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Ölmeztürk Karakurt TC, Kuyrukluyıldız U, Onk D, Ünver S, Arslan YK. Evaluation of the effects of total intravenous anesthesia and inhalation anesthesia on postoperative cognitive recovery. DIE ANAESTHESIOLOGIE 2023; 72:19-24. [PMID: 35024878 DOI: 10.1007/s00101-021-01083-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 10/24/2021] [Accepted: 11/18/2021] [Indexed: 11/01/2022]
Abstract
OBJECTIVE To compare the effects of total intravenous anesthesia (TIVA) and inhalation anesthesia (IA) used in lumbar disc herniectomy on postoperative cognitive recovery based on the mini-mental state examination (MMSE) score and neuron-specific enolase (NSE) levels. MATERIAL AND METHODS The study sample consisted of 80 patients aged 18-65 years who were scheduled for elective lumbar disc herniectomy. The patients were divided into two groups according to the anesthesia technique applied, such as TIVA or IA. The patients in the TIVA group were administered remifentanil and propofol and those in the IA group were administered sevoflurane for maintenance. The MMSE was applied to the patients before the operation and 1h and 24 h postoperatively. Venous blood samples were obtained for the measurement of NSE before the operation and on the 24 h postoperatively. RESULTS The mean preoperative MMSE scores were similar in the two groups. In the TIVA group, the preoperative and postoperative MMSE scores at 1 h were similar but were higher at 24 h postoperatively compared to the previous two scores (p = 0.001 and p < 0.001, respectively). In the IA group, the preoperative and postoperative 24 h MMSE scores were similar but lower at 1h postoperatively than the other two scores (p = 0.006 and p < 0.001, respectively). In the TIVA group, there was a significant decrease in the postoperative serum NSE levels than the preoperative values (p = 0.038). CONCLUSION The use of IA may result in higher cognitive dysfunction 1h after the operation compared to TIVA. The effects of both methods on cognitive functions were similar at 24 h postoperatively.
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Affiliation(s)
- Tülay Ceren Ölmeztürk Karakurt
- Mengücek Gazi Training and Research Hospital, Anesthesiology and Reanimation Clinic, Erzincan Binali Yıldırım University, Erzincan, Turkey.
| | - Ufuk Kuyrukluyıldız
- Faculty of Medicine, Department of Anesthesiology and Reanimation, Erzincan Binali Yıldırım University, Erzincan, Turkey
| | - Didem Onk
- Faculty of Medicine, Department of Anesthesiology and Reanimation, Erzincan Binali Yıldırım University, Erzincan, Turkey
| | - Süheyla Ünver
- Dr.Abdurrahman Yurtarslan Oncology Training and Research Hospital, Department of Anesthesiology and Reanimation, Health Sciences University, Ankara, Turkey
| | - Yusuf Kemal Arslan
- Faculty of Medicine, Department of Biostatistics, Erzincan Binali Yıldırım University, Erzincan, Turkey
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Ahn JH, Park J, Shim JG, Lee SH, Ryu KH, Jeong T, Cho EA. Dynamic Arterial Elastance as a Predictor of Supine-to-Prone Hypotension (SuProne Study): An Observational Study. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:2049. [PMID: 38138152 PMCID: PMC10744433 DOI: 10.3390/medicina59122049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 11/17/2023] [Accepted: 11/20/2023] [Indexed: 12/24/2023]
Abstract
Background and Objectives: Supine-to-prone hypotension is caused by increased intrathoracic pressure and decreased venous return in the prone position. Dynamic arterial elastance (Eadyn) indicates fluid responsiveness and can be used to predict hypotension. This study aimed to investigate whether Eadyn can predict supine-to-prone hypotension. Materials and Methods: In this prospective, observational study, 47 patients who underwent elective spine surgery in the prone position were enrolled. Supine-to-prone hypotension is defined as a decrease in Mean Arterial Pressure (MAP) by more than 20% in the prone position compared to the supine position. Hemodynamic parameters, including systolic blood pressure (SAP), diastolic blood pressure, MAP, stroke volume variation (SVV), pulse pressure variation (PPV), stroke volume index, cardiac index, dP/dt, and hypotension prediction index (HPI), were collected in the supine and prone positions. Supine-to-prone hypotension was also assessed using two different definitions: MAPprone < 65 mmHg and SAPprone < 100 mmHg. Hemodynamic parameters were analyzed to determine the predictability of supine-to-prone hypotension. Results: Supine-to-prone hypotension occurred in 13 (27.7%) patients. Eadyn did not predict supine-to-prone hypotension [Area under the curve (AUC), 0.569; p = 0.440]. SAPsupine > 139 mmHg (AUC, 0.760; p = 0.003) and dP/dtsupine > 981 mmHg/s (AUC, 0.765; p = 0.002) predicted supine-to-prone hypotension. MAPsupine, SAPsupine, PPVsupine, and HPIsupine predicted MAPprone <65 mm Hg. MAPsupine, SAPsupine, SVVsupine, PPVsupine, and HPIsupine predicted SAPprone < 100 mm Hg. Conclusions: Dynamic arterial elastance did not predict supine-to-prone hypotension in patients undergoing spine surgery. Systolic arterial pressure > 139 mmHg and dP/dt > 981 mmHg/s in the supine position were predictors for supine-to-prone hypotension. When different definitions were employed (mean arterial pressure < 65 mmHg in the prone position or systolic arterial pressure < 100 mmHg in the prone position), low blood pressures in the supine position were related to supine-to-prone hypotension.
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Affiliation(s)
| | | | | | | | | | | | - Eun-Ah Cho
- Department of Anesthesiology and Pain Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul 03181, Republic of Korea; (J.H.A.); (J.P.); (J.-G.S.); (S.H.L.); (K.-H.R.); (T.J.)
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Tosi F, Garra R, Festa R, Visocchi M. Technologies in Anaesthesia for the Paediatric Patient. ACTA NEUROCHIRURGICA. SUPPLEMENT 2023; 135:33-38. [PMID: 38153446 DOI: 10.1007/978-3-031-36084-8_7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2023]
Abstract
Spine surgery is an increasingly frequent surgery and includes a wide range of procedures, from minor surgeries (removal of herniated discs, simple laminectomies) to major surgeries (arthrodesis, removal of spinal meningiomas, etc.).These surgeries commonly involve complex patients (elderly population, ASA II-III) and are sometimes performed in emergency settings (polytrauma, cauda syndrome, pathological fractures), which require specific positions (pronation or lateral decubitus), whereby there can be difficulty in airway management, especially in surgeries that concern the cervical tract.One of the main peculiarities of spine surgery involves the prone position.Patient positioning on the operating bed is an action that must be carried out under medical supervision, in particular by the anaesthetist who is supposed to supervise the regular positioning of the patient at the very moment in which it is performed. The correct positioning of the patient is one of the most important moments of the patient care process in the operating room, given that an error in this field may cause serious damage to the patient by giving rise to permanent and significant nerve damage.The prone position is associated with a variety of complications (Kwee et al., Int Surg 100(2): 292-303, 2015). The points of greatest compression during pronation are eyes, nose, breasts, genitals and neck veins.Therefore, the main risks that can derive from an incorrect position are visual disturbances from inappropriate orbital compression, brachial plexus stretching, ulnar nerve compression and lateral femur-cutaneous nerve stretching. In addition, an inappropriate compression of the abdominal organs in this position, may cause ischemia and consequent organ failure resulting in hospitalization prolongation, permanent disability and sometimes even death (Edgcombe et al., Br J Anaesth 100: 165-183, 2008).In addition to the mechanical effects on anatomical structures, there are also the physiological effects of the prone position, which can be divided into circulatory and respiratory effects.These effects are even more pronounced in elderly patients, cardiopaths or patients with respiratory diseases.
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Application of Propofol Target-Controlled Infusion for Optimized Hemodynamic Status in ESRD Patients Receiving Arteriovenous Access Surgery: A Randomized Controlled Trial. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58091203. [PMID: 36143879 PMCID: PMC9504673 DOI: 10.3390/medicina58091203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Revised: 08/26/2022] [Accepted: 08/31/2022] [Indexed: 11/22/2022]
Abstract
Background and Objectives: End-stage renal disease (ESRD) is associated with increased anesthetic risks such as cardiovascular events resulting in higher perioperative mortality rates. This study investigated the perioperative and postoperative outcomes in ESRD patients receiving propofol target-controlled infusion with brachial plexus block during arteriovenous (AV) access surgery. Materials and Methods: We recruited fifty consecutive patients scheduled to receive AV access surgery. While all patients received general anesthesia combined with ultrasound-guided brachial plexus block, the patients were randomly assigned to one of two general anesthesia maintenance groups, with 23 receiving propofol target-controlled infusion (TCI) and 24 receiving sevoflurane inhalation. We measured perioperative mean arterial pressure (MAP), heart rate, and cardiac output and recorded postoperative pain status and adverse events in both groups. Results: ESRD patients receiving propofol TCI had significantly less reduction in blood pressure than those receiving sevoflurane inhalation (p < 0.05) during AV access surgery. Perioperative cardiac output and heart rate were similar in both groups. Both groups reported relatively low postoperative pain score and a low incidence of adverse events. Conclusions: Propofol TCI with brachial plexus block can be used as an effective anesthesia regimen for ESRD patients receiving AV access surgery. It can be used with less blood pressure fluctuation than inhalational anesthesia.
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Alnemri A, Sussman S, Estephan L, Hamilton C, Stewart M, Zhan T, Thaler A, Ananth A, Boon M, Huntley C, Hunt P. Cost of Total Intravenous Anesthesia Versus Inhalation Anesthesia in Obstructive Sleep Apnea Surgery. Laryngoscope 2022; 132:1487-1494. [PMID: 35234282 DOI: 10.1002/lary.30094] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Revised: 02/12/2022] [Accepted: 02/18/2022] [Indexed: 01/18/2023]
Abstract
OBJECTIVES To compare cost and time spent in surgical and postoperative courses in patients with obstructive sleep apnea (OSA) undergoing surgery with either total intravenous anesthesia (TIVA) or inhalational anesthesia. STUDY DESIGN Retrospective chart review. METHODS Retrospective review on patients undergoing surgery for OSA under general anesthesia from January 2019 to October 2020. Cost per service was acquired for the day of surgery. RESULTS A total of 230 patients were included: 95 received TIVA; 135 received inhalation anesthesia. Total cost was significantly higher in the TIVA nasal surgery group by $286 (P = .035). TIVA produced significantly higher pharmacy and operating room costs across all surgeries and OSA severities. These increased costs were offset by significantly lower supply costs in upper airway stimulator (UAS, -$419.50; P = .007) and uvulopalatopharyngoplasty (UPPP, -$115.16; P = .015) patients receiving TIVA. In the TIVA cohort, there was a trend toward lower recovery room costs after UAS (-$111.09; P = .063) and nasal surgery (-$64.45; P = .096) and anesthesia costs after nasal surgery (-$36.67; P = .054). Total recovery time was reduced by 18 minutes (P = .004) for nasal surgery, 25 minutes (P = .043) for UAS, and 27 minutes (P = .147) for UPPP patients receiving TIVA. CONCLUSION When used in an outpatient setting for patients with OSA, TIVA adds to pharmacy and operating room costs, but this is usually offset by lower supply, anesthesia, and recovery room costs. We found decreased recovery times in the TIVA cohort. TIVA has proven benefits in patient outcomes and can be cost-effective in OSA surgery. LEVEL OF EVIDENCE 3 Laryngoscope, 2022.
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Affiliation(s)
- Angela Alnemri
- Department of Otolaryngology, Thomas Jefferson University, Philadelphia, Pennsylvania, U.S.A
| | - Sarah Sussman
- Department of Otolaryngology, Thomas Jefferson University, Philadelphia, Pennsylvania, U.S.A
| | - Leonard Estephan
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, U.S.A
| | - Callum Hamilton
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, U.S.A
| | - Matthew Stewart
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, U.S.A
| | - Tingting Zhan
- Department of Biostatistics, Thomas Jefferson University, Philadelphia, Pennsylvania, U.S.A
| | - Adam Thaler
- Department of Anesthesia, Thomas Jefferson University, Philadelphia, Pennsylvania, U.S.A
| | - Ashwin Ananth
- Department of Otolaryngology, Thomas Jefferson University, Philadelphia, Pennsylvania, U.S.A
| | - Maurits Boon
- Department of Otolaryngology, Thomas Jefferson University, Philadelphia, Pennsylvania, U.S.A
| | - Colin Huntley
- Department of Otolaryngology, Thomas Jefferson University, Philadelphia, Pennsylvania, U.S.A
| | - Patrick Hunt
- Department of Anesthesia, Thomas Jefferson University, Philadelphia, Pennsylvania, U.S.A
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Franzén S, Semenas E, Taavo M, Mårtensson J, Larsson A, Frithiof R. Renal function during sevoflurane or total intravenous propofol anaesthesia a single-centre parallel randomised controlled study. Br J Anaesth 2022; 128:838-848. [DOI: 10.1016/j.bja.2022.02.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 02/16/2022] [Accepted: 02/18/2022] [Indexed: 11/02/2022] Open
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Stewart M, Estephan L, Thaler A, Zhan T, Connors K, Malkani K, Hunt P, Boon M, Huntley C. Reduced Recovery Times with Total Intravenous Anesthesia in Patients with Obstructive Sleep Apnea. Laryngoscope 2020; 131:925-931. [PMID: 33141982 DOI: 10.1002/lary.29216] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 09/10/2020] [Accepted: 10/15/2020] [Indexed: 01/15/2023]
Abstract
OBJECTIVES/HYPOTHESIS There is currently no standard of care in terms of anesthesia modality for patients receiving upper airway surgery with comorbid obstructive sleep apnea (OSA). Although both total intravenous anesthesia (TIVA) and volatile gas anesthesia are commonly utilized in ambulatory otolaryngology surgery, it is currently unclear if there are any advantages with one modality over the other. We hypothesize that patients receiving upper airway surgery with comorbid OSA will have quicker recovery times with TIVA. STUDY DESIGN Retrospective chart review from January 2019 to December 2019. METHODS All patients aged 18 and older receiving upper airway surgery (upper airway stimulation, nasal surgery, modified uvulopalatopharyngoplasty) were included. Patients were excluded when there was incomplete or missing data in the electronic medical record. RESULTS Eighty-six patients received gas anesthesia and 62 patients received TIVA. Phase I recovery times were significantly reduced by surgery and by severity of OSA: nasal surgery, upper airway stimulation, and modified uvulopalatopharyngoplasty had a reduction of 35.5 minutes (P < .001), 42.5 minutes (P < .001), and 36 minutes (P = .022), respectively. In terms of severity, mild, moderate, and severe OSA had reductions of 23.5 minutes (P = .004), 52 minutes (P = .004), and 47 minutes (P < .001), respectively. The severity of OSA generally correlated with increased time spent in Phase I: as severity increased, Phase I time increased by 16.8 minutes for the gas cohort (P < .001), whereas in the TIVA cohort, it increased only 4.3 minutes (P = .489). CONCLUSION Patients having upper airway surgery with comorbid OSA that received TIVA (propofol and remifentanil) spent significantly less time in Phase I and the recovery room overall compared to those receiving volatile gas anesthesia in the form of sevoflurane, and this correlated with the severity of OSA. LEVEL OF EVIDENCE 3. Laryngoscope, 131:925-931, 2021.
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Affiliation(s)
- Matthew Stewart
- Department of Otolaryngology - Head and Neck Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, U.S.A
| | - Leonard Estephan
- Department of Otolaryngology - Head and Neck Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, U.S.A
| | - Adam Thaler
- Department of Anesthesiology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, U.S.A
| | - Tingting Zhan
- Division of Biostatistics, Department of Pharmacology and Experimental Therapeutics, Thomas Jefferson University, Philadelphia, Pennsylvania, U.S.A
| | - Kevin Connors
- Department of Otolaryngology - Head and Neck Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, U.S.A
| | - Kabir Malkani
- Department of Otolaryngology - Head and Neck Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, U.S.A
| | - Patrick Hunt
- Department of Anesthesiology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, U.S.A
| | - Maurits Boon
- Department of Otolaryngology - Head and Neck Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, U.S.A
| | - Colin Huntley
- Department of Otolaryngology - Head and Neck Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, U.S.A
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Kim DH, Yun HJ, Park S, Leem JG, Karm MH, Choi SS. Comparison between total intravenous anesthesia and balanced anesthesia on postoperative opioid consumption in patients who underwent laparoscopic-assisted distal gastrectomy. Medicine (Baltimore) 2020; 99:e20224. [PMID: 32384519 PMCID: PMC7220423 DOI: 10.1097/md.0000000000020224] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Remifentanil is the most frequently prescribed opioid for total intravenous anesthesia (TIVA) or balanced anesthesia (BA), due to its favorable pharmacological properties. However, several studies have reported opioid-induced hyperalgesia and/or acute tolerance after intraoperatively using remifentanil. In addition, it is imperative to control postoperative pain with lower doses of opioid anesthetic agents. Therefore, we compared the amount of opioid consumption between TIVA with propofol-remifentanil and BA with desflurane-remifentanil, to control postoperative pain in patients who underwent laparoscopic-assisted distal gastrectomy (LADG) with gastroduodenostomy.We retrospectively evaluated demographic variables (age, gender, height, weight, and smoking habits), the duration of general anesthesia (GA), and intraoperatively administered remifentanil consumption through the electronic medical records of patients who underwent LADG with gastroduodenostomy due to early stomach cancer. The primary outcome was postoperative opioid consumption during postoperative day (POD) 2. The secondary outcomes were the incidence of any rescue opioid analgesics administered, numeric rating scale, and various adverse effects during POD 2. We categorized the data in 2 patient groups to compare TIVA with propofol-remifentanil (TIVA group) to BA with desflurane-remifentanil (BA group) on the postoperative opioid analgesic consumption.We divided 114 patients into the TIVA (46 patients) and BA (68 patients) groups. Opioid consumption as a primary outcome was significantly higher in the BA group than in the TIVA group during POD 2 except in the post-anesthesia care unit. The cumulative opioid consumption was significantly higher in the BA than in the TIVA group. The incidence of rescue analgesic at POD 2 was higher in the BA than in the TIVA group. In the TIVA group, remifentanil consumption was higher, and the duration of GA was shorter than that in the BA group. No statistically significant differences were observed when comparing other variables.Our results indicated that the maintenance of GA with TIVA (propofol-remifentanil) reduces opioid consumption for postoperative pain control compared to BA (desflurane-remifentanil) in patients undergoing LADG with gastroduodenostomy.
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Affiliation(s)
- Doo-Hwan Kim
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine
| | - Hye Joo Yun
- Department of Anesthesiology and Pain Medicine, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea
| | - Sooin Park
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine
| | - Jeong-Gil Leem
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine
| | - Myong-Hwan Karm
- Department of Dental Anesthesiology, Seoul National University Dental Hospital, Seoul, Republic of Korea
| | - Seong-Soo Choi
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine
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Calixto-Flores A, Moreno-Arias JA. Effect of Intravenous Total Anesthesia on Hemodynamic Changes in Renal Transplant. Transplant Proc 2020; 52:1106-1109. [PMID: 32192744 DOI: 10.1016/j.transproceed.2020.02.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 02/05/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND The objective of the transanesthetic management of renal transplant is to achieve graft function and improve its prognosis and quality of life of the patient; total intravenous anesthesia (TIVA) is an attractive alternative for the maintenance of hemodynamic stability, lower immunologic involvement, and prevention of reperfusion ischemia injury, which are fundamental in the success of the transplant. The objective of the study was to determine the effect of TIVA on hemodynamic changes in renal transplant. METHODS We performed a retrospective observational study of patients who received transplants under TIVA from March 1, 2014, to March 31, 2019. Baseline vital signs and their variability were analyzed in addition to the times and goals of surgery and anesthesia. The statistical analysis was descriptive and inferential and with χ2 test, Student t test, and Fisher exact test. RESULTS A total of 30 patients were included, and P < .001 was determined in the variability of hemodynamics during the transanesthetic period and at the end of the surgery (χ2 and Student t was applied). In addition, P < .001 was obtained with a mean difference of 6.12 and CI of 5.02 to 7.22 for creatinine at 24 hours post transplant, of 2.42 and CI of 1.89 to 2.95 and P < .001 for creatinine at 48 hours, and P < .001 at 72 hours. There was spontaneous uresis in 90%. CONCLUSIONS TIVA and the use of adjuvants could be the best option for the anesthetic management of renal transplant and offers greater benefits compared with traditional management.
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Affiliation(s)
- Arnulfo Calixto-Flores
- Anesthesiology Service of the High Specialty Medical Unit, Specialty Hospital Dr Antonio Fraga Mouret, La Raza National Medical Center, IMSS, Mexico City, Mexico.
| | - Jorge Alejandro Moreno-Arias
- Anesthesiology Service of the High Specialty Medical Unit, Specialty Hospital Dr Antonio Fraga Mouret, La Raza National Medical Center, IMSS, Mexico City, Mexico
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Chang CY, Chien YJ, Wu MY. Attenuation of increased intraocular pressure with propofol anesthesia: A systematic review with meta-analysis and trial sequential analysis. J Adv Res 2020; 24:223-238. [PMID: 32373356 PMCID: PMC7191318 DOI: 10.1016/j.jare.2020.02.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 01/28/2020] [Accepted: 02/11/2020] [Indexed: 11/26/2022] Open
Abstract
Attenuation of an increase in intraocular pressure (IOP) is crucial to preventing devastating postoperative visual loss following surgery. IOP is affected by several factors, including the physiologic alteration due to pneumoperitoneum and patient positioning and differences in anesthetic regimens. This study aimed to investigate the effects of propofol-based total intravenous anesthesia (TIVA) and volatile anesthesia on IOP. We searched multiple databases for relevant studies published before October 2019. Randomized controlled trials comparing the effects of propofol-based TIVA and volatile anesthesia on IOP during surgery were considered eligible for inclusion. Twenty studies comprising 980 patients were included. The mean IOP was significantly lower in the propofol-based TIVA group after intubation, pneumoperitoneum, Trendelenburg positioning, and lateral decubitus positioning. Moreover, mean arterial pressure and peak inspiratory pressure were also lower after intubation in the propofol-based TIVA group. Trial sequential analyses for these outcomes were conclusive. Propofol-based TIVA is more effective than volatile anesthesia during surgery at attenuating the elevation of IOP and should be considered, especially in at-risk patients.
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Affiliation(s)
- Chun-Yu Chang
- School of Medicine, Tzu Chi University, Hualien 970, Taiwan
| | - Yung-Jiun Chien
- Department of Physical Medicine and Rehabilitation, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City 231, Taiwan
| | - Meng-Yu Wu
- Department of Emergency Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City 231, Taiwan.,Department of Emergency Medicine, School of Medicine, Tzu Chi University, Hualien 970, Taiwan
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Predictive Factors for Hypotension Associated With Supine-to-Prone Positional Change in Patients Undergoing Spine Surgery. J Neurosurg Anesthesiol 2019; 32:140-146. [DOI: 10.1097/ana.0000000000000565] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Should Total Intravenous Anesthesia Be Used to Prevent the Occupational Waste Anesthetic Gas Exposure of Pregnant Women in Operating Rooms? Anesth Analg 2019; 128:188-190. [PMID: 29750693 DOI: 10.1213/ane.0000000000003410] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Kang E, Lee KH, Park JH. Comparison of Two Methods of Anesthesia Using Patient State Index: Propofol Versus Sevoflurane During Interventional Neuroradiology Procedure. Anesth Pain Med 2019; 9:e87518. [PMID: 31341825 PMCID: PMC6614782 DOI: 10.5812/aapm.87518] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 02/20/2019] [Accepted: 02/23/2019] [Indexed: 11/17/2022] Open
Abstract
Background Over the past few decades, interventional neuroradiology (INR) has been a rapidly growing and evolving area of neurosurgery. Sevoflurane and propofol are both suitable anesthetics for INR procedures. While the depth of anesthesia is widely monitored, few studies have examined the patient state index (PSI) during clinical neuroanesthesia. Objectives This study aimed to investigate the differences in PSI values and in hemodynamic variables between sevoflurane anesthetic and propofol anesthetic during INR procedures. Methods We reviewed the medical charts of the patients who underwent embolization of a non-ruptured intracranial aneurysm by a single operator at a single university hospital from May 2013 to December 2014. Sixty-five patients were included and divided into two groups: S group (sevoflurane anesthesia, n = 33) vs. P group (propofol anesthesia, n = 32). The PSI values, hemodynamic variables, and use of hemodynamic drugs between two groups were analyzed. Results There were significant differences between the PSI values obtained through different perioperative stages in the two groups (P < 0.0001). During the procedure, the PSI values were significantly lower in the P group than in the S group (P = 0.000). The P group patients had a more prolonged extubation time (P = 0.005) and more phenylephrine requirement than the S group patients (P = 0.007). More anti-hypertensive drugs were administered to the patients in the S group during extubation (P = 0.0197). Conclusions The PSI can be used to detect changes in anesthetics concentration and in the depth of anesthesia during INR procedures. Although the extubation was faster under sevoflurane anesthetic, propofol anesthetic showed rather smoother recovery.
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Affiliation(s)
- Eunsu Kang
- Haeundae Paik Hospital, Inje University, Busan, Republic of Korea
| | - Ki Hwa Lee
- Haeundae Paik Hospital, Inje University, Busan, Republic of Korea
- Corresponding Author: Haeundae Paik Hospital, Inje University, Busan, Republic of Korea.
| | - Jae-Hong Park
- Haeundae Paik Hospital, Inje University, Busan, Republic of Korea
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Ogurlu M, Sari S, Küçük M, Bakiş M, Uğur B, Eshraghi YE, Galimberti F, Turan A. Comparison of the Effect of Propofol and Sevoflurane Anaesthesia on Acute and Chronic Postoperative Pain after Hysterectomy. Anaesth Intensive Care 2019; 42:365-70. [DOI: 10.1177/0310057x1404200314] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- M. Ogurlu
- Department of Anesthesiology and Reanimation, Adnan Menderes University, Aydin, Turkey
| | - S. Sari
- Department of Anesthesiology and Reanimation, Adnan Menderes University, Aydin, Turkey
| | - M. Küçük
- Department of Anesthesiology and Reanimation, Adnan Menderes University, Aydin, Turkey
| | - M. Bakiş
- Department of Anesthesiology and Reanimation, Adnan Menderes University, Aydin, Turkey
| | - B. Uğur
- Department of Anesthesiology and Reanimation, Adnan Menderes University, Aydin, Turkey
| | - Y. E. Eshraghi
- Department of Anesthesiology and Reanimation, Adnan Menderes University, Aydin, Turkey
- Department of Anesthesiology, Case Western Reserve University, MetroHealth Medical Center, Cleveland, Ohio, USA
| | - F. Galimberti
- Department of Anesthesiology and Reanimation, Adnan Menderes University, Aydin, Turkey
- Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio, USA
| | - A. Turan
- Department of Anesthesiology and Reanimation, Adnan Menderes University, Aydin, Turkey
- Department of Outcomes Research, Cleveland Clinic, Cleveland, Ohio, USA
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Manohar N, Ramesh VJ, Radhakrishnan M, Chakraborti D. Haemodynamic changes during prone positioning in anaesthetised chronic cervical myelopathy patients. Indian J Anaesth 2019; 63:212-217. [PMID: 30988536 PMCID: PMC6423938 DOI: 10.4103/ija.ija_810_18] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Background and Aims: Anaesthetised patients, when positioned prone, experience hypotension and reduction in cardiac output. Associated autonomic dysfunction in cervical myelopathy patients predisposes them to haemodynamic changes. The combined effect of prone positioning and autonomic dysfunction in anaesthetised patients remains unknown. Methods: Thirty adult chronic cervical myelopathy patients, aged 18-65 years with Nurick grade ≥2 were recruited in this prospective observational study. Heart rate, mean blood pressure, cardiac output, stroke volume, total peripheral resistance and stroke volume variation were measured using NICOM® monitor. Data were collected in supine before anaesthetic induction (baseline), 2 minutes after induction, 2 minutes after intubation, before and after prone positioning and every 5 minutes thereafter until skin incision. Repeated measures analysis of variance (ANOVA) was used to analyse the haemodynamic parameters across the time points. Bivariate Spearman's correlation was used to find factors associated with blood pressure changes. A P value <0.05 was kept significant. Results: Cardiac output during the entire study period remained stable (P = 0.186). Sixty percent of the patients experienced hypotension. At 15 and 20 minutes after prone positioning, mean blood pressure decreased (P = 0.001), stroke volume increased (P = 0.001), and heart rate and total peripheral resistance decreased (P < 0.001, P = 0.001, respectively). These changes were significant when compared to pre-prone position values. Number of levels of spinal cord compression positively correlated with the incidence of hypotension. Conclusion: Cervical myelopathy patients experienced hypotension with preserved cardiac output in prone position due to a reduction in total peripheral resistance. Hypotension correlated with the number of levels of spinal cord compression.
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Affiliation(s)
- Nitin Manohar
- Department of Neuroanesthesia, Yashoda Hospitals, Hyderabad, Telangana, India
| | - Venkatapura J Ramesh
- Department of Neuroanesthesia and Neurocritical Care, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Muthuchellappan Radhakrishnan
- Department of Neuroanesthesia and Neurocritical Care, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Dhritiman Chakraborti
- Department of Neuroanesthesia and Neurocritical Care, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
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Grandhi RK, Abd-Elsayed A. Propofol Infusion Therapy. INFUSION THERAPY 2019:27-38. [DOI: 10.1007/978-3-030-17478-1_3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
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Lim A, Braat S, Hiller J, Riedel B. Inhalational versus Propofol-Based Total Intravenous Anaesthesia: Practice Patterns and Perspectives among Australasian Anaesthetists. Anaesth Intensive Care 2018; 46:480-487. [DOI: 10.1177/0310057x1804600509] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Increasing evidence suggests that total intravenous anaesthesia (TIVA) may be the preferred anaesthetic for cancer resection surgery. To assist the preparation of a randomised controlled trial (RCT) examining Volatile (versus TIVA) Anaesthesia and Perioperative Outcomes Related to Cancer (VAPOR-C) we developed an 18-question electronic survey to investigate practice patterns and perspectives (emphasising indications, barriers, and impact on cancer outcomes) of TIVA versus inhalational general anaesthesia in Australasia. The survey was emailed to 1,000 (of 5,300 active Fellows) randomly selected Australian and New Zealand College of Anaesthetists (ANZCA) Fellows. The response rate was 27.5% (n=275). Of the respondents, 18% use TIVA for the majority of cases. In contrast, 46% use TIVA 20% of the time or less. Respondents described indications for TIVA as high risk of nausea, neurosurgery, and susceptibility to malignant hyperthermia. Lack of equipment, lack of education and cost were not considered barriers to TIVA use, and a significant proportion (41%) of respondents would use TIVA more often if setup were easier. Of the respondents, 43% thought that TIVA was associated with less cancer recurrence than inhalational anaesthesia, while 46% thought that there was no difference. Yet, only 29% of respondents reported that they use TIVA often or very often for cancer surgery. In Australasia, there is generally a low frequency of TIVA use despite a perception of benefit when compared with inhalational anaesthesia. Anaesthetists are willing to use TIVA for indications where sufficient evidence supports a meaningful level of improvement in clinical outcome. The survey explores attitudes towards use of TIVA for cancer surgery and demonstrates equipoise in anaesthetists’ opinions regarding this indication. The inconsistent use of TIVA in Australasia, minimal barriers to its use, and the equipoise in anaesthetists’ opinions regarding the effect of TIVA versus inhalational anaesthesia on cancer outcomes support the need for a large prospective RCT.
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Affiliation(s)
- A. Lim
- Department of Anaesthesia, Perioperative and Pain Medicine, Peter MacCallum Cancer Centre, Melbourne, Victoria
| | - S. Braat
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria
| | - J. Hiller
- Department of Anaesthesia, Perioperative and Pain Medicine, Peter MacCallum Cancer Centre; The University of Melbourne; Faculty of Medicine, Nursing and Health Sciences, Monash University; Melbourne, Victoria
| | - B. Riedel
- Director, Department of Anaesthesia, Perioperative and Pain Medicine, Peter MacCallum Cancer Centre; The University of Melbourne; Melbourne, Victoria
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Xu R, Zhou S, Yang J, Li H, Zhang Q, Zhang G, Xu S, Peng Q. Total intravenous anesthesia produces outcomes superior to those with combined intravenous-inhalation anesthesia for laparoscopic gynecological surgery at high altitude. J Int Med Res 2017; 45:246-253. [PMID: 28222645 PMCID: PMC5536599 DOI: 10.1177/0300060516687230] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2016] [Accepted: 12/11/2016] [Indexed: 02/05/2023] Open
Abstract
Objective We compared efficacy and adverse outcomes following totally intravenous anesthesia (TIVA) versus combined intravenous-inhalation anesthesia (CIVIA) on hemodynamics and postoperative recovery following laparoscopic gynecological (LG) surgery at high altitudes. Methods We enrolled 80 ASA I or II patients scheduled for LG surgery and randomly assigned them to TIVA with propofol (group P, n = 40) or CIVIA with isoflurane (group I, n = 40). Mean arterial pressure, heart rate, pulse oxygen saturation, and partial pressure of end-tidal carbon dioxide were measured at various time points. Outcome measures were interval to spontaneous ventilation, eye opening, return to consciousness, extubation, operating room duration. Intraoperative awareness and postoperative nausea/vomiting were assessed at follow-up. Results No differences in hemodynamic parameters were detected in either group. Group P had a significantly shorter postoperative anesthetic recovery time and lower incidence of postoperative nausea/vomiting. Conclusion TIVA is superior to CIVIA for GL surgery at high altitudes.
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Affiliation(s)
- Rui Xu
- Department of Anesthesiology, Zhujiang Hospital, Southern medical University, Guangzhou, Guangdong, China
| | - Shuqin Zhou
- Department of Anesthesiology, Zhujiang Hospital, Southern medical University, Guangzhou, Guangdong, China
- Department of Anesthesiology, the First People’s Hospital of Kashi, Kashi, Xinjiang, China
| | - Jin Yang
- Departement of Anesthesiology, People’s Hospital of Linzhi Area, Tibet, China
| | - Haiyan Li
- Department of Hepatobiliary Surgery II, Zhujiang Hospital of Southern Medical University, Guangzhou, Guangdong, China
| | - Qingguo Zhang
- Department of Anesthesiology, Zhujiang Hospital, Southern medical University, Guangzhou, Guangdong, China
| | - Guohong Zhang
- Department of Pathology, Shantou University Medical College, Shantou, Guangdong, China
| | - Shiyuan Xu
- Department of Anesthesiology, Zhujiang Hospital, Southern medical University, Guangzhou, Guangdong, China
- Shiyuan Xu and Qing Peng, Department of Anesthesiology, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong 510282, China; Department of Hepatobiliary Surgery II, Zhujiang Hospital of Southern Medical University, Guangzhou, Guangdong 510282, China. Emails: ;
| | - Qing Peng
- Department of Hepatobiliary Surgery II, Zhujiang Hospital of Southern Medical University, Guangzhou, Guangdong, China
- Shiyuan Xu and Qing Peng, Department of Anesthesiology, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong 510282, China; Department of Hepatobiliary Surgery II, Zhujiang Hospital of Southern Medical University, Guangzhou, Guangdong 510282, China. Emails: ;
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Prabhakar H, Singh GP, Mahajan C, Kapoor I, Kalaivani M, Anand V. Intravenous versus inhalational techniques for rapid emergence from anaesthesia in patients undergoing brain tumour surgery. Cochrane Database Syst Rev 2016; 9:CD010467. [PMID: 27611234 PMCID: PMC6457852 DOI: 10.1002/14651858.cd010467.pub2] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Brain tumour surgery usually is carried out with the patient under general anaesthesia. Over past years, both intravenous and inhalational anaesthetic agents have been used, but the superiority of one agent over the other is a topic of ongoing debate. Early and rapid emergence from anaesthesia is desirable for most neurosurgical patients. With the availability of newer intravenous and inhalational anaesthetic agents, all of which have inherent advantages and disadvantages, we remain uncertain as to which technique may result in more rapid early recovery from anaesthesia. OBJECTIVES To assess the effects of intravenous versus inhalational techniques for rapid emergence from anaesthesia in patients undergoing brain tumour surgery. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL; 2014, Issue 6) in The Cochrane Library, MEDLINE via Ovid SP (1966 to June 2014) and Embase via Ovid SP (1980 to June 2014). We also searched specific websites, such as www.indmed.nic.in, www.cochrane-sadcct.org and www.Clinicaltrials.gov (October 2014). We reran the searches for all databases in March 2016, and when we update the review, we will deal with the two studies of interest found through this search that are awaiting classification. SELECTION CRITERIA We included randomized controlled trials (RCTs) that compared the use of intravenous anaesthetic agents such as propofol and thiopentone with inhalational anaesthetic agents such as isoflurane and sevoflurane for maintenance of general anaesthesia during brain tumour surgery. Primary outcomes were emergence from anaesthesia (assessed by time to follow verbal commands, in minutes) and adverse events during emergence, such as haemodynamic changes, agitation, desaturation, muscle weakness, nausea and vomiting, shivering and pain. Secondary outcomes were time to eye opening, recovery from anaesthesia using the Aldrete or Modified Aldrete score (i.e. time to attain score ≥ 9, in minutes), opioid consumption, brain relaxation (as assessed by the surgeon on a 4- or 5-point scale) and complications of anaesthetic techniques, such as intraoperative haemodynamic instability in terms of hypotension or hypertension (mmHg), increased or decreased heart rate (beats/min) and brain swelling. DATA COLLECTION AND ANALYSIS We used standardized methods in conducting the systematic review, as described by the Cochrane Handbook for Systematic Reviews of Interventions. Two review authors independently extracted details of trial methods and outcome data from reports of all trials considered eligible for inclusion. We performed all analyses on an intention-to-treat basis. We used a fixed-effect model when we found no evidence of significant heterogeneity between studies, and a random-effects model when heterogeneity was likely. For assessments of the overall quality of evidence for each outcome that included pooled data from RCTs only, we downgraded the evidence from 'high quality' by one level for serious (or by two levels for very serious) study limitations (risk of bias), indirectness of evidence, serious inconsistency, imprecision of effect or potential publication bias. MAIN RESULTS We included 15 RCTs with 1833 participants. We determined that none of the RCTs were of high methodological quality. For our primary outcomes, pooled results from two trials suggest that time to emergence from anaesthesia, that is, time needed to follow verbal commands, was longer with isoflurane than with propofol (mean difference (MD) -3.29 minutes, 95% confidence interval (CI) -5.41 to -1.18, low-quality evidence), and time to emergence from anaesthesia was not different with sevoflurane compared with propofol (MD 0.28 minutes slower with sevoflurane, 95% CI -0.56 to 1.12, four studies, low-quality evidence). Pooled analyses for adverse events suggest lower risk of nausea and vomiting with propofol than with sevoflurane (risk ratio (RR) 0.68, 95% CI 0.51 to 0.91, low-quality evidence) or isoflurane (RR 0.45, 95% CI 0.26 to 0.78) and greater risk of haemodynamic changes with propofol than with sevoflurane (RR 1.85, 95% CI 1.07 to 3.17), but no differences in the risk of shivering or pain. Pooled analyses for brain relaxation suggest lower risk of tense brain with propofol than with isoflurane (RR 0.88, 95% CI 0.67 to 1.17, low-quality evidence), but no difference when propofol is compared with sevoflurane. AUTHORS' CONCLUSIONS The finding of our review is that the intravenous technique is comparable with the inhalational technique of using sevoflurane to provide early emergence from anaesthesia. Adverse events with both techniques are also comparable. However, we derived evidence of low quality from a limited number of studies. Use of isoflurane delays emergence from anaesthesia. These results should be interpreted with caution. Randomized controlled trials based on uniform and standard methods are needed. Researchers should follow proper methods of randomization and blinding, and trials should be adequately powered.
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Affiliation(s)
- Hemanshu Prabhakar
- All India Institute of Medical SciencesDepartment of Neuroanaesthesiology and Critical CareAnsari NagarNew DelhiIndia110029
| | - Gyaninder Pal Singh
- All India Institute of Medical SciencesDepartment of NeuroanaesthesiologyAnsari NagarNew DelhiIndia110029
| | - Charu Mahajan
- All India Institute of Medical SciencesDepartment of Neuroanaesthesiology and Critical CareAnsari NagarNew DelhiIndia110029
| | - Indu Kapoor
- All India Institute of Medical SciencesDepartment of Neuroanaesthesiology and Critical CareAnsari NagarNew DelhiIndia110029
| | - Mani Kalaivani
- All India Institute of Medical SciencesDepartment of BiostatisticsAnsari NagarNew DelhiIndia
| | - Vidhu Anand
- University of MinnesotaDepartment of Medicine420 Delaware Street SEMayo Mail Code 195MinneapolisMNUSA55455
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Gallardo-Hernandez AG, Hernandez-Perez AL, Ordoñez-Espinosa G, Sanchez-Lopez A, Revilla-Monsalve C, Islas-Andrade S. Clinical testing of propofol geriatic dose for sedation designed via in silico trial. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2016; 132:21-7. [PMID: 27282224 DOI: 10.1016/j.cmpb.2016.04.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Revised: 03/07/2016] [Accepted: 04/19/2016] [Indexed: 05/22/2023]
Abstract
The geriatric population shows significant physiological changes due to aging and the multiple co-morbidities that they often present. Conventionally the propofol sedation dose for patients older than 65 years is 80% of the adult dose. We performed an in silico trial for elderly population and the results showed that the necessary simulated dose of propofol was lower than the conventional dose; therefore, a clinical trial was implemented to test three different propofol doses, two of them lower than the conventional dose, during a pacemaker implantation. The clinical trial showed that there was no clinical difference between the effects of the doses. A BIS monitor was used to measure the level of sedation, which proved to be adequate and well maintained by all patients. All the patients maintained an acceptable level of sedation, measured by a BIS monitor. Since propofol has some dose-dependent secondary effects, the use of lower doses, especially the ones designed for this age group, helps to avoid them.
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Affiliation(s)
| | - Ana Luisa Hernandez-Perez
- Research Center in Metabolic Diseases, Instituto Mexicano del Seguro Social (IMSS), Mexico City, Mexico.
| | | | | | - Cristina Revilla-Monsalve
- Research Center in Metabolic Diseases, Instituto Mexicano del Seguro Social (IMSS), Mexico City, Mexico
| | - Sergio Islas-Andrade
- Research Center in Metabolic Diseases, Instituto Mexicano del Seguro Social (IMSS), Mexico City, Mexico
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Saraçoğlu A, Eti Z, Konya D, Kabahasanoğlu K, Göğüş FY. Perioperative Effects of Different Narcotic Analgesics Used to Improve Effectiveness of Total Intravenous Anaesthesia. Turk J Anaesthesiol Reanim 2016; 44:21-5. [PMID: 27366550 DOI: 10.5152/tjar.2016.80037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Accepted: 08/07/2015] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE We aimed to evaluate the depth of anaesthesia, perioperative haemodynamics, postoperative pain scores, analgesic consumption in patients receiving remifentanil- or alfentanil-based total intravenous anaesthesia for single-level lumbar discectomy. METHODS Seventy patients undergoing discectomy were enrolled in the study. Patients were intravenously administered an initial bolus dose of 2 mg kg(-1) propofol and 10 mcg kg(-1) alfentanil or 1 mcg kg(-1) remifentanil, followed by 6 mg kg(-1) h(-1) propofol and either 1 mcg kg(-1) min(-1) alfentanil or 0.25 mcg kg(-1) min(-1) remifentanil infusion. Bispectral index (BIS) values, mean arterial pressure, heart rate, end-tidal carbon dioxide and oxygen saturation were recorded. Postoperative pain scores at 0, 30 and 60 min were measured and recorded with additional opioid requirements. RESULTS Postoperative pain scores at 0 and 30 min, total analgesic consumption and requirement for additional analgesics were significantly high in the remifentanil group. After the first hour, the pain scores were not significantly different. Mean arterial blood pressure was significantly low at 45 and 60 min preoperatively in the remifentanil group. In the remifentanil group, heart rate at 15, 30, 45, 60 min were significantly lower than those in the alfentanil group. BIS values of the two groups were not significantly different at any measurement time point. BIS values of remifentanil group at 30, 45, 60, 90 and 180 min significantly increased compared with those at 15 min. CONCLUSION Alfentanil provided more stable BIS and haemodynamic values preoperatively and less opioid consumption, along with lower pain scores, during the early postoperative period compared with remifentanil in patients undergoing single-level discectomy.
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Affiliation(s)
- Ayten Saraçoğlu
- Department of Anaesthesiology and Reanimation, Marmara University School of Medicine, İstanbul, Turkey
| | - Zeynep Eti
- Department of Anaesthesiology and Reanimation, Marmara University School of Medicine, İstanbul, Turkey
| | - Deniz Konya
- Department of Neurosurgery, Marmara University School of Medicine, İstanbul, Turkey
| | - Kadir Kabahasanoğlu
- Department of Anaesthesiology and Reanimation, Marmara University School of Medicine, İstanbul, Turkey
| | - Fevzi Yılmaz Göğüş
- Department of Anaesthesiology and Reanimation, Marmara University School of Medicine, İstanbul, Turkey
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Desflurane reinforces the efficacy of propofol target-controlled infusion in patients undergoing laparoscopic cholecystectomy. Kaohsiung J Med Sci 2016; 32:32-7. [DOI: 10.1016/j.kjms.2015.11.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Revised: 10/29/2015] [Accepted: 11/25/2015] [Indexed: 11/22/2022] Open
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Borodiciene J, Gudaityte J, Macas A. Lithotomy versus jack-knife position on haemodynamic parameters assessed by impedance cardiography during anorectal surgery under low dose spinal anaesthesia: a randomized controlled trial. BMC Anesthesiol 2015; 15:74. [PMID: 25943374 PMCID: PMC4429455 DOI: 10.1186/s12871-015-0055-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Accepted: 04/29/2015] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Although the prone position providing better exposure for anorectal surgery is required it can cause a reduction of cardiac output and cardiac index. The goal was to compare haemodynamic changes assessed by impedance cardiography during anorectal surgery under low-dose spinal anaesthesia in lithotomy and jack-knife position. METHODS The prospective randomized controlled study included 104, ASA I-II adult patients admitted for elective minor anorectal surgery, assigned to be performed in lithotomy (groupL, n = 52) or jack-knife position (groupJ, n = 52). After arrival to operating room the standard monitoring, impedance cardiography device was connected to the patient, and the following variables were recorded: cardiac output, cardiac index, systemic vascular resistance, stroke index at times of arrival to operating room, placement for, start and end of surgery and placement to bed. Spinal block was made in the sitting position with 4 mg of 0.5% hyperbaric bupivacaine and 10 μg of Fentanyl injected over 2 min. Comparison was based on haemodynamic changes between and inside groups over time. Student's t, chi square tests were used for statistical analysis with p < 0.05 regarded as statistically significant. RESULTS The reduction of cardiac output was statistically significant after placement of the patient into the prone position: from baseline 7.4+/-1.6 to 4.9+/-1.2 after placement for and 4.7+/-1.2 at the start and end of surgery (mean +/-SD l/min). The difference of cardiac output between groups was 2.0 l/min after positioning for and the start of surgery and 1.5 l/min at the end of surgery (p < 0.05). Mean cardiac index reduced from baseline 3.9+/-0.8 to 2.6+/-0.7 and 2.4+/-0.6 (mean+/-SD l/min/m(2)) in groupJ and between groups: by 1.0 l/min/m(2) after placement for, 1.1 at the start and 0.8 at the end of surgery (p < 0.05). Systemic vascular resistance increased from baseline 1080+/-338 to 1483+/-479 after placement for, 1523+/-481 at the start and 1525+/-545 at the end of surgery in groupJ (mean+/-SD dynes/sec/cm(-5), p < 0.05). CONCLUSIONS According to impedance cardiography, jack-knife position after low-dose spinal anaesthesia produces transitory, but statistically significant reduction of cardiac output and cardiac index with increase of systemic vascular resistance, compared to insignificant changes in lithotomy position. TRIAL REGISTRATION Clinical Trials NCT02115178.
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Affiliation(s)
- Jurgita Borodiciene
- Department of Anaesthesiology, Lithuanian University of Health Sciences, Eiveniu str. 2, LT-50009, Kaunas, Lithuania.
| | - Jurate Gudaityte
- Department of Anaesthesiology, Lithuanian University of Health Sciences, Eiveniu str. 2, LT-50009, Kaunas, Lithuania.
| | - Andrius Macas
- Department of Anaesthesiology, Lithuanian University of Health Sciences, Eiveniu str. 2, LT-50009, Kaunas, Lithuania.
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Ryksen E, Diedericks BJS. Calculation of comparative utilisation and cost: a South African perspective on intravenous vs. inhalational anaesthesia for procedures of differing duration. SOUTHERN AFRICAN JOURNAL OF ANAESTHESIA AND ANALGESIA 2014. [DOI: 10.1080/22201173.2012.10872871] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- E Ryksen
- Department of Anaesthesiology, Faculty of Health Sciences, University of the Free State
| | - BJS Diedericks
- Department of Anaesthesiology, Faculty of Health Sciences, University of the Free State
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Choi ES, Shin JY, Oh AY, Park HP, Hwang JW, Lim YJ, Jeon YT. Sevoflurane versus propofol for interventional neuroradiology: a comparison of the maintenance and recovery profiles at comparable depths of anesthesia. Korean J Anesthesiol 2014; 66:290-4. [PMID: 24851164 PMCID: PMC4028556 DOI: 10.4097/kjae.2014.66.4.290] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2013] [Revised: 10/01/2013] [Accepted: 10/01/2013] [Indexed: 11/22/2022] Open
Abstract
Background Sevoflurane and propofol are used widely for interventional neuroradiology (INR). Using the bispectral index (BIS), we compared the clinical properties of sevoflurane and propofol anesthesia in patients undergoing INR at comparable depths of anesthesia. Methods The patients were allocated randomly into two groups. The sevoflurane group received propofol (1.5 mg/kg), alfentanil (5 µg/kg), and rocuronium (0.6 mg/kg) for induction, and the propofol group was induced with a target effect-site concentration of propofol (4 µg/ml), alfentanil (5 µg/kg), and rocuronium (0.6 mg/kg). After intubation, anesthesia was maintained with sevoflurane or propofol with 67% nitrous oxide in 33% oxygen. Sevoflurane and propofol concentrations were titrated to maintain the BIS at 50-60. Phenylephrine or opioid was used to maintain the mean arterial pressure within 20% of the baseline values. The amounts of phenylephrine or alfentanil used, the number of patients showing movement during the procedure, and the recovery times were recorded. Results Compared to the propofol group, the sevoflurane group showed faster recovery in spontaneous ventilation, eye opening, extubation, and orientation (4 vs. 7 min, 7 vs. 9 min, 8 vs. 10 min, 10 vs. 14 min, respectively; P < 0.01). In the propofol group, significantly greater amounts phenylephrine were used (P < 0.05), and more patients moved during the procedure (P < 0.05). Conclusions The use of sevoflurane in maintaining anesthesia during INR was associated with faster recovery, less patient movement during the procedure, and a more stable hemodynamic response when compared to propofol.
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Affiliation(s)
- Eun-Su Choi
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Ji Yeon Shin
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Korea
| | - Ah Young Oh
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Hee-Pyoung Park
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Korea
| | - Jung-Won Hwang
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Young Jin Lim
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Korea
| | - Young-Tae Jeon
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
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Preventing postoperative nausea and vomiting after laparoscopic cholecystectomy: a prospective, randomized, double-blind study. Curr Ther Res Clin Exp 2014; 72:1-12. [PMID: 24648571 DOI: 10.1016/j.curtheres.2011.02.002] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/14/2011] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Postoperative nausea and vomiting (PONV) are potential complications in patients after laparoscopic cholecystectomy (LC). Combination antiemetic therapy often is effective for preventing PONV in patients undergoing LC, and combinations of antiemetics targeting different sites of activity may be more effective than monotherapy. OBJECTIVE The aim of this study was to compare the administration of a subhypnotic dose of propofol combined with dexamethasone with one of propofol combined with metoclopramide to prevent PONV after LC. METHODS Sixty adult patients scheduled for LC were randomly assigned to 1 of 2 treatment groups. The patients in group 1 received 0.5 mg/kg propofol plus 8 mg dexamethasone, and those in group 2 received 0.5 mg/kg propofol plus 0.2 mg/kg metoclopramide. The number of patients experiencing nausea and vomiting at 0 to 4, 4 to 12, and 12 to 24 hours postoperatively and as well as additional use of rescue antiemetics were recorded. RESULTS The total PONV rates up to 24 hours postanesthesia were 23.3% and 50% for group 1 and group 2, respectively. Comparisons of the data revealed that at 0 to 4 hours, the number of patients experiencing vomiting was 6 (20%) in group 1 and14 (46.7%) in group 2 (P = 0.028). The frequency of vomiting in group 1 was significantly lower than that for group 2 (P = 0.028), and the rate of rescue antiemetic use in group 2 was higher than that in group 1 (20% vs 46.7%; P = 0.028). In the evaluation of PONV based on the nausea and vomiting scale scores, the mean PONV score was 0.4 (0.2) in group 1 compared with 1.0 (0.2) in group 2 (P = 0.017). There were no significant differences between the values at 4 to 12 hours and at 12 to 24 hours. The frequency of adverse reactions (respiratory depression: 1.3%, 1.3%; laryngospasm: 1.3%, 0%; cough: 1.3%, 0%; hiccup: 1.3%, 0%;) was not significantly different in the 2 groups. CONCLUSIONS Administration of a subhypnotic dose of 0.5 mg/kg propofol plus 8 mg dexamethasone at the end of surgery was more effective than administration of 0.5 mg/kg propofol plus metoclopramide in preventing PONV in the early postoperative period in adult patients undergoing LC.
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Módolo NSP, Módolo MP, Marton MA, Volpato E, Monteiro Arantes V, do Nascimento Junior P, El Dib RP. Intravenous versus inhalation anaesthesia for one-lung ventilation. Cochrane Database Syst Rev 2013; 2013:CD006313. [PMID: 23846831 PMCID: PMC6464685 DOI: 10.1002/14651858.cd006313.pub3] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND This is an update of a Cochrane Review first published in The Cochrane Library, Issue 2, 2008.The technique called one-lung ventilation can confine bleeding or infection to one lung, prevent rupture of a lung cyst or, more commonly, facilitate surgical exposure of the unventilated lung. During one-lung ventilation, anaesthesia is maintained either by delivering an inhalation anaesthetic to the ventilated lung or by infusing an intravenous anaesthetic. It is possible that the method chosen to maintain anaesthesia may affect patient outcomes. Inhalation anaesthetics may impair hypoxic pulmonary vasoconstriction (HPV) and increase intrapulmonary shunt and hypoxaemia. OBJECTIVES The objective of this review was to evaluate the effectiveness and safety of intravenous versus inhalation anaesthesia for one-lung ventilation. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL); The Cochrane Library (2012, Issue 11); MEDLINE (1966 to November 2012); EMBASE (1980 to November 2012); Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS, 1982 to November 2012) and ISI web of Science (1945 to November 2012), reference lists of identified trials and bibliographies of published reviews. We also contacted researchers in the field. No language restrictions were applied. The date of the most recent search was 19 November 2012. The original search was performed in June 2006. SELECTION CRITERIA We included randomized controlled trials and quasi-randomized controlled trials of intravenous (e.g. propofol) versus inhalation (e.g. isoflurane, sevoflurane, desflurane) anaesthesia for one-lung ventilation in both surgical and intensive care participants. We excluded studies of participants who had only one lung (i.e. pneumonectomy or congenital absence of one lung). DATA COLLECTION AND ANALYSIS Two review authors independently assessed trial quality and extracted data. We contacted study authors for additional information. MAIN RESULTS We included in this updated review 20 studies that enrolled 850 participants, all of which assessed surgical participants-no studies investigated one-lung ventilation performed outside the operating theatre. No evidence indicated that the drug used to maintain anaesthesia during one-lung ventilation affected participant outcomes. The methodological quality of the included studies was difficult to assess as it was reported poorly, so the predominant classification of bias was 'unclear'. AUTHORS' CONCLUSIONS Very little evidence from randomized controlled trials suggests differences in participant outcomes with anaesthesia maintained by intravenous versus inhalational anaesthesia during one-lung ventilation. If researchers believe that the type of drug used to maintain anaesthesia during one-lung ventilation is important, they should design randomized controlled trials with appropriate participant outcomes, rather than report temporary fluctuations in physiological variables.
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Affiliation(s)
- Norma S P Módolo
- Department of Anaesthesiology, Botucatu Medical School, UNESP - Univ Estadual Paulista, Botucatu,
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LI M, MEI W, WANG P, YU Y, QIAN W, ZHANG ZG, TIAN YK. Propofol reduces early post-operative pain after gynecological laparoscopy. Acta Anaesthesiol Scand 2012; 56:368-75. [PMID: 22192060 DOI: 10.1111/j.1399-6576.2011.02603.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/01/2011] [Indexed: 11/26/2022]
Abstract
BACKGROUND There is some evidence that propofol may reduce post-operative pain. However, the results on the analgesic effects of propofol are inconsistent. Thus, we hypothesized that propofol reduces acute pain if confounding factors like opioids are avoided. METHODS In this prospective, randomized, subject- and assessor-blind, parallel-group, head-to-head comparative study, 90 American Society of Anesthesiologists I or II females underwent elective laparoscopies were randomized to receive either propofol-based (PR), or sevoflurane-based (SR), or sevoflurane-propofol-based anesthesia (SPR). Pain score at rest assessed by a numerical rating scale at 0.5 h after surgery was the primary outcome. The secondary outcomes included pain score at 1 and 24 h post-operatively, duration of post-anesthesia care units stay (PACU), incidence of post-operative nausea and vomiting, incidence of shivering, and post-operative quality of recovery score (QoR-40) within the first 24 h post-operatively. RESULTS No patients received rescue analgesia. The pain score at 0.5 h post-operatively was less in group PR when compared with group SR (0.7 ± 1.4 vs. 2.1 ± 1.8; P = 0.010) or group SPR (0.7 ± 1.4 vs. 2.1 ± 2.2; P = 0.008). Group PR was also associated with shorter PACU stay than group SR (21.8 ± 5.7 vs. 26.2 ± 6.9; P = 0.050) or group SPR (21.8 ± 5.7 vs. 27.8 ± 8.9; P = 0.005). Intraoperative bispectral index values, hemodynamic values and post-operative QoR-40 scores did not differ among the three groups. CONCLUSIONS Propofol anesthesia was associated with significantly less pain at 0.5 and 1 h after surgery in patients undergoing gynecological laparoscopies with planned opioid-free post-operative analgesia.
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Affiliation(s)
- M. LI
- Department of Anesthesiology; Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology; China
| | - W. MEI
- Department of Anesthesiology; Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology; China
| | - P. WANG
- Department of Anesthesiology; Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology; China
| | - Y. YU
- Departments of Otolaryngology-Head and Neck Surgery; Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology; Wuhan; China
| | - W. QIAN
- Department of Anesthesiology; Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology; China
| | - Z. G. ZHANG
- School of Medicine and Health Management; Tongji Medical College; Huazhong University of Science and Technology; Wuhan; China
| | - Y. K. TIAN
- Department of Anesthesiology; Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology; China
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Yang LQ, Tao KM, Cheung CW, Liu YT, Tao Y, Wu FX, Yu WF. The effect of isoflurane or propofol anaesthesia on liver injury after partial hepatectomy in cirrhotic patients. Anaesthesia 2010. [DOI: 10.1111/j.1365-2044.2010.06505.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Le TP, Gan TJ. Update on the management of postoperative nausea and vomiting and postdischarge nausea and vomiting in ambulatory surgery. Anesthesiol Clin 2010; 28:225-249. [PMID: 20488392 DOI: 10.1016/j.anclin.2010.02.003] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Postoperative nausea and vomiting (PONV) continues to be one of the most common complaints following surgery, occurring in more than 30% of surgeries, or as high as 70% to 80% in certain high-risk populations without prophylaxis. The 5-hydroxytryptamine type 3 (5-HT(3)) receptor antagonists continue to be the mainstay of antiemetic therapy, but newer approaches, such as neurokinin-1 antagonists, a longer-acting serotonin receptor antagonist, multimodal management, and novel techniques for managing high-risk patients are gaining prominence. The related problem of postdischarge nausea and vomiting (PDNV) has received increasing attention from health care providers. The issues of PONV and PDNV are especially significant in the context of ambulatory surgeries, which comprise more than 60% of the combined 56.4 million ambulatory and inpatient surgery visits in the United States. Because of the relatively brief period that ambulatory patients spend in health care facilities, it is particularly important to prevent and treat PONV and PDNV swiftly and effectively.
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Affiliation(s)
- Tina P Le
- Department of Anesthesiology, Duke University Medical Center, Duke University School of Medicine, Durham, NC 27710, USA
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Meta-Analysis of Average and Variability of Time to Extubation Comparing Isoflurane with Desflurane or Isoflurane with Sevoflurane. Anesth Analg 2010; 110:1433-9. [DOI: 10.1213/ane.0b013e3181d58052] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Andreoni V, Lynne Hughes JM. Propofol and fentanyl infusions in dogs of various breeds undergoing surgery. Vet Anaesth Analg 2009; 36:523-31. [DOI: 10.1111/j.1467-2995.2009.00490.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Profound intraoperative metabolic acidosis and hypotension in a child undergoing multilevel spinal fusion. Case Rep Med 2009; 2009:190263. [PMID: 19841685 PMCID: PMC2763138 DOI: 10.1155/2009/190263] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2009] [Accepted: 09/11/2009] [Indexed: 11/17/2022] Open
Abstract
The prone position may cause cardiovascular system depression. Yet, the mechanisms involved and preemptive measures are not well understood (Edgcombe et al. (2008)). During spinal surgery in the prone position, hypotension may occur. Implicated factors include prolonged abdominal compression impeding venous return resulting in increased blood loss, decreased cardiovascular reserve, and the use of total intravenous anesthesia (TIVA) which has been shown to blunt the sympathetic response more than inhalation anesthesia. We present a case of hypotension during spinal surgery with all its challenges. Hypotension and acidosis persisted despite all supporting measures, and only to improve with supine positioning. Differential diagnosis for such an event are discussed. Although abdominal compression may not be obvious before the start of surgery, compressing the spine during surgery may lead to abdominal compression and hypoperfusion to abdominal organs.
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Sabbagh AJ, Al-Yamany M, Bunyan RF, Takrouri MSM, Radwan SM. Neuroanesthesia management of neurosurgery of brain stem tumor requiring neurophysiology monitoring in an iMRI OT setting. Saudi J Anaesth 2009; 3:91-3. [PMID: 20532111 PMCID: PMC2876938 DOI: 10.4103/1658-354x.57877] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
This report describes a rare case of ventrally exophytic pontine glioma describing operative and neuroanesthesia management. The combination of intraoperative neuromonitoring was used. It constituted: Brain stem evoked responses/potentials, Motor EP: recording from cranial nerve supplied muscle, and Sensory EP: Medial/tibial. Excision of the tumor was done with intra-operative magnatic resonance imaging (iMRI), which is considered a new modality.
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Affiliation(s)
- Abdulrahmam J. Sabbagh
- Department of Neurosurgery, King Fahd Medical City, PO Box - 59046, Riyadh - 115 25, Kingdom of Saudi Arabia
| | - Mahmoud Al-Yamany
- Department of Neurosurgery, King Fahd Medical City, PO Box - 59046, Riyadh - 115 25, Kingdom of Saudi Arabia
| | - Reem F. Bunyan
- Department of Neurology and Neurophysiology, King Fahd Medical City, PO Box - 59046, Riyadh - 115 25, Kingdom of Saudi Arabia
| | - Mohamad S. M. Takrouri
- Department of Anesthesia, Neuroscience Center (020007), King Fahd Medical City, PO Box - 59046, Riyadh - 115 25, Saudi Arabia
| | - Sabry Mohammed Radwan
- Department of Anesthesia, Neuroscience Center (020007), King Fahd Medical City, PO Box - 59046, Riyadh - 115 25, Saudi Arabia
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Akkurt BCO, Temiz M, Inanoglu K, Aslan A, Turhanoglu S, Asfuroglu Z, Canbolant E. Comparison of recovery characteristics, postoperative nausea and vomiting, and gastrointestinal motility with total intravenous anesthesia with propofol versus inhalation anesthesia with desflurane for laparoscopic cholecystectomy: A randomized controlled study. CURRENT THERAPEUTIC RESEARCH 2009; 70:94-103. [PMID: 24683221 PMCID: PMC3967343 DOI: 10.1016/j.curtheres.2009.04.002] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/29/2009] [Indexed: 11/16/2022]
Abstract
BACKGROUND Clinical effects, recovery characteristics, and costs of total intravenous anesthesia with different inhalational anesthetics have been investigated and compared; however, there are no reported clinical studies focusing on the effects of anesthesia with propofol and desflurane in patients undergoing laparoscopic cholecystectomy. OBJECTIVE The aim of this study was to determine the effects of total intravenous anesthesia with propofol and alfentanil compared with those of desflurane and alfentanil on recovery characteristics, postoperative nausea and vomiting (PONV), duration of hospitalization, and gastrointestinal motility. METHODS Patients classified as American Society of Anesthesiologists physical status I or II undergoing elective laparoscopic cholecystectomy due to benign gallbladder disease were enrolled in the study. Patients were randomly assigned at a 1:1 ratio to receive total intravenous anesthesia with propofol (2-2.5 mg/kg) and alfentanil (20 μg/kg) or desflurane (4%-6%) and alfentanil (20 μg/kg). Perioperative management during premedication, intraoperative analgesia, relaxation, ventilation, and postoperative analgesia were carried out identically in the 2 groups. Extubation time, recovery time, PONV, postoperative antiemetic requirement, time to gastrointestinal motility and flatus, duration of hospitalization, and adverse effects were recorded. Postoperative pain was assessed using a visual analogue scale. RESULTS Sixty-eight patients were assessed for inclusion in the study; 5 were excluded because they chose open surgery and 3 did not complete the study because they left the hospital. Sixty patients (33 women, 27 men) completed the study. Recovery time was significantly shorter in the propofol group (n = 30) compared with the desflurane group (n = 30) (8.0 [0.77] vs 9.2 [0.66] min, respectively; P < 0.005). Fifteen patients (50.0%) in the propofol group and 20 patients (66.7%) in the desflurane group experienced nausea during the first 24 hours after surgery. The difference was not considered significant. In the propofol group, significantly fewer patients had vomiting episodes compared with those in the desflurane group (2 [6.7%] vs 16 [53.3%]; P < 0.005). Significantly fewer patients in the propofol group required analgesic medication in the first 24 hours after surgery compared with those in the desflurane group (10 [33.3%] vs 15 [50.0%]; P < 0.005). Patients in the propofol group experienced bowel movements in a significantly shorter period of time compared with patients in the desflurane group (8.30 [1.67] vs 9.76 [1.88] hours; P = 0.02). The mean time to flatus occurred significantly sooner after surgery in the propofol group than in the desflurane group (8.70 [1.79] vs 9.46 [2.09] hours; P = 0.01). The duration of hospitalization after surgery was significantly shorter in the propofol group than in the desflurane group (40.60 [3.49] vs 43.60 [3.56] hours; P = 0.03). CONCLUSION Total intravenous anesthesia with propofol and alfentanil was associated with a significantly reduced rate of PONV and analgesic consumption, shortened recovery time and duration of hospitalization, accelerated onset of bowel movements, and increased patient satisfaction compared with desflurane and alfentanil in these patients undergoing laparoscopic surgery who completed the study.
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Affiliation(s)
- B. Cagla Ozbakis Akkurt
- Department of Anaesthesiology, School of Medicine, Mustafa Kemal University, Antakya, Hatay, Turkey
| | - Muhyittin Temiz
- Department of General Surgery, School of Medicine, Mustafa Kemal University, Antakya, Hatay, Turkey
| | - Kerem Inanoglu
- Department of Anaesthesiology, School of Medicine, Mustafa Kemal University, Antakya, Hatay, Turkey
| | - Ahmet Aslan
- Department of General Surgery, School of Medicine, Mustafa Kemal University, Antakya, Hatay, Turkey
| | - Selim Turhanoglu
- Department of Anaesthesiology, School of Medicine, Mustafa Kemal University, Antakya, Hatay, Turkey
| | - Zeynel Asfuroglu
- Department of Anaesthesiology, School of Medicine, Mustafa Kemal University, Antakya, Hatay, Turkey
| | - Elif Canbolant
- Department of General Surgery, School of Medicine, Mustafa Kemal University, Antakya, Hatay, Turkey
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Ko JS, Gwak MS, Choi SJ, Kim GS, Kim JA, Yang M, Lee SM, Cho HS, Chung IS, Kim MH. The effects of desflurane and propofol-remifentanil on postoperative hepatic and renal functions after right hepatectomy in liver donors. Liver Transpl 2008; 14:1150-8. [PMID: 18668648 DOI: 10.1002/lt.21490] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Various volatile anesthetics have been used in hepatectomy in living donors, and their effects on major organs have been extensively evaluated. However, the impact of total intravenous anesthesia (TIVA) on postoperative liver and renal functions after large liver resections has been less extensively investigated than that of volatile agents. The aim of this study was to compare the postoperative hepatic and renal functions between volatile anesthesia with desflurane and TIVA with propofol-remifentanil in living donors undergoing right hepatectomy. Seventy adult patients were randomly allocated into 2 groups: the desflurane group (n = 35) and TIVA group (n = 35). Aspartate aminotransferase, alanine aminotransferase, prothrombin time (PT), albumin, total bilirubin (TB), blood urea nitrogen (BUN), creatinine (Cr), BUN/Cr ratio, estimated glomerular filtration rate (GFR), platelet count, and hemoglobin levels were analyzed in the preoperative period, immediately after the operation, and on the first, second, third, fifth, seventh, and thirtieth postoperative days (PODs). Most of the liver function test results were not significantly different between the 2 groups. However, PT (international normalized ratio) and TB were significantly greater on POD 5 in the TIVA group. Among the renal function tests, Cr was significantly higher and estimated GFR was significantly lower on POD 1 in the TIVA group. The platelet counts and hemoglobin levels were similar between the 2 groups. In conclusion, the results of our study suggest that living related donors for liver transplant may have a better outcome following anesthesia with desflurane. However, further testing will be necessary to prove this hypothesis.
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Affiliation(s)
- Justin Sang Ko
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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van den Hout WB, Peul WC, Koes BW, Brand R, Kievit J, Thomeer RTWM. Prolonged conservative care versus early surgery in patients with sciatica from lumbar disc herniation: cost utility analysis alongside a randomised controlled trial. BMJ 2008; 336:1351-4. [PMID: 18502912 PMCID: PMC2427123 DOI: 10.1136/bmj.39583.709074.be] [Citation(s) in RCA: 99] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVE To determine whether the faster recovery after early surgery for sciatica compared with prolonged conservative care is attained at reasonable costs. DESIGN Cost utility analysis alongside a randomised controlled trial. SETTING Nine Dutch hospitals. PARTICIPANTS 283 patients with sciatica for 6-12 weeks, caused by lumbar disc herniation. INTERVENTIONS Six months of prolonged conservative care compared with early surgery. MAIN OUTCOME MEASURES Quality adjusted life years (QALYs) at one year and societal costs, estimated from patient reported utilities (UK and US EuroQol, SF-6D, and visual analogue scale) and diaries on costs (healthcare, patient's costs, and productivity). RESULTS Compared with prolonged conservative care, early surgery provided faster recovery, with a gain in QALYs according to the UK EuroQol of 0.044 (95% confidence interval 0.005 to 0.083), the US EuroQol of 0.032 (0.005 to 0.059), the SF-6D of 0.024 (0.003 to 0.046), and the visual analogue scale of 0.032 (-0.003 to 0.066). From the healthcare perspective, early surgery resulted in higher costs (difference euro1819 (pound1449; $2832), 95% confidence interval euro842 to euro2790), with a cost utility ratio per QALY of euro41 000 (euro14,000 to euro430 000). From the societal perspective, savings on productivity costs led to a negligible total difference in cost (euro-12, euro-4029 to euro4006). CONCLUSIONS Faster recovery from sciatica makes early surgery likely to be cost effective compared with prolonged conservative care. The estimated difference in healthcare costs was acceptable and was compensated for by the difference in absenteeism from work. For a willingness to pay of euro40,000 or more per QALY, early surgery need not be withheld for economic reasons. Trial registration Current Controlled Trials ISRCTN 26872154.
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Affiliation(s)
- Wilbert B van den Hout
- Department of Medical Decision Making, Leiden University Medical Center, PO Box 9600, 2300RC Leiden, Netherlands.
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Abstract
Prone positioning of patients during anaesthesia is required to provide operative access for a wide variety of surgical procedures. It is associated with predictable changes in physiology but also with a number of complications, and safe use of the prone position requires an understanding of both issues. We have reviewed the development of the prone position and its variants and the physiological changes which occur on prone positioning. The complications associated with this position and the published techniques for various practical procedures in this position will be discussed. The aim of this review is to identify the risks associated with prone positioning and how these risks may be anticipated and minimized.
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Affiliation(s)
- H Edgcombe
- Royal Berkshire NHS Foundation Trust, London Road, Reading RG1 5AN, UK
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Tsai YC, Wang LY, Yeh LS. Clinical comparison of recovery from total intravenous anesthesia with propofol and inhalation anesthesia with isoflurane in dogs. J Vet Med Sci 2008; 69:1179-82. [PMID: 18057835 DOI: 10.1292/jvms.69.1179] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The characteristics of recovery from total intravenous anesthesia (TIVA) with propofol and inhalation anesthesia with isoflurane was clinically compared in 149 client-owned dogs that anesthetized for surgical or diagnostic procedures. In all dogs, anesthesia was induced with an intravenous injection of propofol following premedication with acepromazine or diazepam. As a result, 58 dogs anesthetized with propofol-TIVA showed slower but smoother recovery than 91 dogs anesthetized with isoflurane anesthesia. The dogs stood at 34.5 +/- 19.3 and 27.7 +/- 17.2 min after propofol-TIVA and isoflurane anesthesia, respectively. Adverse effects, including hypersalivation, neurologic excitement (paddling, muscle tremor/twitching, opisthotonos) and vomiting/retching, were observed in similar infrequent incidences during the recovery from both anesthetic protocols. Propofol-TIVA is suggested to be an alternative anesthetic protocol for canine practice.
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Affiliation(s)
- Yi-Chin Tsai
- Graduate Institute of Veterinary Medicine, National Taiwan University, No. 1, Section 4, Roosevelt Road, Taipei, Taiwan 106
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Cheng SS, Yeh J, Flood P. Anesthesia Matters: Patients Anesthetized with Propofol Have Less Postoperative Pain than Those Anesthetized with Isoflurane. Anesth Analg 2008; 106:264-9, table of contents. [DOI: 10.1213/01.ane.0000287653.77372.d9] [Citation(s) in RCA: 104] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Magni G, La Rosa I, Gimignani S, Melillo G, Imperiale C, Rosa G. Early postoperative complications after intracranial surgery: comparison between total intravenous and balanced anesthesia. J Neurosurg Anesthesiol 2007; 19:229-34. [PMID: 17893573 DOI: 10.1097/ana.0b013e31806e5f5a] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
This prospective study was performed to compare the incidence of complications occurring after neurosurgical procedures in patients anesthetized with either sevoflurane-fentanyl or propofol-remifentanil anesthesia. We enrolled 162 American Society of Anesthesiologists (ASA) I to III patients (82 females and 80 males, Glasgow 15) undergoing elective neurosurgical procedures. Anesthesia was conducted using either propofol-remifentanil (T group; n=80 patients) or sevoflurane-fentanyl (S group; n=82 patients). All patients were monitored in the postanesthesia care unit for 6 hours after extubation. We analyzed and compared in both groups the incidence of high severity complications such as respiratory events (PaO2 <90 mm Hg; PaCO2 >45 mm Hg) and neurologic events (seizures, new motor or sensory deficit, unexpected delay of awakening) and the incidence of low severity complications such as hypertension (mean arterial pressure increase above 30% of baseline), hypotension (mean arterial pressure decrease below 30% of baseline), pain, shivering, nausea, and vomiting. A total of 162 complications occurred in 92 patients (57%) with 50 patients (31%) having had 1, 26 patients (16%) having had 2, and 16 patients (10%) having had 3 or more events. The most frequent complication was respiratory impairment (28%) which was frequently reported only in the first postoperative hour. Out of the total number of complicating events, 77 (48 %) were found in group S, and 85 (52%) in group T (P=ns). Severe complications were rarely reported and evenly distributed in the 2 anesthetic groups. Similarly, no difference could be demonstrated in the composite incidence of less serious complications between the 2 anesthetic regimens tested in this study. This study confirms that the recovery period after neurosurgical procedures remains a time of great potential danger to patients given the high incidence of postoperative complicating events independently from the anesthetic strategy.
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Affiliation(s)
- Giuseppina Magni
- Department of Anesthesia and Intensive Care, Policlinico Umberto I, University of Rome La Sapienza, Italy.
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Cole CD, Gottfried ON, Gupta DK, Couldwell WT. TOTAL INTRAVENOUS ANESTHESIA. Oper Neurosurg (Hagerstown) 2007; 61:369-77; discussion 377-8. [DOI: 10.1227/01.neu.0000303996.74526.30] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Gozdemir M, Sert H, Yilmaz N, Kanbak O, Usta B, Demircioglu RI. Remifentanil-propofol in vertebral disk operations: hemodynamics and recovery versus desflurane-n(2)o inhalation anesthesia. Adv Ther 2007; 24:622-31. [PMID: 17660173 DOI: 10.1007/bf02848787] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
The purpose of this study was to ascertain whether total intravenous anesthesia (TIVA) with propofol and remifentanil differs from inhalational anesthesia with desflurane and nitrous oxide in terms of hemodynamics, recovery profile, and postoperative analgesic demand in patients undergoing elective microsurgical vertebral disk resection. A total of 60 patients were randomly assigned to receive TIVA with propofol and remifentanil or inhalational anesthesia with desflurane and nitrous oxide. The TIVA group (n=30) then received 50%/50% N(2)O/O(2). A constant infusion of remifentanil was provided at 0.125 microg/kg/min accompanied by propofol at 10 mg/kg/h in the first 10 min, 6 mg/kg/h in the second 10 min, then 4 mg/kg/h. The desflurane group (n=30) received 50%/50% N(2)O/O(2), with 5% desflurane after intubation and 6% before incision; desflurane was administered in a minimum alveolar concentration 1 fashion during the operation. Hemodynamic, O(2) saturation, and end-tidal CO(2) data were recorded before induction, after intubation, after prone positioning, 5, 10, 15, 20, and 30 min into the operation, and at 15-min intervals thereafter until the end of the operation. Details on perioperative bradycardia, hypotension or hypertension, spontaneous breathing, extubation, eye opening, recovery time of ability to give name and date of birth, postoperative nausea and vomiting, shivering, agitation, and hypoxia were recorded. Patients anesthetized with desflurane responded to skin incision with increasing blood pressure and tachycardia; however, no other hemodynamic differences were noted between the 2 groups. In the TIVA group, recovery times were shorter for spontaneous ventilation (2.33-3.53 min), extubation (3.13-3.88 min), eye opening (4.06-6.23 min), and being able to give name and date of birth (5.4-7.9 min) compared with times in the desflurane group (P<.05). In the TIVA group, more postoperative shivering (16.7% of patients) and greater analgesic demand were seen than in the desflurane group. Although nausea and vomiting were more common in the desflurane group, no difference in bronchospasm was reported. In the TIVA group, a shorter recovery period and a greater demand for postoperative analgesia were seen. Because of the lack of residual analgesic effects, postoperative analgesic treatment should be initiated immediately in patients undergoing TIVA.
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Affiliation(s)
- Muhammet Gozdemir
- Ataturk Research and Training Hospital, Department of Anesthesiology, Ankara, Turkey.
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Abstract
The safe performance of complex spine surgery requires the close collaboration of the anesthesiology and surgical teams. The avoidance of medical and anesthetic complications depends on the appropriate preoperative medical evaluation, patient positioning, selection and administration of anesthetic agents, management of intraoperative fluid status, emergence from anesthesia, and administration of postoperative analgesia.
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Affiliation(s)
- Eugene Ornstein
- Department of Anesthesiology, M4GN, College of Physicians and Surgeons of Columbia University, 630 West 168th Street, New York, NY 10032, USA.
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Imani F, Jafarian A, Hassani V, Khan ZH. Propofol–alfentanil vs propofol–remifentanil for posterior spinal fusion including wake-up test. Br J Anaesth 2006; 96:583-6. [PMID: 16567343 DOI: 10.1093/bja/ael075] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Wake-up test can be used during posterior spinal fusion (PSF) to ensure that spinal function remains intact. This study aims at assessing the characteristics of the wake-up test during propofol-alfentanil (PA) vs propofol-remifentanil (PR) infusions for PSF surgery. METHODS Sixty patients with scoliosis and candidates for PSF surgery were randomly allocated in either alfentanil (PA) or remifentanil (PR) group. After an i.v. bolus of alfentanil 30 microg kg(-1) in the PA group or remifentanil 1 microg kg(-1) in the PR group, anaesthesia was induced with thiopental and atracurium. During maintenance, opioid infusion consisted of alfentanil 1 microg kg(-1) min(-1) or remifentanil 0.2 microg kg(-1) min(-1), in the PA group and the PR group, respectively. All patients received propofol 50 microg kg(-1) min(-1). Atracurium was given to maintain the required surgical relaxation. At the surgeon's request, all infusions were discontinued. Patients were asked to move their hands and feet. Time from anaesthetic discontinuation to spontaneous ventilation (T(1)), and from then until movement of the hands and feet (T(2)), and its quality were recorded. RESULTS The average T(1) and T(2) were significantly shorter in the PR group [3.6 (2.5) and 4.1 (2) min] than the PA group [6.1 (4) and 7.5 (4.5) min]. Quality of wake-up test, however, did not show significant difference between the two groups studied. CONCLUSION Wake-up test can be conducted faster with remifentanil compared with alfentanil infusion during PSF surgery.
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Affiliation(s)
- F Imani
- Department of Anaesthesiology, Rasool-Akram Hospital, School of Medicine, Iran University of Medical Sciences Tehran, Iran.
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Sudheer PS, Logan SW, Ateleanu B, Hall JE. Haemodynamic effects of the prone position: a comparison of propofol total intravenous and inhalation anaesthesia. Anaesthesia 2006; 61:138-41. [PMID: 16430566 DOI: 10.1111/j.1365-2044.2005.04464.x] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The haemodynamic changes of the prone position were investigated in 40 ASA I-II patients undergoing lumbar spine surgery. Patients were randomly assigned, following propofol intravenous induction, to receive maintenance of anaesthesia using either isoflurane 1-1.2% in air or target controlled propofol 3 microg.ml(-1) infusion. Measurements of non-invasive blood pressure, heart rate and cardiac output were made in the supine position. The patient was then turned prone onto a Montreal pattern mattress and measurements repeated. Cardiac output measurements were made using a non-invasive cardiac output monitor. We found a significant reduction in cardiac index in both groups and a significantly greater change with propofol compared to isoflurane on turning supine to prone (CI change 0.4 vs 0.7 l.min(-1).m(-2) p = 0.001 and SVRI change 89 vs 177 dyne.s(-1).cm(-5), p = 0.041). We conclude that turning healthy patients prone produces a clinically significant reduction in cardiac output, the change being greater during maintenance of anaesthesia using propofol compared to isoflurane.
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Affiliation(s)
- P S Sudheer
- University of Wales College of Medicine, Heath Park, Cardiff CF14 4XN, Wales, UK
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Braun JP, Walter M, Lein M, Roigas J, Schwilk B, Moshirzadeh M, Eveslage K, Rehberg-Klug B, Hansen D, Spies C. Klinischer Behandlungspfad „laparoskopische Prostatektomie“. Anaesthesist 2005; 54:1186-96. [PMID: 16075255 DOI: 10.1007/s00101-005-0905-3] [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: 11/25/2022]
Abstract
METHODS In this study we investigated the anesthesiological module of a clinical pathway. We chose the pathway of "laparoscopic prostatectomy" as an example for time-consuming minimally invasive surgery and 40 patients were randomly assigned to 2 groups receiving either total intravenous anesthesia (TIVA) using propofol/ remifentanil or balanced minimal flow anesthesia using desflurane/ remifentanil. During this module the indicators of quality such as vigilance, pain, postoperative nausea and vomiting (PONV) and mobilization were measured. Costs were evaluated and analyzed by a bottom-up procedure. RESULTS There were no anesthesia-related deviations from clinical pathways and both forms of anesthesia management were equally well tolerated by the patients. No significant difference was observed regarding hemodynamic measurements or PONV. The patients in the desflurane/ remifentanil group recovered more rapidly (p=0.037) and had more pain. The amount of analgesic agents given immediately following anesthesia was significantly higher than in the TIVA group (p=0.017). The median anesthesia costs per minute for laparoscopic prostatectomy in the propofol group were 2.79 EUR (minimum cost 2.41 EUR, maximum cost 3.21 EUR) and in the desflurane group 2.68 EUR (minimum cost 2.45 EUR, maximum cost 3.39 EUR). The total anesthesia costs for both groups were within the proceeds matrix range for diagnosis-related groups (DRG). However, the cost analysis for medication was slightly higher than the proceeds matrix range for DRGs. CONCLUSION Both forms of anesthesia can be implemented for time-consuming surgical procedures and allow a cost-effective anesthesia management. Anesthesiological procedures must go hand-in-hand with the type of anesthesia selected. The prophylactic use of analgetics for desflurane/ remifentanil anesthesia should be given earlier and in higher doses than in propofol/ remifentanil anesthesia. The prophylactic use of antiemetics following laparoscopic procedures of long duration is indicated. Optimizing anesthesiological procedures could lead to a continuous improvement in the quality of therapeutic pathways.
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Affiliation(s)
- J-P Braun
- Klinik für Anästhesiologie und operative Intensivmedizin, Charité Universitätsmedizin, Campus Mitte, Schumannstrasse 20-21, 10117 Berlin.
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Magni G, Baisi F, La Rosa I, Imperiale C, Fabbrini V, Pennacchiotti ML, Rosa G. No difference in emergence time and early cognitive function between sevoflurane-fentanyl and propofol-remifentanil in patients undergoing craniotomy for supratentorial intracranial surgery. J Neurosurg Anesthesiol 2005; 17:134-8. [PMID: 16037733 DOI: 10.1097/01.ana.0000167447.33969.16] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Balanced anesthesia with sevoflurane-fentanyl has been widely accepted as anesthetic management for neurosurgery. Propofol-remifentanil regimen has been successfully used in various surgical settings, but a comprehensive comparison of sevoflurane-fentanyl and propofol-remifentanil anesthesia in patients undergoing craniotomy for supratentorial intracranial surgery has not yet been done. The aim of this prospective, randomized, open-label clinical trial was to compare clinical properties of sevoflurane-fentanyl with propofol-remifentanil anesthesia in patients undergoing supratentorial intracranial surgery. The primary endpoint was to compare early postoperative recovery and cognitive functions within the two groups; we also evaluated hemodynamic events, vomiting, shivering, and pain. One hundred twenty patients (64 males; age 15-75 years) were randomized to either total intravenous anesthesia (group T) or sevoflurane anesthesia (group S). Emergence and extubation times and cognitive function (Short Orientation Memory Concentration Test [SOMCT]) were compared in the two groups. Brain swelling, incidence of hypotensive and hypertensive episodes, postoperative vomiting, shivering, and pain were also analyzed. The mean emergence time (12.2 +/- 4.9 minutes for group S versus 12.3 +/- 6.1 minutes for group T; P = 0.92) and extubation time (18.2 +/- 2.3 minutes for group S versus 18.3 +/- 2.1 minutes for group T; P = 0.80) were similar in the two groups. Average SOMCT scores, both 15 minutes after extubation (25.6 +/- 4.9 in group S versus 23.9 +/- 7.5 in group T; P = 0.14) and 45 minutes after extubation (27.3 +/- 2.2 in group S versus 26.0 +/- 5.1 in group T; P = 0.07) were also comparable. Brain swelling was present in seven and five patients in groups S and T, respectively (P = 0.76). Hypotension was present in 12% (group S) and 28% (group T) of patients (P = 0.02). Hypertension was present in 17% of patients in group S and 40% of patients in group T (P = 0.0046). Shivering was present in 18% and 25% of patients in groups T and S (P = 0.37). Our study demonstrates that there is no patient benefit of using total intravenous anesthesia with an ultra-short-acting opioid over the conventional balanced volatile technique in terms of recovery and cognitive functions.
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Affiliation(s)
- G Magni
- Department of Anesthesia and Intensive Care, Policlinico Umberto I, University of Rome La Sapienza, Rome, Italy.
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