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Objective:To compare the myocardial protection in pediatric patients undergoing living-donor liver transplantation (LDLT) performed under propofol- versus desflurane-based anesthesia. Methods:Sixty American Society of Anesthesiologists Physical Status classification Ⅲ or Ⅳ pediatric patients of both sexes, aged 5-24 months, weighing 5-15 kg, scheduled for elective LDLT under general anesthesia, were divided into 2 groups ( n=30 each) using a random number table method: propofol group (group P) and desflurane anesthesia group (group D). During anesthesia maintenance, propofol 5-10 mg·kg -1·min -1 was intravenously infused in group P, desflurane 0.65 MAC-1.30 MAC was inhaled in group D. At 5 min after induction of anesthesia, at 1 h of reperfusion, at the end of surgery, at 1, 2, 3, 7 and 14 days after surgery, and on the day of discharge, the concentrations of serum high-sensitivity cardiac troponin I, creatine kinase isoenzyme, N-terminal pro-B-type natriuretic peptide were determined by enzyme-linked immunosorbent assay, the occurrence of nausea and vomiting, agitation, and shivering, postoperative tracheal extubation time, intensive care unit stay time, and postoperative length of hospital stay were recorded within 24 h after surgery. Results:Compared with group P, the concentrations of serum high-sensitivity cardiac troponin I and creatine kinase isoenzyme were significantly decreased after surgery, the extubation time and intensive care unit stay time were shortened ( P<0.05), and no significant change was found in serum N-terminal pro-B-type natriuretic peptide concentrations, postoperative length of hospital stay and incidence of postoperative adverse effects at each time point in group D ( P>0.05). Conclusions:Desflurane has better myocardial protection than propofol in pediatric patients undergoing LDLT, which is helpful for early prognosis.
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Objective:To compare the effects of desflurane and sevoflurane anesthesia on the sleep quality of sleep-deprived mice.Methods:Thirty-two clean-grade healthy male C57BL/6 mice, aged 10 weeks, weighing 20-25 g, were divided into 4 groups ( n=8 each) by the random number table method: control group (C group), sleep deprivation group (SD group), sleep deprivation+ sevoflurane group (SD+ SEV group), and sleep deprivation+ desflurane group (SD+ DES group). In the four groups, EEG-EMG electrodes were implanted for recording EEG and EMG, and sleep deprivation model was developed by the gentle stimulation method with a brush for 12 h (6: 00-18: 00) after 7 days of adaptation. The 6 h after sleep deprivation was divided into 2 time periods: T 1 period (18: 00-20: 00) and T 2 period (20: 00-24: 00). T 1 period In SD group, mice were allowed ad libitum recovery sleep after sleep deprivation. C group and SD group were exposed to 60% oxygen 1.5 L/min. In SD+ DES group and SD+ SEV group, mice were exposed to 6% desflurane and 2.5% sevoflurane, respectively, for 2 h in 60% oxygen 1.5 L/min following sleep deprivation. T 2 period Four groups were allowed ad libitum recovery sleep with the EEG-EMG signal recording. The percentages and number of wakefulness time, rapid eye movement time and non-rapid eye movement time during each time period were calculated using Lunion Data software. Results:Compared with C group, the percentage of non-rapid eye movement time and the percentage of rapid eye movement time were significantly decreased, and the percentage of wakefulness time was increased during 12 h sleep deprivation in SD group, SD+ SEV group and SD+ DES group ( P<0.05). Compared with T 1 period, the percentage of non-rapid eye movement time was significantly increased, and the percentage of wakefulness time and percentage of rapid eye movement time were decreased in T 2 period in SD group ( P<0.05). Compared with SD group, the percentage of non-rapid eye movement time and percentage of rapid eye movement time were significantly decreased, and the percentage of wakefulness time was increased in T 2 period in SD+ SEV group and SD+ DES group ( P<0.05). There was no significant difference in the percentage of non-rapid eye movement, rapid eye movement and wakefulness time in T 2 period between SD+ SEV group and SD+ DES group ( P>0.05). Compared with SD+ SEV group, the number of non-rapid eye movement in T 2 period was significantly reduced in SD+ DES group ( P<0.05). Conclusions:The effect of desflurane anesthesia in improving sleep quality is better than sevoflurane anesthesia in sleep-deprived mice.
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Background: Daycare surgeries are those surgical procedures in which the patients are admitted and discharged on the same day. As daycare surgeries surged, there is a need to have an anaesthetic agent which can be efficient and also causes fewer side effects. This study effectively analyses the efficacy and safety profile of the two most popular anaesthetic agents used in daycare surgeries. Methods: This is a retrospective study that was conducted between January 2022 and March 2022. The included patients were between 25 years and 65 years old. The outcomes were based on several factors like the efficacy of the anaesthesia (based on 4-point scale, recovery time and appearance of any side effects. Results: The efficacy of the anaesthetic action was assessed by the 4-point scale of anaesthetic effect, which showed a better outcome with sevoflurane. The Recovery Time in Group 1 was 19.92�24 minutes while in Group 2 it was 25.04�03 minutes. The findings reveal that the numbers of patients with complications are more in Group 1 as compared to Group 2 patients. Conclusion: Daycare surgery has increased and so, there is need to find an anesthetic agent which can efficiently be used. Anaesthetic efficiency is quite higher in sevoflurane as compared to desflurane. In the case of each complication, sevoflurane proved to have lesser complications as compared to desflurane. Sevoflurane is a better alternative to desflurane in daycare surgery as the anaesthetic agent of choice.
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@#Objective To evaluate the association between anesthesia regimen (volatile or intravenous anesthetics) and postoperative infection in adult cardiac patients undergoing cardiac surgery. Methods The clinical data of 496 elective adults undergoing cardiac surgery under cardiopulmonary bypass from June 2019 to June 2020 in West China Hospital of Sichuan University were retrospectively analyzed, including 251 females and 245 males with an average age of 54.1±11.4 years. American Society of Anesthesiologists grade was Ⅰ-Ⅲ. There were 243 patients in a volatile group with sevoflurane or desflurane, and 253 patients in an intravenous anesthesia group with propofol. The primary outcome was the incidence of infection within 30 days after cardiac surgery, including pulmonary infection, surgical site infection, sepsis, and urinary tract infection. The secondary outcomes were duration of mechanical ventilation, incidence of reintubation, ICU stay, postoperative length of hospital stay and total hospitalization cost. Results A total of 155 (31.3%) patients developed postoperative infection within 30 days, with an incidence of 32.9% in the volatile group and 29.6% in the intravenous anesthesia group. There was no statistical difference in the incidence of infection (RR=1.111, 95%CI 0.855 to 1.442, P=0.431) or the secondary outcomes (P>0.05) between the two groups. Conclusion The anesthesia regimen (volatile or intravenous anesthetics) has no association with the risk of occurrence of postoperative infection in adult patients undergoing elective cardiac surgery with cardiopulmonary bypass.
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@#Objective To determine whether there was a clinical relevant association between anesthetic regimen (propofol or inhalational anesthetics) and the occurrence of postoperative delirium (POD) in patients undergoing cardiac surgery. Methods This retrospective study was conducted on patients with elective cardiac surgery under cardiopulmonary bypass (CPB) at West China Hospital of Sichuan University between October 2018 and March 2019. The patients were divided into a propofol group or an inhalational anesthetics group according to anesthetic regimen (including CPB). The primary outcome was the occurrence of POD during first 3 days after surgery. Logistic regression analysis was used to determine the relationship between anesthetic regimen and the occurrence of POD. Results A total of 197 patients who met the inclusion criteria were included, with an average age of 53 years, and 51.8% (102/197) were females. POD occurred in 21.3% (42/197) patients. The incidence of POD was 21.4% in the propofol group and 21.2% in the inhalational anesthetics group; there was no significant difference between the two groups (RR=1.01, 95%CI 0.51-2.00, P=0.970). Logistic regression analysis did not find that anesthetic regimen was a risk factor for delirium after cardiac surgery after adjusting risk factors (OR=1.05, 95%CI 0.48-2.32, P=0.900). Conclusion Anesthetic regimen (propofol or inhalational anesthetics) is not associated with an increased risk for POD in adult patients undergoing elective cardiac surgery under CPB.
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@#Objective To evaluate the association of anesthesia regime (volatile or intravenous anesthetics) with the occurrence of postoperative pulmonary complications (PPCs) in adult patients undergoing elective cardiac surgery under cardiopulmonary bypass (CPB). Methods The electronic medical records of 194 patients undergoing elective cardiac surgery under CPB at West China Hospital, Sichuan University between September 2018 and February 2019 were reviewed, including 92 males and 102 females with an average age of 53 years. The patients were classified into a volatile group (n=94) or a total intravenous anesthesia (TIVA) group (n=100) according to anesthesia regimen during surgery (including CPB). The primary outcome was the incidence of PPCs within first 7 d after surgery. Secondary outcomes included incidence of reintubation, duration of mechanical ventilation, ICU stay and hospital stay. Results There was no significant difference in the incidence of PPCs between the two groups (RR=1.020, 95%CI 0.763-1.363, P=0.896), with an incidence of 48.9% in the volatile group and 48.0% in the TIVA group. Secondary outcomes were also found no significant difference between the two groups (P>0.05). Conclusion No association of anesthesia regimen with the incidence of PPCs is found in adult patients undergoing elective cardiac surgery under CPB.
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Abstract Background and objectives: This clinical trial aimed to evaluate the effects of two different inhalation anesthetic agents on postoperative olfactory memory and olfactory function in patients who underwent micro laryngeal surgery. Methods: This randomized prospective controlled study consisted of 102 consecutive patients with a voice disorder. The patients underwent micro laryngeal surgery for voice disorders under general anesthesia. Patients who did not meet inclusion criteria and/or declined to participate (n = 34) were excluded from the study. Patients were divided into two groups. Four patients from Group 1 and four patients from Group 2 were lost to follow-up. Group 1 (n = 30) received sevoflurane, and Group 2 (n = 30) received desflurane during anesthesia. We compared the results by performing the pre-op and post-op Connecticut Chemosensory Clinical Research Center Olfactory test. Results: Thirty-three patients (55%) were male and 27 (45%) were female. The mean age was 48.18 ± 13.88 years (range: 19‒70 years). Preoperative and postoperative olfactory functions did not show a significant difference within the groups postoperatively (p > 0.05). Preoperative and postoperative olfactory memory showed a significant decrease 3 hours after the surgery (p < 0.05). Conclusions: Olfactory functions and memory were not affected by desflurane in the early postoperative period. Although sevoflurane did not affect olfactory functions, it had a temporary negative effect on olfactory memory in the early postoperative period.
Resumo Introdução e objetivos: O estudo avaliou o efeito pós-operatório de dois agentes anestésicos inalatórios distintos na memória olfativa de curta duração e na função olfativa em pacientes submetidos à microcirurgia de laringe. Método: O estudo prospectivo controlado randomizado avaliou, consecutivamente, 102 pacientes com alteração vocal submetidos à microcirurgia de laringe sob anestesia geral. Trinta e quatro pacientes não obedeceram aos critérios de inclusão e/ou não aceitaram participar do estudo e foram excluídos. Os pacientes foram divididos em dois grupos. Quatro pacientes do Grupo 1 e quatro do Grupo 2 foram perdidos durante o seguimento. O Grupo 1 (n = 30) recebeu sevoflurano durante a anestesia e o Grupo 2 (n = 30), desflurano. Comparamos resultados pré e pós-operatórios de memória olfativa e funções olfativas, realizando o Connecticut Chemosensory Clinical Research Center Olfactory test. Resultados: Foram incluídos um total de 33 (55%) homens e 27 (45%) mulheres. A idade média foi 48,18 ± 13,88 anos (variação: 19-70 anos). As funções olfativas pré e pós-operatórias não apresentaram diferença estatisticamente significante dentro dos grupos no pós-operatório (p > 0,05). A memória olfativa pré e pós-operatória não mostrou diminuição estatisticamente significante quando avaliada três horas após a cirurgia (p< 0,05). Conclusões: Memória e funções olfativas não foram alteradas pelo desflurano no pós-operatório imediato. Embora o sevoflurano não tenha alterado as funções olfativas, causou efeito temporário negativo na memória olfativa no pós-operatório imediato.
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Humans , Male , Female , Adult , Aged , Young Adult , Smell/drug effects , Smell/physiology , Anesthetics, Inhalation/pharmacology , Sevoflurane/pharmacology , Desflurane/pharmacology , Memory, Short-Term/drug effects , Memory, Short-Term/physiology , Postoperative Period , Prospective Studies , Larynx/surgery , Middle AgedABSTRACT
Background: The number and variety of procedures done onday care basis has rapidly increased in recent past. For daycare anaesthesia, the use of anaesthetics that provide fast andsmooth induction, allow quick changes in depth whilemaintaining anaesthesia, early recovery and less postoperative nausea and vomiting are recommended. The aim ofthis study to compared the haemodynamic characteristics ofsevoflurane and desflurane anaesthesia and Fast track criteriaof recovery after ambulatory surgery.Materials & Methods: A double blind randomized study in theDepartment of Anaesthesiology and Intensive Care Unit atGovt. Medical College, Amritsar. 100 patients of AmericanSociety of Anaesthesiologist grade I or II in the age group of 20to 50 years undergoing short surgical procedure under generalanaesthesia were included. Continuous monitoring of vitalswas started after attaching Multipara monitor. In first 15minutes of intra-operative period monitoring of BP, HR, SPO2and ECG pattern were done every 5 minutes after that timeinterval was changed to 10 minutes till completion of surgery.After completion of surgery emergence time was noted. Inrecovery room assessment of variables required for fast trackscoring system were recorded after every 5 minutes. All theresults were be compiled, analyzed statistically and theappropriate test was applied and the blinding of the study wasopened at the end.Results: Our study showed that the mean age of patients inboth the groups was found to be statistically insignificant(p>0.05). The mean duration of surgery in both the groups wasfound to be statistically insignificant (p>0.05). The fast trackscore in group S and D at different time interval wasstatistically insignificant (p>0.05) and the maximum number ofpatients achieving PADDS score between 60-120 minutes.83% patients were ready to go home at 120 minutes.Conclusion: We concluded that both the inhalationalanaesthetics i.e. sevoflurane and desflurane provide similarhaemodynamic stability, but desflurane is associated withfaster emergence as compared to sevoflurane.
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BACKGROUND: Hypercapnia causes dilation of cerebral vessels and increases cerebral blood flow, resulting in increased intracranial pressure. Sevoflurane is reported to preserve cerebrovascular carbon dioxide reactivity. However, the contribution of inhaled anesthetics to vasodilatory responses to hypercapnia has not been clarified. Moreover, the cerebrovascular response to desflurane under hypercapnia has not been reported. We examined the effects of sevoflurane and desflurane on vasodilatory responses to hypercapnia in rats. METHODS: A closed cranial window preparation was used to measure the changes in pial vessel diameters. To evaluate the cerebrovascular response to hypercapnia and/or inhaled anesthetics, the pial vessel diameters were measured in the following states: without inhaled anesthetics at normocapnia (control values) and hypercapnia, with inhaled end-tidal minimal alveolar concentration (MAC) of 0.5 or 1.0 of either sevoflurane or desflurane at normocapnia, and an MAC of 1.0 of sevoflurane or desflurane at hypercapnia. RESULTS: Under normocapnia, 1.0 MAC, but not 0.5 MAC, of sevoflurane or desflurane dilated the pial arterioles and venules. In addition, under both 1.0 MAC of sevoflurane and 1.0 MAC of desflurane, hypercapnia significantly dilated the pial arterioles and venules in comparison to their diameters without inhaled anesthetics. The degrees of vasodilation were similar for desflurane and sevoflurane under both normocapnia and hypercapnia. CONCLUSIONS: Desflurane induces cerebrovascular responses similar to those of sevoflurane. Desflurane can be used as safely as sevoflurane in neurosurgical anesthesia.
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Animals , Rats , Anesthesia , Anesthetics , Arterioles , Carbon Dioxide , Cerebrovascular Circulation , Hypercapnia , Intracranial Pressure , Vasodilation , VenulesABSTRACT
BACKGROUND: Biliary atresia is an extrahepatic progressive obliterate cholangiopathy that occurs in infants. Kasai procedure, a surgical method that can help re-establish bile flow from the liver into the intestine, is its first line treatment. Since infants with biliary atresia already have advanced hepatic dysfunction, all kinds of schemes should be considered to minimize further liver damage during surgery. The objective of this study was to compare the postoperative hepatic functions between the two commonly used inhalational anesthetics in infants undergoing the Kasai procedure (i.e., desflurane and sevoflurane). METHODS: This prospective, randomized, double-blind, single-center, and parallel group study included 40 children undergoing Kasai procedure. They were randomly allocated to Group S (sevoflurane) or Group D (desflurane). All the patients were anesthetized with designated anesthetic agent with the end-tidal concentration of about 0.8–1 minimum alveolar concentration. Postoperative hepatic functions were assessed by aspartate aminotransferase (AST), alanine aminotransferase (ALT), albumin, prothrombin time, and total bilirubin. RESULTS: A total of 38 patients were selected for the study. In both groups, AST, ALT were increased in magnitude to the peak on postoperative day 0 and decreased to preoperative value at postoperative day 3. There were no significant differences between the groups in any laboratory results related to liver function. CONCLUSIONS: Sevoflurane and desflurane, inhalation anesthetics for maintaining anesthesia used in infants undergoing the Kasai procedure, did not show any difference in preserving postoperative hepatic function.
Subject(s)
Child , Humans , Infant , Alanine Transaminase , Anesthesia , Anesthetics , Anesthetics, Inhalation , Aspartate Aminotransferases , Bile , Biliary Atresia , Bilirubin , Intestines , Liver , Liver Function Tests , Methods , Portoenterostomy, Hepatic , Prospective Studies , Prothrombin TimeABSTRACT
BACKGROUND: General anesthesia with intravenous or inhalation anesthetics reduces respiratory functions. We investigated the effects of propofol, desflurane, and sevoflurane on postoperative respiratory function tests.METHODS: This single-center randomized controlled study was performed in a university hospital from October 2015 to February 2017. Ninety patients scheduled for endoscopic endonasal transsphenoidal pituitary surgery were randomly categorized into either of these three groups: propofol (n = 30, the Group TIVA), desflurane (n = 30, the Group D) or sevoflurane (n = 30, the Group S). We analyzed the patients before, after, and 24 h following surgery, to identify the following parameters: forced expiratory volume in 1 second (FEV₁) %, forced vital capacity (FVC) %, FEV₁/FVC, and arterial blood gases (ABG). Furthermore, we also recorded the intraoperative dynamic lung compliance and airway resistance values.RESULTS: We did not find any significant differences in FEV₁ values (primary outcome) among the groups (P = 0.336). There was a remarkable reduction in the FEV₁ and FVC values in all groups postoperatively relative to the baseline (P < 0.001). The FVC, FEV₁/FVC, ABG analysis, compliance, and airway resistance were similar among the groups. Intraoperative dynamic compliance values were lower at the 1st and 2nd hours than those immediately after intubation (P < 0.001).CONCLUSIONS: We demonstrated that propofol, desflurane, and sevoflurane reduced FEV₁ and FVC values postoperatively, without any significant differences among the drugs.
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Humans , Airway Resistance , Anesthesia, General , Anesthetics, Inhalation , Compliance , Forced Expiratory Volume , Gases , Intubation , Lung Compliance , Propofol , Prospective Studies , Respiratory Function Tests , Vital CapacityABSTRACT
The safety of occupational exposure to inhaled anesthetics remains a concern among the medical staff in hospitals. Few reports are seen about the impact of inhaled anesthetics on the reproductive system, particularly that of males. Several clinical and basic studies on isoflurane and others suggest that inhaled anesthetics affect the reproductive system of rodents by decreasing the sperm count, inducing sperm morphological abnormality, reducing sperm motility, and changing the levels of reproductive hormones, the underlying mechanisms of which are mainly associated with the alteration of the hypothalamic-pituitary-gonadal axis and DNA damage and apoptosis of reproductive cells. This article reviews the main impacts of inhaled anesthetics on the male reproductive system and the possible mechanisms.
Subject(s)
Humans , Male , Anesthetics, Inhalation , Pharmacology , Apoptosis , DNA Damage , Genitalia, Male , Isoflurane , Pharmacology , Occupational Exposure , Sperm Count , Sperm Motility , SpermatozoaABSTRACT
Objective To investigate the application effect of interventional surgery in the treatment of facial superficial mixed hemangi-oma through the laryngeal mask ventilation under desflurane anesthesia. Methods In the period from February 2016 to April 2017 in our hospital 118 cases of facial superficial hemangioma under interventional surgery in infants( aged 3-15 months) were retrospectively analyzed;according to the difference of anesthesia,they were divided into control group (51 cases) and observation group (67 cases);the two groups of children were administered sufentanil anesthesia, in the control group laryngeal mask airway under propofol, the observation group was giv-en under laryngeal mask airway inhalation of desflurane maintenance. Then was compared the difference in anesthesia monitoring indexes of the two groups, such as mean arterial pressure ( MAP) , saturation of pulse oximetry ( SpO2 ) , heart rate ( HR) , end-tidal carbon dioxide ( ETCO2 ) , laryngeal mask removal time, loss of consciousness time, laryngeal mask removal time, consciousness recovery duration, clinical efficacy and intraoperative and postoperative adverse reactions difference. Results For the control group, the laryngeal mask removal time and consciousness recovery time length were significantly longer than those of the observation group and the difference was statistically signifi-cant (P<0. 05);after anesthesia induction, the laryngeal mask insertion time, operation start time and laryngeal mask removal time, MAP and HR of the observation group and the control group were lower than those before anesthesia induction, and MAP and HR of control group were lower than those of the observation group and the deference was statistically significant (P<0. 05). The total efficiency of the observa-tion group (97. 02％) was significantly higher than the control group (88. 24％), the adverse reaction rate (23. 52％) of children in the control group was significantly higher than that (7. 46％) of those in the observation group, and the differences were statistically significant (P<0. 05). Conclusion In the infant facial superficial hemangioma interventional surgery, laryngeal mask airway can be used for anesthe-sia maintenance for desflurane effect and clinical curative effect in the effective protection of anesthesia at the same time, but also can reduce the risk of anesthesia and intraoperative blood pressure fluctuations, especially in the stabilization of hemodynamics of the patients.
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Objective To investigate the effects of desflurane on postoperative nausea and vomiting in patients undergoing gynecological laparoscopic surgery.Methods Patients who underwent gynecological laparoscopic surgery in the hospital from Dec.2016 to Nov.2017 were selected and divided into two groups,64 cases in the observation group and 68 cases in the control group.The observation group were treated by desflurane,and the control group were treated by desflurane combined with propofol.General information and intraoperative information of patients were collected.The time of eye opening,extubation,staying in postanesthesia care unit (PACU),postoperative stay were recorded.The incidence and severity of nausea and vomiting from 0 to 6 hours and 6 to 24 hours after surgery were also recorded.Results There was no significant difference in general information between the two groups such as anesthesia time,fluid input and total amount of opioids in operation (P＞ 0.05).The incidence and severity of PONV after surgery from 0 to 6 hours and 6 to 24 hours was similar (P＞ 0.05).The eye opening time,extubation time,staying time in PACU was meaningfully lower in observation group compared with control group(P＜0.05),but the duration of hospitalization after surgery was insignificant(P＞0.05).Conclusion Anesthesia with desflurane doesn't lead to more often or more severe nausea or vomiting,while it help patients wake up faster,which is worthy of clinical promotion.
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BACKGROUND: A rapid increase in desflurane concentration has been demonstrated to induce transient sympathetic hyperactivity and lead to increases in blood pressure and heart rate (HR). Additionally, the use of dexmedetomidine as an anesthetic adjunct has been reported to attenuate intraoperative sympathetic responses. We examined the hemodynamic effects of dexmedetomidine infusion before anesthetic induction on desflurane-induced cardiovascular changes. METHODS: Patients were randomly divided into three groups. They received either normal saline (NS) (group 1, only NS) or dexmedetomidine solution diluted in 50 ml NS (group 2, 0.5 µg/kg; group 3, 1.0 µg/kg) for 10 minutes with a syringe pump before anesthetic induction. Desflurane was administered at a vaporizer dial setting of 8% for 5 minutes by manual ventilation. RESULTS: In group 1, the HR significantly increased above the baseline during the entire 5 minutes after desflurane inhalation and the mean blood pressure (MBP) significantly increased above the baseline at 1, 2, and 3 minutes after desflurane inhalation. However, in groups 2 and 3, the increases in HR and MBP induced by desflurane inhalation were significantly suppressed. The HR and MBP in group 2 remained closer to the baseline than in group 3. CONCLUSIONS: A loading infusion of dexmedetomidine for 10 minutes before induction of general anesthesia effectively attenuates the transient cardiovascular stimulation induced by desflurane inhalation, without significant hemodynamic side effects. The HR and MBP remained closer to the baseline after administration of 0.5 µg/kg dexmedetomidine than after administration of a dose of 1.0 µg/kg.
Subject(s)
Humans , Anesthesia, General , Blood Pressure , Dexmedetomidine , Heart Rate , Hemodynamics , Inhalation , Nebulizers and Vaporizers , Syringes , VentilationABSTRACT
Abstract Background and objectives There is a strong demand for fast and predictable anesthesia recovery with few side effects. Choice of the hypnotic agent could impact on that. This study investigated the differences between recoveries after remifentanil-propofol and remifentanil-desflurane anesthesias guided by bispectral index (BIS®). Methods Forty patients were randomly assigned into 2 groups according to the anesthesia technique applied: remifentanil-propofol (REM-PRO) and remifentanil-desflurane (REM-DES). After the discontinuation of the anesthetics, the times to extubation, to obey commands and to recover the airway protection reflex were recorted. In the post-anesthetic recovery room (PACU) it was recorded the occurrence of nausea and vomiting (PONV), scores of Ramsay sedation scale and of numeric pain scale (NPS), morphine dose and length of stay in the unit. Results Data from 38 patients were analyzed: 18 from REM-PRO and 20 from REM-DES group. Anesthesia times were similar (REM-PRO = 193 min, SD 79.9 vs. 175.7 min, SD 87.9 REM-DES; p = 0.5). REM-DES had shorter times than REM-PRO group: time to follow command (8.5 min; SD 3.0 vs. 5.6 min; SD 2.5; p = 0.0) and extubation time (6.2 min; 3.1-8.5 vs. 9.5 min; 4.9-14.4; p = 0.0). Times to recover airway protective reflex were similar: 16 patients from REM-PRO (88.9%) restored the airway protective reflex 2 min after extubation vs. 17 from REM-DES (89.5%); and 2 patients from REM-PRO (11.1%) vs. 2 from REM-DES (10.5%) 6 min after extubation, p = 1. Ramsay sedation score, NPS, PONV incidents, morphine dose and PACU stay of length PACU were also similar. Conclusion Remifentanil-desflurane-based anesthesia has a faster extubation time and to follow command than remifentanil-propofol-based anesthesia when both guided by BIS®.
Resumo Justificativa e objetivos Há uma forte demanda por recuperação pós-anestésica rápida e previsível com poucos efeitos adversos. A escolha do agente hipnótico pode influenciar isso. Este estudo investigou as diferenças da recuperação no pós-operatório entre as técnicas anestésicas com remifentanil-propofol e com remifentanil-desflurano ambas com monitoração guiada pelo índice bispectral (BIS ®). Métodos Foram randomicamente distribuídos 40 pacientes em dois grupos de acordo com a técnica anestésica aplicada: remifentanil-propofol (REM-PRO) e remifentanil-desflurano (REM-DES). Após a descontinuação dos anestésicos foram registrados os tempos para extubação, obedecer a comandos e recuperar o reflexo de proteção das vias aéreas. Na sala de recuperação pós-anestésica (SRPA) foi registrado a ocorrência de náuseas e vômitos (NVPO), os escores na escala de sedação de Ramsay e na escala numérica de dor (END), a dose de morfina utilizada e o tempo de permanência nesta unidade. Resultados Os dados de 38 pacientes foram analisados: 18 do grupo REM-PRO e 20 do grupo REM-DES. Os tempos de anestesia foram semelhantes (REM-PRO = 193 minutos, DP 79,9 vs. 175,7 minutos, DP 87,9 REM-DES; p = 0,5). O grupo REM-DES apresentou tempos mais curtos do que o grupo REM-PRO: tempo para obedecer a comandos (8,5 minutos; DP 3,0 vs. 5,6 minutos; DP 2,5; p = 0,0) e tempo de extubação (6,2 minutos; 3,1-8,5 vs. 9,5 minutos; 4,9-14,4; p = 0,0). Os tempos para recuperação do reflexo de proteção das vias aéreas foram semelhantes: 16 pacientes do grupo REM-PRO (88,9%) recuperaram o reflexo de proteção das vias aéreas dois minutos após a extubação vs. 17 do grupo REM-DES (89,5%) e dois pacientes do grupo REM-PRO (11,1%) vs. dois do REM-DES (10,5%) seis minutos após a extubação, p = 1. Os escores de Ramsay, NPS, a incidência de NVPO, a dose de morfina e o tempo de permanência na SRPA também foram semelhantes. Conclusão A anestesia com remifentanil-desflurano tem um perfil de recuperação da anestesia pós-anestésica mais rápido do que o da anestesia com remifentanil-propofol quando ambas guiadas pelo BIS®.
Subject(s)
Humans , Female , Anesthesia Recovery Period , Propofol/administration & dosage , Monitoring, Intraoperative/methods , Anesthetics, Intravenous/administration & dosage , Anesthetics, Inhalation/administration & dosage , Anesthetics, Combined/administration & dosage , Remifentanil/administration & dosage , Desflurane/administration & dosage , Analgesics, Opioid/administration & dosage , Double-Blind Method , Prospective Studies , Recovery of Function , Consciousness Monitors , Middle AgedABSTRACT
Objective To investigate the effect of desflurane post-processing on the expression of glucose transporter 4 (GIUT4)in myocardial ischemia-reperfusion injury.Methods Twenty-four male New Zealand white rabbits were randomly divided into 4 groups (n =6 each):normal control group (group NC),ischemic-reperfusion group (group IR),ischemic-reperfusion postconditioning group (group IRP),desflurane aftertreatment group (group Des).Myocardial ischemia-reperfusion model was established by ligating the left coronary artery.Plasma glucose,Insulin and myocardial glucose uptake rate were measured at the time point before ischemia (T0),30 min after ischemia (T1),30 min (T2),60 min (T3) and 120 min (T4) after reperfusion,for dynamic comparison;the expression of GLUT4 mRNA in myocardium was detected by quantitative RT-PCR,and GLUT4 protein was detected by Western blot.Results Compared with group NC,the levels of blood glucose at T2-T4 increased in group IR (P＜0.05),but blood glucose in group Des was significantly lower than that in groups IR and IRP at T2-T4 (P＜0.05).Compared with group NC,serum insulin levels in groups IR,IRP and Des were significantly higher at T1-T3 (P＜0.05).The level of serum insulin in groups IRP and Des at T1 and T2 was significantly higher than that in group IR (P＜0.05),while that in group Des was higher than that in group IRP (P＜0.05).Blood glucose uptake rate in group IR at T2-T4 was significantly lower than that in groups NC,IRP and Des (P＜0.05),while the blood glucose uptake rate was higher in group Des than that in group IRP (P＜0.05).compared with group NC,the expression of GLUT4 mRNA and protein in groups IR,IRP and Des decreased (P＜0.05),but compared with groups IR and IRP,GLUT4 mRNA and protein expression increased in group Des (P＜0.05).Conclusion Postconditioning of desflurane can improve myocardial ischemia-reperfusion insulin resistance and increase myocardial glucose uptake,which may be related to the increase of myocardial GLUT4 expression.
ABSTRACT
Malignant hyperthermia (MH) may lead to metabolic crisis of skeletal muscle in susceptible individuals following exposure to triggering agents such as volatile anesthetics or depolarizing muscle relaxants. MH is a rare and a potentially lethal disease, which can lead to cardiac arrest. We report a case of severe MH, in which the rapidly evolving signs of hypermetabolism eventually resulted in cardiac arrest. Despite conventional treatments following cardiopulmonary resuscitation, the patient's vital signs did not improve. Therefore, we applied extracorporeal membrane oxygenation for providing hemodynamic support.
Subject(s)
Humans , Anesthetics , Cardiopulmonary Resuscitation , Dantrolene , Extracorporeal Membrane Oxygenation , Heart Arrest , Hemodynamics , Malignant Hyperthermia , Muscle, Skeletal , Neuromuscular Depolarizing Agents , Vital SignsABSTRACT
BACKGROUND: Droperidol (DHB) reportedly reduces the dose of propofol needed to achieve hypnosis when anesthesia is induced and decreases the bispectral index (BIS) in propofol-sedated patients during spinal anesthesia. We reported previously that supplemental DHB decreased the BIS after the administration of sevoflurane and remifentanil. This study investigated the effect of DHB on desflurane (DES) consumption in a clinical setting. METHODS: We conducted a prospective, randomized double-blinded study of 35 women with American Society of Anesthesiologist physical status I or II who underwent a mastectomy. Either DHB (20 µg/kg) or a saline placebo was administered to patients 30 min after the induction of anesthesia. A blinded anesthesiologist maintained a BIS value of 50 during anesthesia by modulating inhaled DES concentrations that changed 0.5% at 2.5 min intervals and maintained analgesia via the constant administration of remifentanil by referring to vital signs. The primary endpoint was the effect of DHB on DES consumption. The secondary endpoints included blood circulatory parameters, the time from the end of surgery to extubation, and discharge time between the groups. RESULTS: The characteristics of the patients did not differ between the groups. The DHB group used a mean of 27.2 ± 6.0 ml of DES compared with 41.4 ± 9.5 ml by the placebo group (P < 0.05). CONCLUSIONS: A small dose of DHB reduced the DES concentration needed to maintain a BIS of 50. Our results show that DHB reduced the consumption of DES without adverse effects.
Subject(s)
Female , Humans , Analgesia , Anesthesia , Anesthesia, General , Anesthesia, Spinal , Breast Neoplasms , Breast , Droperidol , Hypnosis , Mastectomy , Propofol , Prospective Studies , Vital SignsABSTRACT
ABSTRACT PURPOSE: To compared the effects of sevoflurane and desflurane on early anesthesia recovery in patients undergoing to craniotomy for intracranial lesions. METHODS: After IRB approval, the study included 50 patients aged 18-70 years who had ASA physical statuses of I-II and were scheduled for intracranial surgery. Patients were randomly divided into two groups: sevoflurane and desflurane. Anaesthesia was routinely induced in all patients followed by desflurane 5%-6% or sevoflurane 1%-2%. Moreover remifentanil infusion (0.05-0.2 mcg/kg/min) was adjusted to maintain mean arterial pressure (MAP) within 20% baseline and heart rate <90 bpm. Postoperatively, patients were evaluated over time for responses to painful stimulus, eye opening, hand squeezing, extubation, orientation and time required to achieve a Modified Aldrete Score of 9-10. Parametric and non-parametric data were assessed using Student's t- and Mann-Whitney U tests, respectively. A p<0.05 was taken as statistically significant. RESULTS: The times to responses to painful stimuli (7.7±2.7 vs. 4.8±1.7 min.; p<0.001), emergence (9.5±2.81 vs. 6.3±2.2 min.; p<0.001), hand-squeezing (12.1±2.9 vs. 8.2±2.3 min.; p<0.001), extubation (10.1±2.87 vs. 7.1±1.6 min.; p<0.001), orientation (15.3±3.2 vs. 10.3±2.7 min.; p<0.001) and Aldrete score of 9-10 (23.3±6.1 vs. 15.8±3.8 min.; p<0.001) were significantly lower with desflurane-based anaesthesia vs. sevoflurane-based anaesthesia. CONCLUSION: Desflurane yields early recovery functions and facilitates early postoperative neurologic examinations of intracranial surgery patients.