Effect of inhalation of sevoflurane during cardiopulmonary bypass on early postoperative brain injury in patients undergoing cardiac valve replacement / 中华麻醉学杂志

Objective:To evaluate the effect of inhalation of sevoflurane during cardiopulmonary bypass (CPB) on early postoperative brain injury in the patients undergoing cardiac valve replacement.Methods:Forty-two American Society of Anesthesiaologists physical status Ⅱ or Ⅲ patients of either sex, aged 40-70 yr, weighing 47-86 kg, scheduled for elective single valve replacement under CPB, were divided into 3 groups ( n=14 each) using a random number table method: control group (group C), combined intravenous-inhalational anesthesia group (group CA) and sevoflurane group (group S). During CPB, propofol 4-6 mg·kg -1·h -1 was intravenously infused in group C, propofol 2-3 mg·kg -1·h -1 was intravenously infused, and 0.5 MAC sevoflurane was inhaled via the membrane oxygenator in group CA, and 1.0-1.5 MAC sevoflurane was inhaled via the membrane oxygenator in group S. The anesthesia and sedation index values were maintained at 40-60 during operation in the three groups.Blood samples were taken from arteries before anesthesia induction (T 1), at 30 min and 6 and 24 h after termination of CPB (T 2-4) for determination of plasma concentrations of neuron-specific enolase (NSE) and Tau protein. Results:Compared with group C, the plasma concentration of NSE was significantly decreased at T 2, 3, and plasma concentration of Tau protein was decreased at T 2-4 in group S, and the plasma concentration of Tau protein was decreased at T 2 in group CA ( P<0.05). Compared with group CA, the plasma concentration of NSE was significantly decreased at T 2, 3, and the plasma concentration of Tau protein was decreased at T 2-4 in group S ( P<0.05). Conclusions:Inhalation of sevoflurane during CPB can reduce early postoperative brain injury to a certain extent in the patients undergoing cardiac valve replacement.

Effect of dexmedetomidine on agitation and hemodynamics during the recovery period in children after sevoflurane anesthesia / 中国医师进修杂志

Objective:To investigate the effect of dexmedetomidine on agitation and hemodynamics during the recovery period in children after sevoflurane anesthesia.Methods:A total of 120 pediatric patients with selective tonsillectomy and adenoidectomy admitted to Shaoxing Central Hospital from January 2019 to December 2020 were randomly divided into the control group and the observation group, with 60 cases in each group. Both groups were induced by sevoflurane inhalation, followed by endotracheal intubation with 0.6 mg rocuronium and 2 μg/kg fentanyl intravenous injection. The observation group received dexmedetomidine combined with sevoflurane to maintain anesthesia, while the control group received normal saline combined with sevoflurane to maintain anesthesia. Heart rate (HR) and mean arterial pressure (MAP) were recorded at four times: before anesthesia (T 0), endotracheal intubation (T 1), the beginning of surgery (T 2) and the end of surgery (T 3). The time of anesthesia, surgery, recovery and extubation were recorded. Pediatric anesthesia emergence delirium (PAED) score, faces pain scale (FPS) score, the incidence of agitation and postoperative special events were compared between the two groups. Results:There were no significant differences in operation time, anesthesia time, extubation time and recovery time between the two groups ( P>0.05). The levels of HR and MAP in the control group were increased at T 1, T 2, T 3, and were higher than those in the observation group, the differences were statistically significant ( P<0.05). The scores of FPS, PAED and the incidence of agitation in the observation group were lower than those in the control group: (2.32 ± 0.61) scores vs. (3.66 ± 0.85) scores, (6.88 ± 1.85) scores vs. (11.75 ± 3.03) scores, 13.33% (8/60) vs. 3.33% (2/60), the differences were statistically significant ( t = 9.92, 10.63, χ2 = 3.93, P<0.05). The incidences of postoperative treatment with propofol, analgesics and respiratory tract adverse events in the observation group were lower than those in the control group: 3.33%(2/60) vs. 13.33%(8/60), 5.00%(3/60) vs. 16.67% (10/60), 3.33%(2/60) vs. 15.00%(9/60), the differences were statistically significant ( χ2 = 3.93, 4.23, 4.90, P<0.05). Conclusions:Dexmedetomidine maintenance induction of anesthesia for sevoflurane anesthesia in children can effectively reduce the incidence of agitation in the period of recovery, and has little effect on hemodynamics, with high safety.

Anesthetic effects of inhalational sevoflurane versus intravenous ketamine in pediatric surgical anesthesia / 中国基层医药

Objective:To investigate the anesthetic effects of inhalational sevoflurane versus intravenous ketamine in pediatric surgical anesthesia. Methods:A total of 100 patients with appendicitis who underwent appendectomy in Ningbo Ninth Hospital between June 2017 and August 2018 were included in this study. They were randomly assigned to receive either inhalational anesthesia with sevoflurane (observation group, n = 50) or intravenous anesthesia with ketamine (control group, n = 50). Hemodynamic indexes at different time periods (T1: 5 minutes after entering the room, T2: after anesthesia induction, T3: immediately after skin incision, T4: operation completion), anesthesia induction, duration for anesthesia induction and recovery from anesthesia, liver function, and adverse reactions were compared between the observation and control groups. Results:There was no significant difference in peripheral oxygen saturation (SpO 2) level at different time periods between the observation and control groups (all P > 0.05). At T1, there were no significant differences in mean arterial pressure and heart rate between the two groups (both P > 0.05). At T2, T3 and T4, mean arterial pressure in the observation group was (67.25 ± 1.32) mmHg, (67.52 ± 1.32) mmHg, and (66.28 ± 1.31) mmHg, respectively, and heart rate was (115.21 ± 2.32) beats/minute, (112.21 ± 1.34) beats/minute and (111.25 ± 1.32) beats/minute, respectively. There were significant differences in mean arterial pressure and heart rate measured at T2, T3 and T4 between the observation and control groups ( t = 19.176, 16.817, 30.015, 58.797, 51.649, 2.617, all P < 0.05). The time to pain reflex disappearance and the time to eyelash reflex disappearance in the observation group were (2.32 ± 0.21) minutes and (1.26 ± 0.32) minutes, respectively, which were significantly longer than those in the control group ( t = 9.247, 4.251, both P < 0.05). The time to eye opening or body movement and the time to getting out of operation room were (3.21 ± 1.32) minutes and (5.52 ± 1.13) minutes respectively, which were significantly shorter than those in the control group ( t = 91.851, 109.641, both P < 0.05). After surgery, alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase and bilirubin levels in the observation group were (26.01 ± 1.32) U/L, (22.02 ± 1.32) U/L, (486.32 ± 2.74) U/L, (0.66 ± 0.02) U/L, respectively. There were significant differences in these indexes between observation and control groups ( t = 6.036, 6.798, 23.741, 3.500, all P < 0.05). The incidence of adverse reactions in the observation group was significantly lower than that in the control group ( χ2 = 9.470, P < 0.05). Conclusion:Inhalational sevoflurane is advantageous over and safer than intravenous ketamine in pediatric surgical anesthesia.

Effect of different withdrawal sequences on quality of recovery in patients undergoing endoscopic sinus surgery under combined intravenous and inhalation anesthesia / 中国基层医药

Objective:To investigate the effect of two different withdrawal sequences on the quality of recovery in patients undergoing nasal endoscopic surgery under combined intravenous and inhalation anesthesia.Methods:Seventy patients scheduled for endoscopic sinus surgery in The First Affiliated Hospital of Xiamen University, China from January to June 2019 were included in this study and randomly assigned to undergo intravenous anesthesia alone (Group A, n = 35) or combined intravenous and inhalation anesthesia (Group B, n = 35). Propofol 2-4 mg/kg, fentanyl 3-4 μg/kg, cisatracurium besylate 0.2 mg/kg were used to induce anesthesia. Propofol 4-6 mg/kg/h, remifentanil 6.5-13.0 mg/kg/h, sevoflurane ≥ 0.30 minimum alveolar concentration were used to maintain anesthesia. At 30 minutes before the end of surgery, inhalational sevoflurane administration and pump propofol administration were stopped in the groups A and B respectively. At 10 minutes before the end of surgery, pump propofol administration and inhalational sevoflurane administration were stopped in the groups A and B respectively. At the end of surgery, pump remifentanil administration was stopped in both groups A and B. The time to spontaneous breathing recovery, the time to consciousness recovery, and the time to tracheal extubation were recorded. Mean arterial pressure and heart rate were recorded at the time of entering the operation room (T0), at the end of anesthesia (T1), at the time of spontaneous breathing recovery (T2), consciousness recovery (T3) and tracheal extubation (T4), 5 minutes (T5) and 10 minutes after tracheal extubation (T6). Agitation score was recorded at T2-T6 and at 20 minutes after tracheal extubation (T7). Cough score was recorded at T4. Results:The time to spontaneous breathing recovery, the time to consciousness recovery, and the time to tracheal extubation in group A were (16.0 ± 4.6) minutes, (18.0 ± 5.3) minutes, (19.0 ± 5.5) minutes, respectively, which were significantly longer than (8.8 ± 3.5) minutes, (9.5 ± 4.1) minutes, (10.7 ± 4.5) minutes, respectively in the group B ( t = 9.554, 8.881, 9.011, all P < 0.05). There were no significant differences in mean arterial pressure and heart rate recorded at T0-T6 between groups A and B (all P > 0.05). There was no significant difference in agitation score measured at T3-T6 between groups A and B (all P > 0.05). There was no significant difference in cough score recorded at T4 between groups A and B ( P > 0.05). Conclusion:Two different withdrawal sequences can maintain stable hemodynamics and reduce agitation during recovery period and cough during extubation. The recovery time of remifentanil combined with propofol is longer than that of remifentanil combined with sevoflurane.

Meta-analysis of the effects of total intravenous anesthesia and inhalation anesthesia on early postoperative immune function, recurrence and metastasis in patients with malignant tumors / 中国医师进修杂志

Objective:To compare the effects of total intravenous anesthesia and inhalation anesthesia on early postoperative immune function, recurrence and metastasis by Meta-analysis in patients with malignant tumors.Methods:The PubMed, Embase and Cochrane Library were searched by computer from January 2010 to January 2020. The randomized controlled trials of surgical treatment using total intravenous anesthesia or inhalation anesthesia in patients with malignant tumors were collected. The RevMan 5.3 and STATA 15.0 softwares were used to analyze the impact of 2 anesthesia methods on early postoperative immune function indexes and tumor recurrence and metastasis in patients with malignant tumors. The immune function indexes included interleukin (IL)-6, IL-10, transforming growth factor (TGF)-β, vascular endothelial growth factor (VEGF)-C and natural killer (NK) cell.Results:A total of 8 articles were included, with a total of 665 patients. Meta analysis results show that, compared with inhalation anesthesia, total intravenous anesthesia could significantly reduce the levels of IL-6, TGF-β and VEGF-C in patients with malignant tumors after surgery ( SMD = - 0.35, - 0.26 and - 0.64; 95% CI - 0.58 to - 0.12, - 0.49 to - 0.02 and - 0.99 to - 0.28; P<0.01 or <0.05); the 2 anesthesia methods had no significant effect on IL-10 and NK cell in patients with malignant tumors after surgery ( SMD = 0.16 and 0.18, 95% CI - 0.07 to 0.39 and - 0.23 to 0.60, P>0.05); and the 2 anesthesia methods had no significant effect on tumor recurrence and metastasis in patients with malignant tumors ( RR = 0.70, 95% CI 0.47 to 1.03, P = 0.07). Conclusions:Total intravenous anesthesia may improve the early postoperative immune function in patients with malignant tumor by reducing the levels of pro-cancer factors IL-6, TGF-β and VEGF-C, but total intravenous anesthesia has no obvious effect on reducing postoperative tumor recurrence and metastasis in patients with malignant tumor.

Effects of two anesthetic methods on cognitive function in elderly patients undergoing laparoscopic cervical cancer resection / 中国基层医药

Objective@#To investigate the effects of two anesthetic modes on cognitive function in elderly patients undergoing laparoscopic cervical cancer resection.@*Methods@#From August 2016 to April 2018, 60 elderly patients undergoing laparoscopic cervical cancer resection in the General Hospital of Armed Police were divided into control groupand observation group according to odd and even of bed number, with 30caese in each group.Intravenous anesthesia was used in the control group, and intravenous anesthesia combined with inhalation anesthesia was used in the observation group.The anesthetic effect, MMSE score, MoCA score and the incidence of cognitive dysfunction were compared between the two groups.@*Results@#The anesthesia effect time, extubation time and recovery time of the observation group were (1.62±0.30)min, (15.68±3.26)min, (8.69±3.68)min, respectively, which were significantly shorter than those of the control group[(4.68±0.91)min, (27.46±4.03)min, (20.36±4.58)min](all P<0.05). There were no statistically significant differences in MMSE score and MoCA score between the two groups before operation (all P<0.05), and there was statistically significant difference in MMSE score between the two groups at 2 h and 6 h after operation (all P<0.05). The MMSE score in the observation group was higher than that in the control group(all P<0.05), but there was no statistically significant difference on the 1st day after operation (P>0.05). At 2 h, 6 h, 1 d after operation, the MoCA scores in the observation group were significantly higher than those in the control group (all P<0.05). The incidence of cognitive dysfunction in the observation group was 6.67%(2/30), which was significantly lower than 26.67%(8/30) in the control group (P<0.05).@*Conclusion@#Compared with intravenous anesthesia alone, intravenous anesthesia combined with inhalation anesthesia for elderly patients undergoing laparoscopic cervical cancer resection has a good anesthetic effect and can reduce the incidence of cognitive dysfunction, which is worthy of further application in clinical practice.

Effects of different anesthesia methods on cognitive function and inflammatory factors in elderly patients with lung cancer during perioperative period / 中国基层医药

Objective To explore the effects of different anesthesia methods on cognitive function and serum interleukin-6 ( IL -6), interleukin -8 ( IL -8) levels in elderly patients with lung cancer during perioperative period.Methods From March 2015 to March 2017, ninety elderly patients undergoing radical resection of lung cancer treated in Heji Hospital Affiliated to Changzhi Medical College were selected in the research.According to the different anesthesia methods,they were divided into inhalation anesthesia group( A group),general intravenous anes-thesia group(B group) and epidural block anesthesia group(C group),with 30 cases in each group.The minimum mental state examination(MMSE) scores,cognitive dysfunction rate,serum IL-6 and IL-8 levels of the three groups before operation,one day after operation and three days after operation were compared.Results One day and three days after operation,the MMSE scores of C group were (25.62 ± 2.11) points,(27.12 ± 2.04) points,respectively, which were higher than those of group A[(22.61 ± 2.75) points,(25.78 ± 2.68)points] and B group[(22.34 ± 2.01)points,(25.81 ± 2.42) points],the differences were statistically significant(tA group =4.756,2.179,tB group =6.165,2.267,all P<0.05).One day and three days after operation,the cognitive dysfunction rates of C group were 26.67% (8/30),6.67% (2/30),respectively,which were lower than those of A group[50.00% (15/30),26.67% (8/30)] and B group[66.67% (20/30),30.00% (9/30)],the differences were statistically significant(χ2A group =3.455,4.320,χ2B group =9.643,5.455,all P<0.05).One day and three days after operation,the serum IL-6 and IL-8 levels of C group[IL-6:(99.53 ± 16.82)ng/mL,(83.24 ± 8.34) ng/mL,IL-8:(50.43 ± 7.84)ng/mL, (42.15 ± 5.25)ng/mL] were lower than those of A group[IL-6:(122.43 ± 18.41)ng/mL,(88.51 ± 10.42)ng/mL, IL-8:(64.53 ± 8.94)ng/mL,(55.62 ± 6.78) ng/mL] and B group[IL-6:(124.52 ± 20.10) ng/mL,(87.95 ± 9.34)ng/mL,IL-8:(63.27 ± 9.03)ng/mL,(54.62 ± 6.30) ng/mL],the differences were statistically significant (IL-6:tA group =5.030,2.163,tB group =5.222,2.060,all P<0.05;IL-8:tA group =6.495,8.604,tB group =5.881, 8.329,all P<0.05).Conclusion The influence of epidural block anesthesia on postoperative cognitive dysfunction in elderly patients with radical resection of lung cancer is minimal,which can inhibit the expression of inflammatory factors.It is better than the other two anesthesia methods,and it is worthy of radical operation for elderly patients with lung cancer.

Effects of dexmedetomidine during combined intravenous-inhalational anesthesia on motor evoked potentials monitoring and postoperative agitation in elderly patients undergoing cervical spine sur-gery / 中华麻醉学杂志

Objective To investigate the effects of different doses of dexmedetomidine during com-bined intravenous-inhalational anesthesia on motor evoked potentials ( MEPs) monitoring and postoperative agitation in elderly patients undergoing cervical spine surgery. Methods Sixty patients of both sexes, aged 65-81 yr, weighing 51-78 kg, of American Society of Anesthesiologists physical statusⅠorⅡ, undergo-ing elective cervical spine surgery under general anesthesia, were divided into 3 groups ( n=20 each) using a random number table method: control group ( group C) , low-dose dexmedetomidine group ( group D1 ) and high-dose dexmedetomidine group ( group D2 ) . Anesthesia was induced by intravenous injection of mid-azolam 0. 04 mg∕kg, cisatracurium 0. 15 mg∕kg, propofol 2 mg∕kg and sufentanil 0. 3-0. 4 μg∕kg. MEPs was assessed with nerve electrophysiology monitor after induction of anesthesia. Anesthesia was maintained by inhalation of sevoflurane ( end-tidal concentration 1％) and target-controlled infusion of propofol ( target plasma concentration 2-3 μg∕ml). Narcotrend index was maintained at D2-E1. When T4∕T1>75％ (at T0 ) , dexmedetomidine was intravenously infused over 10 min in a loading dose of 0. 6μg∕kg, followed by an infusion of 0. 3μg·kg-1 ·h-1 until the end of surgery in group D1 . Dexmedetomidine was intravenously infused over 10 min in a loading dose of 1 μg∕kg, followed by an infusion of 0. 3 μg·kg-1 ·h-1 until the end of surgery in group D2 . The equal volume of normal saline was given intravenously in group C. At T0 , immediately after the end of administration of dexmedetomidine loading dose ( T1 ) and at 60 min of dexme-detomidine infusion ( T2 ) , the effective elicitation of MEPs and amplitude and latency of MEPs were recor-ded. The intraoperative cardiovascular events and occurrence of postoperative agitation in postanesthesia care unit were recorded. Results Compared with group C, no significant change was found in the latency, amplitude and effective elicitation rate of MEPs at each time point in group D1 ( P>0. 05) , the amplitude of MEPs was significanty decreased, the latency of MEPs was prolonged, and the elicitation rate of MEPs was decreased at T2 in group D2 , and the incidence of bradycardia during operation was significanty in-creased, and the incidence of postoperative agitation was decreased in D1 and D2 groups ( P<0. 05) . Com-pared with group D1 , the amplitude of MEPs was significantly decreased, the latency of MEPs was pro-longed, and the effective elicitation rate of MEPs was decreased at T2 ( P<0. 05), and no significant change was found in the incidence of intraoperative bradycardia and postoperative agitation in group D2 ( P>0. 05) . Conclusion Dexmedetomidine infused over 10 min in a loading dose of 0. 6 μg∕kg, followed by an intravenous infusion of 0. 3 μg·kg-1 ·h-1 until the end of surgery during combined intravenous-inhala-tional anesthesia exerts no effect on MEPs monitoring, and can decrease the incidence of postoperative agita-tion at the same time in elderly patients undergoing cervical spine surgery.

Clinical observation of laryngeal mask airway inhalation sevoflurane anesthesia for pediatric hernia surgery / 中国基层医药

Objective To investigate and analyze the clinical effect of laryngeal mask airway inhalation anesthe-sia with sevoflurane on pediatric colic surgery.Methods From July 2014 to November 2016,92 cases with pediatric hernia in Jiaxing Hospital of Zhejiang Corps of Armed Police Force were randomly divided into study group and control group according to the digital table ,with 46 patients in each group.All patients were selected according to the specific circumstances given hernia surgery ,sevoflurane inhalation anesthesia with laryngeal mask airway in the study group in the operation,the control group was given tracheal intubation anesthesia.The changes of vital signs ,the anesthesia effect and treatment satisfaction etc.were observed and analyzed.Results All the patients were treated by surgery , the heart rate (HR) and mean arterial pressure(MAP) changes in the study group were significantly better than those in the control group(all P＜0.05).The eye opening time and awake time in the study group were (7.28 ±1.07)min, (12.96 ±1.38 ) min, respectively, which were significantly better than those in the control group [ ( 13.02 ± 1.75)min,(21.13 ±2.82)min] (t＝18.979,P＝0.001;t＝17.649,P＝0.001).The total satisfaction rate of the study group was 97.83%,which was significantly higher than 82.61%of the control group (χ2＝13.126＝0.002). Conclusion The application of laryngeal surgery in children with hernia in mask ventilation of sevoflurane anesthe -sia,has good anesthetic effect ,it has less influence on hemodynamics in children ,and rapid postoperative recovery.

Efficacy of domestic electronic vaporizer when used for sevoflurane anesthesia in rabbits / 中华麻醉学杂志

Objective To evaluate the efficacy of domestic electronic vaporizer when used for sevoflurane anesthesia in rabbits.Methods Ninety healthy pathogen-free New Zealand rabbits of both sexes,aged 4-5 months,weighing 2.5-3.5 kg,were divided into 3 groups (n=30 each) using a random number table:mechanical vaporizer group (group M),domestic electronic vaporizer group (group E) and Zeus electronic vaporizer group (group Z).In group M,the mechanical vaporizer was used,the sevoflurane vaporizer dial was adjusted to 2％,with the fresh air flow set at 2 L/min.In E and Z groups,BR850 domestic electronic vaporizer and Zeus electronic vaporizer were used,respectively,and the concentration of sevoflurane inhaled was 2％.Sevoflurane was inhaled for 2 h in each group.The formula method and weighing method were used to calculate the consumption of sevoflurane in group M.The electronic calculation method and weighing method were used to calculate the consumption of sevoflurane in Z and E groups.The stable value of end-tidal sevoflurane concentration (ETCsev) and time for ETCsev reaching the stable value were recorded.ETCsev was recorded every 10 min after reaching the stable value (T1T12).Results Compared with group M,the consumption of sevoflurane (weighing method) was significantly reduced,and the time for ETCsev reaching the stable value was shortened in Z and E groups (P＜ 0.05).Compared with group Z,the consumption of sevoflurane (weighing method) was significantly increased (P＜0.05),and no significant change was found in the time for ETCsev reaching the stable value in group E (P＞0.05).Compared with the consumption of sevoflurane (weighing method),no significant change was found in the consumption of sevoflurane (electronic method) in group Z (P＞0.05),and the consumption of sevoflurane (electronic method) was significantly increased in group E (P＜0.05).There was no significant difference in the stable value of ETCsev between the three groups (P＜0.05).There was no significant difference in ETCsev between and within groups (P＞0.05).Conclusion The domestic electronic vaporizer achieves automatic and precise control of volatile concentrations of inhalation anesthetics and can be effectively used for sevoflurane anesthesia in rabbits.When compared with Zeus electronic vaporizer,the precision of the domestic electronic vaporizer needs further improvement,but the cost is obviously low,the compatibility is strong,and it has clinical application value.

Sevoflorano como coadyuvante en la sedación durante ventilación mecánica en pacientes médicos de Unidad de Cuidados Intensivos: resultados preliminares en una serie de casos / Sevoflorane as adjuvant for sedation during mechanical ventilation in intensive care unit medical patients: Preliminary results of a series of cases

Objective: To disclose our preliminary experience in inhalation sedation with sevoflorane in a standardized manner using the Anesthetic Conserving Device in intubated, critically ill patients in our ICU. Patients: It has been used in nine cases of adult patients, six men and three women, over 24 months. Results: A proper implementation of the protocol by physicians and the nursing staff has been achieved, meeting the goals established for sedation (RASS 0, -2) free of hepatic or renal adverse outcomes or side effects. Conclusions: In our limited experience, adjuvant inhalation sedation with sevoflorane in the ICU is safe and complementary to the use of intravenous drugs such as propofol, remifentanil and midazolam, which are currently commonly used to achieve goal-directed sedation.

Objetivo: Explicar nuestra experiencia preliminar en la utilización de sedación inhalatoria de manera estandarizada con sevoflorano mediante dispositivo Anesthetic Conserving Device en pacientes críticos intubados en nuestra UCI. Pacientes: se ha utilizado en 9 casos, en pacientes adultos, 6 hombres y 3 mujeres, durante un periodo de 24 meses. Resultados: se ha conseguido una adecuada implantación del protocolo por parte de médicos y personal de enfermería, logrando los objetivos de sedación fijados en un primer momento (RASS 0, -2) y sin obtener resultados adversos ni efectos secundarios a nivel hepático y/o renal. Conclusiones: en nuestra limitada experiencia, la sedación inhalatoria con sevoflorano coadyuvante en UCI es una técnica segura y complementaria al uso de fármacos intravenosos, como propofol, remifentanilo y midazolam, utilizados habitualmente, para lograr una sedación guiada por objetivos.

Isoflurane effects on the proliferation and differentiation of neural stem cells in the hippocampus of neonatal rats / 中国组织工程研究

BACKGROUND:Isoflurane is an anesthesia drug that has a certain effect on the nervous system. It possibly causes neurologic disorders through impacting nerve stem cel function or morphology. OBJECTIVE:To investigate the effects of isoflurane on the proliferation and differentiation of neural stem cels in the hippocampus of rats. METHODS:Neural stem cels from the hippocampus of neonatal Sprague-Dawley rats, aged 7 days, were induced and differentiated. Passage 3 cels were obtained and divided into two groups: isoflurane group (a mixture gas of 2.8% isoflurane, 5% CO2 and 95% O2) and control group (a mixture of 5% CO2 and 95% O2). After intervention of 6 hours folowed by 2 hours of routine culture, anti-BrdU monoclonal antibody immunofluorescent staining was used to detect cel proliferation, and western blot assay to detect the expression of β3-tubulin and glial fibrilary acidic protein. RESULTS AND CONCLUSION:Compared with the control group, the number of BrdU positive cels in the isoflurane group reduced significantly, indicating that isoflurane inhibits the proliferation of neural stem cels. Compared with the control group, the expression of glial fibrilary acidic protein in the isoflurane group up-regulated, but the expression of β3-tubulin had no changes, indicating isoflurane promotes the differentiation of neural stem cels into astrocytes. Cite this article:Min N, Hu QF, Li XP, Nie XH, Yang LL.Isoflurane effects on the proliferation and differentiation of neural stem cels in the hippocampus of neonatal rats. Zhongguo Zuzhi Gongcheng Yanjiu. 2016;20(1):118-122.

Comparison of development of postoperative cognitive dysfunction using different methods of anes-thesia in elderly patients / 中华麻醉学杂志

Objective To compare the development of postoperative cognitive dysfunction ( POCD) under total inhalation anesthesia with sevoflurane versus total intravenous anesthesia with propofol in elderly patients. Methods Sixty American Society of Anesthesiologists physical status Ⅱ or Ⅲ patients, aged 65-77 yr, weighing 43-78 kg, with preoperative Mini?Mental State Examination ( MMSE) score≥25, scheduled for elective surgery for oral and maxillofacial carcinoma, were divided into 2 groups ( n=30 each) using a random number table: total inhalation anesthesia with sevoflurane group ( group S) and total intravenous anesthesia with propofol?based anesthesia group ( group P ) . The patients were tracheally intuba?ted under local infiltration anesthesia. In group S, anesthesia was induced with inhalation of 8% sevoflurane (oxygen flow rate 8 L∕min), rocuronium 0?9 mg∕kg was injected intravenously when the bispectral index ( BIS) value reached 45, and the patients were mechanically ventilated; anesthesia was maintained with inhalation of sevoflurane with the end?tidal concentration of 2%-3%. In group P , anesthesia was induced with iv propofol 2 mg∕kg and sufentanil 0?3μg∕kg, rocuronium 0?9 mg∕kg was injected intravenously when the BIS value reached 45, and the patients were mechanically ventilated; anesthesia was maintained with target?controlled infusion of propofol ( target plasma concentration 3-5μg∕ml) and remifentanil ( target plas?ma concentration 3-5 ng∕ml). In both groups, intermittent iv boluses of cisatracurium 0?04 mg∕kg were given to maintain muscle relaxation during operation, and BIS value was maintained at 40-60 during opera?tion. Before intubation ( T1 ) , immediately after onset of intubation ( T2 ) , at 10 min of intubation ( T3 ) , immediately after begninning of skin incision ( T4 ) , while operating on the base of tongue or sawing the low?er jaw ( T5 ) , at the end of operation ( T6 ) and on the morning of the postoperative day 1 ( T7 ) , blood sam?ples from the elbow vein were collected for determination of plasma norepinephrine and epinephrine concen?trations by high?performance liquid chromatography and electrochemistry. At T1?7 and on the morning of the postoperative day 3 ( T8 ) , blood samples from the elbow vein were collected for measurement of plasma cor?tisol concentrations by radioimmunoassay. MMSE was used to assess the cognitive function on the postopera?tive day 7. MMSE score0?05) . Conclusion Although the probability of the development of POCD is low when the two anesthetic methods are used, total intravenous anesthesia with propofol?based anesthesia induces a marked decrease in periop?erative stress responses when compared with total inhalation anesthesia with sevoflurane.

Identification of types of GABAA receptors in neurons in brain tissues at target of anesthetic action of isoflurane in mice / 中华麻醉学杂志

Objective To identify the types of γ?aminobutyric acid type A ( GABAA ) receptors in neurons in brain tissues at the target of anesthetic action of isoflurane in mice. Methods Two mouse strains were developed that were either sensitive or resistant to isoflurane. One hundred isoflurane?sensitive ICR∕CD?1 mice ( 50 males, 50 females) and 100 isoflurane?resistant ICR∕CD?1 mice ( 50 males, 50 fe?males) , aged 65-70 days, were used in this study. Brain tissues were obtained, and total RNA was ex?tracted and then reverse transcribed to cDNA using AMV reverse transcriptase. Polymerase chain reaction was used to detect the cDNA sequences. Chi?square analysis was used to compare the cDNA sequence of each GABAA receptor subunit between two strains. Results The cDNA sequence of GABAA receptor sub?units α1?6 , β2,3 andγ1?3 in isoflurane?sensitive strain was completely consistent with that in isoflurane?resist?ant strain. A single nucleotide polymorphism at the nucleotide position 462 ( C∕G) in the β1 sequence was found. The allele C frequencies were 11.0% and 87.0% in isoflurane?sensitive strain and isoflurane?resistant strain, respectively. Compared with isoflurane?sensitive strain, the allele C frequency in cDNA sequences of β1 subunit was significantly increased in isoflurane?resistant strain ( P<0.01) . Conclusion β1 subunit?containing GABAA receptor in neurons in brain tissues is the target of anesthetic action of isoflurane in mice.

Influence of sevoflurane concentration and stimulation voltage on motor evoked potentials in intraspinal tumor surgery / 北京大学学报(医学版)

Objective:To evaluate the effects of increasing end-tidal concentrations of sevoflurane and increasing stimulation voltage on motor evoked potentials,so as to provide evidence in making anesthesia plan for intraspinal tumor surgery.Methods:In the study,48 patients scheduled to undergo intraspinal tumor surgery [American Society of Anesthesiology,(ASA)Ⅰ-Ⅱ,18-65 years old]were enrolled. After general anesthesia induction,the patients were assigned to receive sevoflurane anesthesia of increa-sing end-tidal concentration in the sequence of 0.0%,0.5%,1 .0% and 1 .5% respectively,under a background of propofol and remifentanil.All the observations were done before the important steps of sur-gery.Remifentanil infusion rate was 0.2 μg /(kg·min),while the propofol infusion rate was adjusted to maintain the bispectral index values within the range of 30-50.At each concentration,4 stimulation voltages of 300 V,400 V,500 V and 600 V were employed to elicit motor evoked potentials (MEPs). The amplitude and latency of each MEP were compared.The success ratio was also recorded.Results:The concentration of sevoflurane and the stimulation voltage had impacts on the amplitude and latency of MEPs.Under each stimulation voltage,the MEPs amplitude decreased following increasing end-tidal sevoflurane concentrations,and significant differences were found in comparing 1 .5% sevoflurane (left 20.50 μV,70.71 μV,135.97 μV,190.00μV ,right 14.29 μV,50.71 μV,73.10μV,77.50μV) with 0.0% sevoflurane (left 143.00 μV,388.10 μV,484.53 μV,500.00 μV,right 176.00 μV, 407.60 μV,384.35 μV,451.00 μV)and 0.5% sevoflurane (left 100.00 μV,362.57 μV,444.05μV,435.00 μV,right 115.00 μV,207.15 μV,258.34 μV,358.50 μV),left χ2 =27.46,P<0.01,right χ2 =60.49,P<0.01;left χ2 =20.73,P<0.01,right χ2 =55.05,P<0.01;left χ2 =34.25,P<0.01,right χ2 =33.58,P<0.01;left χ2 =28.61,P<0.01 ,right χ2 =49.04,P<0.01;while there were no statistical differences in the latency changes (P =0.26 ).Under each end-tidal sevoflurane concentration,the MEPs amplitude increased following increasing stimulation voltages,and significant differences were found in comparing 300 V (left 143.00 μV,100.00 μV,61.50 μV,20.50μV ,right 176.00 μV,115.00 μV,41.07 μV,14.29 μV)with 400 V (left 388.10 μV,362.57μV,198.81 μV,70.71 μV,right 407.60 μV,207.15 μV,89.00 μV,50.71 μV)and 500 V (left 484.53 μV,444.05 μV,216.24μV,135.97 μV,right 384.35 μV,258.34μV,187.50μV,73.10μV)and 600 V (left 500.00 μV,435.00 μV,344.00 μV,190.00 μV,right 451.00 μV,385.50μV,156.00μV,77.50μV),leftχ2 =45.55,P<0.01,rightχ2 =25.73,P<0.01;leftχ2 =46.67, P<0.01,right χ2 =55.30,P<0.01;left χ2 =47.36,P<0.01,right χ2 =47.82,P<0.01;left χ2 =38.67,P<0.01,right χ2 =45.87,P<0.01;while the latencies were decreased,and significant dif-ferences were found in comparing 300 V with 400 V and 500 V and 600V(left F=7.50,P=0.01 ,right F=13.33,P<0.01),but the differences had little clinical significance.The success ratio decreased by increasing end-tidal sevoflurane concentration,and significant differences were found in comparing 1 .5%sevoflurane (left 43.8%,70.8%,77.1%,81.3%,right 37.5%,60.4%,75.0%,66.7%)with 0.0%sevoflurane (left 79.2%,87.5%,95.8%,93.8%,right 75.0%,95.8%,95.8%,95.8%)and 0.5%sevoflurane (left 72.9%,89.6%,95.8%,95.8%,right 66.7%,89.6%,95.8%,97.9%);the suc-cess ratio increased by increasing stimulation voltage,and significant differences were found in comparing 300 V(left 79.2%,72.9%,62.5%,43.8%,right 75.0%,66.7%,60.4%,37.5%)with 400 V(left 87.5%,89.6%,77.1%,70.8% ,right 95.8%,89.6%,79.2%,60.4%)and 500 V(left 95.8%, 95 .8%,9 1 .7%,77 .1%,right 95 .8%,95 .8%,8 1 .3%,75 .0%)and 600 V (left 93 .8%,95 .8%, 89.6%,81.3%,right 95.8%,97.9%,89.6%,66.7%),but there were no statistical differences in the success ratio of MEPs between the group with stimulation voltage of 600 V ,end tidal sevoflurane concen-tration of 1 .5% and the group with stimulation voltage of 300 V,end tidal sevoflurane concentration of 0.0% (P=0.22).Conclusion:Sevoflurane inhibited MEPs in a dose-dependent manner.It can de-crease the amplitudes and prolong the latencies.But increasing stimulation voltage will facilitate MEPs monitoring and increase the success ratio.Sevoflurane can be used in larger parts of MEPs monitoring surgery by increasing the stimulation voltage.

Bispectral index in calves anesthetized with xylazine, midazolam, ketamine, isoflurane and subjected to continuous rate infusion of lidocaine

PURPOSE: To assess the bispectral index (BIS) and recovery in calves anesthetized with xylazine, midazolam, ketamine and isoflurane and subjected to CRI of lidocaine. METHODS: Xilazine was administered followed by ketamine and midazolam, orotracheal intubation and maintenance on isoflurane using mechanical ventilation. Lidocaine (2 mg kg-1 bolus) or saline (0.9%) was administered IV followed by a CRI (100 µg kg-1 minute-1) of lidocaine (L) or saline (C). Were recorded BIS, heart rate (HR), mean arterial pressure (MAP) and rectal temperature (RT) before administration of premedication (TB) and 15 minutes after (TX), before administering lidocaine (T0) and 20, 40, 60 and 80 minutes after the start of the CRI . Time do sternal recumbency (SRE) and standing (ST) and plasma lidocaine concentration also evaluated. RESULTS: In both treatments BIS decreased significantly at all times compared to TB. TX was higher than the subsequent times. HR decreased from baseline at all times and decreased from T40 in L compared to C. SRE was higher in L compared to C. CONCLUSIONS: Bispectral index values were consistent with the degree of hypnosis of the animals. Lidocaine did not potentiate isoflurane anesthesia assessed by BIS in unstimulated calves anesthetized with constant E´Iso. Lidocaine increased the time to sternal recumbency. .

Effects of a continuous rate infusion of butorphanol in isoflurane-anesthetized horses on cardiorespiratory parameters, recovery quality, gastrointestinal motility and serum cortisol concentrations

PURPOSE: To assess the cardiorespiratory parametes, recovery, gastrointestinal motility and serum cortisol concentrations in horses anesthetized with isoflurane with or without a continuous rate infusion (CRI) of butorphanol for orchiectomy. METHODS: Twelve adult, intact, male horses weighing 332 ± 55 kg were included in the study. Xilazine was administered as premedication. Anesthesia was induced with ketamine and midazolam and maintained with isoflurane. Butorphanol (0.025 mg kg-1 bolus) or an equivalent volume of saline (0.9%) was given intravenously followed by a CRI of butorphanol (BG) (13 µg kg-1 hour-1) or saline (CG). Cardiorespiratory variables were recorded before (T0) and every 15 minutes for 75 minutes after the start of infusion. Serum cortisol concentration was measured at T0 and 60 minutes, and 30 minutes and 19 hours after the horse stood up. Recovery from anesthesia was evaluated using a scoring system. Gastrointestinal motility was evaluated before anesthesia and during 24 hours after recovery. RESULTS: There were no significant differences between groups in cardiopulmonary variables, or recovery scores or serum cortisol concentrations. A reduction in gastrointestinal motility was recorded for 60 minutes in BG. CONCLUSIONS: Continuous rate infusion of butorphanol in horses anesthetized with isoflurane did not adversely affect the cardiopulmonary variables monitored, or recovery scores. A small but statistically significant reduction in gastrointestinal motility occurred in the butorphanol group. .

Effects of continuous rate infusion of butorphanol in isoflurane-anesthetized calves

PURPOSE: To assess the hemodynamic changes and bispectral index (BIS) following administration of a continuous rate infusion (CRI) of butorphanol in isoflurane-anesthetized calves. METHODS: Eight calves weighing 110 ± 12 kg were included in the study. Anesthesia was induced with 5% isoflurane in O2 delivered via face mask and maintained with end-tidal concentration of 1.4%. IPPV was set to a peak inspiratory airway pressure of 15 cmH2O and respiratory rate of six breaths minute-1. Forty minutes after the start of anesthetic maintenance, 0.1 mg kg-1butorphanol was administered intravenously, followed by a CRI of 20 µg kg-1 minute-1. Hemodynamic variables and BIS were recorded before butorphanol administration (T0), and at 10, 20, 40 and 80 minutes following the CRI. Anesthesia was discontinued after the last recording and the calves were allowed to recover. The time to sternal recumbency (SRE) and standing (ST) were evaluated. RESULTS: There were no significant differences between the moments in all hemodynamic variables and BIS. The time to SRE and ST was 9 ± 5 and 14 ± 7 minutes, respectively. CONCLUSION: The continuous rate infusion did not produce clinically relevant changes in hemodynamic or bispectral index values compared to baseline in mechanically ventilated and unstimulated calves anesthetized at 1.4% isoflurane. .

Effect of isoflurane anesthesia on noise-induced hearing loss in guinea pigs / 中华麻醉学杂志

Objective To evaluate the effect of isoflurane anesthesia on noise-induced hearing loss in guinea pigs.Methods Forty-eight healthy adult male guinea pigs,aged 3 months,weighing 400-500 g,were randomly divided into 4 groups (n =12 each) using a random number table:control group (C group),isoflurane group (I group),noise-induced hearing loss group (N group),and isoflurane + noise-induced hearing loss group (I + N group).Isoflurane was inhaled for 140 min at a concentration of 1％ in I and I + N groups.N and I + N groups were exposed to the noise of 4 kHz center frequency and 118-122 dB sound pressure level for 120 min starting from 20 min after administration.Mean arterial pressure (MAP) was recorded at 10,40,70,100 and 120 min of exposure to noise and cochlear blood flow (CoBF) was recorded before administration and at 10,40,70,100 and 120 min of exposure to noise.Auditory brainstem response (ABR) threshold was recorded before administration and at 1 h,72 h,and 10 days after the end of exposure to noise.Arterial blood samples were obtained and the plasma noradrenaline (NE) concentration was detected by HPLC before exposure to noise and immediately after the end of exposure to noise.Results Compared with group C,MAP and the change rate of CoBF were significantly decreased,and the plasma NE concentration was increased immediately after the end of exposure to noise in I group,and MAP was increased,the change rate of CoBF was decreased,and the plasma NE concentration immediately after the end of exposure,and ABR threshold after the end of exposure were increased in N and I + N groups.Compared with N group,MAP was significantly decreased,the change rate of CoBF was increased,the plasma NE concentration immediately after the end of exposure,and ABR threshold at 1 and 72 h after the end of exposure were increased,and no significant was found in ABR threshold at 10 days after the end of exposure in I + N group.Conclusion Isoflurane anesthesia exerts temporary but not permanent protective effects against noise-induced hearing loss in guinea pigs and partial inhibition of activation of sympathetic nerve and increased CoBF may be involved in the mechanism.

Comparison of kidney injury in diabetic patients undergoing liver cancer resection performed under different methods of anesthesia / 中华麻醉学杂志

Objective To compare the kidney injury in diabetic patients undergoing liver cancer resection performed under different methods of anesthesia.Methods Sixty diabetic patients of both sexes,aged 40-64 yr,weighing 48-75 kg,of ASA physical shatus Ⅱ or Ⅲ (liver function Child-Pugh grade A),scheduled for elective liver cancer resection,were randomly divided into 2 groups (n =30 each) using a random number table:total intravenous anesthesia with propofol group (group P) and combined intravenous-inhalational anesthesia with sevoflurane group (group S).In group S,8％ sevoflurane was inhaled (FGF 8 L/min),and sufentanil 0.4 μg/kg and cisatracurium besylate 0.2 mg/kg were injected intravenously after the patients lost consciousness.In group P,propofol 1-2 mg/kg,sufentanil 0.4 μg/kg and cisatracurium besylate 0.2 mg/kg were injected intravenously.The patients were tracheally intubated and mechanically ventilated.Anesthesia was maintained with inhalation of 2 ％-3 ％ sevoflurane (FGF 2 L/min) in group S,or with iv infusion of propofol 0.5-0.8 mg· kg-1 · h-1 in group P,and with iv sufentanil 10 μg and cisatracurium 0.1 mg/kg when needed in both groups.BIS value was maintained at 40-60 and PET CO2 at 35-45 mmHg during operation.Before induction of anesthesia,at the end of operation,and at 24 and 72 h after operation,blood samples were collected from the central vein for determination of the levels of serum creatinine,blood urea nitrogen,serum cystatin C and 24 h.urinary microalbuminuria.Results Compared with group S,the levels of serum cystatin C at 24 and 72 h after operation and 24 h urinary microalbuminuria were significantly increased,and no significant changes were found in the levels of serum creatinine and blood urea nitrogen at each time point in group P.Conclusion The kidney injury is reduced in the diabetic patients undergoing liver cancer resection performed under combined intravenous-inhalational anesthesia with sevoflurane as compared with that under total intravenous anesthesia with propofol.