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Zhang C, Huang D, Zeng W, Ma J, Li P, Jian Q, Huang J, Xie H. Effect of additional equipotent fentanyl or sufentanil administration on recovery profiles during propofol-remifentanil-based anaesthesia in patients undergoing gynaecologic laparoscopic surgery: a randomized clinical trial. BMC Anesthesiol 2022; 22:127. [PMID: 35488192 PMCID: PMC9052673 DOI: 10.1186/s12871-022-01671-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 04/18/2022] [Indexed: 11/24/2022] Open
Abstract
Background In clinical practice, sufentanil has a stronger sedative effect on patients than fentanyl at equivalent doses. This study hypothesized that, at equivalent doses, patients undergoing gynaecologic laparoscopic surgery (GLS) receiving fentanyl would have an earlier emergence from anaesthesia (EA), a shorter time to extubation (TE), and a better degree of wakefulness. Therefore, this study evaluated the effects of equipotent doses of fentanyl and sufentanil on the quality of emergence in patients undergoing GLS. Methods One hundred seven patients scheduled for GLS under general anaesthesia were randomly divided into two groups and were induced with 0.35 µg/kg sufentanil (Group S; n = 55) or 3.5 µg/kg fentanyl (Group F; n = 52). When the GLS was almost over, the patient's abdominal cavity was flushed with warm saline, and 5 µg of sufentanil or 50 µg of fentanyl in a double-blind manner was intravenously injected into the patients. The primary outcomes of the study included EA, TE, the rate of leaving the surgical bed voluntarily and the incidence of endotracheal tube tolerance. The Ramsay Sedation Scale (RSS), and Verbal Rating Scale (VRS) scores at 15 and 30 min in the postanaesthesia care unit (PACU), as well as other adverse events, including nausea and vomiting, itching, delirium, dizziness, chills, and respiratory depression (SpO2 < 95%) in the PACU, were evaluated as secondary outcomes. Results There were no statistically significant dissimilarities between the two groups with respect to baseline characteristics. For recovery, the EA (9.0 ± 4.8 min vs. 8.9 ± 3.0 min; P = 0. 146), TE (9.5 ± 4.7 min vs. 9.0 ± 3.0 min; P = 0.135), rate of leaving the surgical bed voluntarily (31.18% vs. 38.46%; P = 0.976), and incidence of endotracheal tube tolerance (94.55% vs. 96.15%; P = 0.694) were not significantly different between the two groups. In the PACU, the 15-min RSS score (2.07 ± 0.38 vs. 2.15 ± 0.36; P = 0.125), the 30-min RSS score (2.02 ± 0.13 vs. 2.04 ± 0.19; P = 0.207), the 15-min VRS score (0.50 ± 0.57 vs. 0.67 ± 0.55; P = 0.295), and the 30-min VRS score (0.45 ± 0.50 vs. 0.75 ± 0.52; P = 0.102) were not significantly different between Groups S and F. No adverse events, such as nausea, vomiting, pruritus, delirium, and tremors, occurred in either group. The rates of respiratory depression (1.82% vs. 1.92%; P = 0.968) and dizziness (0.00% vs. 4.85%; P = 0.142) were not different between Groups S and F in the PACU. Conclusions The majority of patients scheduled for GLS were able to rapidly and smoothly emerge from anaesthesia. After surgery, similar outcomes, including EA, TE, the incidence of endotracheal tube tolerance, the rate of leaving the surgical bed voluntarily, RSS scores, VRS scores, and adverse events in the PACU, were achieved for the patients between the two anaesthetic protocols.
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Affiliation(s)
- Chunyuan Zhang
- Department of Anesthesiology, Affiliated Boai Hospital of Zhongshan, Southern Medical University, No. 6 Chenggui Road, East District, Zhongshan, 528400, Guangdong, People's Republic of China
| | - Ding Huang
- Department of Anesthesiology, Affiliated Boai Hospital of Zhongshan, Southern Medical University, No. 6 Chenggui Road, East District, Zhongshan, 528400, Guangdong, People's Republic of China.
| | - Wei Zeng
- Department of Anesthesiology, Affiliated Boai Hospital of Zhongshan, Southern Medical University, No. 6 Chenggui Road, East District, Zhongshan, 528400, Guangdong, People's Republic of China.
| | - Jian Ma
- Department of Anesthesiology, Affiliated Boai Hospital of Zhongshan, Southern Medical University, No. 6 Chenggui Road, East District, Zhongshan, 528400, Guangdong, People's Republic of China
| | - Ping Li
- Department of Anesthesiology, Affiliated Boai Hospital of Zhongshan, Southern Medical University, No. 6 Chenggui Road, East District, Zhongshan, 528400, Guangdong, People's Republic of China
| | - Qichang Jian
- Department of Anesthesiology, Affiliated Boai Hospital of Zhongshan, Southern Medical University, No. 6 Chenggui Road, East District, Zhongshan, 528400, Guangdong, People's Republic of China
| | - Jiamin Huang
- Department of Anesthesiology, Affiliated Boai Hospital of Zhongshan, Southern Medical University, No. 6 Chenggui Road, East District, Zhongshan, 528400, Guangdong, People's Republic of China
| | - Huanlong Xie
- Department of Anesthesiology, Affiliated Boai Hospital of Zhongshan, Southern Medical University, No. 6 Chenggui Road, East District, Zhongshan, 528400, Guangdong, People's Republic of China
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Effects of Full Inhalation of Sevoflurane and Total Intravenous Anesthesia on Hemodynamics, Serum Myocardial Enzymes, and Myocardial Markers in Elderly Patients Undergoing Hysterectomy. BIOMED RESEARCH INTERNATIONAL 2021; 2021:9983988. [PMID: 34258289 PMCID: PMC8257341 DOI: 10.1155/2021/9983988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 06/11/2021] [Indexed: 11/23/2022]
Abstract
Objective To compare the effects of sevoflurane inhalation and intravenous anesthesia on hemodynamics, serum myocardial enzymes, and myocardial markers in elderly patients undergoing hysterectomy. Methods Group A and group B were established randomly regarding a total of 126 elderly patients who underwent an elective hysterectomy. Patients in group A were given full anesthesia with sevoflurane, and patients in group B were given anesthesia with intravenous anesthesia. The operation time, anesthesia time, and recovery time in Postanesthesia Care Unit (PACU) were compared; plasma cortisol concentration, hemodynamics, serum myocardial enzymes, and myocardial markers were detected and compared between the two groups of patients before anesthesia (T0), after anesthesia (T1), and after surgery (T2). Results Group A observed a longer extubation time and recovery time in PACU than group B (P < 0.05). Results show a lower systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR), and plasma cortisol concentration of T1 by comparison with those of T0 (P < 0.05), but no significant difference remains in terms of intergroup SBP, DBP, and HR (P > 0.05), and there was no interaction effect of groups and time (P > 0.05). The two groups showed no great disparity in the levels of lactate dehydrogenase (LDH), aspartate transaminase (AST), creatine kinase (CK), and CK-MB as a subtype of CK before surgery between the two groups of patients (P > 0.05). After surgery, LDH, AST, CK, and CK-MB levels in both groups were witnessed a surge, in which group A obtained higher levels of LDH, AST, CK, and CK-MB (all P < 0.05). Conclusion Total intravenous anesthesia will not increase the hemodynamic fluctuation of elderly patients undergoing hysterectomy and can reduce the damage to the myocardium of patients with surgical trauma, which can protect the myocardium of elderly patients to a certain extent, so it can be adopted as the optimal anesthesia protocol for surgery.
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Zheng H, Wei XC, Yu T, Lei Q. Anesthesia of a high-altitude area inhabitant who underwent aortic dissection emergency surgery in a low-altitude area. J Int Med Res 2021; 48:300060520979871. [PMID: 33349120 PMCID: PMC7758670 DOI: 10.1177/0300060520979871] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Heart surgery in patients from high-altitude areas is more challenging than usual. Few studies have been published on this issue, and none of them have discussed the effect of an altitude change (from high to low altitude) on a patient’s physiology or its effects on a patient’s perioperative management. Here, we present the case of a 46-year-old man who was a long-time resident of Tibetan area in Sichuan (altitude >3000 m) who underwent Stanford type A aortic dissection emergency surgery on the plain. Anesthetic management occurred through monitoring of the bispectral index (BIS) and transesophageal echocardiography (TEE), and we used a relatively loose fluid hydration strategy. The surgery was performed using cardiopulmonary bypass (CPB), deep hypothermia (DH), and selective antegrade cerebral perfusion. The most prominent anesthesia challenges for these patients are physiological changes due to habitation in an high-altitude environment (chronic hypoxemia), which can cause hyperhemoglobinemia, polycythemia, hypercoagulable blood, and even pulmonary hypertension, cor pulmonale, or congestive heart failure. Optimized perioperative management and close cooperation among the entire cardiac medical team were the key factors in the successful management of this rare case.
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Affiliation(s)
- Huan Zheng
- Department of Anesthesiology, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China.,Chinese Academy of Sciences Sichuan Translational Medicine Research Hospital, Chengdu, China
| | - Xin-Chuan Wei
- Department of Anesthesiology, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China.,Chinese Academy of Sciences Sichuan Translational Medicine Research Hospital, Chengdu, China
| | - Tao Yu
- Chinese Academy of Sciences Sichuan Translational Medicine Research Hospital, Chengdu, China.,Department of Cardiovascular Surgery, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Qian Lei
- Department of Anesthesiology, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China.,Chinese Academy of Sciences Sichuan Translational Medicine Research Hospital, Chengdu, China
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Yu X, Zhou Y, Zheng X, Shao S, He H. Clinical efficacy of intravenous anesthesia on breast segmental surgery and its effects on oxidative stress response and hemodynamics of patients. Exp Ther Med 2021; 21:11. [PMID: 33235620 PMCID: PMC7678611 DOI: 10.3892/etm.2020.9443] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Accepted: 08/03/2020] [Indexed: 12/17/2022] Open
Abstract
This study was designed to investigate the clinical efficacy of intravenous anesthesia on breast segmental surgery and the effects on hemodynamics of patients. A total of 267 patients were collected as research subjects. These patients underwent breast segmental surgery in Chun'an First People's Hospital from March 2015 to September 2018. Among them, 137 patients undergoing intravenous anesthesia were the research group, and 130 patients undergoing inhalation anesthesia were the control group. The following parameters were recorded: Clinical efficacy, postoperative adverse conditions, hemodynamic indicators including systolic blood pressure (SBP), diastolic blood pressure (DBP) and heart rate (HR). Visual analogue scale (VAS) was used to observe the analgesic effect of the two groups, the mental state of patients in the two groups was observed by mini-mental state examination (MMSE) scoring method, and systemic evaluation was made by oxidative stress (OS) reaction indicators. The MMSE scores of the two groups decreased one day after surgery, but the score in the research group was higher than that in the control group (P<0.05). The levels of SBP and DBP at T1 and T2 in the control group were significantly higher than those in the research group (P<0.05). HR of research group at T1 and T2 was lower than that at T0 and that at corresponding time of control group (P<0.05). The incidence rate of postoperative adverse reactions in the research group was significantly lower than that in the control group (P<0.05). In conclusion, intravenous anesthesia for breast segmental surgery can reduce the occurrence of adverse reactions after surgery, with complete sedation and analgesia. Patients were able to wake up quickly and stably after surgery, and their cognitive function and OS recovered rapidly. However, due to the great impact on hemodynamics during surgery, attention should be paid to maintain hemodynamic stability during surgery to avoid hypotension and bradycardia.
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Affiliation(s)
- Xiaohong Yu
- Department of Nursing Care, Chun'an First People's Hospital, Hangzhou, Zhejiang 311700, P.R. China
| | - Yinchan Zhou
- Department of Nursing Care, Chun'an First People's Hospital, Hangzhou, Zhejiang 311700, P.R. China
| | - Xuezhen Zheng
- Department of Nursing Care, Chun'an First People's Hospital, Hangzhou, Zhejiang 311700, P.R. China
| | - Su Shao
- Department of Nursing Care, Chun'an First People's Hospital, Hangzhou, Zhejiang 311700, P.R. China
| | - Huihong He
- Department of Nursing Care, Chun'an Hospital of TCM, Hangzhou, Zhejiang 311700, P.R. China
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Wang Y, Cao M, Cao G, Liu Y, Zhang Y. Effect of combined intravenous-inhalation anesthesia on postoperative cognitive dysfunction after laparoscopic radical resection of cervical cancer: A protocol for systematic review and meta-analysis. Medicine (Baltimore) 2020; 99:e23124. [PMID: 33157991 PMCID: PMC7647552 DOI: 10.1097/md.0000000000023124] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Accepted: 10/15/2020] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE To evaluate the effect of combined intravenous-inhalation anesthesia (CIVIA) on postoperative cognitive dysfunction (POCD) after laparoscopic radical resection of cervical cancer. METHODS By using a predefined standardized study protocol, we conducted a systematic review of randomized controlled trials (RCTs) with meta-analysis, searching the following data bases: PubMed, Embase, Web of Science, and Cochrane Library. RESULTS This systematic review evaluated the effect of CIVIA on POCD after laparoscopic radical resection of cervical cancer. CONCLUSION This systematic review provided up-to-date evidence to evaluate the effect of CIVIA on POCD after laparoscopic radical resection of cervical cancer. OSF REGISTRATION NUMBER DOI 10.17605/OSF.IO/82FNA.
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Affiliation(s)
- Ying Wang
- Department of Surgical Anaesthesia, Second Affiliated Hospital Oetianjin University of TCM, Tianjin
| | - Meihua Cao
- Department of Nursing, Dongtai Hospital Affiliated to Nantong University, Dongtai, Jiangsu
| | - Guofen Cao
- Department of Gynaecology Third Ward, Harbin Medical University Cancer Hospital, Harbin, Heilongjiang
| | - Yujie Liu
- Department of Surgical Anaesthesia, Second Affiliated Hospital Oetianjin University of TCM, Tianjin
| | - Ying Zhang
- Department of Gynaecology, Second Affiliated Hospital Oetianjin University of TCM, Tianjin, China
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Heller BJ, DeMaria S, Mendoza E, Hyman J, Iloreta AMC, Lin HM, Govindaraj S, Levine AI. Nitrous oxide anesthetic versus total intravenous anesthesia for functional endoscopic sinus surgery. Laryngoscope 2019; 130:E299-E304. [PMID: 31369152 DOI: 10.1002/lary.28201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 06/30/2019] [Accepted: 07/08/2019] [Indexed: 11/10/2022]
Abstract
BACKGROUND Functional endoscopic sinus surgery is a common procedure for sinonasal disease, frequently performed in the outpatient setting. General anesthesia maintained with total intravenous anesthesia (TIVA) with propofol has been shown to give superior surgical conditions compared to inhaled anesthetics. This study evaluated the effects of TIVA versus a predominantly nitrous oxide (N2 O)-based anesthetic with a low-dose propofol and remifentanil infusion on sinus surgery. METHODS Patients were randomized to either a N2 O-based (nitrous oxide with propofol and remifentanil) or TIVA (propofol and remifentanil without nitrous oxide) group. The surgeon was blinded to the anesthetic technique. Surgical field grading was performed in real time by the otolaryngologist every 15 minutes with the Boezaart grading system. RESULTS There were no statistically significant differences between the Boezaart scores, duration of surgery, or estimated blood loss between the two anesthetic techniques. However, the use of N2 O provided a statistically significant, 38% reduction in time from surgery end to extubation. The TIVA group had significantly decreased mean and median pain scores in the post-anesthesia care unit (PACU). There was no difference in the rate of postoperative nausea and vomiting between the two groups. CONCLUSION A N2 O-based anesthetic for functional endoscopic sinus surgery provides similar intraoperative and postoperative conditions when compared to TIVA, while being superior in terms of time to extubation. Although the TIVA group had significantly decreased pain scores, this did not lead to a decrease in pain medicine received in the PACU, and there was no difference between groups in time to discharge. LEVEL OF EVIDENCE 1b Laryngoscope, 130:E299-E304, 2020.
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Affiliation(s)
- Benjamin J Heller
- The Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A
| | - Samuel DeMaria
- The Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A
| | - Erick Mendoza
- The Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A
| | - Jaime Hyman
- The Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A
| | | | - Hung-Mo Lin
- The Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A
| | - Satish Govindaraj
- The Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A
| | - Adam I Levine
- The Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A
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Grant MC, Gibbons MM, Ko CY, Wick EC, Cannesson M, Scott MJ, Wu CL. Evidence review conducted for the AHRQ Safety Program for Improving Surgical Care and Recovery: focus on anesthesiology for gynecologic surgery. Reg Anesth Pain Med 2019; 44:rapm-2018-100071. [PMID: 30737316 DOI: 10.1136/rapm-2018-100071] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 12/11/2018] [Accepted: 12/27/2018] [Indexed: 12/27/2022]
Abstract
Enhanced recovery after surgery (ERAS) protocols for gynecologic (GYN) surgery are increasingly being reported and may be associated with superior outcomes, reduced length of hospital stay, and cost savings. The Agency for Healthcare Research and Quality, in partnership with the American College of Surgeons and the Johns Hopkins Medicine Armstrong Institute for Patient Safety and Quality, has developed the Safety Program for Improving Surgical Care and Recovery, which is a nationwide initiative to disseminate best practices in perioperative care to more than 750 hospitals across five major surgical service lines in a 5-year period. The program is designed to identify evidence-based process measures shown to prevent healthcare-associated conditions and hasten recovery after surgery, integrate those into a comprehensive service line-based pathway, and assist hospitals in program implementation. In conjunction with this effort, we have conducted an evidence review of the various anesthesia components which may influence outcomes and facilitate recovery after GYN surgery. A literature search was performed for each intervention, and the highest levels of available evidence were considered. Anesthesiology-related interventions for preoperative (carbohydrate loading/fasting, multimodal preanesthetic medications), intraoperative (standardized intraoperative pathway, regional anesthesia, protective ventilation strategies, fluid minimization) and postoperative (multimodal analgesia) phases of care are included. We have summarized the best available evidence to recommend the anesthetic components of care for ERAS for GYN surgery.
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Affiliation(s)
- Michael Conrad Grant
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins Hospital and Health System, Baltimore, Maryland, USA
- Armstrong Institute for Patient Safety and Quality, Johns Hopkins Hospital and Health System, Baltimore, Maryland, USA
| | - Melinda M Gibbons
- Department of Surgery, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California, USA
| | - Clifford Y Ko
- Department of Surgery, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California, USA
| | - Elizabeth C Wick
- Armstrong Institute for Patient Safety and Quality, Johns Hopkins Hospital and Health System, Baltimore, Maryland, USA
| | - Maxime Cannesson
- Department of Anesthesiology and Perioperative Medicine, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California, USA
| | - Michael J Scott
- Department of Anesthesiology, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
- Department of Anesthesiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Christopher L Wu
- Anesthesiology, Hospital for Special Surgery, New York City, New York, USA
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