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1.
Medicine (Baltimore) ; 100(13): e25288, 2021 Apr 02.
Artigo em Inglês | MEDLINE | ID: mdl-33787614

RESUMO

ABSTRACT: Target-controlled infusion of remifentanil is known to reduce cough effectively during emergence from general anesthesia. The effect of smoking on emergence cough remains controversial. Therefore, we aimed to investigate the effect-site concentration (Ce) of remifentanil in the male patients undergoing laparoscopic or robotic cholecystectomy for suppressing emergence cough in smokers and non-smokers.Twenty smokers and 24 non-smokers (sex, male; age range, 20-65 years) were enrolled in this study. Anesthesia was maintained using sevoflurane and remifentanil. The Ce of remifentanil in 50% (EC50) and 95% (EC95) of the patients required for suppressing emergence cough were determined for each group (smokers and non-smokers) using Dixon up-and-down method and isotonic regression method with a bootstrapping approach.Dixon up-and-down method revealed that the EC50 value was significantly higher in smokers (3.51 ±â€Š0.60 ng/mL) than in non-smokers (2.71 ±â€Š0.30 ng/mL) (P < 0.001). In smokers and non-smokers, isotonic regression revealed EC50 to be 4.40 (83% CI, 4.17-4.58) ng/mL and 2.58 (83% CI, 2.31-2.87) ng/mL, respectively, and EC95 to be 4.76 (95% CI, 4.73-4.78) ng/mL and 3.15 (95% CI, 3.04-3.18) ng/mL, respectively.The Ces of remifentanil required to prevent cough during emergence were significantly higher in smokers than in non-smokers. Therefore, clinicians should pay attention to the smoking history of a patient to prevent cough during emergence.


Assuntos
Anestesia Geral/efeitos adversos , Antitussígenos/administração & dosagem , Colecistectomia , Tosse/prevenção & controle , Remifentanil/administração & dosagem , Fumar/efeitos adversos , Adulto , Idoso , Período de Recuperação da Anestesia , Humanos , Laparoscopia , Masculino , Pessoa de Meia-Idade , Análise de Regressão , Procedimentos Cirúrgicos Robóticos , Sevoflurano/administração & dosagem , Adulto Jovem
3.
Medicine (Baltimore) ; 100(8): e24842, 2021 Feb 26.
Artigo em Inglês | MEDLINE | ID: mdl-33663105

RESUMO

ABSTRACT: An association between animals and volatile anaesthetic requirements has been shown; however, evidence related to the postoperative outcome of human patients is lacking. Our aim was to investigate whether there is a difference in the requirement for sevoflurane among people undergoing gastrointestinal surgery.We observed 390 adult patients who underwent gastrointestinal surgery with an American Society of Anesthesiologists physical status of I or II with an expected surgery duration of > 2 hours. We used the bispectral index (BIS) to guide the regulation of end-tidal sevoflurane concentration (ETsevo). The mean ETsevo from 20 minutes after endotracheal intubation to 2 hours after the start of surgery was calculated for all patients. Differential sevoflurane requirements were identified according to ETsevo. The BIS, ETsevo, heart rate, mean arterial pressure, dose of sufentanil and cisatracurium, tracheal extubation time, incidence of intraoperative awareness, and incidence of postoperative nausea and vomiting were compared between patients with a low requirement for sevoflurane (group L) and patients with a high requirement for sevoflurane (group H).The mean ETsevo of the 390 patients was 1.55% ±â€Š0.26%. Based on our definition, patients with an ETsevo of < 1.29% were allocated to the low requirement group (group L; n = 69), while patients with an ETsevo of > 1.81% were allocated to the high requirement group (group H; n = 78). The ETsevo of group L was significantly lower than the ETsevo of group H (1.29% ±â€Š0.014% vs 1.82% ±â€Š0.017%, P < .001). There was no significant difference in the ETsevo, BIS, heart rate, mean arterial pressure, dose of sufentanil and cisatracurium, tracheal extubation time, incidence of intraoperative awareness, and incidence of postoperative nausea and vomiting. The tracheal extubation time in the L group was significantly shorter than that in the H group. No intraoperative awareness occurred.There was a significant difference in the requirement for sevoflurane in adult patients. The tracheal extubation time in group L was significantly shorter than that in group H.


Assuntos
Período de Recuperação da Anestesia , Anestesia Geral/métodos , Anestésicos Inalatórios/farmacocinética , Sevoflurano/farmacocinética , Extubação/efeitos adversos , Anestésicos Inalatórios/administração & dosagem , Estudos de Casos e Controles , Monitores de Consciência , Procedimentos Cirúrgicos do Sistema Digestório/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Sevoflurano/administração & dosagem
4.
Medicine (Baltimore) ; 100(6): e23570, 2021 Feb 12.
Artigo em Inglês | MEDLINE | ID: mdl-33578509

RESUMO

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


Assuntos
Débito Cardíaco/efeitos dos fármacos , Desflurano/farmacocinética , Expiração/fisiologia , Ventilação Pulmonar/fisiologia , Sevoflurano/farmacocinética , Adulto , Idoso , Algoritmos , Anestésicos Inalatórios/administração & dosagem , Anestésicos Inalatórios/farmacocinética , Débito Cardíaco/fisiologia , Ensaios Clínicos como Assunto , Simulação por Computador/estatística & dados numéricos , Desflurano/administração & dosagem , Quimioterapia Combinada , Feminino , Humanos , Pulmão/metabolismo , Pulmão/fisiologia , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Alvéolos Pulmonares/efeitos dos fármacos , Alvéolos Pulmonares/metabolismo , Alvéolos Pulmonares/fisiologia , Sevoflurano/administração & dosagem
5.
Med. paliat ; 27(2): 141-145, abr.-jun. 2020. ilus
Artigo em Espanhol | IBECS | ID: ibc-194838

RESUMO

Una paciente frágil afecta de úlceras crónicas en piernas sobreinfectadas por Staphylococcus aureus resistente a meticilina y Pseudomonas aeruginosa sensible, y causantes de dolor somático y neuropático refractario a los analgésicos sistémicos, aceptó ser tratada con sevoflurano tópico como terapia fuera de indicación. La primera irrigación se siguió de un control completo e inmediato del dolor que persistía entre las irrigaciones diarias, por lo que la paciente pudo descansar y dormir ya desde el primer día. Los cultivos del exudado de las heridas tomados al cuarto día de tratamiento con sevoflurano ya resultaron negativos. Al alta hospitalaria tres semanas después la herida izquierda estaba ya cerrada y la derecha cerró dos semanas después aplicando sevoflurano como tratamiento extrahospitalario. El sevoflurano ejerció efectos analgésico, antimicrobiano y cicatrizante, sin efectos adversos severos, por lo que aparece como una nueva estrategia de futuro muy interesante para el ámbito de los cuidados paliativos


A frail patient was suffering from chronic leg ulcers superinfected by methicillin-resistant Staphylococcus aureus and sensitive Pseudomonas aeruginosa, and causing severe somatic and neuropathic pain, which was refractory to conventional systemic analgesics. The patient accepted to be treated with topical sevoflurane as off-label treatment. Pain completely disappeared after the first irrigation with sevoflurane and the analgesic effect persisted between daily irrigations, so that the patient could regain night resting. Cultures of the ulcer exudate taken after 4 days with sevoflurane yielded negative results. The patient was discharged 3 weeks later with the left ulcer healed; the right ulcer healed after 2 more weeks of outpatient treatment with sevoflurane. Therefore, sevoflurane caused analgesic, antimicrobial, and pro-healing effects without noticeable adverse effects, making this new alternative very promising for the care of palliative patients


Assuntos
Humanos , Feminino , Idoso de 80 Anos ou mais , Úlcera da Perna/tratamento farmacológico , Staphylococcus aureus Resistente à Meticilina/efeitos dos fármacos , Pseudomonas aeruginosa/efeitos dos fármacos , Sevoflurano/administração & dosagem , Staphylococcus aureus Resistente à Meticilina/isolamento & purificação , Infecções por Pseudomonas/tratamento farmacológico , Administração Tópica , Idoso Fragilizado , Cicatrização/efeitos dos fármacos , Manejo da Dor
6.
Hosp. domic ; 4(2): 45-50, abr.-jun. 2020. ilus
Artigo em Espanhol | IBECS | ID: ibc-193390

RESUMO

El sevoflurano es un líquido volátil no inflamable, derivado halogenado del éter que se utiliza para inducción y mantenimiento de la anestesia general, por vía inhalatoria. Se han descrito sus propiedades analgésicas, antimicrobianas y vasodilatadoras en el tratamiento de las úlceras venosas crónicas. En el presente artículo reportamos un caso clínico de utilización de sevoflurano tópico en nuestra unidad, en una paciente que presentaba úlceras venosas sin mejoría tras cuidados estándar. Se inician instilaciones del fármaco, registrando una mejoría del dolor basal y del estado de las úlceras


Sevoflurane is a volatile non-flammable liquid, halogenated derivative of ether and used inhaled for induction and maintenance of general anesthesia. Its analgesic, antimicrobial and vasodilator properties have been described in the treatment of chronic venous ulcers. In this article we report a clinical case of the use of topical sevoflurane in our unit, in a patient who presented with venous ulcers without improvement after standard care. Drug instillations were initiated, recording an improvement in basal pain and the state of ulcers


Assuntos
Humanos , Feminino , Idoso de 80 Anos ou mais , Sevoflurano/administração & dosagem , Inibidores da Agregação de Plaquetas/administração & dosagem , Úlcera Varicosa/tratamento farmacológico , Resultado do Tratamento , Doença Crônica
8.
Medicine (Baltimore) ; 99(16): e19733, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32311965

RESUMO

RATIONALE: Becker muscular dystrophy (BMD) and Duchenne muscular dystrophy (DMD) are progressive neuromuscular disorders caused by mutations in the dystrophin gene. The management of anesthesia in patients with BMD is complicated because they are highly sensitive to the conventional anesthetics such as volatile anesthetics and muscle relaxants. It is reported that anesthesia in patients with DMD is associated with several complications. However, a few case reports have been published on adult patients with BMD undergoing surgery with general anesthesia. Reports indicate that children with BMD may experience some serious complications with flurane-inhaled anesthesia. However, no study has yet shown that the use of flurane-induced anesthesia in adults with DMD carries high risks. PATIENT CONCERNS: We describe a 56-year-old woman with BMD who was scheduled for laparoscopic hysterectomy and bilateral adnexectomy under general anesthesia due to a mass in the uterus. The patient was diagnosed with BMD 20 years back and reported that during this period, she was able to walk slowly with help during her daily life. Additionally, she also had a history of hypertension since 4 years and type 2 diabetes mellitus since 2 years. DIAGNOSIS: The patient was postmenopausal and presented with abnormal uterine bleeding and elevated CA125. Abdominal ultrasonography revealed diffuse enlargement of the uterus and hypoechoic internal echoes. These findings were suggestive of diffuse adenomyosis with multiple uterine leiomyomas, which would have adverse effects later in her life. Therefore, the patient required surgery to address the symptoms and further confirm the diagnosis. The final diagnosis was confirmed by histopathological analysis. INTERVENTIONS: The patient was scheduled for laparoscopic hysterectomy and bilateral adnexectomy. Anesthesia was induced and maintained by a combination of intravenous and inhalation anesthetic agents, particularly cisatracurium besilate and inhaled. sevoflurane. OUTCOMES: The duration of anesthesia and postoperative period were uneventful. At the end of the operation, the patient had normal vital signs and was fully conscious. The patient was followed up for 8 months and no complications were noted during this period. LESSONS: The combination of sevoflurane and cisatracurium besilate is a safe and effective method for the anesthetic management of adult patients with BMD scheduled for laparoscopic gynecological surgery. On the other hand, it is important to be aware of even rare complications of procedures, so that necessary precautions can be undertaken. Further investigations are necessary to determine the safe dosage of volatile anesthetics specifically for this clinical scenario so that anesthesiologists can use this combination method more accurately and precisely.


Assuntos
Anestesia Geral/métodos , Distrofia Muscular de Duchenne , Anestésicos Inalatórios/administração & dosagem , Atracúrio/administração & dosagem , Atracúrio/análogos & derivados , Feminino , Procedimentos Cirúrgicos em Ginecologia , Humanos , Laparoscopia , Pessoa de Meia-Idade , Bloqueadores Neuromusculares/administração & dosagem , Sevoflurano/administração & dosagem
9.
PLoS One ; 15(4): e0231955, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32302373

RESUMO

Resting-state functional Magnetic Resonance Imaging (rs-fMRI) has become an established technique in humans and reliably determines several resting state networks (RSNs) simultaneously. Limited data exist about RSN in dogs. The aim of this study was to investigate the RSNs in 10 healthy beagle dogs using a 3 tesla MRI scanner and subsequently perform group-level independent component analysis (ICA) to identify functionally connected brain networks. Rs-fMRI sequences were performed under steady state sevoflurane inhalation anaesthesia. Anaesthetic depth was titrated to the minimum level needed for immobilisation and mechanical ventilation of the patient. This required a sevoflurane MAC between 0.8 to 1.2. Group-level ICA dimensionality of 20 components revealed distributed sensory, motor and higher-order networks in the dogs' brain. We identified in total 7 RSNs (default mode, primary and higher order visual, auditory, two putative motor-somatosensory and one putative somatosensory), which are common to other mammals including humans. Identified RSN are remarkably similar to those identified in awake dogs. This study proves the feasibility of rs-fMRI in anesthetized dogs and describes several RSNs, which may set the basis for investigating pathophysiological characteristics of various canine brain diseases.


Assuntos
Anestésicos Inalatórios/administração & dosagem , Encéfalo/fisiologia , Sevoflurano/administração & dosagem , Animais , Encéfalo/diagnóstico por imagem , Mapeamento Encefálico , Cães , Feminino , Humanos , Processamento de Imagem Assistida por Computador , Imagem por Ressonância Magnética , Masculino
10.
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
11.
Life Sci ; 249: 117472, 2020 May 15.
Artigo em Inglês | MEDLINE | ID: mdl-32112870

RESUMO

Aim Determine changes in the expressions of the ion channel-TRPV1-and neuropeptides-NKA, NKB, calcitonin gene-related peptide (CGRP), and SP-in 14-, 21-, and 42-day-old rats after inhaling 1.5% and 2.6% sevoflurane. MAIN METHODS: A small in-house inhalation anesthesia chamber was designed to allow 14-, 21-, and 42-day-old rats inhale 1.5% and 2.6% sevoflurane, and rats in the control group inhaled carrier gas(1 L/min air +1 L/min O2). In addition, 14- and 21-day-old rats were pretreated with capsazepine, followed by inhalation of 1.5% and 2.6% sevoflurane or the carrier gas. The expression of TRPV1 in lung tissues was detected by Western blotting, whereas the expressions of NKA, NKB, CGRP, and SP in the trachea were detected by immunohistochemistry. KEY FINDINGS: After inhalation of 1.5% sevoflurane, the expression of TRPV1 in the lung tissues of 14- and 21-day-old rats was significantly increased compared with that in the control group, which was antagonized by capsazepine pretreatment. Moreover, inhalation of 1.5% sevoflurane markedly increased the expressions of NKA, NKB, CGRP, and SP in the trachea of 21-day-old rats and of NKB, CGRP, and SP in the trachea of 14-day-old rats. The expressions of these molecules were antagonized by capsazepine pretreatment. Conversely, inhalation of 2.6% sevoflurane decreased the expressions of NKA and NKB in the trachea of 42-day-old rats. SIGNIFICANCE: Sevoflurane did not upregulate the expression of TRPV1 in the airways of late-developing rats. This anesthetic may have a two-way effect on airways, resulting in considerable effects in pediatric clinical anesthesia management.


Assuntos
Anestésicos Inalatórios/administração & dosagem , Sevoflurano/administração & dosagem , Canais de Cátion TRPV/metabolismo , Traqueia/metabolismo , Administração por Inalação , Fatores Etários , Animais , Gasometria , Peso Corporal/efeitos dos fármacos , Peptídeo Relacionado com Gene de Calcitonina/metabolismo , Capsaicina/análogos & derivados , Capsaicina/farmacologia , Relação Dose-Resposta a Droga , Neurocinina A/metabolismo , Neurocinina B/metabolismo , Ratos , Ratos Sprague-Dawley , Respiração/efeitos dos fármacos , Substância P/metabolismo
12.
Chem Biol Interact ; 322: 109027, 2020 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-32147387

RESUMO

OBJECTIVE: Evidence has shown that sevoflurane plays a protective role in acute lung injury (ALI) due to its anti-inflammatory and apoptotic-regulating activity. Nevertheless, the mechanism of sevoflurane is still not completely understood. This study intends to discuss the mechanism of sevoflurane on ALI and the possible mechanisms involved. METHODS: ALI model of rats was established through intravenous injection of endotoxin lipopolysaccharide. microRNA-34a-3p (miR-34a-3p) and signal transducers and activators of transcription 1 (STAT1) expression in lung tissues of ALI rats were detected. The optimal inhaled concentration of sevoflurane was screened, and then the modeled rats were injected with miR-34a-3p inhibitors, overexpressed STAT1 and inhaled 1.0 Minimum Alveolar Concentration (MAC) sevoflurane to determine mean arterial pressure (MAP) of rats, wet weight/dry weight ratio and myeloperoxidase (MPO) activity, oxidative stress- and inflammation-related factors in lung tissues of rats, along with lung cell viability and apoptosis. RESULTS: MiR-34a-3p was downregulated while STAT1 was upregulated in ALI rats. Sevoflurane of 1.0 MAC was selected as the optimal inhalation concentration. Sevoflurane (1.0 MAC) increased MAP at T3 and reduced MPO activity, alleviated pathological damage, suppressed apoptosis, oxidative stress and inflammation, and induced cell viability in lung tissues of ALI rats. Down-regulated miR-34a-3p or up-regulated STAT reversed the functions of sevoflurane (1.0 MAC) on ALI rats. CONCLUSION: Collectively, we demonstrate that sevoflurane reduces inflammatory factor expression, increases lung cell viability and inhibits lung cell apoptosis in ALI through upregulation of miR-34a-3p and downregulation of STAT1, which provides new clues for ALI treatment.


Assuntos
Apoptose , Pulmão/metabolismo , MicroRNAs/metabolismo , Fator de Transcrição STAT1/metabolismo , Sevoflurano/administração & dosagem , Lesão Pulmonar Aguda/etiologia , Lesão Pulmonar Aguda/metabolismo , Lesão Pulmonar Aguda/veterinária , Administração por Inalação , Animais , Antagomirs/metabolismo , Apoptose/efeitos dos fármacos , Sobrevivência Celular/efeitos dos fármacos , Regulação para Baixo/efeitos dos fármacos , Lipopolissacarídeos/toxicidade , Pulmão/patologia , Masculino , MicroRNAs/antagonistas & inibidores , MicroRNAs/genética , Estresse Oxidativo/efeitos dos fármacos , Peroxidase/metabolismo , Interferência de RNA , RNA Interferente Pequeno/metabolismo , Ratos , Ratos Sprague-Dawley , Fator de Transcrição STAT1/antagonistas & inibidores , Fator de Transcrição STAT1/genética , Sevoflurano/farmacologia , Regulação para Cima/efeitos dos fármacos
13.
Otolaryngol Head Neck Surg ; 162(6): 853-859, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32178568

RESUMO

OBJECTIVE: To examine the influence of sevoflurane-based combined intravenous and inhaled anesthesia versus propofol-based total intravenous anesthesia (TIVA) on intraoperative neuromonitoring (IONM) during thyroidectomy. STUDY DESIGN: A randomized controlled trial. SETTING: The present study was conducted in a tertiary hospital. SUBJECTS AND METHODS: Forty patients were randomly assigned to a sevoflurane-based combined intravenous and inhalation group (group S) or a propofol-based total intravenous group (group P). Anesthesia was induced with midazolam, sufentanil, propofol, and cisatracurium in both groups and was maintained with sevoflurane and remifentanil in group S and with TIVA with propofol and remifentanil in group P. IONM was performed intermittently according to the IONM formula standard. RESULTS: The time until detection of the first positive electromyographic (EMG) signal was significantly longer in group S (median, 41.0 minutes [interquartile range, 37.5-49.3]) than in group P (37.0 minutes [33.3-41.5], P = .028). All patients in group P had a positive EMG signal at initial monitoring, whereas 8 patients (40.0%) in group S did not. The rate of positive EMG signal at initial monitoring was significantly higher in group P than in group S (P = .006). The amplitude of the evoked potentials at V1, R1, R2, and V2 were similar between the groups. CONCLUSION: Combined intravenous and inhaled anesthesia based on sevoflurane-remifentanil prolonged the time until detection of a positive EMG signal during IONM as compared with TIVA with propofol-remifentanil in patients undergoing thyroidectomy.


Assuntos
Anestesia por Inalação/métodos , Anestesia Intravenosa/métodos , Eletromiografia/métodos , Monitorização Intraoperatória/métodos , Sevoflurano/administração & dosagem , Tireoidectomia/métodos , Adulto , Anestésicos Inalatórios/administração & dosagem , Feminino , Seguimentos , Humanos , Masculino , Estudos Prospectivos
14.
Transplant Proc ; 52(4): 1094-1101, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32178928

RESUMO

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


Assuntos
Anestesia Intravenosa/métodos , Raquianestesia/métodos , Anestesia Balanceada/métodos , Transplante de Rim/métodos , Rim/efeitos dos fármacos , Adolescente , Adulto , Anestésicos/administração & dosagem , Bupivacaína/uso terapêutico , Desflurano/administração & dosagem , Feminino , Fentanila/administração & dosagem , Humanos , Masculino , Pessoa de Meia-Idade , Propofol , Sevoflurano/administração & dosagem , Adulto Jovem
15.
Med Sci Monit ; 26: e919971, 2020 Mar 21.
Artigo em Inglês | MEDLINE | ID: mdl-32198342

RESUMO

BACKGROUND Intravenous lidocaine administered during surgery improves postoperative outcomes; however, few studies have evaluated the relationship between intravenous lidocaine and volatile anesthetics requirements. This study assessed the effects of lidocaine treatment on sevoflurane consumption and postoperative consciousness disorders in children undergoing major spine surgery. MATERIAL AND METHODS Patients were randomly divided into 2 treatment groups: lidocaine and placebo (control). The lidocaine group received lidocaine as a bolus of 1.5 mg/kg over 30 min, followed by a continuous infusion at 1 mg/kg/h to 6 h after surgery. The following data were assessed: end-tidal sevoflurane concentration required to maintain a bispectral index BIS between 40 and 60, intraoperative blood pressure, heart rate, demand for fentanyl, and consciousness level assessed after surgery using the Richmond Agitation-Sedation Scale. Any treatment-related adverse events were recorded. RESULTS Compared to the control group, lidocaine treatment reduced by 15% the end-tidal sevoflurane concentration required to maintain the intraoperative hemodynamic stability and appropriate level of anesthesia (P=0.0003). There were no intergroup differences in total dose of fentanyl used, average mean arterial pressure, or heart rate measured intraoperatively. The postoperative level of patient consciousness did not differ during the first 6 h between groups. After 9 h, more patients in the control group were still sleepy (P=0.032), and there were fewer perioperative complications in the lidocaine group. CONCLUSIONS Lidocaine treatment decreases sevoflurane consumption and improves recovery profiles in children undergoing major spine surgery.


Assuntos
Período de Recuperação da Anestesia , Lidocaína/administração & dosagem , Sevoflurano/administração & dosagem , Coluna Vertebral/cirurgia , Adolescente , Anestesia Geral , Anestésicos Combinados/administração & dosagem , Criança , Relação Dose-Resposta a Droga , Feminino , Hemodinâmica/efeitos dos fármacos , Humanos , Infusões Intravenosas , Período Intraoperatório , Lidocaína/efeitos adversos , Lidocaína/sangue , Masculino , Monitorização Intraoperatória , Sevoflurano/sangue
16.
PLoS One ; 15(2): e0223700, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32092080

RESUMO

Emulsified volatile anesthetic can be directly injected into the circulation and eliminated from blood through lungs. Taking advantage of the unique pharmacokinetics of the emulsified volatile anesthetics, we aimed to develop a less traumatic method to differentially deliver them to the spinal cord of rabbit. Sixteen New Zealand White rabbits were randomly assigned to the isoflurane or sevoflurane group. A catheter was placed into the descending aorta, and emulsified isoflurane (8mg/kg/h) or sevoflurane (12mg/kg/h) was given respectively. The concentration and partial pressure of the anesthetics in the jugular and femoral vein were measured. Our results showed that the partial pressure for isoflurane was 3.91±1.11 mmHg and 12.61±1.60 mmHg (1.0MAC), and for sevoflurane was 3.89±1.00 mmHg and 19.92±1.84mmHg (1.0MAC), in the jugular vein and femoral vein, respectively. There was significant difference between jugular and femoral vein partial pressure for both isoflurane and sevoflurane groups (both P < 0.001). In conclusion, a simple and minimally invasive method has been successfully developed to selectively deliver isoflurane and sevoflurane to the spinal cord in the rabbit. Before the anesthetics taking action on the brain, 69% of isoflurane and 81% of sevoflurane were removed through lungs. This method can be used to investigate sites and mechanisms of volatile anesthetic action.


Assuntos
Anestésicos Inalatórios/administração & dosagem , Medula Espinal/metabolismo , Anestésicos Inalatórios/farmacocinética , Animais , Encéfalo/efeitos dos fármacos , Emulsões , Veia Femoral , Isoflurano/administração & dosagem , Veias Jugulares , Pulmão/metabolismo , Métodos , Pressão Parcial , Coelhos , Sevoflurano/administração & dosagem , Volatilização
17.
Anesthesiology ; 132(5): 1034-1044, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32044799

RESUMO

BACKGROUND: General anesthetics-induced changes of electrical oscillations in the basal ganglia may render the identification of the stimulation targets difficult. The authors hypothesized that while sevoflurane anesthesia entrains coherent lower frequency oscillations, it does not affect the identification of the subthalamic nucleus and clinical outcome. METHODS: A cohort of 19 patients with Parkinson's disease with comparable disability underwent placement of electrodes under either sevoflurane general anesthesia (n = 10) or local anesthesia (n = 9). Microelectrode recordings during targeting were compared for neuronal spiking characteristics and oscillatory dynamics. Clinical outcomes were compared at 5-yr follow-up. RESULTS: Under sevoflurane anesthesia, subbeta frequency oscillations predominated (general vs. local anesthesia, mean ± SD; delta: 13 ± 7.3% vs. 7.8 ± 4.8%; theta: 8.4 ± 4.1% vs. 3.9 ± 1.6%; alpha: 8.1 ± 4.1% vs. 4.8 ± 1.5%; all P < 0.001). In addition, distinct dorsolateral beta and ventromedial gamma oscillations were detected in the subthalamic nucleus solely in awake surgery (mean ± SD; dorsal vs. ventral beta band power: 20.5 ± 6.6% vs. 15.4 ± 4.3%; P < 0.001). Firing properties of subthalamic neurons did not show significant difference between groups. Clinical outcomes with regard to improvement in motor and psychiatric symptoms and adverse effects were comparable for both groups. Tract numbers of microelectrode recording, active contact coordinates, and stimulation parameters were also equivalent. CONCLUSIONS: Sevoflurane general anesthesia decreased beta-frequency oscillations by inducing coherent lower frequency oscillations, comparable to the pattern seen in the scalp electroencephalogram. Nevertheless, sevoflurane-induced changes in electrical activity patterns did not reduce electrode placement accuracy and clinical effect. These observations suggest that microelectrode-guided deep brain stimulation under sevoflurane anesthesia is a feasible clinical option.


Assuntos
Anestésicos Inalatórios/administração & dosagem , Estimulação Encefálica Profunda/métodos , Neurônios/efeitos dos fármacos , Doença de Parkinson/terapia , Sevoflurano/administração & dosagem , Núcleo Subtalâmico/efeitos dos fármacos , Potenciais de Ação/efeitos dos fármacos , Potenciais de Ação/fisiologia , Adulto , Idoso , Anestésicos Locais/administração & dosagem , Ritmo beta/efeitos dos fármacos , Ritmo beta/fisiologia , Estudos de Coortes , Eletroencefalografia/efeitos dos fármacos , Eletroencefalografia/métodos , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Neurônios/fisiologia , Doença de Parkinson/fisiopatologia , Núcleo Subtalâmico/fisiologia , Resultado do Tratamento
18.
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
19.
Agri ; 32(1): 1-7, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32030694

RESUMO

OBJECTIVES: This study aims to investigate the effects of suprascapular nerve and axillary nerve block on postoperative pain, tramadol consumption, sevoflurane consumption and visual clarity of the surgical field in arthroscopic shoulder surgery. METHODS: Forty-six patients undergoing arthroscopic shoulder surgery were randomized to receive either both suprascapular and axillary nerve block with ultrasound guidance (20 ml 0.25% bupivacaine) before general anesthesia (group SSAXB, n=23) or a subacromial local infiltration (20 ml 0.25% bupivacaine) after the procedure (group control, n=23). End-tidal sevoflurane consumption, visualization of the arthroscopic field scores of the patients were recorded during the procedure. The patient's postoperative pain scores (at PACU, 4, 8, 12, 24 hours after the surgery) and tramadol consumption were also recorded. RESULTS: End-tidal sevoflurane concentration values were similar in both groups (p>0.05). Group SSAXB had a better mean static pain score in the PACU (Group SSAXB 4.27±1.48 vs Group C 6.24±1.09 p<0.05). Tramadol consumption was lower in group SSAXB than in group C (253.1±85.3 mg vs 324.2±72 mg, p=0.005). Visual clarity scores of the arthroscopic field were higher in group SSAXB than in group C along the intraoperative period (p<0.05). CONCLUSION: SSAXB are effective in postoperative analgesia, reduce tramadol consumption and provide a clean image in the arthroscopic area of arthroscopic shoulder surgery, but these blocks do not reduce sevoflurane consumption.


Assuntos
Anestésicos Inalatórios/uso terapêutico , Bloqueio do Plexo Braquial , Dor Pós-Operatória/prevenção & controle , Sevoflurano/uso terapêutico , Ultrassonografia de Intervenção , Anestésicos Inalatórios/administração & dosagem , Artroscopia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Medição da Dor , Estudos Prospectivos , Sevoflurano/administração & dosagem
20.
Anesthesiology ; 132(5): 1003-1016, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32108685

RESUMO

BACKGROUND: Preexisting factors such as age and cognitive performance can influence the electroencephalogram (EEG) during general anesthesia. Specifically, spectral EEG power is lower in elderly, compared to younger, subjects. Here, the authors investigate age-related changes in EEG architecture in patients undergoing general anesthesia through a detailed examination of spectral and entropic measures. METHODS: The authors retrospectively studied 180 frontal EEG recordings from patients undergoing general anesthesia, induced with propofol/fentanyl and maintained by sevoflurane at the Waikato Hospital in Hamilton, New Zealand. The authors calculated power spectral density and normalized power spectral density, the entropic measures approximate and permutation entropy, as well as the beta ratio and spectral entropy as exemplary parameters used in current monitoring systems from segments of EEG obtained before the onset of surgery (i.e., with no noxious stimulation). RESULTS: The oldest quartile of patients had significantly lower 1/f characteristics (P < 0.001; area under the receiver operating characteristics curve, 0.84 [0.76 0.92]), indicative of a more uniform distribution of spectral power. Analysis of the normalized power spectral density revealed no significant impact of age on relative alpha (P = 0.693; area under the receiver operating characteristics curve, 0.52 [0.41 0.63]) and a significant but weak effect on relative beta power (P = 0.041; area under the receiver operating characteristics curve, 0.62 [0.52 0.73]). Using entropic parameters, the authors found a significant age-related change toward a more irregular and unpredictable EEG (permutation entropy: P < 0.001, area under the receiver operating characteristics curve, 0.81 [0.71 0.90]; approximate entropy: P < 0.001; area under the receiver operating characteristics curve, 0.76 [0.66 0.85]). With approximate entropy, the authors could also detect an age-induced change in alpha-band activity (P = 0.002; area under the receiver operating characteristics curve, 0.69 [0.60 78]). CONCLUSIONS: Like the sleep literature, spectral and entropic EEG features under general anesthesia change with age revealing a shift toward a faster, more irregular, oscillatory composition of the EEG in older patients. Age-related changes in neurophysiological activity may underlie these findings however the contribution of age-related changes in filtering properties or the signal to noise ratio must also be considered. Regardless, most current EEG technology used to guide anesthetic management focus on spectral features, and improvements to these devices might involve integration of entropic features of the raw EEG.


Assuntos
Envelhecimento/efeitos dos fármacos , Anestesia Geral/métodos , Anestésicos Inalatórios/administração & dosagem , Eletroencefalografia/efeitos dos fármacos , Entropia , Sevoflurano/administração & dosagem , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Envelhecimento/fisiologia , Eletroencefalografia/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Distribuição Aleatória , Estudos Retrospectivos , Adulto Jovem
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