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Liu B, Tang W, Li H, Liu R, Dong F, Guo Y, Li J, Hou K. Point-of-care detection of sevoflurane anesthetics in exhaled breath using a miniature TOFMS for diagnosis of postoperative agitation symptoms in children. Analyst 2022; 147:2484-2493. [DOI: 10.1039/d2an00479h] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
A miniature TOFMS with MEPEI has been developed for POC diagnosis of postoperative agitation symptoms, and can analyze sevoflurane by direct sampling. The risk is high when the sevoflurane in the exhaled breath is higher than 500 ppmv.
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Affiliation(s)
- Bing Liu
- Environment Research Institute, Shandong University, 72 Binhai Road, Qingdao 266237, People's Republic of China
| | - Wenxi Tang
- Department of Anesthesiology, Qilu Hospital (Qingdao), Cheeloo College of Medicine, Shandong University, Qingdao, 758 Hefei Road, Qingdao 266035, People's Republic of China
| | - Hang Li
- Key Laboratory of Separation Science for Analytical Chemistry, Dalian Institute of Chemical Physics, Chinese Academy of Sciences, Dalian 116023, People's Republic of China
| | - Ruidong Liu
- Environment Research Institute, Shandong University, 72 Binhai Road, Qingdao 266237, People's Republic of China
| | - Fengshuo Dong
- Environment Research Institute, Shandong University, 72 Binhai Road, Qingdao 266237, People's Republic of China
| | - Yingzhe Guo
- Environment Research Institute, Shandong University, 72 Binhai Road, Qingdao 266237, People's Republic of China
| | - Jianjun Li
- Department of Anesthesiology, Qilu Hospital (Qingdao), Cheeloo College of Medicine, Shandong University, Qingdao, 758 Hefei Road, Qingdao 266035, People's Republic of China
| | - Keyong Hou
- Environment Research Institute, Shandong University, 72 Binhai Road, Qingdao 266237, People's Republic of China
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2
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A vertebrate model to reveal neural substrates underlying the transitions between conscious and unconscious states. Sci Rep 2020; 10:15789. [PMID: 32978423 PMCID: PMC7519646 DOI: 10.1038/s41598-020-72669-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 08/28/2020] [Indexed: 12/16/2022] Open
Abstract
The field of neuropharmacology has not yet achieved a full understanding of how the brain transitions between states of consciousness and drug-induced unconsciousness, or anesthesia. Many small molecules are used to alter human consciousness, but the repertoire of underlying molecular targets, and thereby the genes, are incompletely understood. Here we describe a robust larval zebrafish model of anesthetic action, from sedation to general anesthesia. We use loss of movement under three different conditions, spontaneous movement, electrical stimulation or a tap, as a surrogate for sedation and general anesthesia, respectively. Using these behavioral patterns, we find that larval zebrafish respond to inhalational and IV anesthetics at concentrations similar to mammals. Additionally, known sedative drugs cause loss of spontaneous larval movement but not to the tap response. This robust, highly tractable vertebrate model can be used in the detection of genes and neural substrates involved in the transition from consciousness to unconsciousness.
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Dhande K, Kshirsagar J, Dhande A, Patil N, V P. Hemodynamic Stability, Patient Acceptance and Cost of Intravenous Propofol and Inhalational Sevoflurane for Induction of Anaesthesia: A Prospective, Randomized Comparative Study. Cureus 2020; 12:e7687. [PMID: 32431967 PMCID: PMC7233506 DOI: 10.7759/cureus.7687] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Introduction The effects of an anesthetic agent on the hemodynamic stability are of prime importance in patients with compromised hemodynamics. Although comparative studies of sevoflurane and propofol are reported, most of these are aimed to assess maintenance and early postoperative recovery. There are very few studies on hemodynamic changes occurring with these two agents. This study compares the hemodynamic stability, patient acceptance, and cost of intravenous (IV) propofol versus inhalational (IH) sevoflurane for the induction of anesthesia. Methods This prospective, randomized comparative study was conducted among 80 patients with American Society of Anaesthesiologists (ASA) grade-I requiring general anesthesia (GA) for elective surgical procedures. The study was approved by the institutional ethics committee and was conducted as per the principles of the Declaration of Helsinki and Good Clinical Practice (GCP) guidelines. Enrolled patients were randomized to receive either intravenous (IV) propofol 2 mg/kg (n=40) or gradual inhalational (IH) induction with sevoflurane (n=40). All patients were maintained with sevoflurane 2% in 67% nitrous oxide (N2O) and O2. Hemodynamic parameters like pulse rate and mean arterial pressure (MAP) were monitored every minute up to five minutes. Patients' acceptance was assessed on a 10-item questionnaire, and the cost of anesthesia was assessed based on the anesthetic requirement. The hemodynamic parameters were compared between the two groups using two-way repeat-measures ANOVA. The incidence of hypotension was compared using Fischer's test. Results The two groups were similar at baseline with respect to the demography and other baseline characteristics. There was greater (p<0.05) fall in MAP with propofol induction (28.48%) compared to sevoflurane (14.61%). Greater reduction in pulse rate (p<0.05) with sevoflurane (9.18) induction was observed compared to propofol (5.28). Patient acceptance for both drugs was similar (p>0.05). Although sevoflurane was unpleasant, propofol injection was painful. Ninety percent of patients preferred propofol for repeat anesthesia as against 85% of patients with sevoflurane. Considering the quantity of anesthetic consumed and the unit cost, propofol was more costly as compared to sevoflurane. Conclusion Sevoflurane maintains better hemodynamic stability compared to propofol, and patient acceptance of both drugs is similar. Induction with sevoflurane was found to be cheaper as compared to propofol induction.
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Affiliation(s)
| | | | - Ashish Dhande
- Urology, DY Patil University - School of Medicine, Navi Mumbai, IND
| | - Narendra Patil
- Anesthesiology, DY Patil University - School of Medicine, Navi Mumbai, IND
| | - Parvati V
- Anesthesiology, DY Patil University - School of Medicine, Navi Mumbai, IND
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Iqbal F, Thompson AJ, Riaz S, Pehar M, Rice T, Syed NI. Anesthetics: from modes of action to unconsciousness and neurotoxicity. J Neurophysiol 2019; 122:760-787. [PMID: 31242059 DOI: 10.1152/jn.00210.2019] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Modern anesthetic compounds and advanced monitoring tools have revolutionized the field of medicine, allowing for complex surgical procedures to occur safely and effectively. Faster induction times and quicker recovery periods of current anesthetic agents have also helped reduce health care costs significantly. Moreover, extensive research has allowed for a better understanding of anesthetic modes of action, thus facilitating the development of more effective and safer compounds. Notwithstanding the realization that anesthetics are a prerequisite to all surgical procedures, evidence is emerging to support the notion that exposure of the developing brain to certain anesthetics may impact future brain development and function. Whereas the data in support of this postulate from human studies is equivocal, the vast majority of animal research strongly suggests that anesthetics are indeed cytotoxic at multiple brain structure and function levels. In this review, we first highlight various modes of anesthetic action and then debate the evidence of harm from both basic science and clinical studies perspectives. We present evidence from animal and human studies vis-à-vis the possible detrimental effects of anesthetic agents on both the young developing and the elderly aging brain while discussing potential ways to mitigate these effects. We hope that this review will, on the one hand, invoke debate vis-à-vis the evidence of anesthetic harm in young children and the elderly, and on the other hand, incentivize the search for better and less toxic anesthetic compounds.
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Affiliation(s)
- Fahad Iqbal
- Vi Riddell Pain Program, Alberta Children's Hospital Research Institute, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Andrew J Thompson
- Vi Riddell Pain Program, Alberta Children's Hospital Research Institute, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Neuroscience, Faculty of Science, University of Calgary, Calgary, Alberta, Canada
| | - Saba Riaz
- Vi Riddell Pain Program, Alberta Children's Hospital Research Institute, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Marcus Pehar
- Vi Riddell Pain Program, Alberta Children's Hospital Research Institute, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Tiffany Rice
- Department of Anesthesiology, Perioperative and Pain Medicine, Alberta Children's Hospital, University of Calgary, Calgary, Alberta, Canada
| | - Naweed I Syed
- Vi Riddell Pain Program, Alberta Children's Hospital Research Institute, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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5
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The effect of sevoflurane and isoflurane anesthesia on single unit and local field potentials. Exp Brain Res 2019; 237:1521-1529. [PMID: 30919011 DOI: 10.1007/s00221-019-05528-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Accepted: 03/22/2019] [Indexed: 10/27/2022]
Abstract
Volatile general anesthetics are used commonly in adults and children, yet their mechanisms of action are complex and the changes in single unit firing and synaptic activity that underlie the broad decreases in neuronal activity induced by these drugs have not been well characterized. Capturing such changes throughout the anesthesia process is important for comparing the effects of different anesthetics and gaining a better understanding of their mechanisms of action and their impact on different brain regions. Using chronically implanted electrodes in the rabbit somatosensory cortex, we compared the effects of two common general anesthetics, isoflurane, and sevoflurane, on cortical neurons. Single unit activity and local field potentials (LFP) were recorded continuously before and during anesthetic delivery at 1 MAC, as well as during recovery. Our findings show that although isoflurane and sevoflurane belong to the same class of volatile general anesthetics, their effects upon cortical single units and LFP were quite different. Overall, the suppression of neuronal firing was greater and more uniform under sevoflurane. Moreover, the changes in LFP frequency bands suggest that effect of anesthesia upon beta oscillations does not necessarily depend on the level of single unit activity, but rather on the changes in GABA/glutamate neurotransmission induced by each drug.
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Kulkarni S, Harsoor SS, Chandrasekar M, Bhaskar SB, Bapat J, Ramdas EK, Valecha UK, Pradhan AS, Swami AC. Consensus statement on anaesthesia for day care surgeries. Indian J Anaesth 2017; 61:110-124. [PMID: 28250479 PMCID: PMC5330067 DOI: 10.4103/ija.ija_659_16] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
The primary aim of day-care surgery units is to allow for early recovery of the patients so that they can return to their familiar 'home' environment; the management hence should be focused towards achieving these ends. The benefits could include a possible reduction in the risk of thromboembolism and hospital-acquired infections. Furthermore, day-care surgery is believed to reduce the average unit cost of treatment by up to 70% as compared to inpatient surgery. With more than 20% of the world's disease burden, India only has 6% of the world's hospital beds. Hence, there is an immense opportunity for expansion in day-care surgery in India to ensure faster and safer, cost-effective patient turnover. For this to happen, there is a need of change in the mindset of all concerned clinicians, surgeons, anaesthesiologists and even the patients. A group of nine senior consultants from various parts of India, a mix of private and government anaesthesiologists, assembled in Mumbai and deliberated and discussed on the various aspects of day-care surgery. They formulated a consensus statement, the first of its kind in the Indian scenario, which can act as a guidance and tool for day-care anaesthesia in India. The statements are derived from the available published evidence in peer-reviewed literature including guidelines of several bodies such as the American Society of Anesthesiologists, British Association of Day Surgery and International Association of Ambulatory Surgery. The authors also offer interpretive comments wherever such evidence is inadequate or contradictory.
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Affiliation(s)
- Satish Kulkarni
- Lilavati Hospital and Research Centre, Mumbai, Maharashtra, India
| | - S S Harsoor
- Department of Anaesthesiology, Bangalore Medical College and Research Centre, Bengaluru, Karnataka, India
| | - M Chandrasekar
- Aarogyasri Trust, Government of Telangana, Hyderabad, Telangana, India
| | - S Bala Bhaskar
- Department of Anaesthesiology and Critical Care, Vijayanagar Institute of Medical Sciences, Bellary, Karnataka, India
| | - Jitendra Bapat
- Hinduja Hospital and Medical Research Centre, Mumbai, Maharashtra, India
| | | | - Umesh Kumar Valecha
- Department of Anaesthesiology, BLK Super Specialty Hospital, New Delhi, India
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7
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Dongare DH, Kale JV, Naphade RW. Comparison of vital capacity induction with sevoflurane to intravenous induction with propofol in adult patients. Anesth Essays Res 2015; 8:319-23. [PMID: 25886328 PMCID: PMC4258959 DOI: 10.4103/0259-1162.143122] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Various techniques exist for gaseous induction in adults. Vital capacity induction (VCI) is a special technique for gaseous induction of anesthesia. AIMS We compared the two methods for time of induction, vital parameters at induction, and suitability for laryngeal mask insertion and its effects, if any on the emergence and postoperative cognitive function tests. SETTINGS AND DESIGN A total of 60 adult American Society of Anesthesiologists grades I and II gynecological patients were randomly allocated into two groups of 30 each. MATERIALS AND METHODS Group "S" received VCI with 8% sevoflurane in 8 l/min oxygen and group "P" received intravenous induction with propofol after premedication. Laryngeal mask airway (LMA) was inserted and anesthesia maintained with oxygen, nitrous oxide, and sevoflurane in both groups. Induction time, corresponding entropy, vital parameters, and emergence time were noted. Postoperative cognitive and psychomotor functions were noted with P-deletion test, digit symbol substitution test, and finger nose test. STATISTICAL ANALYSIS USED Unpaired t-test and Fisher exact test. RESULTS Time for induction was 61 ± 32 s and 31 ± 10.8 s for VCI (group S) and propofol (group P), respectively. The difference was statistically significant (P = 0.001). About 70% patients in VCI had excellent conditions for LMA insertion when compared with 76% in propofol group (P = 0.3855). The incidence of airway complications, emergence times, and recovery of postoperative cognitive functions was not significantly different in both groups. CONCLUSIONS VCI provides an induction and recovery comparable to propofol induction.
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Affiliation(s)
- Dhanashree H Dongare
- Department of Anesthesia, Smt. Kashibai Navale Medical College and General Hospital, Pune, Maharashtra, India
| | - Jyothi V Kale
- Department of Anesthesia, Smt. Kashibai Navale Medical College and General Hospital, Pune, Maharashtra, India
| | - Ramesh W Naphade
- Department of Anesthesia, Smt. Kashibai Navale Medical College and General Hospital, Pune, Maharashtra, India
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8
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Becker K, Eder M, Ranft A, von Meyer L, Zieglgänsberger W, Kochs E, Dodt HU. Low dose isoflurane exerts opposing effects on neuronal network excitability in neocortex and hippocampus. PLoS One 2012; 7:e39346. [PMID: 22723999 PMCID: PMC3377629 DOI: 10.1371/journal.pone.0039346] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2011] [Accepted: 05/22/2012] [Indexed: 11/18/2022] Open
Abstract
The anesthetic excitement phase occurring during induction of anesthesia with volatile anesthetics is a well-known phenomenon in clinical practice. However, the physiological mechanisms underlying anesthetic-induced excitation are still unclear. Here we provide evidence from in vitro experiments performed on rat brain slices that the general anesthetic isoflurane at a concentration of about 0.1 mM can enhance neuronal network excitability in the hippocampus, while simultaneously reducing it in the neocortex. In contrast, isoflurane tissue concentrations above 0.3 mM expectedly caused a pronounced reduction in both brain regions. Neuronal network excitability was assessed by combining simultaneous multisite stimulation via a multielectrode array with recording intrinsic optical signals as a measure of neuronal population activity.
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Affiliation(s)
- Klaus Becker
- Department of Bioelectronics, FKE, Vienna University of Technology, Vienna, Austria.
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9
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Goodwin N, Strong PJ, Sudhir G, Wilkes AR, Hall JE. Effect of breathing low concentrations of volatile anaesthetic agents on incidence of adverse airway events. Anaesthesia 2005; 60:955-9. [PMID: 16179038 DOI: 10.1111/j.1365-2044.2005.04279.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The effect of breathing 0.1 minimum alveolar concentrations (MAC) of desflurane or isoflurane for three minutes on the incidence of adverse airway events on a subsequent breath of 2 MAC was investigated. Twenty-five volunteers known to develop an adverse airway event to desflurane or isoflurane took part in the study. Each volunteer was exposed to isoflurane and desflurane at least 24 h apart. Volunteers were assessed for adverse airway events while breathing 2 MAC inhalational anaesthetic following breathing 100% O(2) for 3 min. This was repeated with 0.1 MAC inhalational anaesthetic in oxygen instead of 100% O(2). Adverse airway events decreased from 88% to 40% when tests were conducted with desflurane (p = 0.002). With isoflurane, the reduction from 60% to 52% was not statistically significant (p = 0.774). Breathing low concentrations of desflurane decreases the incidence of adverse airway events on subsequent inhalation of higher concentration of desflurane.
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Affiliation(s)
- N Goodwin
- University Hospital of Wales, Heath Park, Cardiff CF14 4XN, Wales, UK
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10
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Hernandez-Divers SM, Schumacher J, Stahl S, Hernandez-Divers SJ. COMPARISON OF ISOFLURANE AND SEVOFLURANE ANESTHESIA AFTER PREMEDICATION WITH BUTORPHANOL IN THE GREEN IGUANA (IGUANA IGUANA). J Zoo Wildl Med 2005; 36:169-75. [PMID: 17323555 DOI: 10.1638/04-057.1] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
The anesthetic and cardiopulmonary effects of butorphanol followed by sevoflurane or isoflurane were compared in 23 male green iguanas (Iguana iguana). Heart and respiratory rates were recorded before administration of butorphanol (2 mg/kg i.m.) and at 30 min after premedication. Anesthesia was induced in 12 iguanas (group 1) with isoflurane (5%) and in 11 iguanas (group 2) with sevoflurane (7%). Heart rate, relative arterial oxygen hemoglobin saturation (SpO2), and end-tidal CO2 concentrations (EtCO2) were measured every minute for the first 5 min and every 5 min thereafter. Arterial blood gas parameters were determined at 10 and 40 min after induction. Thirty minutes after butorphanol administration, no significant changes in heart and respiratory rate were seen as compared with baseline values. Quality and time to induction were superior with butorphanol-sevoflurane (6 +/- 3 min) than with butorphanol-isoflurane (9 +/- 4 min). Vaporizer settings during maintenance ranged between 1-3% and 2-4%, respectively. No significant differences in heart rate were noted between groups. In the sevoflurane group, SpO2 values were > 90% throughout. Although SpO2, values were < 90% at 20, 25, and 30 min in the isoflurane group, no significant differences in SpO2 values were seen over time and between groups. A significant decrease in EtCO2 with time was present in both groups, with no significant differences between the groups. At 10 and 40 min, arterial blood oxygen saturation values were > 90% in both groups and no significant differences were noted with time and between groups. Recovery time was significantly longer in the butorphanol-isoflurane group (35 +/- 27 min) than in the butorphanol-sevoflurane group (7 +/- 4 min). The cardiopulmonary effects of butorphanol-isoflurane and butorphanol-sevoflurane assessed in this study are similar, and both inhalants appear to be safe and effective for induction and maintenance in the green iguana.
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Affiliation(s)
- Sonia M Hernandez-Divers
- Department of Small Animal Medicine and Surgery, College of Veterinary Medicine, University of Georgia, Athens, Georgia 30602, USA
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11
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Lewis MC, TerRiet M, DeLaCruz L, Matadial CM, Gerenstein R, DeSouza G, Chidiac GJ. Rapid sevoflurane induction compared with thiopental. J Clin Anesth 2004; 16:271-5. [PMID: 15261318 DOI: 10.1016/j.jclinane.2003.09.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2003] [Revised: 09/02/2003] [Accepted: 09/02/2003] [Indexed: 11/26/2022]
Abstract
STUDY OBJECTIVES To examine whether the speed of induction of anesthesia with sevoflurane/nitrous oxide (N2O) utilizing a 10-second vital capacity rapid inhalation induction (VCRII) followed by tidal breathing was similar or faster than cautious intravenous (i.v.V) thiopental induction with inhaled N2O. DESIGN Prospective, randomized, double-blinded study. SETTING Veterans Affairs Medical Center. PATIENTS 50 male ASA physical status I, II, and III patients scheduled for general anesthesia. INTERVENTIONS Patients were randomized to receive either 8% sevoflurane or i.v. thiopental. Patients were allocated to one of two groups of 25 patients each. In both groups, the breathing circuit was initially primed for 5 minutes with (4 L/min) and O2 (2 L/min), while the Y-piece was occluded. In the sevoflurane group, the circuit was additionally primed with 8% sevoflurane. Patients were trained to perform a vital capacity breath. After maximal exhalation, the occluding plug was rapidly removed from the Y-piece and connected to the facemask. The patient then inspired to vital capacity, held his breath for 10 seconds, and then was allowed to breathe normally. At the end of the 10-second breathhold, and as the patient started normal breathing, either thiopental (thiopental group) or normal saline (sevoflurane group) was injected at a rate of 4 mL every 10 seconds. MEASUREMENTS A study-blinded observer recorded the time to induction, as defined by the time to loss of eyelash reflex, and noted the occurrence of side effects. MAIN RESULTS The speed of induction was the same for both groups (p > 0.05). An average of eight breaths was required before loss of eyelash reflex. Side effects occurred in 36% of the patients in the thiopental group, and 32% in the sevoflurane group (p > 0.05); these were minor and did not affect induction. CONCLUSION Sevoflurane/N2O VCRII as used in this investigation is an effective inhalation technique; it resulted in an induction time similar to that of slow i.v. thiopental with inhaled N2O.
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Affiliation(s)
- Michael C Lewis
- Department of Anesthesiology, V.A. Medical Center, Miami, FL 33125, USA.
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12
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Goodwin N, Campbell AE, Hall JE, Plummer S, Harmer M. A comparison of 8% and 12% sevoflurane for inhalation induction in adults. Anaesthesia 2004; 59:15-9. [PMID: 14687093 DOI: 10.1111/j.1365-2044.2004.03481.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Sevoflurane is a non-pungent volatile anaesthetic agent with a low blood-gas solubility coefficient. It has been studied in concentrations of up to 8% for induction of anaesthesia. Previous work has suggested that there may be a ceiling effect with increasing concentration of sevoflurane above 6%, but there are no published studies using 12% sevoflurane. This study compared 8 and 12% sevoflurane to induce anaesthesia in adults. Sevoflurane was administered using two adapted datum vaporisers with the interlock removed. Induction with 12% sevoflurane compared to 8% sevoflurane produced a significant decrease in the time to achieve central pupils, corresponding to surgical anaesthesia and the third part of Guedel's stage 3 of anaesthesia (mean time (SD) 201 s (81) and 247 s (39), respectively, p < 0.05). Twelve-percent sevoflurane produced a similar stable cardiovascular profile to 8% sevoflurane, and there was no increase in respiratory complications.
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Affiliation(s)
- N Goodwin
- Department of Anaesthetics, University of Wales College of Medicine, Heath Park, Cardiff CF14 4XW, UK.
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13
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Yamaguchi S, Egawa H, Mishio M, Okuda Y, Kitajima T. Bispectral monitoring during vital capacity rapid inhalation induction with sevoflurane. J Clin Anesth 2003; 15:24-8. [PMID: 12657407 DOI: 10.1016/s0952-8180(02)00476-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
STUDY OBJECTIVE To evaluate the variables of bispectral index (BIS) values during vital capacity rapid inhalation induction (VCRII) with sevoflurane. DESIGN Randomized, prospective study. SETTING University hospital. PATIENTS 40 ASA physical status I and II patients scheduled for elective orthopedic surgery with general anesthesia. INTERVENTIONS Patients was divided into two groups, both of which received intravenous (IV) injection of propofol 2 mg/kg followed by inhalation of sevoflurane 3% (Group P), or vital capacity inhalation induction with sevoflurane 8% (Group S). After loss of consciousness, tracheal intubation was performed with vecuronium 0.1 mg/kg. MEASUREMENTS AND MAIN RESULTS The induction times in Group P were significantly shorter than those in Group S (p < 0.01). In Group S, BIS values were gradually decreased and maintained the adequate hypnotic levels were maintained during induction. In Group P, although BIS values were rapidly decreased, the values remained higher compared with Group S. The BIS value before intubation in Group S was significantly lower than that in Group P (25 +/- 9 and 38 +/- 7, respectively; p < 0.01). Five of 20 Group P patients had BIS values exceeding 60 before tracheal intubation, but no patient in Group S had a BIS value as high. Mean arterial pressure immediately after intubation in Group S was significantly lower than that in Group P (p < 0.05). CONCLUSION VCRII with a high concentration of sevoflurane provided adequate BIS values during induction, suggesting that it may allow smoother transition from anesthesia induction to maintenance, and also maintain an adequate hypnotic level in readiness for certain stimuli such as laryngoscopy and tracheal intubation.
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Affiliation(s)
- Shigeki Yamaguchi
- Department of Anesthesiology, Dokkyo University School of Medicine, Mibu, Tochigi, Japan
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14
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Mutoh T, Kanamaru A, Suzuki H, Tsubone H, Nishimura R, Sasaki N. Respiratory reflexes in spontaneously breathing anesthetized dogs in response to nasal administration of sevoflurane, isoflurane, or halothane. Am J Vet Res 2001; 62:311-9. [PMID: 11277193 DOI: 10.2460/ajvr.2001.62.311] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To characterize respiratory reflexes elicited by nasal administration of sevoflurane (Sevo), isoflurane (Iso), or halothane (Hal) in anesthetized dogs. ANIMALS 8 healthy Beagles. PROCEDURE A permanent tracheostomy was created in each dog. Two to 3 weeks later, dogs were anesthetized by IV administration of thiopental and alpha-chloralose. Nasal passages were isolated such that inhalant anesthetics could be administered to the nasal passages while the dogs were breathing 100% O2 via the tracheostomy. Respiratory reflexes in response to administration of each anesthetic at 1.2 and 2.4 times the minimum alveolar concentration (MAC) and the full vaporizer setting (5%) were recorded. Reflexes in response to administration of 5% of each anesthetic also were recorded following administration of lidocaine to the nasal passages. RESULTS Nasal administration of Sevo, Iso, and Hal induced an immediate ventilatory response characterized by a dose-dependent increase in expiratory time and a resulting decrease in expired volume per unit of time. All anesthetics had a significant effect, but for Sevo, the changes were smaller in magnitude. Responses to administration of each anesthetic were attenuated by administration of lidocaine to the nasal passages. CONCLUSIONS AND CLINICAL RELEVANCE Nasal administration of Sevo at concentrations generally used for mask induction of anesthesia induced milder reflex inhibition of breathing, presumably via afferent neurons in the nasal passages, than that of Iso or Hal. Respiratory reflexes attributable to stimulation of the nasal passages may contribute to speed of onset and could promote a smoother induction with Sevo, compared with Iso or Hal.
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Affiliation(s)
- T Mutoh
- Laboratory of Veterinary Surgery, Graduate School of Agricultural and Life Sciences, University of Tokyo, Japan
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Delgado-Herrera L, Ostroff RD, Rogers SA. Sevoflurance: approaching the ideal inhalational anesthetic. a pharmacologic, pharmacoeconomic, and clinical review. CNS DRUG REVIEWS 2001; 7:48-120. [PMID: 11420572 PMCID: PMC6741648 DOI: 10.1111/j.1527-3458.2001.tb00190.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Sevoflurane is a safe and versatile inhalational anesthetic compared with currently available agents. Sevoflurane is useful in adults and children for both induction and maintenance of anesthesia in inpatient and outpatient surgery. Of all currently used anesthetics, the physical, pharmacodynamic, and pharmacokinetic properties of sevoflurane come closest to that of the ideal anesthetic (200). These characteristics include inherent stability, low flammability, non-pungent odor, lack of irritation to airway passages, low blood:gas solubility allowing rapid induction of and emergence from anesthesia, minimal cardiovascular and respiratory side effects, minimal end-organ effects, minimal effect on cerebral blood flow, low reactivity with other drugs, and a vapor pressure and boiling point that enables delivery using standard vaporization techniques. As a result, sevoflurane has become one of the most widely used agents in its class.
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Affiliation(s)
- L Delgado-Herrera
- Abbott Laboratories, Hospital Products Division, 200 Abbott Park Road, Abbott Park, IL 60064, USA.
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Muzi M, Colinco MD, Robinson BJ, Ebert TJ. The Effects of Premedication on Inhaled Induction of Anesthesia with Sevoflurane. Anesth Analg 1997. [DOI: 10.1213/00000539-199711000-00034] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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