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1.
Pain Res Manag ; 2021: 5517150, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33936350

RESUMO

Background: Pain aggravates the autonomic response to stress and raises neuroendocrine stress hormone levels. We compared the effects of propofol and sevoflurane on postoperative pain and neuroendocrine stress hormones. A prospective, randomized, and controlled trial was conducted with 60 patients. Methods: We randomly allocated patients to groups P (remifentanil/propofol, n = 30) and S (remifentanil/sevoflurane, n = 30). Preoperative blood samples were taken to measure serum adrenocorticotropic hormone (ACTH), corticotropin-releasing hormone (CRH), glucagon, cortisol, aldosterone, and prostaglandin E2 (PGE2) levels. Intraoperatively and postoperatively, clinical parameters were monitored at different time points. The hormone levels were again measured in the follicular fluid and blood postoperatively. Result: Demographic data were similar. The preoperative serum aldosterone levels were significantly higher in group P (p=0.001). Preoperative and postoperative serum ACTH, glucagon, cortisol, and PGE2 levels were significantly different in group P (p=0.009, p=0.004, p=0.029, and p=0.002); serum ACTH, glucagon, and PGE2 levels increased while serum cortisol levels decreased postoperatively. In group S, serum CRH and aldosterone levels, both increased in the postoperative period compared to the preoperative (p=0.001, p=0.006). Postoperatively, glucagon and PGE2 levels were both higher in group P than group S (p=0.019, p=0.015). In postoperative follicular fluid, glucagon and PGE2 levels were higher in group P, while cortisol levels were higher in group S (p=0.001, p=0.007, and p=0.001). Conclusion: The effects of anesthetic agents were different. In group P, in the preoperative and postoperative evaluation, ACTH, glucagon, and PGE2 increased postoperatively, while cortisol decreased. In group S, aldosterone and CRH increased postoperatively. Glucagon and PG E2 were higher in group P than S, postoperatively.


Assuntos
Anestésicos Inalatórios/uso terapêutico , Sistemas Neurossecretores/fisiopatologia , Recuperação de Oócitos/métodos , Dor Pós-Operatória/tratamento farmacológico , Propofol/uso terapêutico , Sevoflurano/uso terapêutico , Adolescente , Adulto , Anestésicos Inalatórios/farmacologia , Feminino , Humanos , Masculino , Propofol/farmacologia , Estudos Prospectivos , Sevoflurano/farmacologia , Adulto Jovem
2.
Pain Res Manag ; 2021: 6644262, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33727997

RESUMO

Background and Objectives. Several anesthesia techniques were applied to hemorrhoidectomy, but postoperative pain and urinary retention were still two unsolved problems. The aim of this prospective randomized study was to evaluate the effect of ultrasound-guided pudendal nerve block (PNB) combined with deep sedation compared to spinal anesthesia for hemorrhoidectomy. Methods. One hundred and twenty patients undergoing Milligan-Morgan hemorrhoidectomy were randomized to receive PNB combined with deep sedation using propofol (Group PNB, n = 60) or spinal anesthesia (Group SA, n = 60). Pain intensity was assessed using the visual analogue scale (0: no pain to 10: worst possible pain). The primary outcome was pain scores recorded at rest at 3, 6, 12, 24, 36, and 48 h and on walking at 12, 24, 36, and 48 h postoperatively. Secondary outcomes were analgesic consumption, side effects, and patient satisfaction after surgery. Results. Ultrasound-guided bilateral PNB combined with deep sedation using propofol could successfully be applied to Milligan-Morgan hemorrhoidectomy. Postoperative pain intensity was significantly lower in Group PNB compared to Group SA at rest at 3, 6, 12, 24, 36, and 48 h (p < 0.001) and during mobilization at 12, 24, 36, and 48 h (p < 0.001) postoperatively. Sufentanil consumption in Group PNB was significantly lower than that in Group SA, during 0-24 h (p < 0.001) and during 24-48 h (p < 0.001) postoperatively. Urinary retention was significantly lower in Group PNB compared to Group SA (6.9% vs 20%, p=0.034). The patients in Group PNB had higher satisfaction compared to Group SA (p < 0.001). Conclusions. Ultrasound-guided PNB combined with propofol sedation is an effective anesthesia technique for Milligan-Morgan hemorrhoidectomy.


Assuntos
Raquianestesia/métodos , Sedação Profunda/métodos , Hemorroidectomia/métodos , Bloqueio Nervoso/métodos , Propofol/uso terapêutico , Nervo Pudendo/efeitos dos fármacos , Nervo Pudendo/diagnóstico por imagem , Ultrassonografia de Intervenção/métodos , Adolescente , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Dor Pós-Operatória/tratamento farmacológico , Propofol/farmacologia , Estudos Prospectivos , Adulto Jovem
3.
Medicine (Baltimore) ; 100(6): e24690, 2021 Feb 12.
Artigo em Inglês | MEDLINE | ID: mdl-33578603

RESUMO

ABSTRACT: Pediatric procedural sedation (PPS) is often performed outside of the operating room, and by various sub-specialty providers. There is no consistency in how pediatric emergency medicine (PEM) fellows are trained in PPS. The objective of this study was to survey PEM program directors (PDs) and PEM fellows about their current sedation teaching practices via a direct survey. While many fellowship programs train PEM fellows in PPS, we hypothesize that there is no consistent method of developing and measuring this skill.A 12-question survey was sent to PEM PDs directly via email. A separate 17-question survey was sent to current PEM fellows via their program coordinators by email. Each survey had multiple choice, yes-no and select-all program questions. Responses were collected in an online (REDCap) database and summarized as frequencies and percentages.Based on identifiable email, 67 programs were contacted, with a PD response rate of 46 (59%). Sixty-two program coordinators were contacted based on identifiable email with 78 fellow responses. We noted that 11/46 PD respondents offer a formal PPS rotation. Thirty programs report using propofol in the emergency department and 93% of PD respondents (28/30) actively train fellows in the use of propofol. Approximately 62% of PEM fellow respondents (48/78) report sedating without any attending oversight. Twenty-eight percent of PEM fellow respondents report using simulation as a component of their sedation training.PPS is a critical skill. However, there is a lack of consistency in both education and evaluation of competency in this area. An organized PPS rotation would improve PPS case exposure and PPS skills.


Assuntos
Anestesiologia/educação , Educação de Pós-Graduação em Medicina/estatística & dados numéricos , Bolsas de Estudo/estatística & dados numéricos , Medicina de Emergência Pediátrica/educação , Anestésicos Intravenosos/administração & dosagem , Anestésicos Intravenosos/uso terapêutico , Competência Clínica/estatística & dados numéricos , Gerenciamento de Dados , Educação de Pós-Graduação em Medicina/métodos , Escolaridade , Serviço Hospitalar de Emergência/estatística & dados numéricos , Humanos , Internato e Residência/normas , Avaliação de Programas e Projetos de Saúde/estatística & dados numéricos , Propofol/administração & dosagem , Propofol/uso terapêutico , Treinamento por Simulação/estatística & dados numéricos , Inquéritos e Questionários
4.
Medicine (Baltimore) ; 100(4): e23930, 2021 Jan 29.
Artigo em Inglês | MEDLINE | ID: mdl-33530193

RESUMO

BACKGROUND: To investigate whether closed-loop systems under bispectral index anesthesia depth monitoring can reduce the intraoperative propofol dosage. METHODS: All randomized controlled trials (RCTs) on reducing propofol dosage under closed-loop systems were collected, and the literature was screened out, the abstracts and full texts were carefully read, and the references were tracked, data extraction and quality evaluation were conducted on the included research, and the RevMan5.3 software was used for meta-analysis. The main results were propofol and the incidence of adverse reactions such as hypertensive hypotension and postoperative cognitive dysfunction. A total of 879 cases were included in 8 articles, including 450 occurrences in the closed-loop system group and 429 cases in the open-loop system group. RESULTS: Compared with manual control, closed-loop systems under bispectral index anesthesia depth monitoring reduced the dose of propofol (MD: -0.62, 95% CI: -1.08--0.16, P = .008), with heterogeneity (I2 = 80%). Closed-loop systems significantly reduced the incidence of abnormal blood pressure (MD: -0.02, 95%CI: -0.05-0.01, P = .15, I2 = 74%) and postoperative cognitive dysfunction (MD: -0.08, 95% CI: -0.14 -0.01, P = .02, I2 = 94%). CONCLUSION: Bispectral index monitoring of propofol closed-loop target-controlled infusion system can reduce the amount of propofol, reduce the incidence of adverse reactions such as hypertensive or hypotension and postoperative cognitive dysfunction.


Assuntos
Anestésicos Intravenosos/uso terapêutico , Monitores de Consciência , Propofol/uso terapêutico , Anestesia Intravenosa/métodos , Anestésicos Intravenosos/administração & dosagem , Anestésicos Intravenosos/efeitos adversos , Relação Dose-Resposta a Droga , Humanos , Complicações Cognitivas Pós-Operatórias/induzido quimicamente , Propofol/administração & dosagem , Propofol/efeitos adversos , Ensaios Clínicos Controlados Aleatórios como Assunto
5.
Mil Med ; 186(Suppl 1): 370-377, 2021 01 25.
Artigo em Inglês | MEDLINE | ID: mdl-33499544

RESUMO

BACKGROUND: Target-controlled infusion anesthesia is used worldwide to provide user-defined, stable, blood concentrations of propofol for sedation and anesthesia. The drug infusion is controlled by a microprocessor that uses population-based pharmacokinetic data and patient biometrics to estimate the required infusion rate to replace losses from the blood compartment due to drug distribution and metabolism. The objective of the research was to develop and validate a method to detect and quantify propofol levels in the blood, to improve the safety of propofol use, and to demonstrate a pathway for regulatory approval for its use in the USA. METHODS: We conceptualized and prototyped a novel "smart" biosensor-enabled intravenous catheter capable of quantifying propofol at physiologic levels in the blood, in real time. The clinical embodiment of the platform is comprised of a "smart" biosensor-enabled catheter prototype, a signal generation/detection readout display, and a driving electronics software. The biosensor was validated in vitro using a variety of electrochemical methods in both static and flow systems with biofluids, including blood. RESULTS: We present data demonstrating the experimental detection and quantification of propofol at sub-micromolar concentrations using this biosensor and method. Detection of the drug is rapid and stable with negligible biofouling due to the sensor coating. It shows a linear correlation with mass spectroscopy methods. An intuitive graphical user interface was developed to: (1) detect and quantify the propofol sensor signal, (2) determine the difference between targeted and actual propofol concentration, (3) communicate the variance in real time, and (4) use the output of the controller to drive drug delivery from an in-line syringe pump. The automated delivery and maintenance of propofol levels was demonstrated in a modeled benchtop "patient" applying the known pharmacokinetics of the drug using published algorithms. CONCLUSIONS: We present a proof-of-concept and in vitro validation of accurate electrochemical quantification of propofol directly from the blood and the design and prototyping of a "smart," indwelling, biosensor-enabled catheter and demonstrate feedback hardware and software architecture permitting accurate measurement of propofol in blood in real time. The controller platform is shown to permit autonomous, "closed-loop" delivery of the drug and maintenance of user-defined propofol levels in a dynamic flow model.


Assuntos
Técnicas Biossensoriais , Anestesia Intravenosa , Anestésicos Intravenosos , Cateteres , Humanos , Infusões Intravenosas , Propofol/uso terapêutico
6.
Br J Anaesth ; 126(3): 665-673, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33358336

RESUMO

BACKGROUND: Postoperative delirium (POD) is a frequent complication in older patients. Dexmedetomidine might be effective in decreasing the incidence of POD. We hypothesised that adding low-dose rate dexmedetomidine infusion to a propofol sedation regimen would have fewer side-effects and would counteract the possible delirium producing properties of propofol, resulting in a lower risk of POD than propofol with placebo. METHODS: In this double-blind placebo-controlled trial, patients ≥60 yr old undergoing on-pump cardiac surgery were randomised 1:1 to the following postoperative sedative regimens: a propofol infusion and dexmedetomidine (0.4 µg kg-1 h-1) or a propofol infusion and saline 0.9% (placebo group). The study drug was started at chest closure and continued for 10 h. The primary endpoint was in-hospital POD, assessed using the Confusion Assessment Method and chart review method. RESULTS: POD over the course of hospital stay occurred in 31/177 (18%) and 33/172 (19%) patients in the dexmedetomidine and placebo arm, respectively (P=0.687; odds ratio=0.89; 95% confidence interval, 0.52-1.54). The incidence of POD in the intensive care alone, or on the ward alone, was also not significantly different between the groups. Subjects in the dexmedetomidine group spent less median time in a delirious state (P=0.026). Median administered postoperative norepinephrine was significantly higher in the dexmedetomidine group (P<0.001). One patient in the dexmedetomidine group and 10 patients in the placebo group died in the hospital. CONCLUSIONS: Adding low-dose rate dexmedetomidine to a sedative regimen based on propofol did not result in a different risk of in-hospital delirium in older patients undergoing cardiac surgery. With a suggestion of both harm and benefit in secondary outcomes, supplementing postoperative propofol with dexmedetomidine cannot be recommended based on this study. CLINICAL TRIAL REGISTRATION: NCT03388541.


Assuntos
Procedimentos Cirúrgicos Cardíacos , Delírio/prevenção & controle , Dexmedetomidina/administração & dosagem , Hipnóticos e Sedativos/uso terapêutico , Complicações Pós-Operatórias/prevenção & controle , Propofol/administração & dosagem , Idoso , Dexmedetomidina/uso terapêutico , Relação Dose-Resposta a Droga , Método Duplo-Cego , Quimioterapia Combinada , Feminino , Humanos , Hipnóticos e Sedativos/administração & dosagem , Infusões Intravenosas , Masculino , Propofol/uso terapêutico , Resultado do Tratamento
7.
Acta otorrinolaringol. esp ; 71(5): 316-320, sept.-oct. 2020.
Artigo em Espanhol | IBECS | ID: ibc-195219

RESUMO

Este documento pretende dar a conocer la endoscopia de sueño inducido entre los distintos especialistas que tratan a los pacientes con trastornos respiratorios del sueño y ser una guía para los especialistas que vayan a realizarla de modo que pueda ser reproducible


This document introduces drug-induced sleep endoscopy to the specialist treating sleep breathing disorders and is intended as a guide for those willing to perform the procedure so that it can be reproducible


Assuntos
Humanos , Guias de Prática Clínica como Assunto , Endoscopia/métodos , Sedação Profunda/métodos , Apneia Obstrutiva do Sono/diagnóstico , Endoscopia/normas , Sedação Profunda/normas , Apneia Obstrutiva do Sono/terapia , Propofol/uso terapêutico , Hipnóticos e Sedativos/uso terapêutico , Midazolam/uso terapêutico
9.
Artigo em Inglês | MEDLINE | ID: mdl-32678526

RESUMO

The Psychiatric Consultation Service at Massachusetts General Hospital sees medical and surgical inpatients with comorbid psychiatric symptoms and conditions. During their twice-weekly rounds, Dr Stern and other members of the Consultation Service discuss diagnosis and management of hospitalized patients with complex medical or surgical problems who also demonstrate psychiatric symptoms or conditions. These discussions have given rise to rounds reports that will prove useful for clinicians practicing at the interface of medicine and psychiatry.


Assuntos
Infecções por Coronavirus/terapia , Desprescrições , Dexmedetomidina/uso terapêutico , Delírio do Despertar/diagnóstico , Hipnóticos e Sedativos/uso terapêutico , Pneumonia Viral/terapia , Respiração Artificial/métodos , Síndrome de Abstinência a Substâncias/diagnóstico , Adulto , Analgésicos Opioides/uso terapêutico , Benzodiazepinas/uso terapêutico , Betacoronavirus , Delírio do Despertar/terapia , Humanos , Masculino , Exame Neurológico , Pandemias , Guias de Prática Clínica como Assunto , Propofol/uso terapêutico , Síndrome de Abstinência a Substâncias/terapia
10.
Brasília; s.n; 29 jul. 2020.
Não convencional em Português | LILACS, BRISA/RedTESA, PIE | ID: biblio-1117728

RESUMO

O Informe Diário de Evidências é uma produção do Ministério da Saúde que tem como objetivo acompanhar diariamente as publicações científicas sobre tratamento farmacológico e vacinas para a COVID-19. Dessa forma, são realizadas buscas estruturadas em bases de dados biomédicas, referentes ao dia anterior desse informe. Não são incluídos estudos pré-clínicos (in vitro, in vivo, in silico). A frequência dos estudos é demonstrada de acordo com a sua classificação metodológica (revisões sistemáticas, ensaios clínicos randomizados, coortes, entre outros). Para cada estudo é apresentado um resumo com avaliação da qualidade metodológica. Essa avaliação tem por finalidade identificar o grau de certeza/confiança ou o risco de viés de cada estudo. Para tal, são utilizadas ferramentas já validadas e consagradas na literatura científica, na área de saúde baseada em evidências. Cabe ressaltar que o documento tem caráter informativo e não representa uma recomendação oficial do Ministério da Saúde sobre a temática. Foram encontrados 16 artigos e 3 protocolos.


Assuntos
Humanos , Pneumonia Viral/tratamento farmacológico , Infecções por Coronavirus/tratamento farmacológico , Betacoronavirus/efeitos dos fármacos , Avaliação da Tecnologia Biomédica , Midazolam/uso terapêutico , Imunoglobulinas/uso terapêutico , Metilprednisolona/uso terapêutico , Vacinas contra Influenza/uso terapêutico , Propofol/uso terapêutico , Cloroquina/uso terapêutico , Anti-Inflamatórios não Esteroides/uso terapêutico , Fentanila/uso terapêutico , Estudos Transversais , Estudos de Coortes , Enoxaparina/uso terapêutico , Azitromicina/uso terapêutico , Ritonavir/uso terapêutico , Cobre/uso terapêutico , Lopinavir/uso terapêutico , Resveratrol/uso terapêutico , Interferon alfa-2/uso terapêutico , Hidroxicloroquina/uso terapêutico , Ketamina/uso terapêutico
11.
Sci Rep ; 10(1): 8858, 2020 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-32483313

RESUMO

Propofol, a common intravenous anesthetic, has been found to exert anti-cancer effects with inhibition of cancer cell proliferation, migration and invasion. We tested its possible action against HER2-overexpressing breast cancer cells that developed resistance against trastuzumab. Cell viability assay, ELISA for cytokines, mammosphere formation, quantitative RT-PCR for EMT/IL-6-targeting miRNAs and the in vivo experimental pulmonary metastasis model were performed to understand the epigenetic action of propofol. Propofol sensitized HER2 overexpressing cells to trastuzumab but such action was even more pronounced in resistant cells. Increased cytokines IL-6 as well as IL-8 were released by resistant cells, along with increased mammospheres and induction of EMT, all of which was inhibited by propofol. IL-6 targeting tumor suppressor miR-149-5p was found to be the novel miRNA that was up-regulated by propofol, resulting in the observed effects on cell viability, IL-6 production, mammospheres generation as well as EMT induction. Further, antagonizing miR-149-5p attenuated the propofol effects confirming the epigenetic activity of propofol through miR-149-5p regulation. Finally, in vivo validation in an experimental metastasis model conformed an inhibitory action of propofol against experimental lung metastasis and the essential mechanistic role of miR-149-5p/IL-6 loop. These results present a novel role of general anesthetic propofol against resistant breast cancer cells and the underlying epigenetic regulation of a tumor suppressor miRNA.


Assuntos
Anestésicos/farmacologia , Resistencia a Medicamentos Antineoplásicos/genética , Epigênese Genética/efeitos dos fármacos , Interleucina-6/metabolismo , MicroRNAs/metabolismo , Propofol/farmacologia , Anestésicos/uso terapêutico , Animais , Antagomirs/metabolismo , Antagomirs/uso terapêutico , Antineoplásicos Imunológicos/farmacologia , Antineoplásicos Imunológicos/uso terapêutico , Neoplasias da Mama/tratamento farmacológico , Neoplasias da Mama/patologia , Linhagem Celular Tumoral , Sobrevivência Celular/efeitos dos fármacos , Feminino , Humanos , Neoplasias Pulmonares/tratamento farmacológico , Neoplasias Pulmonares/secundário , Camundongos , Camundongos Nus , MicroRNAs/antagonistas & inibidores , MicroRNAs/genética , Propofol/uso terapêutico , Receptor ErbB-2/metabolismo , Transplante Heterólogo , Trastuzumab/farmacologia , Trastuzumab/uso terapêutico
12.
Rev. Rol enferm ; 43(6): 458-463, jun. 2020. ilus, tab, graf
Artigo em Espanhol | IBECS | ID: ibc-193670

RESUMO

Una de las funciones de quienes nos dedicamos a la anestesia es tratar el dolor en los pacientes. En consecuencia, hay que evitar que la administración de medicación en la inducción anestésica lo provoque. De los distintos modos de administrar medicación intravenosa, en este estudio sólo haremos referencia a la administración mediante jeringa. A partir de la técnica Push-Stop-Push y con una determinada velocidad de administración, se ha diseñado una nueva técnica de administración intravenosa a la que se ha llamado «Push-Aspire-Push». Esta técnica consiste en inyectar un cierto volumen de medicamento, aspirar y volver a inyectar otro volumen; todo ello en un tiempo determinado. Al administrar la medicación de esta manera, se consigue que esté más tiempo en contacto con la pared vascular de la zona de punción, en la medida en que se crean turbulencias en el lecho. De este modo, la medicación analgésica y/o anestésica local podrá hacer más efecto en la zona de inserción del catéter. Se ha podido verificar que con la técnica Push-Aspire-Push ha desaparecido, independientemente del calibre de catéter o zona de punción, el dolor en los pacientes estudiados, sin que haya aumentado el tiempo de inducción anestésica ni se hayan utilizado técnicas molestas


One of the functions of those who dedicate ourselves to anesthesia is to treat pain in patients. Therefore, it is necessary to avoid that the administration of medication in anesthetic induction causes it. Of the different ways of administering an intravenous medication, we are only going to refer to administration by syringe. Based on the Push-Stop-Push technique and with a certain administration speed, a new intravenous administration technique has been designed which has been called «Push-Aspire-Push». This technique consists of injecting a certain volume of medication, aspirating and re-injecting another volume; all this in a certain time. By administering the medication in this way, we achieve that it is in longer contact with the vascular wall of the puncture area, as certain turbulences are created in the bed. In this way, the analgesic and / or local anesthetic medication may have more effect in the catheter insertion area. It has been verified that, with the Push-Aspire-Push technique, pain has disappeared, regardless of the catheter size or puncture site, in the patients studied, without increasing the anesthetic induction time or using annoying techniques


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Injeções Intravenosas/enfermagem , Administração Intravenosa/métodos , Injeções Intravenosas/instrumentação , Resultado do Tratamento , Projetos Piloto , Dor/prevenção & controle , Propofol/uso terapêutico , Anestesia/enfermagem , Anestésicos Intravenosos/uso terapêutico
13.
Medicine (Baltimore) ; 99(19): e20224, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32384519

RESUMO

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


Assuntos
Analgésicos Opioides/uso terapêutico , Anestesia Geral/métodos , Gastrectomia/métodos , Laparoscopia/métodos , Dor Pós-Operatória/tratamento farmacológico , Adulto , Fatores Etários , Idoso , Analgésicos Opioides/administração & dosagem , Período de Recuperação da Anestesia , Anestesia Geral/efeitos adversos , Anestesia Intravenosa , Anestésicos Intravenosos/uso terapêutico , Anestesia Balanceada/efeitos adversos , Anestesia Balanceada/métodos , Pesos e Medidas Corporais , Desflurano/uso terapêutico , Feminino , Gastrectomia/efeitos adversos , Humanos , Laparoscopia/efeitos adversos , Masculino , Pessoa de Meia-Idade , Propofol/uso terapêutico , Remifentanil/uso terapêutico , Fatores Sexuais , Fumar/epidemiologia
14.
PLoS One ; 15(5): e0233598, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32437450

RESUMO

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


Assuntos
Anestesia Intravenosa , Anestésicos Inalatórios/uso terapêutico , Anestésicos Intravenosos/uso terapêutico , Desflurano/uso terapêutico , Neoplasias Pancreáticas/cirurgia , Propofol/uso terapêutico , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Análise de Sobrevida
15.
Medicine (Baltimore) ; 99(20): e20289, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32443375

RESUMO

BACKGROUND: Recent studies have suggested that propofol combined butorphanol (PB) has anesthetic effect in laparoscopic surgery (LS) for ectopic pregnancy (EP). But investigations of its potential effects are inconsistent. We will explore the current literature examining PB in LS for EP. METHODS: We will perform a comprehensive search from MEDLINE, Embase, Cochrane Library, PsycINFO, Global Health, Web of Science, Allied and Complementary Medicine Database, and China National Knowledge Infrastructure from inception to the present. Other literatures, such as conference abstracts, references to the relevant reviews will also be checked. Two authors will check the titles, abstracts, and full texts independently. They will also independently carry out data collection and study quality assessment. We will conduct statistical analysis using RevMan 5.3 software. RESULTS: This study will provide accurate results on the anesthetic effect and safety of PB in LS for EP. CONCLUSION: This study will establish high-quality evidence of the anesthetic effect and safety of PB in LS for EP to facilitate the clinical practice and guideline development. STUDY REGISTRATION NUMBER: INPLASY202040044.


Assuntos
Butorfanol/uso terapêutico , Laparoscopia/métodos , Gravidez Ectópica/cirurgia , Propofol/uso terapêutico , Butorfanol/administração & dosagem , Butorfanol/efeitos adversos , Feminino , Humanos , Laparoscopia/efeitos adversos , Gravidez , Propofol/administração & dosagem , Propofol/efeitos adversos , Ensaios Clínicos Controlados Aleatórios como Assunto , Projetos de Pesquisa
16.
Anaesth Crit Care Pain Med ; 39(3): 341-343, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32360979
17.
Int J Pediatr Otorhinolaryngol ; 134: 110042, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32302883

RESUMO

OBJECTIVES: In pediatric airway surgery, SponTaneous Respiration using IntraVEnous anesthesia and Hi-flow nasal oxygen (STRIVE Hi) has not been well explored. Here, we report our experience of using STRIVE Hi in endoscopic evaluations and surgeries of the pediatric airway. METHODS: This retrospective review was based on 45 airway procedures conducted under STRIVE Hi, performed by a single surgeon at a single institute from May 2017 to September 2018. After induction of anesthesia, continuous infusion with propofol and remifentanil was provided to ensure an adequate level of anesthesia and supply of humidified oxygen via a nasal cannula. Monitoring was conducted using a transcutaneous CO2 sensor and a pulse oximeter, and the oxygen reserve and bispectral indexes were measured. No muscle relaxant was administered. RESULTS: The median age of the patients was 16.0 months (range: 1-215 months) and the median weight was 10.2 kg (range: 2.4-38.5 kg). The median duration of spontaneous respiration was min 40 (range: 10-140 min). The airway procedures included diagnostic microlaryngoscopy, tracheocutaneous fistula excision, balloon dilation, supraglottoplasty, laryngeal cleft repair, injection laryngoplasty, papilloma excision, and subglottic cyst removal. During these procedures, STRIVE Hi facilitated evaluation of dynamic obstruction of the airway and the immediate outcome of surgical treatment and provided a good surgical view. Intubation and the termination of spontaneous respiration were required in only five patients. CONCLUSIONS: STRIVE Hi is an effective and feasible anesthesia option in pediatric airway surgery. It provides unobstructed surgical access and is applicable to a wide range of procedures.


Assuntos
Anestesia Intravenosa/métodos , Cânula , Doenças da Laringe/cirurgia , Oxigenoterapia/métodos , Doenças da Traqueia/cirurgia , Adolescente , Analgésicos Opioides/uso terapêutico , Anestésicos Intravenosos/uso terapêutico , Monitorização Transcutânea dos Gases Sanguíneos , Criança , Pré-Escolar , Dilatação , Feminino , Humanos , Lactente , Recém-Nascido , Intubação Intratraqueal/estatística & dados numéricos , Laringoplastia/métodos , Laringoscopia/métodos , Masculino , Oximetria , Propofol/uso terapêutico , Remifentanil/uso terapêutico , Respiração , Estudos Retrospectivos
18.
A A Pract ; 14(6): e01179, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32224687

RESUMO

Verbal orders in the operating room between the surgeon and circulating nurse are prevalent at many institutions. We present a case in which a communication breakdown involving a verbal order resulted in the patient receiving an excessively high dose of epinephrine via subcuticular infiltration. The overdose was quickly identified by an increase in T-wave amplitude on electrocardiogram (ECG). The hemodynamic changes were treated, and the patient suffered no long-term sequelae. This report emphasizes the need to have strategies in place to prevent medication errors.


Assuntos
Overdose de Drogas/diagnóstico , Epinefrina/efeitos adversos , Erros Médicos/efeitos adversos , Propofol/administração & dosagem , Pressão Sanguínea/efeitos dos fármacos , Overdose de Drogas/tratamento farmacológico , Overdose de Drogas/fisiopatologia , Hemodinâmica/efeitos dos fármacos , Humanos , Lactente , Masculino , Período Perioperatório , Relações Médico-Enfermeiro , Propofol/uso terapêutico , Sevoflurano/administração & dosagem , Sevoflurano/uso terapêutico , Resultado do Tratamento
19.
Rev. cuba. anestesiol. reanim ; 19(1): e560, ene.-abr. 2020. tab
Artigo em Espanhol | LILACS, CUMED | ID: biblio-1093126

RESUMO

Introducción: Las técnicas de administración de anestesia en cirugía torácica han experimentado gran evolución y mayor fundamento científico. La anestesia intravenosa total basada en la analgesia favorece a que el período perioperatorio transcurra sin dolor y la recuperación sin complicaciones. Objetivo: Comparar la efectividad y seguridad de dos técnicas de anestesia intravenosa total en cirugía torácica electiva con remifentanilo como base analgésica. Métodos: Estudio causiexperimental, prospectivo realizado en el Hospital Docente Clínico Quirúrgico Dr. Salvador Allende, en el período comprendido entre enero de 2013 a enero de 2015, en 45 pacientes, programados para cirugía torácica electiva, divididos en dos grupos según hipnótico utilizado. Grupo A: Propofol/Remifentanil y Grupo B: Midazolam/Remifentanil. Se evaluaron variables hemodinámicas en diferentes momentos del período intraoperatorio. Variables de oxigenación (PaO2 y SaO2) durante la ventilación unipulmonar y los tiempos de recuperación anestésica. Resultados: Predominaron los pacientes mayores de 60 años en los dos grupos, con estado físico ASA III. No hubo diferencias en la oxigenación arterial entre los grupos. Hubo disminución de la tensión arterial sistólica en el grupo A sin diferencias significativas. La recuperación de la anestesia fue significativamente más demorada en el grupo B. Conclusiones: La técnica de anestesia intravenosa total con remifentanil como base analgésica asociado a propofol resultó segura y efectiva en pacientes operados de cirugía torácica(AU)


Introduction: Anesthesia administration techniques in thoracic surgery have undergone great evolution and greater scientific foundation. Total intravenous anesthesia based on analgesia favors the perioperative period without pain and recovery without complications. Objective: To compare the effectiveness and safety of two techniques of total intravenous anesthesia in elective thoracic surgery with remifentanil as an analgesic base. Methods: Prospective and causiexperimental study carried out at Dr. Salvador Allende Clinical-Surgical Teaching Hospital, in the period from January 2013 to January 2015, with 45 patients scheduled for elective thoracic surgery, who were divided into two groups according to the hypnotic drug used. Group A: propofol/remifentanil, and group B: midazolam/remifentanil. Hemodynamic variables were evaluated at different times during the intraoperative period. Oxygenation variables (PaO2 and SaO2) during unipulmonary ventilation and anesthetic recovery times. Results: Patients older than 60 years predominated in the two groups, with a physical status of ASA III. There were no differences in arterial oxygenation between the groups. There was a decrease in systolic blood pressure in group A without significant differences. The recovery of anesthesia was significantly more delayed in group B. Conclusions: The total intravenous anesthesia technique with remifentanil as an analgesic base associated with propofol was safe and effective in patients undergoing thoracic surgery(AU)


Assuntos
Humanos , Pessoa de Meia-Idade , Idoso , Cirurgia Torácica/métodos , Midazolam/uso terapêutico , Propofol/uso terapêutico , Anestesia Intravenosa/métodos , Estudos Prospectivos , Ensaios Clínicos Controlados não Aleatórios como Assunto , Remifentanil/uso terapêutico
20.
Rev. esp. anestesiol. reanim ; 67(4): 204-207, abr. 2020.
Artigo em Espanhol | IBECS | ID: ibc-198029

RESUMO

La hidrocefalia es una distensión activa del sistema ventricular del cerebro. Las mejores tasas de supervivencia de los pacientes con enfermedad neuroquirúrgica se acompañan de un mayor número de procedimientos no neuroquirúrgicos en pacientes que tienen dispositivos neuroquirúrgicos terapéuticos. No está clara la verdadera incidencia del embarazo en pacientes con hidrocefalia obstructiva controlada con derivación ventriculoperitoneal (DVP). Presentamos un caso de una mujer embarazada de 34 años con una DVP para hidrocefalia obstructiva. Debido a la obstrucción de la DVP secundaria al volumen del útero, ella presentó varios episodios de deterioro neurológico durante el embarazo. Se planificaron una cesárea electiva y una revisión de la DVP para el mismo tiempo operatorio. Este caso inusual representa un desafío al que el anestesiólogo debe enfrentarse para proporcionar el mejor manejo simultáneo del delicado bienestar de la madre, su cerebro, y el feto


Hydrocephalus is an active distension of the ventricular system of the brain. The improved survival rates of patients with neurosurgical pathology is accompanied by a greater number of non-neurosurgical procedures in patients who have therapeutic neurosurgical devices. The real incidence of pregnancy in patients with obstructive hydrocephalus controlled with ventriculoperitoneal shunt (VPS) is unclear. We present a case of a pregnant 34-year-old female with a VPS for obstructive hydrocephalus. Due to VPS obstruction secondary to uterus volume, she presented several episodes of neurological impairment during pregnancy. An elective caesarean section (C-section) and VPS review were planned for the same operative time. This rare case reflects the challenge that the anaesthesiologist has to face in order to provide the best and simultaneous management of the wellbeing of the mother, the mother's brain and the foetus


Assuntos
Humanos , Feminino , Gravidez , Adulto , Derivação Ventriculoperitoneal , Hidrocefalia/complicações , Cesárea/métodos , Anestesia Geral , Rocurônio/uso terapêutico , Fármacos Neuromusculares não Despolarizantes/uso terapêutico , Sevoflurano/uso terapêutico , Anestésicos Inalatórios/uso terapêutico , Anestésicos Gerais/uso terapêutico , Fentanila/uso terapêutico , Propofol/uso terapêutico , Sugammadex/uso terapêutico , Hidrocefalia/cirurgia
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