Propofol total intravenous anesthesia vs. sevoflurane inhalation anesthesia: Effects on post­operative cognitive dysfunction and inflammation in geriatric patients undergoing laparoscopic surgery.

Propofol total intravenous anesthesia (TIVA) or sevoflurane inhalation anesthesia (IA) affects post-operative cognitive dysfunction in geriatric patients undergoing laparoscopic surgery; however, relevant real-world clinical evidence on the matter is limited. The present study aimed to compare the effects of propofol TIVA and sevoflurane IA on post-operative cognitive dysfunction in the aforementioned type of patients. The present prospective study enrolled 197 geriatric patients undergoing laparoscopic surgery. Patients were assigned to the propofol TIVA group (n=97) and sevoflurane IA group (n=100) according to the actual anesthesia regimens. The mini-mental state examination (MMSE) score was assessed before surgery and on day (D)1, D3 and D7 following surgery in both groups. The MMSE score on D1 was higher in the TIVA group compared with the IA group (P=0.006). The change in the MMSE scores from before surgery to D1 (P<0.001), D3 (P=0.011) and D7 (P=0.003) was smaller in the TIVA group vs. the IA group. Multivariate linear regression analyses suggested that the anesthesia method of TIVA (vs. IA) was independently related to the increased MMSE score on D1 (b=0.803; P=0.001) and D7 (b=0.472; P=0.025). The levels of interleukin (IL)-17A, IL-6 and tumor necrosis factor-α on D1, D3 and D7 exhibited a slightly decreasing trend in the TIVA group vs. the IA group, although the difference was not statistically significant (all P>0.05). Notably, the levels of IL-17A before surgery (P=0.015), on D3 (P=0.016) and D7 (P=0.002), as well as those of IL-6 on D1 (P=0.027), were negatively associated with the MMSE score at the corresponding time points. Overall, the present study demonstrates that propofol TIVA ameliorates post-operative cognitive dysfunction on D1 compared with sevoflurane IA and exerts a potentially suppressive effect on inflammation in geriatric patients undergoing laparoscopic surgery.

The effects of dexmedetomidine on the cognitive function of mild cognitive impairment (MCI) rats.

Background: The study sought to investigate the effects of dexmedetomidine (DEX) on cognitive function after anesthesia and to examine its actual mechanism. Methods: A total of 48 rats were injected with d-galactose (D-gal) 1,000 mg·kg-1·d-1 and normal saline at the neck and back for 1 week to establish rats with mild cognitive impairment (MCI) and conduct behavioral tests. Sevoflurane was inhaled and DEX was pumped into each group respectively. Morris water maze (MWM) test was conducted 24 hours later. The inflammatory factors interleukin (IL)-1, interleukin (IL)-6, and a tumor necrosis factor (TNF)-α in brain homogenate were quantitatively measured by enzyme-linked immunosorbent assay (ELISA) on the next day. The apoptosis of hippocampal cells was observed by hematoxylin-eosin staining (HE staining). Results: In relation to the model establishment, we found that there was no significant difference in body weight and swimming speed before and after modeling. There was no statistically significant difference in the escape latency between Groups A, B, C, and D before modeling. After modeling, there was no statistical difference in the escape latency between Groups A, B, and C, but the difference was statistically significant when compared to Group D (P<0.05). In relation to the DEX intervention, we found that compared to Group C, MWM test performance in Groups A and B was considerably worse longer escape latencies and fewer platform crossings within 90 seconds), and were more significant in Group A. Compared with Group D, the levels of inflammatory cytokines of the brain homogenates were elevated, and this elevation was highest in Group A, followed by Group B; the pathological changes were consistent with changes in behavioral tests. In Group A, there were obvious disorders of glial cell arrangement, apoptosis and deletion. There was no significant change in Group D. And the changes of vertebral cells in Group B and Group C were slight, with orderly arrangement and intact cell structure. Conclusions: DEX inhibits the apoptosis of hippocampal cells and reduces the cognitive dysfunction of rats with MCI induced by D-gal via the inhibition of the release of inflammatory cytokines.

Sevoflurane Inhalation Anesthesia for Uncooperative Pediatric Outpatients in the Treatment of Ankyloglossia: A Retrospective Study of 137 Cases.

Background: To retrospectively assess the efficacy and safety of sevoflurane inhalation anesthesia for the treatment of ankyloglossia on uncooperative pediatric outpatients. Methods: Pediatric patients with ankyloglossia (Degree 3 to Degree 5, coarse or thick) were enrolled in this retrospective analysis. The treatment of ankyloglossia was conducted with sevoflurane induction (8%) and maintenance (2%-3%) continuously with nasal cannula. Heart rate, respiratory rate, electrocardiogram, blood pressure, and peripheral blood oxygen saturation were monitored continuously during operations. Onset time, recovery time, adverse complications were recorded until Aldrete score was ≥ 9. Patients were followed up 24 h, 1 and 2 weeks after operation. Results: One hundred and thirty-seven children completed surgeries with ideal anesthesia status. The operation duration were 10-20 minutes (15.15 ± 2.04), and the children woke up in 10-30 minutes (18.95 ± 3.91). The average intra-operative blood oxygen saturation were lower than preoperative ones (p = .005). Adverse effects were 13.1%, including 3 (2.2%) respiratory depression (SpO2 < 90%), 11 (8.0%) dysphoria and crying during recovery, 2 (1.5%) transient fever symptom. Conclusions: Sevoflurane inhalation anesthesia in the treatment of ankyloglossia resulted in rapid onset and recovery, with few adverse reactions and significant clinical efficacy, and was suited to uncooperative pediatric outpatients.

Role of dexmedetomidine in reducing the incidence of postoperative cognitive dysfunction caused by sevoflurane inhalation anesthesia in elderly patients with esophageal carcinoma.

BACKGROUND: Sevoflurane anesthesia is a high-risk factor for postoperative cognitive dysfunction (POCD) in elderly patients. Recently, some studies demonstrated that dexmedetomidine (DEX) could reduce the incidence of POCD caused by sevoflurane anesthesia. We hypothesized that DEX could reduce the incidence of POCD caused by sevoflurane anesthesia through decreasing plasma interleukin (IL-6) and tumor necrosis factor (TNF)-α concentrations. MATERIALS AND METHODS: A total of 120 patients aged 65-75 years scheduled for esophageal carcinoma resection were randomly assigned to four groups. Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) were used to measure patients' cognitive function the day before operation and the 1st, 3rd, and 7th postoperative days. The plasma TNF-α, IL-6, and S100 ß protein concentrations were measured by ELISA 10 min before anesthesia administration and the 1st, 3rd, and 7th postoperative days. RESULTS: There were no significant differences in the demographic or clinical characteristics or perioperative hemodynamic status in all groups. Compared with Group M + P, the MMSE and MoCA scores were significantly lower and the plasma TNF-α, IL-6, and S100 ß protein concentrations were significantly higher in Group M + S at the 1st, 3rd, and 7th postoperative days (P < 0.05). Compared with Group M + S, the MMSE and MoCA scores were significantly higher and the plasma TNF-α, IL-6, and S100 ß protein concentrations were significantly lower in Group D + S at the 1st, 3rd, and 7th postoperative days (P < 0.05). CONCLUSION: The POCD incidence was higher in elderly patients receiving sevoflurane anesthesia and DEX could alleviate POCD in these patients through decreasing plasma TNF-α and IL-6 concentrations.

Blood Gas Analysis of Respiratory Depression during Sevoflurane Inhalation Induction for General Anesthesia in the Disabled Patients / 대한소아치과학회지

Tidal volume by sevoflurane in small amounts is stable due to the increase in the breathing rate. But alveolus ventilation decreases due to sevoflurane as the degree of sedation increases; this ultimately causes PaCO2 to rise. The occurrence of suppression of breath increases the risk of severe hypoxia and hypercapnia in deeply sedated patients with disabilities. Sevoflurane inhalation anesthesia has a number of risks and may have unexpected problems with hemodynamic changes depending on the underlying state of the body. This study was conducted to examine the stability of internal acid-base system caused by respiratory depression occurring when patients with disabilities are induced by sevoflurane.Anesthetic induction was carried out by placing a mask on top of the patient's face and through voluntary breathing with 4 vol% of sevoflurane, 4 L/min of nitrous oxide, and 4 L/min of oxygen. After the patient's loss of consciousness and muscle relaxation, IV line was inserted by an expert and intravenous blood gas was analyzed by extracting blood from vein.In a deeply sedated state, the average amount of pH of the entire patients was measured as 7.36 ± 0.06. The average amount of PvCO₂ of the entire patients was measured as 48.8 ± 8.50 mmHg. The average amount of HCO₃₋ of the entire patients was measured as 27.2 ± 3.0 mmol/L.In conclusion, in dental treatment of patients with disabilities, the internal acid base response to inhalation sedation using sevoflurane is relatively stable.

Sevoflurane aggregates cognitive dysfunction and hippocampal oxidative stress induced by ß-amyloid in rats.

AIMS: To investigate the effects of sevoflurane inhalation on ß-amyloid (Aß)-induced cognitive disorders and hippocampal oxidative stress in rat models. MATERIALS AND METHODS: Cognitive dysfunction is induced by hippocampal injection of Aß1-40 (10µg in 2µl) for 22days. To explore the effect of sevoflurane inhalation on Aß1-40 induced cognitive disorder, two doses of sevoflurane inhalation are used: 1.3% (Aß+S1) and 2.6% (Aß+S2). Sham operation (Sham, for operation control), saline injection (Control, for injection control) and 30% oxygen inhalation after Aß1-40 injection (Aß+O2, for inhalation control) were used as controls. All rats were further tested in electrical Y-maze and Morris water maze. Serum S100ß levels, hippocampal superoxide dismutase (SOD) activity, S100ß expression and malonyldialdehyde (MDA) concentrations were further quantified. KEY FINDINGS: Rats in Aß+O2, Aß+S1 and Aß+S2 groups had lower number of correct actions in the electrical Y maze task, longer escape latencies, less time exploring the original platform, elevated serum S100ß levels, depressed hippocampal SOD activity, S100ß expression and higher MDA concentrations compared to control group (p<0.05). Such difference was not significant between Aß+S1 and Aß+O2 rats. Rats in Aß+S2 group, however, showed significantly impaired performances compared to those in Aß+S1 group (p<0.05). SIGNIFICANCE: Sevoflurane (2.6%) can aggravate the Aß-induced cognitive dysfunction, possibly via the intracerebral oxidative stress response.

THE CLINICAL APPLICATION OF ANESTHESIA FOR DENTAL PHOBIA IN CHILDREN'S O-RAL TREATMENT SEVOFLURANE INHALATION / 现代医院

Objective To explore dental phobia in children 's oral treatment sevoflurane inhalation anesthesia clinical results.Methods 100 cases of dental phobia children in our hospital between January 2012 to January 2014 were observed, which were divided to the school -age group and preschool group , 50 patients, respectively.They were all treated with heptafluorobutyric alkyl inhalation anesthesia , and the anesthesia effects were compared .Results The adverse effects, oxygen saturation and mean arterial blood pressure changes and induction of anesthesia in chil -dren awake have statistically significant difference (p <0.05).Conclusion This study suggest that sevoflurane in -halation anesthesia is an effective dental phobia children 's oral therapy, and has a high application value .