Association between telomere length in the DNA of peripheral blood leukocytes and the propofol dose in anesthesia induction: an observational study

Abstract Introduction: Propofol is a widely used anesthetic and its dose is closely related to aging. Telomere length (TL) is a unique heritable trait, and emerging as a biomarker of aging, health and disease. Telomerase RNA component (TERC) plays an important role in maintaining TL. We proposed a hypothesis that propofol dose in general anesthesia can be predicted by measuring TL before operation, which greatly reduced the risk of anesthesia, especially the elderly. Methods: The association between the propofol dose in anesthesia induction and: TL in the DNA of peripheral blood leukocytes; body weight; sex; difference of the Bispectral Index (BIS) before and after anesthesia induction in patients was evaluated by multivariable linear regression analyses. The mutation at the 5'end or 3'end of TERC was detected. We recruited 100 patients of elective surgery. Results: We found that propofol dose in anesthesia induction was clearly correlated significantly with TL (r = 0.78, p < 0.001), body weight (r = 0.84, p = 0.004), sex (r = 0.83, p= 0.84, p = 0.004), sex (r = 0.83, p = 0.004), and difference of BIS before and after anesthesia induction (r = 0.85, p = 0.029). By comparing the absolute values of standardized regression coefficients (0.58, 0.21, 0.19, and 0.12) of the four variables, it can be seen that TL contributes the most to the propofol dose in anesthesia induction. However, the mutation at the 5' end or 3' end of TERC was not found. Conclusions: These findings provide preliminary evidence that the propofol dose in anesthesia induction was clearly correlated with genetically determined TL. TL may be a promising predictor of the propofol dose, which is beneficial to improve the safety of anesthesia and reduce perioperative complications.

Role of melatonin in attenuation of hemodynamic response to intubation and anesthetic requirements: a randomized, controlled, double-blind study

Abstract Background Melatonin has been studied to have anxiolytic, sedative, and analgesic effects. However, there is limited data on the effect of melatonin in the attenuation of hemodynamic response to intubation. We aimed to study whether preanesthetic oral melatonin attenuates hemodynamic responses to intubation and anesthetic requirements. Methods Sixty-four patients scheduled for laparoscopic cholecystectomy were randomized into melatonin or placebo group (n = 32 each). Melatonin group received two tablets (3 mg each) of melatonin, and the placebo group received two tablets of vitamin D3 120 min before induction. Hemodynamic parameters were recorded during induction and postintubation for 15 minutes. Total induction dose of propofol, total intraoperative fentanyl consumption, and adverse effects of melatonin were also noted. Results Postintubation rise in heart rate (HR) was less in the melatonin group compared to the placebo group (10.59% vs. 37.08% at 1 min, respectively) (p< 0.0001). Maximum percentage increase in systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean blood pressure (MBP) was lesser in melatonin group than placebo group (SBP 9.25% vs. 37.73%, DBP 10.58% vs. 35.51%, MBP 9.99% vs. 36.45% at 1 min postintubation. respectively) (p< 0.0001). Induction dose of propofol (1.42 mg.kg-1 vs. 2.01 mg.kg-1) and the number of patients requiring additional fentanyl intraoperatively (3 vs. 11) were also significantly reduced in the melatonin group. Conclusion Premedication with 6 mg of oral melatonin resulted in significant attenuation of postintubation rise in HR, SBP, DBP, and MBP. It also reduced the induction dose of propofol, total intraoperative fentanyl consumption without any adverse effects.

¿Anestesia halogenada o anestesia total endovenosa en neurocirugía? / Volatile or total intravenous anesthesia for neurosurgery?

Total intravenous anesthesia (TIVA) with propofol/remifentanil appears in the literatura as a good option for neurosurgical patients who have increased intracranial pressure (ICP),risk of postoperative nausea and vomiting (PONV), need for neuromonitoring, and in those with impaired brain self-regulation. On the other hand, in patients with normal neurological status, normal ICP, a technique with volatile (halogenated) agents plus an opiiid can be used. This review describes two anesthetic techniques available for use in neurosurgery, highlighting the neurophysiological changes, advantages and disadvantages of each technique. MATERIAL AND METHOD: PubMed search engine was used for bibliographic search. DISCUSSION: The search for an ideal anesthetic in neurosurgery is still a matter of debate. There are numerous investigations aimed at finding an optimal agent that ensure the coupling between cerebral flow (CBF) and metabolism, keeping self-regulation intact without increasing the CBF and intracerebral pressure (ICP). CONCLUSIONS: Both anesthetic techniques, TIVA and volatile agents (halogenated), can be used in neurosurgical procedures and should provide neuroprotection, brain relaxation and a rapid awakening.

La anestesia total endovenosa (TIVA) con propofol/remifentanilo aparece en la literatura como una buena opción para pacientes neuroquirúrgicos que tienen aumento de la presión intracraneana (PIC), riesgo de náuseas y vómitos posoperatorios (NVPO), necesidad de neuromonitoreo, y en aquellos con alteración de la autorregulación cerebral. Por otra parte, en pacientes con estado neurológico normal, PIC normal puede usarse una técnica con agentes volátiles (halogenados) más un opioide. Esta revisión describe dos técnicas anestésicas disponibles para su uso en neurocirugía, destaca los cambios neurofisiológicos, ventajas y desventajas de cada técnica. MATERIAL Y MÉTODO: Para búsqueda bibliográfica se usó buscador PubMed. DISCUSIÓN: La búsqueda de un anestésico ideal en neurocirugía sigue siendo tema de debate. Existen numerosas investigaciones destinadas a buscar un agente óptimo que asegure el acoplamiento entre flujo sanguíneo cerebral (FSC) y metabolismo, manteniendo la autorregulación intacta sin aumentar el FSC y presión intracerebral (PIC). CONCLUSIONES: Ambas técnicas anestésicas, TIVA y agentes volátiles (halogenados), pueden ser usadas en procedimientos neuroquirúrgicos y deben brindar neuroprotección, relajación cerebral y un despertar rápido.

¿Por qué el propofol en el paciente con cáncer? / ¿Why propofol in the cancer patient?

INTRODUCTION: Cancer is a chronic, incapacitating and high mortality disease. OBJECTIVE: To carry out an update on the beneficial properties of the use of propofol as an anesthetic agent in cancer patients. METHODOLOGICAL DESIGN: A manual and digital search was performed in different databases such as MEDLINE, Scielo, IBECS and Cochrane, with the following descriptors: propofol, cancer, immunity and cancer. Development: 90% of deaths related to cancer are due to the progression of the disease, to metastases and not to the primary tumor. Therefore, preventing immunosuppression in the perioperative period is particularly important. During the perioperative period, there are factors that activate or inhibit immune responses. Recent findings have suggested that anesthesia can induce metabolic, inflammatory and immunological changes in the perioperative period. Propofol promotes the cytotoxicity of natural killer cells, reduces the motility of tumor cells, inhibits cyclo-oxygenase. It has been revealed that this drug exhibits anticancer properties in some types of cancer: colon cancer, gastric cancer, bile duct cancer. CONCLUSIONS: Propofol has a potential benefit as an anesthetic agent in patient with cancer. Only the accumulation of even more scientific evidence would allow us to give greater value to the use of this drug.

INTRODUCCIÓN: El cáncer es una enfermedad crónica, incapacitante y de gran mortalidad. OBJETIVO: Realizar una actualización sobre las beneficiosas propiedades del uso del propofol como agente anestésico en el paciente oncológico. DISEÑO METODOLÓGICO: Se realizó una búsqueda manual y digital en diferentes bases de datos como MEDLINE, Scielo, IBECS y Cochrane, con los descriptores siguientes: propofol, cáncer, inmunidad y cáncer. Desarrollo: El 90% de las muertes relacionadas con el cáncer son debido a la progresión de la enfermedad, a las metástasis y no al tumor primario. Por ello, prevenir la inmunosupresión en el período perioperatorio toma particular importancia. Durante el periodo perioperatorio existen factores que activan o inhiben las respuestas inmunitarias. Los descubrimientos recientes han sugerido que la anestesia puede inducir cambios metabólicos, inflamatorios e inmunológicos en el período perioperatorio. El propofol favorece la citotoxicidad de las células naturalkiller, reduce la motilidad de las células tumorales, inhibe la ciclooxigenasa. Ha sido revelado que este fármaco exhibe propiedades anticancerosas en algunos tipos de cáncer: cáncer de colon, cáncer gástrico, cáncer de vías biliares. CONCLUSIONES: El propofol presenta un potencial beneficio como agente anestésico en el paciente con cáncer. Solo bastaría la acumulación de aún más evidencia científica que nos permita darle mayor valor al uso de este fármaco.

The role of PI3K/Akt signal pathway in the protective effects of propofol on intestinal and lung injury induced by intestinal ischemia/reperfusion

Abstract Purpose: To investigate the role of PI3k/Akt signal pathway in the protective effects of propofol on intestinal and lung injury induced by intestinal ischemia/reperfusion(I/R). Methods: Male Sprague-Dawley rats were subjected to 45 min of ischemia by occluding the superior mesenteric artery and to 2h of reperfusion to establish the model of I/R. Twenty four rats were randomly divided into four groups: Sham, intestinal I/R (II/R), propofol (P), wortmannin (W). In groups P, W, propofol was injected intravenously and continuously at the onset of reperfusion via infusion pump. PI3K inhibitor (wortmannin) was administered intravenously in group W 25 min before ischemia. Intestinal tissues and lung tissues were obtained for determination of histologic injury, wet/dry weight ratio, malondialdehyde (MDA) levels, superoxide dismutase (SOD) and myeloperoxidase (MPO) activities. Meanwhile, the expressions of caspase-3 and phosphorylated Akt (p-Akt) in intestines and lungs were detected by western blot. Results: Propofol treatment alleviated intestinal and lung morphological changes which were observed in II/R group，Moreover, wet/dry weight ratio, the MDA level, MPO activity and expression of caspase-3 were significantly decreased whereas the SOD activity and p-Akt expression were significantly increased. Notably, the protections were significantly reversed by pretreatment of wortmannin. Conclusion: PI3K/Akt pathway activation play a critical role in the protective effects of propofol on intestinal and lung injury induced by ischemia/reperfusion.

Propofol, fentanyl and remifentanil do not impair the phagocytic capacity to of human peripheral blood polimorphonuclear cells / Propofol, fentanil y remifentanil no alteran la capacidad de las células polimorfonucleares humanas de fagocitar a la Candida albicans

OBJECTIVES: The capacity of polymorphonuclear cells (PMN) to phagocyte microorganisms is an important function to be preserved during surgical interventions. Therefore, the aim of this study was to determine the effect of propofol, fentanyl and remifentanil combination on Candida albicans engulfment by human PMN. MATERIALS AND METHODS: Twenty patients scheduled to undergo surgical interventions (ASA I-II) received propofol, fentanyl and remifentanil as intravenous anesthesia. PMNs were obtained before and after the surgical procedure and phagocytosis assay was performed using opsonized C. albicans. RESULTS AND CONCLUSIONS: No differences between the values obtained before and after anesthesia treatment in the number of phagocytic PMN and the number of C. albicans engulfed were observed. These results suggest that the used anesthesic protocol does not alter one of the most important immune mechanisms.

OBJETIVOS: La capacidad de las células polimorfonucleares (CPN) de fagocitar a los microorganismos es una importante función que se debe de preservar durante las intervenciones quirúrgicas. Por lo tanto, el propósito de este estudio fue determinar el efecto de la combinación del propofol, el fentanil y el remifentanil en la ingestión de Candida albicans por parte de las CPN humanas. MATERIALES Y MÉTODOS: Veinte pacientes sujetos a intervenciones quirúrgicas (ASA I-II) recibieron propofol, fentanil y remifentanil como anestesia endovenosa. Los CPN se obtuvieron antes y después del procedimiento quirúrgico y el ensayo de fagocitosis fue realizando usando C. albicans opsonizada. RESULTADOS Y CONCLUSIONES: No se observaron diferencias significativas en los valores obtenidos antes y después del tratamiento anestésico tanto en el número de CPN fagocíticas como en el número de C. albicans dentro de las células. Estos hallazgos sugieren que el protocolo anestésico usado no altera uno de los mecanismos de defensa más importante del organismo.

Effects of propofol pretreatment on myocardial cell apoptosis and SERCA2 expression in rats with hepatic ischemia/reperfusion / Efeitos do pré-tratamento com propofol sobre a apoptose de células miocárdicas e expressão de SERCA2 em ratos com isquemia/reperfusão hepática

Abstract Introduction: Hepatic ischemia-reperfusion injury is a common pathophysiological process in liver surgery. Whether Propofol can reduce myocardial ischemia-reperfusion injury induced by hepatic ischemia-reperfusion injury in rats, together with related mechanisms, still needs further studies. Objective: To investigate if propofol would protect the myocardial cells from apoptosis with hepatic ischemia-reperfusion injury. Methods: Male Sprague-Dawley rats (n = 18) were randomly allocated into three groups: Sham Group (Group S, n = 6), Hepatic Ischemia-reperfusion Injury Group (Group IR, n = 6) and Propofol Group (Group P, n = 6). Group S was only subjected to laparotomy. Group IR was attained by ischemia for 30 min and reperfusion for 4 h. Group P was subjected identical insult as in Group IR with the administration of propofol started 10 min before ischemia with 120 mg.kg−1, following by continuous infusion at 20 mg.kg−1.h−1. Cell apoptosis was examined by terminal deoxynucleotidyl transferase-mediated dUTP-biotin nick end labeling assay. Endoplasmic reticulum Ca2+-ATPase2 (SERCA2) and cysteine-containing aspartic acid cleaved-caspase3 (cleaved-caspase3) were assayed by western blot and Altimeter polymerase chain reaction. Results: Apoptosis rate was increased, with mRNA and protein of SERCA2 down-regulated and cleaved-caspase3 up-regulated in Group IR compared with Group S (p < 0.01). Apoptosis rate was decreased, with mRNA and protein of SERCA2 up-regulated and cleaved-caspase3 down-regulated in Group P compared with Group IR (p < 0.01). Conclusions: Propofol can reduce hepatic ischemia-reperfusion injury-induced myocardial cell apoptosis, meanwhile, can up-regulate mRNA and protein of SERCA2 in rats.

Resumo Introdução: A lesão hepática por isquemia-reperfusão é um processo fisiopatológico comum em cirurgias hepáticas. Mais estudos ainda são necessários para avaliar se o propofol pode reduzir a lesão de isquemia-reperfusão miocárdica induzida pela lesão de isquemia-reperfusão hepática em ratos, juntamente com os mecanismos que estão relacionados. Objetivo: Investigar se propofol protege as células do miocárdio da apoptose com a lesão hepática por isquemia-reperfusão. Métodos: Ratos machos da raça Sprague-Dawley (n = 18) foram alocados aleatoriamente em três grupos: Grupo Sham (Grupo S, n = 6), Grupo Lesão Hepática por Isquemia-reperfusão (Grupo IR, n = 6) e Grupo Propofol (Grupo P, n = 6). O Grupo S foi submetido apenas à laparotomia. O grupo IR foi submetido à isquemia por 30 min e reperfusão por 4 h. O grupo P foi submetido à mesma isquemia do grupo IR, com a administração de 120 mg.kg-1 de propofol iniciada 10min antes da isquemia, seguida de infusão contínua a 20 mg.kg-1.h-1. A apoptose celular foi examinada por meio do ensaio de marcação de terminações dUTP pela deoxinucleotidil transferase. Retículo endoplasmático Ca2+-ATPase2 (SERCA2) e caspase-3 do ácido aspártico contendo cisteína (caspase-3 clivada) foram avaliados com o ensaio western blot e reação em cadeia da polimerase. Resultados: A taxa de apoptose foi maior com mRNA e proteína de SERCA2 regulados para baixo e caspase-3 clivada suprarregulada no Grupo IR, em comparação com o Grupo S (p < 0,01). A taxa de apoptose foi menor com mRNA e proteína de SERCA2 suprarregulada e caspase-3 clivada sub-regulada no Grupo P, em comparação com o Grupo IR (p < 0,01). Conclusões: O propofol pode reduzir a apoptose de células miocárdicas induzida por lesão hepática por isquemia-reperfusão. Entretanto, pode suprarregular o mRNA e a proteína de SERCA2 em ratos.

Propofol attenuates cytokine-mediated upregulation of expression of inducible nitric oxide synthase and apoptosis during regeneration post-partial hepatectomy

Abstract Purpose: To determine the effects of propofol and ketamine anesthesia on liver regeneration in rats after partial hepatectomy (PHT). Methods: Male Wistar albino rats were assigned randomly to four groups of 10. Anesthesia was induced and maintained with propofol in groups 1 and 2, and with ketamine in groups 3 and 4. PHT was undertaken in groups 1 and 3. Rats in groups 2 and 4 (control groups) underwent an identical surgical procedure, but without PHT. At postoperative day-5, rats were killed. Regenerated liver was removed, weighed, and evaluated (by immunohistochemical means) for expression of inducible nitric oxide synthase (iNOS), endothelial NOS (eNOS), apoptosis protease-activating factor (APAF)-1, and proliferating cell nuclear antigen (PCNA). Also, blood samples were collected for measurement of levels of tumor necrosis factor (TNF)-α and interleukin (IL)-6. Results: Between groups 2 and 4, there were no differences in tissue levels of iNOS, eNOS, and APAF-1 or plasma levels of TNF-α and IL-6. eNOS expression was similar in group 1 and group 3. Expression of iNOS and APAF-1 was mild-to-moderate in group 1, but significantly higher in group 3. Groups 1 and 3 showed an increase in PCNA expression, but expression in both groups was comparable. Plasma levels of TNF-α and IL-6 increased to a lesser degree in group 1 than in group 3. Conclusion: Propofol, as an anesthetic agent, may attenuate cytokine-mediated upregulation of iNOS expression and apoptosis in an animal model of liver regeneration after partial hepatectomy.

Cyclosporine A attenuates apoptosis and necrosis after ischemia-reperfusion-induced renal injury in transiently hyperglycemic rats

Abstract Purpose: To investigate the effects of cyclosporine A on renal ischemia-reperfusion injury during transient hyperglycemia in rats. Methods: In a model of ischemia-reperfusion-induced renal injury and transiently induced hyperglycemia by intraperitoneal injection of glucose, 2.5 g.kg-1, Wistar rats were anesthetized with either isoflurane or propofol and received intravenous cyclosporine A, 5 mg.kg-1, five minutes before reperfusion. Comparison groups were isoflurane and propofol sham groups and isoflurane and propofol ischemia-reperfusion-induced renal injury. Renal tubular cell viability was quantitatively assessed by flow cytometry after cell culture and classified as early apoptosis, necrotic cells, and intact cells. Results: Early apoptosis was significantly higher in isoflurane and propofol anesthetized animals subjected to renal ischemia-reperfusion injury when compared to both cyclosporine A treated and sham groups. Necrosis percentage was significantly higher in propofol-anesthetized animals subjected to renal ischemia-reperfusion injury. The percentage of intact cells was lower in both, isoflurane and propofol anesthetized animals subjected to renal ischemia-reperfusion injury. Conclusion: In a model of ischemia-reperfusion-induced renal injury, cyclosporine A, 5 m.kg-1, administered five minutes before renal reperfusion in rats with acute-induced hyperglycemia under either isoflurano or propofol anesthesia, attenuated early apoptosis and preserved viability in renal tubular cells, regardless of the anesthetic used.

Comparisons of the effects of the sevoflurane and propofol on acute ischemia reperfusion and DNA damages in rabbits / Comparações dos efeitos de sevoflurano e propofol sobre isquemia-reperfusão aguda e danos ao DNA em coelhos

Abstract Background and objectives: The aim of this study was to compare the effects of sevoflurane and propofol anesthesia on oxidative DNA damage that occurs in low-extremity ischemia and is caused by tourniquet application. Methods: Fourteen New Zealand rabbits were randomly allocated into two equal groups. Group S (n = 7) received sevoflurane (2.5-4 percent) inhalation and Group P (n = 7) received a propofol infusion (1-2 mg·kg-1·min-1), after which a pneumatic tourniquet was placed on the right lower extremity. Blood samples were collected prior to tourniquet placement (baseline), 120 min after ischemia, 15 min after ischemia and 120 minutes (min) after ischemia. Malondialdehyde (MDA) levels were analyzed to determine lipid peroxidation, and single cell gel electrophoresis (SCGE) was used to determine DNA damage. Results: At 15 min after ischemia, the MDA levels in Group P (8.15 ± 2.61 µM) were higher than baseline (6.26 ± 3.19 µM, p = 0.026) and Group S (4.98 ± 0.77 µM, p = 0.01). DNA damage was similar in both groups, although DNA damage was higher than baseline (tail moment 0.63 ± 0.27, tail intensity 3.76 ± 1.26) in Group P at the 15th minute of reperfusion (tail moment 1.05 ± 0.45, p = 0.06; tail intensity 5.33 ± 1.56, p = 0.01). The increase in tail moment and tail intensity returned to normal levels in both groups 2 hours after the termination of ischemia. Conclusion: Given that oxidative stress and genotoxic effect disappear in the late stages of reperfusion, we conclude that neither sevoflurane nor propofol can be considered superior to the other in anesthesia practices for extremity surgeries involving the use of a tourniquet.

Resumo Justificativa e objetivos: Comparar os efeitos da anestesia com sevoflurano e propofol sobre o dano oxidativo ao DNA que ocorre na isquemia de extremidade inferior e é causada pela aplicação de torniquete. Métodos: Foram alocados aleatoriamente em dois grupos iguais 14 coelhos da raça Nova Zelândia. Grupo S (n = 7) recebeu inalação de sevoflurano (2,5-4%) e Grupo P (n = 7) recebeu perfusão de propofol (1-2 mg·kg-1·min-1), logo após um torniquete pneumático foi colocado na extremidade inferior direita. Amostras de sangue foram coletadas antes da colocação do torniquete (fase basal), após 120 minutos de isquemia, 15 minutos após a isquemia e 120 minutos após a isquemia. Os níveis de malondialdeído (MDA) foram analisados para determinar a peroxidação de lipídios e eletroforese em gel de célula única (EGCU) foi usada para determinar o dano ao DNA. Resultados: Aos 15 minutos após a isquemia, os níveis de MDA no Grupo P (8,15 ± 2,61 µM) foram superiores aos da fase basal (6,26 ± 3,19 µM, p = 0,026) e dp Grupo S (4,98 ± 0,77 µM, p = 0,01). O dano causado ao DNA foi semelhante nos dois grupos, embora tenha sido maior do que na fase basal (momento da cauda 0,63 ± 0,27, intensidade da cauda 3,76 ± 1,26) no Grupo P no 15 minutos de reperfusão (momento da cauda 1,05 ± 0,45, p = 0,06; intensidade da cauda 5,33 ± 1,56, p = 0,01). O aumento no momento da cauda e a intensidade da cauda voltaram aos níveis normais nos dois grupos duas horas após o término da isquemia. Conclusão: Como o estresse oxidativo e o efeito genotóxico desaparecem nos estágios finais da reperfusão, concluímos que não há superioridade tanto de sevoflurano quanto de propofol em práticas de anestesia para procedimentos cirúrgicos de extremidades que envolvem o uso de torniquete.

Comparative evaluation of propofol in nanoemulsion with solutol and soy lecithin for general anesthesia / Avaliação comparativa do propofol em nanoemulsão com solutol e com lecitina de soja para anestesia geral

ABSTRACT INTRODUCTION: The vehicle for propofol in 1 and 2% solutions is soybean oil emulsion 10%, which may cause pain on injection, instability of the solution and bacterial contamination. Formulations have been proposed aiming to change the vehicle and reduce these adverse reactions. OBJECTIVES: To compare the incidence of pain caused by the injection of propofol, with a hypothesis of reduction associated with nanoemulsion and the occurrence of local and systemic adverse effects with both formulations. METHOD: After approval by the CEP, patients undergoing gynecological procedures were included in this prospective study: control (n = 25) and nanoemulsion (n = 25) groups. Heart rate, noninvasive blood pressure and peripheral oxygen saturation were monitored. Demographics and physical condition were analyzed; surgical time and total volume used of propofol; local or systemic adverse effects; changes in variables monitored. A value of p < 0.05 was considered significant. RESULTS: There was no difference between groups regarding demographic data, surgical times, total volume of propofol used, arm withdrawal, pain during injection and variables monitored. There was a statistically significant difference in pain intensity at the time of induction of anesthesia, with less pain intensity in the nanoemulsion group. CONCLUSIONS: Both lipid and nanoemulsion formulations of propofol elicited pain on intravenous injection; however, the nanoemulsion solution elicited a less intense pain. Lipid and nanoemulsion propofol formulations showed neither hemodynamic changes nor adverse effects of clinical relevance.

RESUMO INTRODUÇÃO: O veículo do propofol em soluções a 1 e 2% é a emulsão de óleo de soja a 10%, que pode provocar dor à injeção, instabilidade da solução e contaminação bacteriana. Formulações foram propostas com o objetivo de alterar o veículo e reduzir essas reações adversas. OBJETIVOS: Comparar a incidência de dor à injeção do propofol com a hipótese de redução associada à nanoemulsão e a ocorrência de efeitos adversos locais e sistêmicos com as duas formulações. MÉTODO: Após aprovação pelo Conselho de Ética em Pesquisa, foram incluídos neste estudo prospectivo pacientes submetidas a procedimentos cirúrgicos ginecológicos: grupos controle (n = 25) e nanoemulsão (n = 25). Foram monitorados frequência cardíaca, pressão arterial não invasiva e saturação periférica de oxigênio. Foram analisados dados demográficos e estado físico; tempo cirúrgico e volume total usado de propofol; efeitos adversos locais ou sistêmicos; alterações nas variáveis de monitoramento. Considerou-se significativo valor de p < 0,05. RESULTADOS: Não houve diferença entre os grupos em relação a: dados demográficos, tempos cirúrgicos, volume total usado de propofol, retirada do braço, presença de dor durante a injeção e variáveis de monitoramento. Verificou-se diferença estatística significativa na intensidade da dor no momento da indução da anestesia, com menor intensidade no grupo nanoemulsão. CONCLUSÕES: Ambas as formulações de propofol, lipídica e em nanoemulsão, elicitaram dor à injeção venosa, porém a solução de nanoemulsão promoveu dor em menor intensidade. O propofol lipídico e o propofol em nanoemulsão não apresentaram alterações hemodinâmicas e efeitos adversos de relevância clínica.

A comparative study between propofol and etomidate in patients under general anesthesia / Estudo comparativo entre propofol e etomidato em pacientes sob anestesia geral

ABSTRACT BACKGROUND AND OBJECTIVES: Induction of anesthesia is a critical part of anesthesia practice. Sudden hypotension, arrhythmias, and cardiovascular collapse are threatening complications following injection of induction agent in hemodynamically unstable patients. It is desirable to use a safe agent with fewer adverse effects for this purpose. Present prospective randomized study is designed to compare propofol and etomidate for their effect on hemodynamics and various adverse effects on patients in general anesthesia. METHODS: Hundred ASA I and II patients of age group 18-60 years scheduled for elective surgical procedure under general anesthesia were randomly divided into two groups of 50 each receiving propofol (2 mg/kg) and etomidate (0.3 mg/kg) as an induction agent. Vital parameters at induction, laryngoscopy and thereafter recorded for comparison. Adverse effect viz. pain on injection, apnea and myoclonus were carefully watched. RESULTS: Demographic variables were comparable in both the groups. Patients in etomidate group showed little change in mean arterial pressure (MAP) and heart rate (HR) compared to propofol (p > 0.05) from baseline value. Pain on injection was more in propofol group while myoclonus activity was higher in etomidate group. CONCLUSIONS: This study concludes that etomidate is a better agent for induction than propofol in view of hemodynamic stability and less pain on injection.

RESUMO JUSTIFICATIVA E OBJETIVOS: A indução é uma parte crítica da prática de anestesia. Hipotensão súbita, arritmias e colapso cardiovascular são complicações ameaçadoras após a injeção de agente de indução em pacientes hemodinamicamente instáveis. É aconselhável o uso de um agente seguro com menos efeitos adversos para esse propósito. O presente estudo prospectivo, randômico, teve como objetivo comparar propofol e etomidato quanto a seus efeitos sobre a hemodinâmica e aos vários efeitos adversos em pacientes sob anestesia geral. MÉTODOS: Cem pacientes ASA I e II, entre 18-60 anos, programados para procedimento cirúrgico eletivo sob anestesia geral, foram divididos aleatoriamente em dois grupos de 50 cada para receber propofol (2 mg/kg) e etomidato (0,3 mg/kg) como um agente de indução. Os parâmetros vitais na indução, laringoscopia e posteriormente foram registrados para comparação. Efeitos adversos como dor à injeção, apneia e mioclonia foram cuidadosamente monitorados. RESULTADOS: As variáveis demográficas foram comparáveis em ambos os grupos. Os pacientes do grupo etomidato apresentaram pouca alteração da pressão arterial média (PAM) e da frequência cardíaca (FC) em comparação com o grupo propofol (p < 0,05) a partir do valor basal. Houve mais dor à injeção no grupo propofol, enquanto houve mais atividade mioclônica no grupo etomidato. CONCLUSÕES: Este estudo conclui que etomidato é um agente melhor para a indução do que o propofol em relação à estabilidade hemodinâmica e menos dor à injeção.

Effects of propofol on lipopolysaccharide-induced expression and release of HMGB1 in macrophages

This study aimed to determine the effects of different concentrations of propofol (2,6-diisopropylphenol) on lipopolysaccharide (LPS)-induced expression and release of high-mobility group box 1 protein (HMGB1) in mouse macrophages. Mouse macrophage cell line RAW264.7 cells were randomly divided into 5 treatment groups. Expression levels of HMGB1 mRNA were detected using RT-PCR, and cell culture supernatant HMGB1 protein levels were detected using enzyme-linked immunosorbent assay (ELISA). Translocation of HMGB1 from the nucleus to the cytoplasm in macrophages was observed by Western blotting and activity of nuclear factor kappa-light-chain-enhancer of activated B cells (NF-κB) in the nucleus was detected using ELISA. HMGB1 mRNA expression levels increased significantly in the cell culture supernatant and in cells after 24 h of stimulating RAW264.7 cells with LPS (500 ng/mL). However, HMGB1 mRNA expression levels in the P2 and P3 groups, which received 500 ng/mL LPS with 25 or 50 μmol/mL propofol, respectively, were significantly lower than those in the group receiving LPS stimulation (P<0.05). After stimulation by LPS, HMGB1 protein levels were reduced significantly in the nucleus but were increased in the cytoplasm (P<0.05). Simultaneously, the activity of NF-κB was enhanced significantly (P<0.05). After propofol intervention, HMGB1 translocation from the nucleus to the cytoplasm and NF-κB activity were inhibited significantly (each P<0.05). Thus, propofol can inhibit the LPS-induced expression and release of HMGB1 by inhibiting HMGB1 translocation and NF-κB activity in RAW264.7 cells, suggesting propofol may be protective in patients with sepsis.

General anesthesia type does not influence serum levels of neutrophil gelatinase-associated lipocalin during the perioperative period in video laparoscopic bariatric surgery

OBJECTIVES: Video laparoscopic bariatric surgery is the preferred surgical technique for treating morbid obesity. However, pneumoperitoneum can pose risks to the kidneys by causing a decrease in renal blood flow. Furthermore, as in other surgical procedures, laparoscopic bariatric surgery triggers an acute inflammatory response. Neutrophil gelatinase-associated lipocalin is an early and accurate biomarker of renal injury, as well as of the inflammatory response. Anesthetic drugs could offer some protection for the kidneys and could attenuate the acute inflammatory response from surgical trauma. The objective of this study was to compare the effects of two types of anesthetics, propofol and sevoflurane, on the serum levels of neutrophil gelatinase-associated lipocalin during the perioperative period in laparoscopic bariatric surgery. METHODS: Sixty-four patients scheduled for laparoscopic bariatric surgery were randomized into two anesthesia groups and were administered either total intravenous anesthesia (propofol) or inhalation anesthesia (sevoflurane). In the perioperative period, blood samples were collected at three time points (before anesthesia, 6 hours after pneumoperitoneum and 24 hours after pneumoperitoneum) and urine output was measured for 24 hours. Acute kidney injuries were evaluated by examining both the clinical and laboratory parameters during the postoperative period. The differences between the groups were compared using non-parametric tests. ReBEC (http://www.ensaiosclinicos.gov.br/rg/recruiting/): RBR-8wt2fy RESULTS: None of the patients developed an acute kidney injury during the study and no significant differences were found between the serum neutrophil gelatinase-associated lipocalin levels of the groups during the perioperative period. CONCLUSION: The choice of anesthetic drug, either propofol or sevoflurane, did not affect the serum levels of neutrophil gelatinase-associated lipocalin during the perioperative ...

Influence of Propofol and Fentanyl on Deep Brain Stimulation of the Subthalamic Nucleus

We investigated the effect of propofol and fentanyl on microelectrode recording (MER) and its clinical applicability during subthalamic nucleus (STN) deep brain stimulation (DBS) surgery. We analyzed 8 patients with Parkinson's disease, underwent bilateral STN DBS with MER. Their left sides were done under awake and then their right sides were done with a continuous infusion of propofol and fentanyl under local anesthesia. The electrode position was evaluated by preoperative MRI and postoperative CT. The clinical outcomes were assessed at six months after surgery. We isolated single unit activities from the left and the right side MERs. There was no significant difference in the mean firing rate between the left side MERs (38.7+/-16.8 spikes/sec, n=78) and the right side MERs (35.5+/-17.2 spikes/sec, n=66). The bursting pattern of spikes was more frequently observed in the right STN than in the left STN. All the electrode positions were within the STNs on both sides and the off-time Unified Parkinson's Disease Rating Scale part III scores at six months after surgery decreased by 67% of the preoperative level. In this study, a continuous infusion of propofol and fentanyl did not significantly interfere with the MER signals from the STN. The results of this study suggest that propofol and fentanyl can be used for STN DBS in patients with advanced Parkinson's disease improving the overall experience of the patients.

Effects of propofol on damage of rat intestinal epithelial cells induced by heat stress and lipopolysaccharides

Gut-derived endotoxin and pathogenic bacteria have been proposed as important causative factors of morbidity and death during heat stroke. However, it is still unclear what kind of damage is induced by heat stress. In this study, the rat intestinal epithelial cell line (IEC-6) was treated with heat stress or a combination of heat stress and lipopolysaccharide (LPS). In addition, propofol, which plays an important role in anti-inflammation and organ protection, was applied to study its effects on cellular viability and apoptosis. Heat stress, LPS, or heat stress combined with LPS stimulation can all cause intestinal epithelial cell damage, including early apoptosis and subsequent necrosis. However, propofol can alleviate injuries caused by heat stress, LPS, or the combination of heat stress and LPS. Interestingly, propofol can only mitigate LPS-induced intestinal epithelial cell apoptosis, and has no protective role in heat-stress-induced apoptosis. This study developed a model that can mimic the intestinal heat stress environment. It demonstrates the effects on intestinal epithelial cell damage, and indicated that propofol could be used as a therapeutic drug for the treatment of heat-stress-induced intestinal injuries.

Efeitos de esmolol, lidocaína e fentanil nos intervalos dispersão da onda P, QT, QTc e respostas hemodinâmicas à intubação endotraqueal durante indução com propofol: um estudo comparativo / Effects of esmolol, lidocaine and fentanyl on P wave dispersion, QT, QTc intervals and hemodynamic responses to endotracheal intubation during propofol induction: a comparative study / Efectos del esmolol, de la lidocaína y del fentanilo en los intervalos dispersión de la onda, QT, QTc y respuestas hemodinámicas a la intubación endotraqueal durante inducción con propofol: un estudio comparativo

JUSTIFICATIVA E OBJETIVOS: Investigar o efeito de esmolol, lidocaína e fentanil na dispersão da onda P (DP), durações dos intervalos QT e QT corrigido (QTc) e as respostas hemodinâmicas à intubação endotraqueal durante a indução com propofol. MÉTODOS: Foram incluídos 80 pacientes adultos, estado físico ASA I ou II, idade entre 18 e 60 anos, neste estudo prospectivo, randômico e duplo-cego. Todos os pacientes foram submetidos a exame eletrocardiográfico (ECG) antes da indução da anestesia. Os pacientes foram randomicamente alocados em quatro grupos iguais. O grupo controle (Grupo C) recebeu 5 mL de solução salina; o grupo esmolol (Grupo E) recebeu 0,5 mg.kg-1 de esmolol; o grupo fentanil (Grupo F) recebeu 2 µg.kg-1 de fentanil e o grupo lidocaína (Grupo L) recebeu 1,5 mg.kg-1 de lidocaína antes da indução anestésica. A anestesia foi induzida com propofol. ECG foi feito em todos os pacientes durante o primeiro e o terceiro minutos de indução, 3 minutos após a administração de relaxante muscular e 5 e 10 minutos após intubação. A DP e intervalos QT foram medidos em todos os ECGs. Os intervalos QTc foram determinados com o uso da fórmula de Bazett. Frequência cardíaca (FC) e pressão arterial média (PAM) foram registradas antes e depois da indução anestésica, imediatamente após a intubação e em 1, 3, 5, 7 e 10 minutos após a intubação. RESULTADOS: Após a intubação, a FC aumentou significativamente nos Grupos C, L e F em comparação com o grupo controle. Porém, não houve diferença significativa nos valores da FC após a intubação entre os grupos E e controle. Nos Grupos C e L, a PAM aumentou significativamente após a intubação em comparação com o grupo controle. No entanto, nos Grupos L, F e E não houve diferença significativa entre os valores da PAM após a intubação em comparação com o grupo controle. A DP foi significativamente mais longa no Grupo C após a intubação em comparação com o grupo controle. Porém, nos grupos L, F e E não houve diferença significativa entre os valores de DP após a intubação em comparação com o grupo controle. A duração do intervalo QTc foi significativamente maior nos grupos C e L após a intubação em comparação com o grupo controle. Porém, não houve diferença significativa na duração do QTc nos grupos F e E após a intubação em comparação com o grupo controle. CONCLUSÃO: Concluímos que a administração de esmolol antes da intubação previne a taquicardia, o aumento da PAM e as durações da onda P e intervalo QTc causados pela laringoscopia e intubação traqueal.

BACKGROUND AND OBJECTIVES: In our study we aimed to investigate the effect of esmolol, lidocaine and fentanyl on P-wave dispersion (Pwd), QT and corrected QT (QTc) durations and hemodynamic responses to endotracheal intubation during propofol induction. METHODS: A total of eighty adult patients, American Society of Anesthesiologists (ASA) Physical Status I or II aged 18 to 60 years were included in this prospective, randomised, double-blind study. All patients had control electrocardiograms (ECGs) done before anesthesia induction. The patients were randomised into four equal groups. The control group (Group C) received saline 5 mL, the esmolol group (Group E) received esmolol 0.5 mg.kg-1, the fentanyl group (Group F) received fentanyl 2 µg.kg-1 and the lidocaine group (Group L) received lidocaine 1.5 mg.kg-1 before anesthesia induction. Anesthesia was induced with intravenous propofol. ECGs for all patients were performed during the 1st and 3rd minutes of induction, 3 minutes after administration of muscle relaxant, and at 5 minutes and 10 minutes after intubation. Pwd and QT intervals were measured on all ECGs. QTc intervals were determined using the Bazett formula. Heart rate (HR) and mean arterial pressure (MAP) were recorded before and after induction of anesthesia, immediately after intubation, and 1, 3, 5, 7 and 10 minutes after intubation. RESULTS: Compared with control, HR significantly increased in Group C, Group L and Group F after intubation. However, in Group E, there was no significant difference in HR values between control and after intubation. Compared with control, MAP significantly increased in Group C and Group L after the intubation. However, in Group E and Group F, there was no significant difference in MAP values between control and after the intubation. Compared with control, Pwd significantly increased in Group C after intubation. In Group L, Group F and Group E, there was no significant difference in Pwd values between control and after the intubation. Compared with control, QTc duration significantly increased in Group C and L after the intubation. In Group F and Group E, there was no significant difference in QTc durations between control and after the intubation. CONCLUSION: We concluded that administration of esmolol before intubation prevents tachycardia and an increase in MAP, Pwd and QTc duration caused by laryngoscopy and tracheal intubation.

JUSTIFICATIVA Y OBJETIVOS: Investigar el efecto del esmolol, lidocaína y fentanilo en la dispersión de la onda P (DOP), duraciones de los intervalos QT y QT corregido (QTc) y las respuestas hemodinámicas a la intubación endotraqueal durante la inducción con propofol. MÉTODOS: En este estudio prospectivo, aleatorio y doble ciego, fueron incluidos 80 pacientes adultos, con estado físico ASA I o II, y edad entre 18 y 60 años. Todos los pacientes se sometieron al examen electrocardiográfico (ECG) antes de la inducción de la anestesia. Los pacientes fueron aleatoriamente divididos en cuatro grupos iguales. El grupo control (Grupo C) recibió 5 mL de solución salina; el grupo esmolol (Grupo E) recibió 0,5 mg.kg-1 de esmolol; el grupo fentanilo (Grupo F) recibió 2 µg.kg-1 de fentanilo y el grupo lidocaína (Grupo L) recibió 1,5 mg.kg-1 de lidocaína antes de la inducción anestésica. La anestesia fue inducida con propofol. El ECG se hizo en todos los pacientes durante el primero y el tercer minuto de inducción, 3 minutos después de la administración del relajante muscular y 5 y 10 minutos después de la intubación. La DOP y los intervalos QT se midieron en todos los ECGs. Los intervalos QTc fueron determinados con el uso de la fórmula de Bazett. La frecuencia cardíaca (FC) y la presión arterial promedio (PAP) fueron registradas antes y después de la inducción anestésica, inmediatamente después de la intubación y en 1, 3, 5, 7 y 10 minutos después de la intubación. RESULTADOS: Después de la intubación, la FC aumentó significativamente en los Grupos C, L y F en comparación con el grupo control. Sin embargo, no hubo diferencia significativa en los valores de la FC después de la intubación entre los grupos E y control. En los Grupos C y L, la PAP aumentó significativamente después de la intubación en comparación con el grupo control. Sin embargo, en los Grupos L, F y E no hubo diferencia significativa entre los valores de la PAP posteriormente a la intubación en comparación con el grupo control. La DOP fue significativamente más larga en el Grupo C después de la intubación en comparación con el grupo control. No obstante, en los grupos L, F y E no hubo diferencia significativa entre los valores de DOP después de la intubación en comparación con el grupo control. La duración del intervalo QTc fue significativamente mayor en los grupos C y L después de la intubación en comparación con el grupo control. Sin embargo, no hubo diferencia significativa en la duración del QTc en los grupos F y E después de la intubación en comparación con el grupo control. CONCLUSIONES: Llegamos entonces a la conclusión, de que la administración del esmolol antes de la intubación previene la taquicardia, el aumento de la PAP y las duraciones de la onda P e intervalo QTc causados por la laringoscopia y por la intubación traqueal.

Influência da anestesia venosa total, entropia e laparoscopia sobre o estresse oxidativo / Influence of total intravenous anesthesia, entropy and laparoscopy on oxidative stress / Influencia de la anestesia venosa total, entropía y laparoscopia sobre el estrés oxidativo

JUSTIFICATIVA E OBJETIVOS: Estudos recentes correlacionam mortalidade pós-operatória e anestésica, especialmente a profundidade anestésica e pressão arterial sistólica (PAS). O objetivo deste estudo foi avaliar os efeitos da profundidade da anestesia venosa total (AVT) realizada com remifentanil e propofol com monitoração da entropia de resposta (RE) sobre as concentrações sanguíneas dos marcadores do estresse oxidativo: TBARS e glutationa, durante operações pelo acesso vídeolaparoscópico. MÉTODO: Vinte pacientes adultas, ASA I, IMC 20-26 kg.m-2, idades entre 20 e 40 anos, foram aleatoriamente distribuidas em dois grupos iguais: Grupo I - submetidas a procedimento anestésico-cirúrgico com RE mantida entre 45 e 59 e Grupo II - submetidas a procedimento anestésico-cirúrgico com RE entre 30 e 44. Em ambos os grupos, a infusão de remifentanil e propofol foi controlada pelo sitio efetor (Se), ajustados para manter RE nos valores desejados (Grupos I e II) e avaliando-se sempre a taxa de supressão (TS). As pacientes foram avaliadas em seis momentos: M1(imediatamente antes da indução anestésica), M2 (antes da intubação traqueal [IT]), M3 (5 minutos após IT), M4 (imediatamente antes do pneumoperitônio-PPT), M5 (1 minuto após o PPT) e M6 (uma hora após a operação). Em todos os momentos foram avaliados os seguintes parâmetros: PAS, PAD, FC, RE, TS, TBARS e glutationa. RESULTADOS: Observaram-se aumentos no TBARS e glutationa em M5, tanto no Grupo I como no Grupo II (p < 0,05), com maiores valores no Grupo II. TS em três pacientes no Grupo II, imediatamente após PPT. CONCLUSÕES: A elevação dos marcadores no Grupo I (em M5) sugere aumento do metabolismo anaeróbico (MA) na circulação esplâncnica enquanto os valores mais elevados observados no Grupo II (GII > GI em M5 - p < 0,05%) sugerem interferência de mais um fator (anestesia profunda), como responsável pelo aumento no MA, provavelmente como resultados de maior depressão do sistema nervoso autônomo e menor autorregulação esplâncnica.

BACKGROUND AND OBJECTIVES: Recent studies have correlated postoperative mortality with anesthetic mortality, especially with the depth of anesthesia and systolic blood pressure (SBP). The aim of this study is to evaluate the effects of the depth of total intravenous anesthesia (TIVA) using remifentanil and propofol, performed with monitoring of response entropy (RE) on blood concentrations of oxidative stress markers (TBARS and glutathione) during laparoscopic operations. METHOD: Twenty adult patients, ASA I, BMI 20-26 kg.m-2, aged 20 to 40 years, were randomly distributed into two groups: Group I underwent anesthetic-surgical procedure with RE maintained between 45 and 59, and Group II underwent anesthetic-surgical procedure with RE between 30 and 44. In both groups, the remifentanil and propofol infusion was controlled by the effector site (Es), adjusted to maintain RE desired values (Groups I and II) and always assessing the suppression rate (SR). Patients were evaluated in six periods: M1 (immediately before anesthesia), M2 (before tracheal intubation [TI]), M3 (5-minutes after TI), M4 (immediately before pneumoperitoneum [PPT]), M5 (1-minute after PPT), and M6 (1-hour after the operation). The following parameters were assessed at all times: SBP, DBP, HR, RE, SR, TBARS, and glutathione. RESULTS: We found increases in TBARS and glutathione in M5, both in Group I and Group II (p < 0.05), with higher values in Group II, and SR in three patients in Group II, immediately after PPT. CONCLUSIONS: Increased markers in Group I (M5) suggests an increase in anaerobic metabolism (AM) in the splanchnic circulation while the highest values seen in Group II (GII > GI in M5, p < 0.05%) suggest interference of another factor (deep anesthesia) responsible for the increase in AM, probably as a result of increased autonomic nervous system depression and minor splanchnic self-regulation.

JUSTIFICATIVA Y OBJETIVOS: Estudios recientes correlacionan la mortalidad postoperatoria y anestésica, especialmente con la profundidad anestésica y con la presión arterial sistólica (PAS). El objetivo de este estudio, fue evaluar los efectos de la profundidad de la anestesia venosa total (AVT) realizada con el remifentanil y el propofol, con la monitorización de la entropía de respuesta (RE) sobre las concentraciones sanguíneas de los marcadores del estrés oxidativo: TBARS y glutationa, durante operaciones por el acceso videolaparoscópico. MÉTODO: Veinte pacientes adultas, ASA I, IMC 20 y 26 kg.m-2, con edades entre 20 y 40 años, fueron aleatoriamente distribuidas en dos grupos iguales: Grupo I - sometidas a un procedimiento anestésico-quirúrgico con RE mantenida entre 45 y 59, y el Grupo II - sometidas a un procedimiento anestésico-quirúrgico con RE entre 30 y 44. En los dos grupos, la infusión de remifentanil y propofol fue controlada por el sitio efector (Se), ajustados para mantener RE dentro de los valores deseados (Grupos I y II) y evaluando siempre la tasa de supresión (TS). Las pacientes fueron evaluadas en seis momentos: M1 (inmediatamente antes de la inducción anestésica), M2 (antes de la intubación traqueal [IT]), M3 (5 minutos después de la IT), M4 (inmediatamente antes del pneumoperitoneo - PPT), M5 (1 minuto después del PPT) y M6 (una hora después de la operación). En todos los momentos fueron evaluados los siguientes parámetros: PAS, PAD, FC, RE, TS, TBARS y glutationa. RESULTADOS: Fueron observados aumentos en el TBARS y glutationa en M5, tanto en el Grupo I como en el Grupo II (p < 0,05), con mayores valores en el Grupo II. Y la TS en tres pacientes en el Grupo II, inmediatamente después del PPT. CONCLUSIONES: La elevación de los marcadores en el Grupo I (en M5) nos sugiere un aumento del metabolismo anaeróbico (MA) en la circulación espláncnica, mientras que los valores más elevados observados en el Grupo II (GII > GI en M5 - p < 0,05%) sugieren una interferencia de otro factor (anestesia profunda), como siendo la responsable del aumento en el MA, tal vez como resultado de una mayor depresión del sistema nervioso autónomo y una menor autorregulación espláncnica.

Tabagismo e efeito de dexmedetomidina e fentanil na intubação traqueal / Cigarette smoking and the effect of dexmedetomidine and fentanyl on tracheal intubation / Tabaquismo y efecto de la dexmedetomidina y del fentanil en la intubación traqueal

JUSTIFICATIVA E OBJETIVOS: Comparar os efeitos de dexmedetomidina e fentanil sobre as alterações hemodinâmicas em fumantes crônicos do sexo masculino. MÉTODOS: Este é um estudo prospectivo, randômico e cego. Sessenta pacientes do sexo masculino, tabagistas crônicos, com idades entre 16 e 60 anos foram selecionados. Os pacientes foram alocados aleatoriamente em dois grupos: Grupo D (n = 30) recebeu 1 µg.kg-1 de dexmedetomidina e Grupo F (n = 30) recebeu 3 µg.kg-1 de fentanil em 150 mL de solução salina normal, com início 10 minutos antes da indução da anestesia. Antes da intubação, a frequência cardíaca e a pressão arterial dos pacientes foram medidas. Após a indução da anestesia para intubação endotraqueal, a frequência cardíaca e os valores da pressão arterial foram novamente medidos 1, 3 e 5 minutos após a intubação. RESULTADOS: A frequência cardíaca estava baixa no Grupo D antes da indução da anestesia, intubação e no primeiro e terceiro minutos pósintubação. A pressão arterial sistólica estava baixa no Grupo F antes da intubação. Embora a pressão arterial diastólica estivesse menor antes da indução da anestesia e aos 5 minutos após a intubação em ambos os grupos, ela já estava baixa no Grupo F antes mesmo da intubação. Enquanto a pressão arterial média estava baixa no Grupo D antes da indução anestésica, ela estava baixa no Grupo F antes da intubação. Os valores para o duplo produto (frequência cardíaca vezes pressão arterial sistólica) estavam baixos no Grupo D antes da indução e no 1º e 3º minutos após a intubação. CONCLUSÕES: A dexmedetomidina, aplicada em fumantes crônicos do sexo masculino via infusão a uma dose de 1 µg.kg-1 10 minutos antes de indução anestésica, controla melhor as elevações da frequência cardíaca e do duplo produto a 1 e 3 minutos após a intubação, comparado ao grupo que recebeu 3 µg.kg-1 de fentanil.

BACKGROUND AND OBJECTIVES: To compare the effect of dexmedetomidine and fentanyl on hemodynamic changes in chronic male smokers. METHODS: This is a prospective, randomized, blinded study. Were selected 60 chronic male smokers (aged 16 to 60 years). The patients were randomly divided into two groups: Group D (n = 30) received 1 µg.kg-1 dexmedetomidine and Group F (n = 30) received 3 µg.kg-1 fentanyl in 150 mL of normal saline, beginning 10 minutes before anesthesia induction. Before intubation, the heart rate and blood pressure of patients were measured. After anesthesia induction for endotracheal intubation, heart rate and blood pressure values were measured at 1, 3, and 5 minutes after intubation. RESULTS: Heart rate was low in Group D before anesthesia induction, intubation, and at the 1st and 3rd minutes after intubation. Systolic arterial pressure was low in Group F before intubation. Although diastolic arterial pressure was lower before anesthesia induction and at 5 minutes after intubation in both groups, it was already low in Group F before intubation. Whereas the mean arterial pressure was low in Group D before anesthesia induction, it was low in Group F before intubation. The values for rate-pressure product were low in Group D before induction and at 1 and 3 minutes after intubation. CONCLUSIONS: Dexmedetomidine, which was applied via infusion at a loading dose of 1 µg.kg-1 10 minutes before anesthesia induction in chronic male smokers, better suppressed increases in heart rate and rate-pressure product at 1 and 3 minutes after intubation compared to the group receiving 3 µg.kg-1 fentanyl.

JUSTIFICATIVA Y OBJETIVOS: Comparar los efectos de la dexmedetomidina y del fentanil sobre las alteraciones hemodinámicas en fumadores crónicos del sexo masculino. MÉTODOS: Este es un estudio prospectivo, randómico y ciego. Sesenta pacientes del sexo masculino, fumadores crónicos, con edades entre los 16 y los 60 años, fueron seleccionados. Los pacientes fueron divididos aleatoriamente en dos grupos: Grupo D (n = 30) recibió 1 µg.kg-1 de dexmedetomidina o 3 µg.kg-1 de fentanil, y el Grupo F (n = 30) que recibió 150 mL de solución salina normal, con inicio 10 minutos antes de la inducción de la anestesia. Antes de la intubación, se mensuraron la frecuencia cardíaca y la presión arterial de los pacientes. Después de la inducción de la anestesia para la intubación endotraqueal, la frecuencia cardíaca y los valores de la presión arterial fueron medidos uno, tres y cinco minutos después de la intubación. RESULTADOS: La frecuencia cardíaca estaba baja en el Grupo D antes de la inducción de la anestesia, de la intubación y en el primero y tercer minutos posintubación. La presión arterial sistólica estaba baja en el Grupo F antes de la intubación. Aunque la presión arterial diastólica fuese menor antes de la inducción de la anestesia y a los cinco minutos después de la intubación en ambos grupos, ella ya estaba baja en el Grupo F antes incluso de la intubación. Mientras la presión arterial promedio estaba baja en el Grupo D antes de la inducción anestésica, estaba baja también en el Grupo F antes de la intubación. Los valores para el doble producto (frecuencia cardíaca por la presión arterial sistólica), eran bajos en el Grupo D antes de la inducción y en el 1º y 3º minutos después de la intubación. CONCLUSIONES: Descubrimos pues, que la dexmedetomidina, que fue aplicada en fumadores crónicos del sexo masculino vía infusión a una dosis de 1 µg.kg-1 10 minutos antes de la inducción anestésica, controla mejor las elevaciones de la frecuencia cardíaca y del doble producto a uno y tres minutos después de la intubación, comparado al grupo que recibió 3 µg.kg-1 de fentanil.

Propofol effects on the morphology of rat testes subjected to testicular ischemia­reperfusion / Efeitos do propofol sobre a morfologia do testículo do rato submetido à isquemia-reperfusão testicular

PURPOSE: To evaluate the effects of propofol as an inhibitor of tissue injury in testicular ischemia-reperfusion in rats. METHODS: 30 Wistar rats were assigned to one of three groups of 10 animals: G1, testicular exposure alone; G2 and G3: testicular ischemia caused by left spermatic cord torsion of 720º. In G3, propofol was administered intraperitoneally at 20 mg/kg/h 45 minutes after spermatic cord torsion. In G2 and G3, spermatic cords were detorsioned after 60 min. In all three groups, testes were subsequently repositioned in the scrotum. After 90 days, bilateral orchiectomy was performed for histological examination. RESULTS: No abnormalities in seminiferous tubules were found in G1. In G2, 86.6 percent of left testes exhibited abnormalities, in contrast with 67.8 percent for right testes. In G3, these proportions were 57.3 percent and 45.6 percent, respectively. A statistically significant difference was found between G2 and G3. CONCLUSION: Propofol reduced the tissue damage in rat testes subjected to ischemia-reperfusion caused by spermatic cord torsion.

OBJETIVO: Avaliar os efeitos do propofol como inibidor da lesão tecidual na isquemia-reperfusão testicular em ratos. MÉTODOS: Trinta ratos Wistar foram distribuídos em três grupos de 10 animais. G1: apenas exposição testicular. G2 e G3: isquemia testicular por torção do cordão espermático esquerdo a 720º. G3, 45 minutos após a torção do cordão espermático foi administrado propofol 20mg/Kg/hora via intraperitoneal. Após 60 minutos, nos grupos 2 e 3 foram desfeitas as torções dos cordões espermáticos e em seguida os testículos dos animais dos três grupos foram reposicionados no escroto. Após 90 dias foi realizada a orquiectomia bilateral para análise histológica. RESULTADOS: Nos túbulos seminíferos do grupo 1 não se encontrou anormalidades. Nos túbulos seminíferos do Grupo 2, as anormalidades foram 86,6 por cento nos testículos esquerdos e 67,8 por cento nos testículos direitos. Houve diferença estatisticamente significativa quando se compararam os testículos dos grupos 2 e 3. CONCLUSÃO: O propofol minimiza a lesão tecidual em testículos de ratos submetidos à isquemia-reperfusão na torção do cordão espermático.