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1.
BMC Anesthesiol ; 23(1): 36, 2023 01 31.
Artigo em Inglês | MEDLINE | ID: mdl-36721105

RESUMO

OBJECTIVE: We aimed to investigate the effects of different doses of dexmedetomidine (Dex) on evoked potentials in adult patients undergoing spinal surgery under intravenous anesthesia with low-concentration desflurane. METHODS: Ninety patients were divided into three groups at random. To maintain anesthesia in the control group (group C), desflurane 0.3 MAC (minimal alveolar concentration), propofol, and remifentanil were administered. Dex (0.5 µg·kg-1) was injected for 10 min as a loading dose in the low-dose Dex group (group DL), then adjusted to 0.2 µg·kg-1·h-1 until the operation was completed. Dex (1 µg·kg-1) was injected for 10 min as a loading dose in the high-dose Dex group (group DH), then adjusted to 0.7 µg·kg-1·h-1 until the operation was completed. The additional medications were similar to those given to group C. The perioperative hemodynamics, body temperature, intraoperative drug dosages, fluid volume, urine volume, blood loss, the latency and amplitude of somatosensory evoked potentials (SEPs) at four different time points, the incidence of positive cases of SEPs and transcranial motor evoked potentials (tcMEPs), and perioperative adverse reactions were all recorded. RESULTS: Data from 79 patients were analyzed. The MAP measured at points T2-T4 in group DH was higher than at corresponding points in group C (P < 0.05). The MAP at point T4 in group DL was higher than at corresponding points in group C (P < 0.05). The remifentanil dosage in group DH was significantly lower than in group C (P = 0.015). The fluid volume in group DL was significantly lower than in group C (P = 0.009). There were no significant differences among the three groups in the amplitude and latency of SEP at different time points, nor in the incidence of warning SEP signals. The incidence of positive tcMEP signals did not differ significantly between groups C and DL (P > 0.05), but was significantly higher in group DH than in groups DL (P < 0.05) or C (P < 0.05). The incidence of intraoperative hypertension was significantly higher in group DH than in group C (P = 0.017). CONCLUSIONS: Low-dose Dex has no effect on the SEPs and tcMEPs monitoring during spinal surgery. High-dose Dex has no effect on SEPs monitoring, but it may increase the rate of false positive tcMEPs signals and the incidence of intraoperative hypertension. TRIAL REGISTRATION: This study has completed the registration of the Chinese Clinical Trial Center at 11/09/2020 with the registration number ChiCTR2000038154.


Assuntos
Dexmedetomidina , Hipertensão , Adulto , Humanos , Anestesia Intravenosa , Desflurano , Remifentanil , Anestesia por Inalação , Potenciais Somatossensoriais Evocados
3.
BMC Anesthesiol ; 23(1): 15, 2023 01 10.
Artigo em Inglês | MEDLINE | ID: mdl-36624384

RESUMO

BACKGROUND: Satisfactory brain relaxation is essential in neurosurgery. Desflurane anesthesia and propofol-based total intravenous anesthesia (TIVA) have different effects on cerebral hemodynamics, potentially contributing to discrepant brain relaxation. The purpose of this study was to compare the effects of desflurane and TIVA on brain relaxation in patients undergoing craniotomy for supratentorial tumors. METHODS: In this randomized, controlled study, we enrolled patients aged 18-60 years, with ASA I-III, who were scheduled to undergo elective craniotomy for supratentorial tumors. Patients were randomly assigned in a 1:1 ratio to receive desflurane anesthesia or TIVA. The primary outcome was the proportion of satisfactory brain relaxation. Secondary outcomes included emergence and extubation times, recovery of cognitive function and postoperative complications. RESULTS: Of 369 patients who were assessed for eligibility, 111 were randomized and 110 were included in the modified intention-to-treat analysis (55 in the desflurane group and 55 in the TIVA group). The proportion of satisfactory brain relaxation was similar between the two groups: 69% in the desflurane group and 73% in the TIVA group (RR: 0.950, 95% CI: 0.748-1.207; P = 0.675). Patients assigned to the desflurane group had shorter emergence (10 [8-13] min vs. 13 [10-20] min, P < 0.001) and extubation times (13 [10-18] min vs. 17 [13-23] min, P < 0.001), and better recovery of cognitive function at 15 min after extubation (16 [0-24] vs. 0 [0-20], P = 0.003), but experienced increased postoperative nausea and vomiting (PONV) (16 [29%] vs. 6 [11%] P = 0.017) and tachycardia (22 [40%] vs. 9 [16%], P = 0.006) during recovery. CONCLUSIONS: Desflurane anesthesia and TIVA provide similar brain relaxation in patients without intracranial hypertension undergoing elective craniotomy. Desflurane accelerates the recovery from anesthesia but is associated with increased PONV and tachycardia during the recovery period. TRIAL REGISTRATION: Clinicaltrial.gov (NCT04691128). Date of registration: December 31, 2020.


Assuntos
Anestésicos Inalatórios , Isoflurano , Propofol , Neoplasias Supratentoriais , Humanos , Desflurano , Anestésicos Inalatórios/efeitos adversos , Náusea e Vômito Pós-Operatórios/induzido quimicamente , Anestésicos Intravenosos/efeitos adversos , Isoflurano/efeitos adversos , Anestesia Intravenosa , Período de Recuperação da Anestesia , Propofol/efeitos adversos , Encéfalo/cirurgia , Neoplasias Supratentoriais/cirurgia , Craniotomia
4.
Anesth Analg ; 136(2): 327-337, 2023 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-36638512

RESUMO

BACKGROUND: Volatile anesthetic consumption can be reduced by minimizing excessive fresh gas flows (FGFs). Currently, it is unknown whether decision support tools embedded within commercial electronic health record systems can be successfully adopted to achieve long-term reductions in FGF rates. The authors describe the implementation of an electronic health record-based clinical decision support tool aimed at reducing FGF and evaluate the effectiveness of this intervention in achieving sustained reductions in FGF rates and volatile anesthetic consumption. METHODS: On August 29, 2018, we implemented a decision support tool within the Epic Anesthesia Information Management System (AIMS) to alert providers of high FGF (>0.7 L/min for desflurane and >1 L/min for sevoflurane) during maintenance of anesthesia. July 22, 2015, to July 10, 2018, served as our baseline period before the intervention. The intervention period spanned from August 29, 2018, to December 31, 2019. Our primary outcomes were mean FGF (L/min) and volatile agent consumption (mL/MAC-h). Because a simple comparison of 2 time periods may result in false conclusions due to underlying trends independent of the intervention, we performed segmented regression of the interrupted time series to assess the change in level at the start of the intervention and the differences in slopes before and after the intervention. The analysis was also adjusted for potential confounding variables. Data included 44,899 cases using sevoflurane preintervention with 26,911 cases postintervention, and 17,472 cases using desflurane with 1185 cases postintervention. RESULTS: Segmented regression of the interrupted times series demonstrated a decrease in mean FGF by 0.6 L/min (95% CI, 0.6-0.6 L/min; P < .0001) for sevoflurane and 0.2 L/min (95% CI, 0.2-0.3 L/min; P < .0001) for desflurane immediately after implementation of the intervention. For sevoflurane, mL/MAC-h decreased by 3.8 mL/MAC-h (95% CI, 3.6-4.1 mL/MAC-h; P < .0001) after implementation of the intervention and decreased by 4.1 mL/MAC-h (95% CI, 2.6-5.6 mL/MAC-h; P < .0001) for desflurane. Slopes for both FGF and mL/MAC-h in the postintervention period were statistically less negative than the preintervention slopes (P < .0001 for sevoflurane and P < .01 for desflurane). CONCLUSIONS: A commercial AIMS-based decision support tool can be adopted to change provider FGF management patterns and reduce volatile anesthetic consumption in a sustainable fashion.


Assuntos
Anestésicos Inalatórios , Sistemas de Apoio a Decisões Clínicas , Isoflurano , Éteres Metílicos , Sevoflurano , Desflurano , Registros Eletrônicos de Saúde , Anestesia por Inalação
5.
Medicine (Baltimore) ; 101(45): e31569, 2022 Nov 11.
Artigo em Inglês | MEDLINE | ID: mdl-36397349

RESUMO

Sevoflurane and desflurane are commonly used inhalation anesthetics in clinical practice. This study compared the synergistic effects of sevoflurane and desflurane on the muscarinic agent vecuronium in laparoscopic colon cancer surgery. The aim of this study was to compare sevoflurane and desflurane in a synergistic effect on the muscle relaxant vecuronium in laparoscopic colon cancer surgery. Sixty patients undergoing elective laparoscopic radical resection of colon cancer were randomly divided into sevoflurane (n = 30) and desflurane (n = 30) groups. After anesthesia and successful tracheal intubation, patients in both groups were maintained with combined remifentanil. Muscle relaxant effects were monitored in both groups using a muscle relaxant monitor (train of stimuli-Watch), the onset time, T1 and T2 recovery time, and muscle relaxant dosage of vecuronium were observed. Hemodynamic changes were observed in both groups, and the dosage of vasoactive drugs was recorded. The quality of recovery of the patients was evaluated using the Mini-Mental State Examination (MMSE) and the discharge from the Aldrete score criteria. There was no significant difference in the onset time of vecuronium between the two groups (P > .05). The desflurane group's T1 and T2 recovery times were later than that of the sevoflurane group. The dosage of vecuronium was statistically significantly less than that in the sevoflurane group (P < .05); the extubation time in the desflurane group was statistically significantly longer than that in the sevoflurane group (P < .05). There were no significant differences in preoperative and intraoperative mean arterial pressure, heart rate, ephedrine and atropine dosage, MMSE score, and Aldrete score between the 2 groups (P > .05). Compared with sevoflurane, desflurane has a stronger synergistic effect on the muscle relaxant of vecuronium without increasing the incidence of cardiovascular adverse reactions and affecting patient recovery.


Assuntos
Neoplasias do Colo , Isoflurano , Laparoscopia , Éteres Metílicos , Humanos , Sevoflurano/farmacologia , Desflurano , Brometo de Vecurônio , Éteres Metílicos/efeitos adversos , Período de Recuperação da Anestesia , Neoplasias do Colo/cirurgia , Músculos
6.
Medicine (Baltimore) ; 101(43): e31393, 2022 Oct 28.
Artigo em Inglês | MEDLINE | ID: mdl-36316835

RESUMO

BACKGROUND: Thyroidectomy is performed under general anesthesia using inhaled anesthetics such as sevoflurane or desflurane in many cases. The objective of this study was to investigate whether the incidence of postoperative pain and discomfort after thyroidectomy differed with the type of inhaled anesthetic. METHODS: Eighty-one female patients who underwent thyroidectomy were randomly assigned to the Sevo group (n = 42) or the Des group (n = 39). On the day of surgery and on the first, third, and seventh days after surgery, one registered nurse in charge of the entire questionnaire survey conducted the questionnaire assessment through face-to-face interviews or phone calls with the patients. The questionnaire evaluated the severity scores for seven items (sore throat, wound pain, nausea and vomiting, dizziness, occipital headache, posterior neck pain, and shoulder pain) regarding postoperative pain and discomfort experienced by patients and assessed which of these seven items caused the greatest discomfort to the patient on each day. RESULTS: Except for the severity score for dizziness on the day of surgery, the severity scores of postoperative pain and discomfort experienced by patients on the day of surgery and on the first, third, and seventh days after surgery showed no statistically significant differences between the two groups. In addition, on the day of surgery and on the first, third, and seventh days after surgery, patients reported that sore throat caused the greatest discomfort. CONCLUSION: In patients undergoing thyroidectomy under general anesthesia using sevoflurane or desflurane, except for dizziness on the day of surgery, no other manifestation of postoperative pain and discomfort was influenced by the type of inhaled anesthetic. Moreover, after thyroidectomy, postoperative sore throat caused the greatest discomfort to patients from the day of surgery to the seventh day after surgery.


Assuntos
Anestésicos Inalatórios , Isoflurano , Éteres Metílicos , Faringite , Humanos , Feminino , Sevoflurano , Desflurano , Anestésicos Inalatórios/efeitos adversos , Éteres Metílicos/efeitos adversos , Isoflurano/efeitos adversos , Tireoidectomia/efeitos adversos , Estudos Prospectivos , Tontura , Dor Pós-Operatória/epidemiologia , Dor Pós-Operatória/etiologia
7.
Medicine (Baltimore) ; 101(41): e30030, 2022 Oct 14.
Artigo em Inglês | MEDLINE | ID: mdl-36254073

RESUMO

BACKGROUND: During one-lung ventilation (OLV), deterioration of pulmonary oxygenation reduces arterial oxygen saturation and cerebral oxygen saturation (rSO2). However, oxidative stress during OLV causes lung injury, so the fraction of inspiratory oxygen (FiO2) should be kept as low as possible. We investigated the changes in rSO2 under propofol or desflurane anesthesia while percutaneous oxygen saturation (SpO2) was kept as low as possible during OLV. METHODS: Thirty-six patients scheduled for thoracic surgery under OLV in the lateral decubitus position were randomly assigned to propofol (n = 19) or desflurane (n = 17) anesthesia. FiO2 was set to 0.4 at the start of surgery under two-lung ventilation (measurement point: T3) and then adjusted to maintain an SpO2 of 92% to 94% after the initiation of OLV. The primary outcome was the difference in the absolute value of the decrease in rSO2 from T3 to 30 minutes after the initiation of OLV (T5), which was analyzed by an analysis of covariance adjusted for the rSO2 value at T3. RESULTS: The mean rSO2 values were 61.5% ± 5.1% at T3 and 57.1% ± 5.3% at T5 in the propofol group and 62.2% ± 6.0% at T3 and 58.6% ± 5.3% at T5 in the desflurane group. The difference in the absolute value of decrease between groups (propofol group - desflurane group) was 0.95 (95% confidence interval, [-0.32, 2.2]; P = .152). CONCLUSIONS: Both propofol and desflurane anesthesia maintain comparable cerebral oxygenation and can be used safely, even when the SpO2 is kept as low as possible during OLV.


Assuntos
Anestesia , Ventilação Monopulmonar , Propofol , Desflurano , Humanos , Oxigênio , Saturação de Oxigênio
8.
Medicine (Baltimore) ; 101(38): e30840, 2022 Sep 23.
Artigo em Inglês | MEDLINE | ID: mdl-36197229

RESUMO

Previous studies have demonstrated that anesthetic techniques can affect the outcomes of cancer surgery. We investigated the association between anesthetic techniques and patient outcomes after elective limb-salvage surgery for osteosarcoma (OS). This was a retrospective cohort study of patients who underwent elective limb-salvage surgery for OS between January 2007 and December 2018. Patients were grouped according to the administration of propofol-based total intravenous anesthesia (TIVA) or desflurane (DES) anesthesia. Kaplan-Meier analysis was performed, and survival curves were constructed from the date of surgery to death. Univariate and multivariate Cox regression models were applied to compare the hazard ratios (HRs) for death after propensity matching. Subgroup analyses were done for postoperative recurrence, metastasis, and tumor-node-metastasis (TNM) staging. A total of 30 patients (17 deaths, 56.7%) who received DES anesthesia and 26 (4 deaths, 15.4%) who received TIVA were eligible for analysis. After propensity matching, 22 patients were included in each group. In the matched analysis, patients who received TIVA had better survival with a HR of 0.30 (95% confidence interval [CI], 0.11-0.81; P = .018). Subgroup analyses also showed significantly better survival in the presence of postoperative metastasis (HR, 0.24; 95% CI, 0.06-0.87; P = .030) and with TNM stage II to III (HR, 0.26; 95% CI, 0.09-0.73; P = .011) in the matched TIVA group. In addition, patients administered with TIVA had lower risks of postoperative recurrence and metastasis than those administered with DES anesthesia in the matched analyses. Propofol-based TIVA was associated with better survival in patients who underwent elective limb-salvage surgery for OS than DES anesthesia. Prospective studies are needed to assess the effects of TIVA on oncological outcomes in patients with OS.


Assuntos
Anestésicos Inalatórios , Osteossarcoma , Propofol , Anestesia Intravenosa , Anestésicos Intravenosos , Desflurano , Humanos , Osteossarcoma/cirurgia , Estudos Retrospectivos
11.
Life Sci ; 309: 121004, 2022 Nov 15.
Artigo em Inglês | MEDLINE | ID: mdl-36170891

RESUMO

In this study, the effects of exposure to isoflurane, sevoflurane and desflurane on the oxidative response and inflammation at different times was analyzed in the lungs of adult C57BL/6 mice. 120 animals were divided into 3 groups (n = 40): Isoflurane (ISO), Sevoflurane (SEV) and Desflurane (DES) and exposed to these anesthetics for 1 h (n = 10), 2 h (n = 10) and 3 h (n = 10), at a minimum alveolar concentration (MAC) equal to 1. The control group (CG) (n = 10) was exposed to ambient air. 24 h after the experimental protocol, the animals were euthanized and the bronchoalveolar lavage fluid (BALF), blood and lung tissue samples were collected. In the BALF, animals exposed to isoflurane for 2 h and 3 h showed a greater influx of leukocytes, especially macrophages compared to the CG. The ISO3h had lower leukocyte counts in the peripheral blood compared to CG, ISO1h and ISO2h. There was an increase in CCL-2 levels in the ISO3h compared to the CG. Superoxide dismutase activity was higher in ISO1h compared to CG. The activity of catalase was higher in the ISO1h and ISO2h compared to the CG. The lipid peroxidation, as well as carbonylated protein were higher in the ISO3h compared to the CG (p < 0.05). Similar results were observed in the exposure of SEV and DES compared to inflammation and redox imbalance in different periods. This study demonstrated that time is a determinant to promote a local and systemic inflammatory response to different inhalational anesthetics in a healthy murine model.


Assuntos
Anestésicos Inalatórios , Isoflurano , Éteres Metílicos , Camundongos , Animais , Isoflurano/toxicidade , Sevoflurano/efeitos adversos , Desflurano , Catalase/metabolismo , Camundongos Endogâmicos C57BL , Anestésicos Inalatórios/toxicidade , Superóxido Dismutase/metabolismo , Inflamação/induzido quimicamente , Éteres Metílicos/farmacologia
12.
BMJ Open Qual ; 11(3)2022 08.
Artigo em Inglês | MEDLINE | ID: mdl-36002191

RESUMO

Sustainability interventions were implemented at the Royal Brisbane and Women's Hospital (RBWH) following identification of inhaled anaesthetic gases as a target for reducing medical carbon emissions. This quality improvement study assessed and evaluated the impact of sustainability interventions on the environmental and financial cost of inhaled anaesthetic gas use in order to guide future initiatives and research in reducing carbon emissions from healthcare practice.Ethical exemption was granted from the RBWH Research Ethics Committee (EX/2021/QRBW/76078). Usage (bottles) and expenditure for desflurane and sevoflurane from January 2016 to December 2021 were obtained. Global warming potential and carbon dioxide equivalent (CO2e) were used to report environmental impact of volatile agents. Methods to estimate this were performed in Excel based on Campbell and Pierce methodology. An Environmental Protection Agency greenhouse gas equivalency calculator was used to convert CO2e to equivalent petrol carbon emissions and kilometres travelled by a typical passenger vehicle.The total number of bottles of sevoflurane and desflurane purchased between January 2016 and December 2021 decreased by 34.76% from 1991 to 1299. The number of desflurane bottles purchased decreased by 95.63% from 800 to 35 bottles. The number of sevoflurane bottles purchased increased by 6.13% from 1191 bottles to 1264 bottles. This was achieved by implementing quality improvement interventions such as staff education of desflurane-sparing practices, distribution of posters and progressive removal of desflurane from operating theatres. Total carbon emission from volatile anaesthetics equalled 2326 tonnes CO2e. Combined desflurane and sevoflurane emissions decreased by 87.88%. In 2016, desflurane made up 92.39% of the annual CO2e, which steadily decreased to 33.36% in 2021. Combined sevoflurane and desflurane usage costs decreased by 58.33%.Substantial reductions in carbon emissions from volatile anaesthetics demonstrate the significant degree to which environmentally sustainable practices have been implemented. Applying desflurane-sparing practice can heavily limit anaesthetic drug expenditure and contribution to environmental waste. This is important given the global health sector's challenge to optimise patient outcomes in the face of global climate change crisis.


Assuntos
Anestesia , Anestésicos Inalatórios , Gases de Efeito Estufa , Isoflurano , Éteres Metílicos , Desflurano , Feminino , Humanos , Sevoflurano , Estados Unidos
13.
Sci Rep ; 12(1): 13633, 2022 08 10.
Artigo em Inglês | MEDLINE | ID: mdl-35948604

RESUMO

Desflurane, isoflurane and sevoflurane, three halogenated ethers, are commonly used inhaled anesthetics, both in the operating room and in the intensive care unit (ICU). The potency and dosage of these drugs is expressed by the MAC value (minimum alveolar concentration). Their interaction with hemoglobin and its affinity for oxygen, best described by the oxygen dissociation curve (ODC), has already been investigated, with conflicting results. Altered by many factors, the ODC can be shifted to the left or to the right, therefore increasing or decreasing hemoglobin oxygen (Hb-O2) affinity. In venous blood samples of 22 healthy participants (11 female, 11 male) ODC were measured with a high-throughput method in vitro. Blood samples were either exposed to control or to three different concentrations of desflurane, isoflurane or sevoflurane prior to and during measurements (low, medium and high corresponding to MAC 0.5, MAC 1.0 and MAC 2.0). With increasing concentrations from control to medium, desflurane and isoflurane significantly decreased Hb-O2 affinity by shifting the ODC to the right (p = 0.016 and p < 0.001) but sevoflurane showed no effects. When further increasing concentrations from medium to high, all three inhaled anesthetics shifted the ODC back to the left (p < 0.001). Comparing only controls to high concentrations, a significant increase in Hb-O2 affinity for desflurane (p = 0.005) and sevoflurane (p < 0.001) was detected. Our study shows a varying effect at different doses of inhaled anesthetics on Hb-O2 affinity. While the underlying mechanisms remain unclear, these results show an effect which needs to be further investigated to determine if patients undergoing anesthesia may potentially benefit or get disadvantage from this slightly increased (e.g. impaired pulmonary oxygen uptake), or decreased Hb-O2 affinity (e.g. arterial vascular disease).Trial registration: This study is registered with clinicaltrials.gov (NCT04612270).


Assuntos
Anestésicos Inalatórios , Isoflurano , Éteres Metílicos , Anestésicos Inalatórios/farmacologia , Desflurano , Feminino , Hemoglobinas , Humanos , Isoflurano/farmacologia , Masculino , Éteres Metílicos/farmacologia , Oxigênio , Sevoflurano/farmacologia
14.
J Int Med Res ; 50(8): 3000605221115388, 2022 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-35915871

RESUMO

OBJECTIVE: To determine if the beneficial effects of transient desflurane application mitigates inflammation and decrease associated signaling induced by 1-methyl-4-phenyl-1, 2, 3, 6-tetrahydropyridine (MPTP) in mice. METHODS: Mice were induced to develop Parkinson's disease (PD) by intraperitoneal injection with MPTP for 20 consecutive days, and validated mice were randomly allocated to four groups. Collected samples from euthanized mice were designated for the following analyses: 1) immunohistochemical staining for positive dopaminergic neurons in the substantia nigra and striatum, 2) immunofluorescence staining for ionized calcium binding adaptor molecule-1 (Iba1) and glial fibrillary acid protein (GFAP), and 3) western blotting for p38, p-p38, toll-like receptor 4, and tumor necrosis factor (TNF)-α. RESULTS: The inhalation of desflurane for 1 hour ameliorated locomotory dysfunctions of PD mice by recovering the loss of Iba1- and GFAP-positive dopaminergic neurons, deactivating microglial cells and astrocytes, and decreasing the amounts of inflammatory cytokines (TNF-α). CONCLUSIONS: These findings suggest that transient desflurane inhalation may provide some benefits for PD through ameliorating inflammation and enhancing locomotor activity.


Assuntos
1-Metil-4-Fenil-1,2,3,6-Tetra-Hidropiridina , Doença de Parkinson , 1-Metil-4-Fenil-1,2,3,6-Tetra-Hidropiridina/metabolismo , 1-Metil-4-Fenil-1,2,3,6-Tetra-Hidropiridina/farmacologia , Animais , Desflurano , Modelos Animais de Doenças , Proteína Glial Fibrilar Ácida , Inflamação/patologia , Camundongos , Camundongos Endogâmicos C57BL , Substância Negra/metabolismo , Substância Negra/patologia
16.
Eur J Anaesthesiol ; 39(10): 818-824, 2022 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-36036420

RESUMO

Potent inhaled anaesthetics are halogenated hydrocarbons with a large global warming effect. The use of fluorinated hydrocarbons (most are not anaesthetics) are being restricted but volatile anaesthetics have been exempted from legislation, until now: the EU has formulated a proposal to ban or at least severely restrict the use of desflurane starting January 2026. This narrative review addresses the implications of a politics-driven decision - without prior consultation with major stakeholders, such as the European Society of Anaesthesiology and Intensive Care (ESAIC) - on daily anaesthesia practice and reviews the potential scientific arguments that would support stopping the routine use of desflurane in anaesthetic practice. Of note, banning or severely restricting the use of one anaesthetic agent should not distract the user from sensible interventions like reducing fresh gas flows and developing technology to capture and recycle or destroy the wasted potent inhaled anaesthetics that we will continue to use. We call to join efforts to minimise our professional environmental footprint.


Assuntos
Anestesia , Anestesiologia , Anestésicos Inalatórios , Isoflurano , Anestésicos Inalatórios/efeitos adversos , Desflurano , Humanos
17.
Biomed Res Int ; 2022: 1812728, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35845953

RESUMO

While sevoflurane and desflurane have been regarded as inhalation agents providing rapid induction and emergence, previous studies demonstrated the superiority of desflurane-anesthesia compared to sevoflurane-anesthesia in the postoperative recovery in obese and geriatric patients. We investigated whether a short-term switch of sevoflurane to desflurane at the end of sevoflurane-anesthesia enhances patient postoperative recovery profile in non-obese patients. We randomly divide patients undergoing elective surgery (n = 60) into two groups: sevoflurane-anesthesia group (Group-S, n = 30) and sevoflurane-desflurane group (Group-SD, n = 30). In Group-S, patients received only sevoflurane-anesthesia until the end of surgery (for >2 hours). In Group-SD, sevoflurane was stopped and switched to desflurane-anesthesia before the completion of sevoflurane-anesthesia (for approximately 30 minutes). We assessed the intergroup differences in the times to get eye-opening, extubation, and a bispectral index of 80 (BIS-80). Group-SD showed significantly shorter times to get eye-opening (438 ± 101 vs. 295 ± 45 s; mean difference, 143 s; 95% confidence interval [CI], 101-183; p < 0.001), extubation (476 ± 108 vs. 312 ± 42 s; mean difference, 164 s; 95% CI, 116-220; p < 0.001), and BIS-80 (378 ± 124 vs. 265 ± 49 minutes; mean difference, 113 s; 95% CI, 58-168 p < 0.001) compared to Group-S. There was no between-group difference in postoperative nausea, vomiting, and hypoxia incidences. Our results suggested that the short-term (approximately 30 minutes) switch of sevoflurane to desflurane at the end of sevoflurane-anesthesia can facilitate the speed of postoperative patient recovery.


Assuntos
Anestésicos Inalatórios , Isoflurano , Éteres Metílicos , Idoso , Período de Recuperação da Anestesia , Anestesia Geral , Anestésicos Inalatórios/farmacologia , Desflurano , Humanos , Isoflurano/farmacologia , Náusea e Vômito Pós-Operatórios , Sevoflurano
18.
BMC Anesthesiol ; 22(1): 226, 2022 07 16.
Artigo em Inglês | MEDLINE | ID: mdl-35842575

RESUMO

BACKGROUND: Remimazolam is a novel intravenous benzodiazepine that is appropriate for the maintenance of anesthesia. Quality of recovery is an important component of health care quality, but there is no published randomized control trial focused on the quality of recovery in patients undergoing total intravenous anesthesia with remimazolam. METHODS: This parallel-group, single-blind randomized control trial at a tertiary care medical center in South Korea was conducted to determine the difference in the quality of recovery between the patients administered remimazolam and those administered an inhalant anesthetic agent. A total of 168 patients aged 19-65 years who underwent elective laparoscopic cholecystectomy or robotic gynecologic surgery were considered for enrollment. Randomization was performed using sealed envelopes containing computer-generated random allocation sequences. Remimazolam was administered for the maintenance of anesthesia in the remimazolam group (Group R), and desflurane was administered in the desflurane group (Group D). The induction protocol and the target value of the bispectral index were identical in both groups. Patients were blinded to the drug that was administered until they finished the postoperative questionnaire. The main outcome measure was the decrement of the QoR-40 score on postoperative day 1 compared to the QoR-40 score on the day before surgery. RESULTS: A total of 165 patients were analyzed. The preoperative and postoperative global QoR-40 scores were 183 and 152 (IQR 173-192 and 136-169), respectively. The perioperative decrement of the global QoR-40 score was 29.96 ± 22.49. The decrement of the QoR-40 score was smaller in Group R than in Group D (26.99 versus 32.90, respectively; mean difference 5.91, 95% confidence interval -0.96-12.79). After adjustment for sex, the type of surgery and surgical time, the administration of remimazolam resulted in a 7.03-point (95% CI 0.35-13.72) less decrement of the QoR-40 score than desflurane. There were no severe adverse events in either group. CONCLUSION: Total intravenous anesthesia maintained with remimazolam provides a better quality of recovery than anesthesia maintained with an inhalant agent in patients undergoing laparoscopic surgery. Additionally, postoperative nausea and vomiting were largely reduced with remimazolam. TRIAL REGISTRATION: KCT0006288 , Clinical Research Information Service (CRIS), Republic of Korea Registration date: 23/06/2021.


Assuntos
Anestesia Geral , Benzodiazepinas , Anestesia Geral/métodos , Desflurano , Feminino , Humanos , Náusea e Vômito Pós-Operatórios , Método Simples-Cego
19.
Int J Clin Pract ; 2022: 7795004, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35685611

RESUMO

The aim of this randomized control trial is to compare the effect of anesthetic agents on blood levels of parathyroid hormone and ionized calcium. 77 American Society of Anesthesiologists I-II patients who would undergo laparoscopic cholecystectomy were enrolled into this prospective study and randomized into 3 groups with sealed envelope technique as Group S: sevoflurane, Group D: desflurane, and Group TIVA: total intravenous anesthesia. The first blood sample was used to check the baseline blood levels of parathyroid hormone and ionized calcium. In Group S or D, maintenance of anesthesia was being performed with 1 MAC (minimum alveolar concentration) sevoflurane or desflurane, respectively, while in Group TIVA, it was performed with 150 mcg/kg/min propofol and 1 mcg/kg/min remifentanil IV infusions. At the 30th minute of anesthesia and at the 1st hour of end of anesthesia, 2nd and 3rd blood samples, respectively, were used to check the blood levels of PTH and Ca. During perioperative period, hemodynamic parameters were also noted. Blood levels of parathyroid hormone at the 30th min after anesthesia were found to be significantly different between groups (P=0,01). The PTH level at the 30th min after anesthesia was found significantly higher in Group S than that of Groups D and TIVA (P=0.005 and P=0.001, respectively). Blood levels of ionized calcium at 30th min after anesthesia were found significantly different between groups (P=0,048). It was found significantly higher in Group TIVA than that in Group S (P=0.024). Desflurane seems to be the best agent for parathyroidectomy procedures. Future research studies are needed to be conducted to reach out more correct and valuable outcomes.


Assuntos
Anestésicos Intravenosos , Cálcio , Período de Recuperação da Anestesia , Anestésicos Intravenosos/farmacologia , Desflurano , Humanos , Hormônio Paratireóideo , Estudos Prospectivos , Sevoflurano
20.
Anesth Analg ; 135(4): 798-806, 2022 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-35552287

RESUMO

BACKGROUND: The pupillary dilation reflex (PDR), the change in pupil size after a nociceptive stimulus, has been used to assess antinociception during anesthesia. The aim of this study was to compare the antinociceptive properties of sevoflurane and desflurane by measuring the PDR amplitude. METHODS: Seventy patients between 20 and 55 years of age were randomly allocated to receive either sevoflurane or desflurane. The PDR amplitude after an electrical standardized noxious stimulation (SNT) was measured using an infrared pupillometer under 1.0 minimum alveolar concentration (MAC). The pupil diameter was measured from 5 seconds before to 5 minutes after the SNT. The mean arterial pressure (MAP), heart rate (HR), and bispectral index (BIS) were also measured immediately before and after SNT as well as 1 minute and 5 minutes after SNT. The primary outcome was the maximum percent increase from the prestimulation value of the pupil diameter, and the secondary outcomes were the maximum percent increase from the prestimulation value of the MAP, HR, and BIS after SNT. RESULTS: The maximum percent increase of the pupil diameter after SNT was not different between the 2 groups (median [first quartile to third quartile], 45.1 [29.3-80.3] vs 43.4 [27.0-103.1]; median difference, -0.3 [95% confidence interval, -16.0 to 16.5]; P = .986). Before SNT, the MAP was higher under 1.0 MAC of sevoflurane than desflurane; however, the maximum percent increase of MAP, HR, and BIS was not different between the 2 groups. CONCLUSIONS: The amount of change in the PDR amplitude, MAP, and HR after SNT was not different between sevoflurane and desflurane anesthesia. This result might suggest that sevoflurane and desflurane may not have different antinociceptive properties at equivalent MAC.


Assuntos
Anestésicos Inalatórios , Isoflurano , Éteres Metílicos , Analgésicos/farmacologia , Anestésicos Inalatórios/farmacologia , Desflurano/farmacologia , Dilatação , Humanos , Isoflurano/farmacologia , Éteres Metílicos/farmacologia , Reflexo Pupilar , Sevoflurano/farmacologia
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