/efeitos adversos , Laringismo/induzido quimicamente , Masculino , Propofol/efeitos adversos , Índice de Gravidade de Doença
10.
BMC Anesthesiol ; 19(1): 100, 2019 06 11.
Artigo em Inglês | MEDLINE | ID: mdl-31185906

RESUMO

BACKGROUND: To compare the effect of premedication with 2 different doses of oral paracetamol to prevent pain at propofol intravenous injection. METHODS: We conducted a double-blind randomized controlled trial in which patients scheduled for induction of general anesthesia with intravenous propofol received either a placebo, 500 mg or 1000 mg of oral paracetamol (P500 and P1000, respectively) 1 h prior to induction. Two mg/kg of propofol was injected at a rate of 600 ml/hr. After 1/4 of the full dose had been injected, the syringe pump was paused, and patients were asked to rate pain at the injection site using a verbal numerical rating score (VNRS) from 0 to 10. RESULTS: Three hundred and twenty-four patients were included. Pain intensity was lower in both P500 and P1000 groups (median VNRS [interquartile range] = 2 [0-3] and 4 [2-5], respectively) than in the placebo group (8 [7-10]; P < 0.001)*. The rate of pain was lower in the P1000 group (70.4%) than in both the P500 and the placebo group (86.1 and 99.1%, respectively; P < 0.001)*. The respective rates of mild (VNRS 1-3), moderate (VNRS 4-6) and severe pain (VNRS 7-10) were 47.2, 23.2 and 0% in the P1000 group, 28.7, 50 and 7.4% in the P500 group, and 0, 22.2 and 76.9% in the placebo group (P < 0.001* for between group comparisons). Tolerance was similar in the 3 groups. CONCLUSIONS: A premedication with oral paracetamol can dose-dependently reduce pain at propofol intravenous injection. To avoid this common uncomfortable concern for the patients, this well-tolerated, available and cheap treatment appears as an option to be implemented in the current practice. TRIAL REGISTRATION: TCTR20150224002 . Prospectively registered on 24 February 2015.


Assuntos
Acetaminofen/administração & dosagem , Analgésicos não Entorpecentes/administração & dosagem , Anestésicos Intravenosos/efeitos adversos , Reação no Local da Injeção/tratamento farmacológico , Dor/tratamento farmacológico , Propofol/efeitos adversos , Administração Oral , Adulto , Método Duplo-Cego , Feminino , Humanos , Infusões Intravenosas/efeitos adversos , Reação no Local da Injeção/diagnóstico , Masculino , Pessoa de Meia-Idade , Dor/induzido quimicamente , Dor/diagnóstico
11.
Curr Opin Anaesthesiol ; 32(4): 457-463, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31219870

RESUMO

PURPOSE OF REVIEW: The purpose of this review is to discuss current drugs used for intravenous moderate and deep sedation by nonanesthesiologists in the United States. We also explore training expectations for moderate and deep sedation as they play key roles in anesthetic selection and preprocedural planning. RECENT FINDINGS: Although opioids and benzodiazepines are considered the standard for moderate sedation, increased interest in propofol, dexmedetomidine, and other sedative-hyptonic drugs require additional attention in terms of training providers and complying with current practice guidelines. SUMMARY: Moderate sedation providers should be familiar with titrating benzodiazepines and opioids to achieve targeted sedation. The use of propofol and ketamine is generally reserved for deep sedation by qualified professionals. However, the role of dexmedetomidine in procedural sedation continues to evolve as its use is explored in moderate sedation. Providers of all sedation types should be aware of hypotension, apnea, hypoventilation, and hypoxia that can develop and they should be able to manage the patient under these circumstances. Preprocedural planning is an integral training expectation to minimize patient risks.


Assuntos
Anestesiologia/educação , Sedação Consciente/métodos , Sedação Profunda/métodos , Educação Médica Continuada , Hipnóticos e Sedativos/administração & dosagem , Administração Intravenosa , Analgésicos Opioides/administração & dosagem , Analgésicos Opioides/efeitos adversos , Anestesiologia/normas , Apneia/diagnóstico , Apneia/etiologia , Benzodiazepinas/administração & dosagem , Benzodiazepinas/efeitos adversos , Sedação Consciente/efeitos adversos , Sedação Consciente/normas , Estado de Consciência/efeitos dos fármacos , Sedação Profunda/efeitos adversos , Sedação Profunda/normas , Dexmedetomidina/administração & dosagem , Dexmedetomidina/efeitos adversos , Relação Dose-Resposta a Droga , Humanos , Hipnóticos e Sedativos/efeitos adversos , Hipotensão/diagnóstico , Hipotensão/etiologia , Hipoventilação/diagnóstico , Hipoventilação/etiologia , Hipóxia/diagnóstico , Hipóxia/etiologia , Guias de Prática Clínica como Assunto , Propofol/administração & dosagem , Propofol/efeitos adversos
12.
Medicine (Baltimore) ; 98(21): e15709, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31124948

RESUMO

BACKGROUND: It is uncertain if dexmedetomidine has more favorable pharmacokinetic profile than the traditional sedative drug propofol in patients who undergo endovascular therapy for acute stroke. We conducted a prospective randomized control trial to compare the safety and efficacy of dexmedetomidine with propofol for patients undergoing endovascular therapy for acute stroke. METHODS: A total of 80 patients who met study inclusion criteria were received either propofol (n = 45) or dexmedetomidine (n = 35) between January 2016 and August 2018. We recorded the favorable neurologic outcome (modified Rankin score <3) both at discharge and 3 months after stroke, National Institute of Health Stroke scale (NIHSS) at 48 hours post intervention, modified thrombolysis in myocardial infarction score on digital subtraction angiography, intraprocedural hemodynamics, recovery time, relevant time intervals, satisfaction score of the surgeon, mortality, and complications. RESULTS: There were no significant differences between the 2 groups (P > .05) with respect to heart rate, respiratory rate, and SPO2 during the procedure. The mean arterial pressure (MAP) was significantly low in the propofol group until 15 minutes after anesthesia was induced. No difference was recorded between the groups at the incidence of fall in MAP >20%, MAP >40% and time spent with MAP fall >20% from baseline MAP. In the propofol group, the time spent with MAP fall >40% from baseline MAP was significantly long (P < .05). Midazolam and fentanyl were similar between the 2 groups (P > .05) that used vasoactive drugs. The time interval from stroke onset to CT room, from stroke onset to groin puncture, and from stroke onset to recanalization/end of the procedure, was not significantly different between the 2 groups (P > .05). The recovery time was longer in the dexmedetomidine group (P < .05). There was no difference between the groups with respect to complications, favorable neurological outcome, and mortality both at hospital discharge and 3 months later, successful recanalization and NIHSS score after 48 hours (P > .05). However, the satisfaction score of the surgeon was higher in the dexmedetomidine group (P < .05). CONCLUSIONS: Dexmedetomidine was undesirable than propofol as a sedative agent during endovascular therapy in patients with acute stroke for a long-term functional outcome, though the satisfaction score of the surgeon was higher in the dexmedetomidine group.


Assuntos
Dexmedetomidina/uso terapêutico , Procedimentos Endovasculares/métodos , Hipnóticos e Sedativos/uso terapêutico , Propofol/uso terapêutico , Acidente Vascular Cerebral/cirurgia , Idoso , Período de Recuperação da Anestesia , Dexmedetomidina/administração & dosagem , Dexmedetomidina/efeitos adversos , Feminino , Fibrinolíticos/administração & dosagem , Hemodinâmica , Humanos , Hipnóticos e Sedativos/administração & dosagem , Hipnóticos e Sedativos/efeitos adversos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Propofol/administração & dosagem , Propofol/efeitos adversos , Estudos Prospectivos , Acidente Vascular Cerebral/tratamento farmacológico , Vasoconstritores/administração & dosagem
13.
Anaesthesia ; 74(10): 1252-1259, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31077340

RESUMO

Propofol is the most commonly administered intravenous agent for anaesthesia in children. However, there are concerns that the emulsified preparation may not be safe in children with an allergy to egg, peanut, soybean or other legumes. We conducted a retrospective study of children with immunologically confirmed egg, peanut, soybean or legume allergy and who underwent general anaesthesia at Princess Margaret Hospital for Children between 2005 and 2015. We extracted details regarding allergy diagnosis, each anaesthetic administered and any adverse events or signs of an allergic reaction in the peri-operative period. A convenience sample of patients without any known food allergies was identified from our prospective anaesthesia research database and acted as a control group. We identified 304 food-allergic children and 649 procedures where propofol was administered. Of these, 201 (66%) had an egg allergy, 226 (74%) had a peanut allergy, 28 (9%) had a soybean allergy and 12 (4%) had a legume allergy. These were compared with 892 allergy-free patients who were exposed to propofol. In 10 (3%) allergy patients and 124 (14%) allergy-free patients, criteria for a possible allergic reaction were met. In nine of the food-allergic children and in all the controls valid non-allergic explanations for the clinical symptoms were found. One likely mild allergic reaction was experienced by a child with a previous history of intralipid allergy. We conclude that genuine serious allergic reaction to propofol is rare and is not reliably predicted by a history of food allergy.


Assuntos
Anestésicos Intravenosos/efeitos adversos , Hipersensibilidade Alimentar/complicações , Propofol/efeitos adversos , Adolescente , Anestesia Geral , Criança , Pré-Escolar , Hipersensibilidade a Drogas/etiologia , Hipersensibilidade a Ovo/complicações , Emulsões/efeitos adversos , Fabaceae/efeitos adversos , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Hipersensibilidade a Amendoim/complicações , Fosfolipídeos/efeitos adversos , Estudos Retrospectivos , Óleo de Soja/efeitos adversos , Soja/efeitos adversos
14.
Medicine (Baltimore) ; 98(20): e15712, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31096522

RESUMO

BACKGROUND: Sedation with etomidate or propofol alone during gastroscopy has many side effects. A systematic review and meta-analysis were conducted to evaluate the safety and efficacy of the combined use of propofol and etomidate for sedation during gastroscopy. METHODS: PubMed, Embase, Medline (via Ovid SP), Cochrane library databases, CINAHL (via EBSCO), China Biology Medicine disc (CBMdisc), Wanfang, VIP, and China National Knowledge Infrastructure (CNKI) databases were systematically searched. We included randomized controlled trials (RCTs) comparing the combined use of propofol and etomidate vs etomidate or propofol alone for sedation during gastroscopy. Data were pooled using the random-effects models or fixed-effect model based on heterogeneity. RESULTS: Fifteen studies with 2973 participants were included in the analysis. Compared to propofol alone, the combined use of propofol and etomidate possibly increased recovery time (SMD = 0.14, 95% CI = 0.04-0.24; P = .005), and the risk for myoclonus (OR = 3.07, 95% CI = 1.73-5.44; P < .001), injection pain, and nausea and vomiting. Furthermore, compared to propofol alone, the combination of propofol and etomidate produced an apparent beneficial effect for mean arterial pressure (MAP) after anesthesia (SMD = 1.32, 95% CI = 0.38-2.26; P = .006), SPO2 after anesthesia (SMD = 0.99, 95% CI = 0.43-1.55; P < .001), apnea or hypoxemia (OR = 0.16, 95% CI = 0.08-0.33; P < .001), injection pain, and body movement. Further, compared to etomidate alone, the combination of propofol and etomidate reduced the risk for myoclonus (OR = 0.15, 95% CI = 0.11-0.22; P < .001), body movement, and nausea and vomiting. CONCLUSION: The combination of propofol and etomidate might increase recovery time vs that associated with propofol, but it had fewer side effects on circulation and respiration in patients undergoing gastroscopy. The combined use of propofol and etomidate can improve and produce an apparent beneficial effect on the adverse effects of propofol or etomidate alone, and it was safer and more effective than propofol or etomidate alone.


Assuntos
Anestésicos Combinados/efeitos adversos , Etomidato/efeitos adversos , Gastroscopia/métodos , Propofol/efeitos adversos , Anestésicos Combinados/administração & dosagem , Anestésicos Combinados/uso terapêutico , Anestésicos Intravenosos/efeitos adversos , Anestésicos Intravenosos/uso terapêutico , Pressão Arterial/efeitos dos fármacos , China/epidemiologia , Etomidato/administração & dosagem , Etomidato/uso terapêutico , Feminino , Humanos , Hipóxia/induzido quimicamente , Reação no Local da Injeção/patologia , Masculino , Mioclonia/induzido quimicamente , Náusea/induzido quimicamente , Propofol/administração & dosagem , Propofol/uso terapêutico , Ensaios Clínicos Controlados Aleatórios como Assunto , Risco , Vômito/induzido quimicamente
15.
PLoS One ; 14(5): e0217269, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31141559

RESUMO

BACKGROUND: Propofol is a widely used anaesthetic drug with advantageous operating conditions and recovery profile. However, propofol could have long term effects on neuronal cells and is associated with post-operative delirium (POD). In this context, one of the contributing factors to the pathogenesis of POD is a reduction of cholinesterase activity. Accordingly, we investigated the effects of propofol on the methylation, expression and activity of cholinergic genes and proteins in an in-vitro model. RESULTS: We found that propofol indeed reduced the activity of AChE / BChE in our in-vitro model, without affecting the protein levels. Furthermore, we could show that propofol reduced the methylation of a repressor region of the CHRNA7 gene without changing the secretion of pro-or anti-inflammatory cytokines. Lastly, propofol changed the expression patterns of genes responsible for maintaining the epigenetic status of the cell and accordingly reduced the tri-methylation of H3 K27. CONCLUSION: In conclusion we found a possible functional link between propofol treatment and POD, due to a reduced cholinergic activity. In addition to this, propofol changed the expression of different maintenance genes of the epigenome that also affected histone methylation. Thus, propofol treatment may also induce strong, long lasting changes in the brain by potentially altering the epigenetic landscape.


Assuntos
Complicações Pós-Operatórias/etiologia , Propofol/efeitos adversos , Linhagem Celular Tumoral , Colinérgicos , Neurônios Colinérgicos/efeitos dos fármacos , Colinesterases/genética , Delírio/etiologia , Epigênese Genética/efeitos dos fármacos , Humanos , Éteres Metílicos , Metilação , Período Pós-Operatório
16.
Curr Opin Anaesthesiol ; 32(4): 531-537, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30994476

RESUMO

PURPOSE OF REVIEW: The decision to undertake monitored anesthesia care (MAC) or general endotracheal anesthesia (GEA) for patients undergoing endoscopic retrograde cholangiopancreatography (ERCP) is influenced by many factors. These include locoregional practice preferences, procedure complexity, patient position, and comorbidities. We aim to review the data regarding anesthesia-administered sedation for ERCP and identify the impact of airway management on procedure success, adverse event rates and endoscopy unit efficiency. RECENT FINDINGS: Several studies have consistently identified patients at high risk for sedation-related adverse events during ERCP. This group includes those with higher American Society of Anesthesiologists class and (BMI). ERCP is commonly performed in the prone position, which can make the placement of an emergent advanced airway challenging. Although this may be alleviated by performing ERCP in the supine position, this technique is more technically cumbersome for the endoscopist. Data regarding the impact of routine GEA on endoscopy unit efficiency remain controversial. SUMMARY: Pursuing MAC or GEA for patients undergoing ERCP is best-approached on an individual basis. Patients at high risk for sedation-related adverse events likely benefit from GEA. Larger, multicenter randomized controlled trials will aid significantly in better delineating which sedation approach is best for an individual patient.


Assuntos
Anestesia Endotraqueal/métodos , Anestesia Geral/métodos , Colangiopancreatografia Retrógrada Endoscópica/efeitos adversos , Sedação Consciente/métodos , Dor Processual/prevenção & controle , Anestesia Endotraqueal/efeitos adversos , Anestesia Geral/efeitos adversos , Colangiopancreatografia Retrógrada Endoscópica/métodos , Tomada de Decisão Clínica , Sedação Consciente/efeitos adversos , Feminino , Humanos , Hipnóticos e Sedativos/administração & dosagem , Hipnóticos e Sedativos/efeitos adversos , Masculino , Monitorização Intraoperatória , Dor Processual/etiologia , Dor Processual/psicologia , Posicionamento do Paciente , Satisfação do Paciente , Seleção de Pacientes , Propofol/administração & dosagem , Propofol/efeitos adversos
17.
J Robot Surg ; 13(5): 709-710, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31028530

RESUMO

Following the interesting reading of the article "A randomised trial to compare the increase in intracranial pressure as correlated with the optic nerve sheath diameter during propofol versus sevoflurane-maintained anesthesia in robot-assisted laparoscopic pelvic surgery", the authors comment some aspects about ocular ultrasonography to measure optic nerve sheath diameter as a tool to detect potential intracranial hypertension, pointing out the utility of Standardized A Scan technique for this purpose.


Assuntos
Anestésicos/efeitos adversos , Hipertensão Intracraniana/diagnóstico , Complicações Intraoperatórias/diagnóstico , Laparoscopia , Nervo Óptico/diagnóstico por imagem , Nervo Óptico/patologia , Pelve/cirurgia , Procedimentos Cirúrgicos Robóticos , Ultrassonografia/métodos , Anestesia/efeitos adversos , Humanos , Hipertensão Intracraniana/etiologia , Pressão Intracraniana , Complicações Intraoperatórias/etiologia , Propofol/efeitos adversos , Sevoflurano/efeitos adversos
18.
Kaohsiung J Med Sci ; 35(2): 111-115, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30848025

RESUMO

Remifentanil was a µ-agonist, with a rapid onset, a powerful narcotic analgesic activity and a fast nonspecific esterases hydrolyzation and theoretically an ideal opioid for percutaneous dilatational tracheostomy (PDT). The present study discussed use of remifentanil in critically ill patients undergoing PDT. Ninety-nine patients were randomly assigned to the propofol/remifentanil group (PR group, n = 49) or the propofol group (P group, n = 50). Two patients (one in P group and one in PR group) were excluded and transferred to surgical way of tracheostomy because of uncontrolled bleeding. The primary outcomes were critical care pain observation (CPOT) scores during PDT; hemodynamic response and side effects, such as bleeding and muscle rigidity (MR). CPOT scores in P group were significantly higher than in PR group during incision and dilation stages (P < 0.05 and P < 0.01). Systolic blood pressure had a significant drop after a bolus of remifentanil in PR group compared with patients in P group (P < 0.056). The incidence of MR was significantly higher in PR group than in P group (P < 0.05). Recovery time in PR group was significantly shorter than in P group (P < 0.05). The occurrence of tachycardia, bleeding, vomiting, and nausea had no statistically differences in both groups. Patients in PR group were undergoing shorter recovery time and better experience of pain in PDT compared with patients in P group, but MR seemed to be higher in PR group. Remifentanil seemed to be a safe and effective opioid used in critically ill patients undergoing PDT.


Assuntos
Estado Terminal , Remifentanil/uso terapêutico , Traqueostomia , Adulto , Feminino , Hemodinâmica/efeitos dos fármacos , Humanos , Masculino , Dor/etiologia , Dor/fisiopatologia , Propofol/administração & dosagem , Propofol/efeitos adversos , Propofol/uso terapêutico , Estudos Prospectivos , Remifentanil/administração & dosagem , Remifentanil/efeitos adversos , Traqueostomia/efeitos adversos , Escala Visual Analógica
19.
Br J Anaesth ; 122(4): 448-459, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30857601

RESUMO

Propofol infusion syndrome is a rare, potentially fatal condition first described in children in the 1990s and later reported in adults. We provide a narrative review of what is currently known about propofol infusion syndrome, including a structured analysis of all published case reports; child and adult cases were analysed separately as propofol is no longer used for long-term sedation in children. The review contains an update on current knowledge of the pathophysiology of this condition along with recommendations for its diagnosis, prevention, and management. We reviewed 108 publications documenting 168 cases of propofol infusion syndrome. We evaluated clinical features and analysed factors influencing mortality in child and adult cases using separate multivariate analysis models. We used separate multiple linear regression models to analyse relationships between cumulative dose of propofol and the number of features seen and organ systems involved. Lipidaemia, fever, and hepatomegaly occurred more frequently in children than in adults, whilst rhabdomyolysis and hyperkalaemia were more frequent in adults. Mortality from propofol infusion syndrome is independently associated with fever and hepatomegaly in children, and electrocardiogram changes, hypotension, hyperkalaemia, traumatic brain injury, and a mean propofol infusion rate >5 mg kg-1 h-1 in adults. The cumulative dose of propofol was associated with an increased number of clinical features and the number of organ systems involved in adult cases only. Clinicians should consider propofol infusion syndrome in cases of unexplained metabolic acidosis, ECG changes, and rhabdomyolysis. We recommend early consideration of continuous haemofiltration in the management of propofol infusion syndrome.


Assuntos
Anestésicos Intravenosos/administração & dosagem , Síndrome da Infusão de Propofol/diagnóstico , Propofol/administração & dosagem , Fatores Etários , Anestésicos Intravenosos/efeitos adversos , Relação Dose-Resposta a Droga , Humanos , Hipnóticos e Sedativos/administração & dosagem , Hipnóticos e Sedativos/efeitos adversos , Propofol/efeitos adversos , Síndrome da Infusão de Propofol/mortalidade , Fatores de Risco
20.
Br J Anaesth ; 122(4): 480-489, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30857604

RESUMO

BACKGROUND: The Strategy to Reduce the Incidence of Postoperative Delirium in the Elderly trial tested the hypothesis that limiting sedation during spinal anaesthesia decreases in-hospital postoperative delirium after hip fracture repair. This manuscript reports the secondary outcomes of this trial, including mortality and function. METHODS: Two hundred patients (≥65 yr) undergoing hip fracture repair with spinal anaesthesia were randomised to heavier [modified Observer's Assessment of Alertness/Sedation score (OAA/S) 0-2] or lighter (OAA/S 3-5) sedation, and were assessed for postoperative delirium. Secondary outcomes included mortality and return to pre-fracture ambulation level at 1 yr. Kaplan-Meier analysis, multivariable Cox proportional hazard model, and logistic regression were used to evaluate intervention effects on mortality and odds of ambulation return. RESULTS: One-year mortality was 14% in both groups (log rank P=0.96). Independent risk factors for 1-yr mortality included: Charlson comorbidity index [hazard ratio (HR)=1.23, 95% confidence interval (CI), 1.02-1.49; P=0.03], instrumental activities of daily living [HR=0.74, 95% CI, 0.60-0.91; P=0.005], BMI [HR=0.91, 95% CI 0.84-0.998; P=0.04], and delirium severity [HR=1.20, 95% CI, 1.03-1.41; P=0.02]. Ambulation returned to pre-fracture levels, worsened, or was not obtained in 64%, 30%, and 6% of 1 yr survivors, respectively. Lighter sedation did not improve odds of ambulation return at 1 yr [odds ratio (OR)=0.76, 95% CI, 0.24-2.4; P=0.63]. Independent risk factors for ambulation return included Charlson comorbidity index [OR=0.71, 95% CI, 0.53-0.97; P=0.03] and delirium [OR=0.32, 95% CI, 0.10-0.97; P=0.04]. CONCLUSIONS: This study found that in elderly patients having hip fracture surgery with spinal anaesthesia supplemented with propofol sedation, heavier intraoperative sedation was not associated with significant differences in mortality or return to pre-fracture ambulation up to 1 yr after surgery. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov NCT00590707.


Assuntos
Sedação Consciente/métodos , Sedação Profunda/métodos , Delírio do Despertar/prevenção & controle , Complicações Pós-Operatórias/prevenção & controle , Atividades Cotidianas , Idoso , Idoso de 80 Anos ou mais , Raquianestesia , Sedação Consciente/efeitos adversos , Relação Dose-Resposta a Droga , Delírio do Despertar/etiologia , Delírio do Despertar/mortalidade , Feminino , Força da Mão , Fraturas do Quadril/mortalidade , Fraturas do Quadril/cirurgia , Humanos , Hipnóticos e Sedativos/administração & dosagem , Hipnóticos e Sedativos/efeitos adversos , Estimativa de Kaplan-Meier , Masculino , Maryland/epidemiologia , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/mortalidade , Propofol/administração & dosagem , Propofol/efeitos adversos , Recuperação de Função Fisiológica
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