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Cubeddu F, Masala G, Sotgiu G, Mollica A, Versace S, Careddu GM. Cardiorespiratory Effects and Desflurane Requirement in Dogs Undergoing Ovariectomy after Administration Maropitant or Methadone. Animals (Basel) 2023; 13:2388. [PMID: 37508165 PMCID: PMC10376119 DOI: 10.3390/ani13142388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 07/08/2023] [Accepted: 07/19/2023] [Indexed: 07/30/2023] Open
Abstract
General anesthesia for ovariectomy in dogs is based on a balanced anesthesia protocol such as using analgesics along with an inhalant agent. While opioids such as fentanyl and methadone are commonly used for their analgesic potency, other drugs can also have analgesic effects. Maropitant, an antiemetic for dogs and cats, has also been shown to exert analgesic effects, especially on visceral pain. The aim of this study was to compare the cardiorespiratory effects and analgesic properties of maropitant and methadone combined with desflurane in dogs undergoing ovariectomy. Two groups of 20 healthy mixed-breeds bitches undergoing elective ovariectomy received intravenous either maropitant at antiemetic dose of 1 mg kg-1 or methadone at the dose of 0.3 mg kg-1. Cardiorespiratory variables were collected before premedication, 10 min after sedation and during surgery. Recovery quality and postoperative pain were evaluated 15, 30, 60, 120, 240 and 360 min postoperatively. Results showed that maropitant produced analgesia and reduced the requirement of desflurane in amounts similar to those determined by methadone (5.39 ± 0.20% and 4.91 ± 0.26%, respectively) without significant difference, while maintaining heart rate, arterial blood pressure, respiratory rate and carbon dioxide end-tidal partial pressure even at a more satisfactory level. Therefore, maropitant may be recommended as an analgesic drug for abdominal surgery not only in healthy dogs but also in those with reduced cardiorespiratory compensatory capacities or at risk of hypotension, especially when combined with a sedative such as dexmedetomidine.
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Affiliation(s)
- Francesca Cubeddu
- Department of Veterinary Medicine, University of Sassari, Via Vienna 2, 07100 Sassari, Italy
| | - Gerolamo Masala
- Department of Veterinary Medicine, University of Sassari, Via Vienna 2, 07100 Sassari, Italy
| | - Giovanni Sotgiu
- Department of Surgical and Experimental Medical Sciences Medicine, Surgery and Pharmacy, University of Sassari, Viale San Pietro 43, 07100 Sassari, Italy
| | - Alessandra Mollica
- Department of Veterinary Medicine, University of Sassari, Via Vienna 2, 07100 Sassari, Italy
| | - Sylvia Versace
- Department of Veterinary Medicine, University of Sassari, Via Vienna 2, 07100 Sassari, Italy
| | - Giovanni Mario Careddu
- Department of Veterinary Medicine, University of Sassari, Via Vienna 2, 07100 Sassari, Italy
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Keller M, Cattaneo A, Spinazzè A, Carrozzo L, Campagnolo D, Rovelli S, Borghi F, Fanti G, Fustinoni S, Carrieri M, Moretto A, Cavallo DM. Occupational Exposure to Halogenated Anaesthetic Gases in Hospitals: A Systematic Review of Methods and Techniques to Assess Air Concentration Levels. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 20:514. [PMID: 36612837 PMCID: PMC9819674 DOI: 10.3390/ijerph20010514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Revised: 12/16/2022] [Accepted: 12/23/2022] [Indexed: 06/17/2023]
Abstract
Objective During the induction of gaseous anaesthesia, waste anaesthetic gases (WAGs) can be released into workplace air. Occupational exposure to high levels of halogenated WAGs may lead to adverse health effects; hence, it is important to measure WAGs concentration levels to perform risk assessment and for health protection purposes. Methods A systematic review of the scientific literature was conducted on two different scientific databases (Scopus and PubMed). A total of 101 studies, focused on sevoflurane, desflurane and isoflurane exposures in hospitals, were included in this review. Key information was extracted to provide (1) a description of the study designs (e.g., monitoring methods, investigated occupational settings, anaesthetic gases in use); (2) an evaluation of time trends in the measured concentrations of considered WAGs; (3) a critical evaluation of the sampling strategies, monitoring methods and instruments used. Results Environmental monitoring was prevalent (68%) and mainly used for occupational exposure assessment during adult anaesthesia (84% of cases). Real-time techniques such as photoacoustic spectroscopy and infrared spectrophotometry were used in 58% of the studies, while off-line approaches such as active or passive sampling followed by GC-MS analysis were used less frequently (39%). Conclusions The combination of different instrumental techniques allowing the collection of data with different time resolutions was quite scarce (3%) despite the fact that this would give the opportunity to obtain reliable data for testing the compliance with 8 h occupational exposure limit values and at the same time to evaluate short-term exposures.
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Affiliation(s)
- Marta Keller
- Department of Science and High Technology, University of Insubria, 22100 Como, Italy
| | - Andrea Cattaneo
- Department of Science and High Technology, University of Insubria, 22100 Como, Italy
| | - Andrea Spinazzè
- Department of Science and High Technology, University of Insubria, 22100 Como, Italy
| | - Letizia Carrozzo
- Department of Science and High Technology, University of Insubria, 22100 Como, Italy
| | - Davide Campagnolo
- Department of Science and High Technology, University of Insubria, 22100 Como, Italy
| | - Sabrina Rovelli
- Department of Science and High Technology, University of Insubria, 22100 Como, Italy
| | - Francesca Borghi
- Department of Science and High Technology, University of Insubria, 22100 Como, Italy
| | - Giacomo Fanti
- Department of Science and High Technology, University of Insubria, 22100 Como, Italy
| | - Silvia Fustinoni
- IRCCS Ca’ Granda Foundation Maggiore Policlinico Hospital, 20122 Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy
| | - Mariella Carrieri
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, 35122 Padova, Italy
| | - Angelo Moretto
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, 35122 Padova, Italy
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Zheng Y, Lu H, Huang H. Desflurane Preconditioning Protects Against Renal Ischemia-Reperfusion Injury and Inhibits Inflammation and Oxidative Stress in Rats Through Regulating the Nrf2-Keap1-ARE Signaling Pathway. Drug Des Devel Ther 2020; 14:1351-1362. [PMID: 32308368 PMCID: PMC7138619 DOI: 10.2147/dddt.s223742] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Accepted: 03/16/2020] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE Kidney is sensitive to ischemia-reperfusion (I/R) injury because of its special structure and function. In this study, we aimed to explore the mechanism of desflurane (DFE) preconditioning effecting on renal I/R injury in rats. METHODS Renal I/R injury rats model was constructed, and the expressions of serum renal function parameters (blood urea nitrogen (BUN) and serum creatinine (SCr)) and lipid peroxidation-related factors were detected using corresponding commercial kits to assess the degrees of renal functional damage and oxidative stress. Hematoxylin--eosin (HE) staining and Masson trichrome staining were applied to measure the renal histologic damage. The expressions of inflammation-related factors were determined by ELISA assay. The cell apoptosis was analyzed using TUNEL, Western blot and immunohistochemistry (IHC). IHC was also used to detect the number of myeloperoxidase (MPO)-positive cells. The expressions of proteins associated with the Nrf2-Keap1-ARE pathway were assessed by Western blot and IHC. RESULTS DFE preconditioning inhibited I/R injury-induced BUN and SCr increase and renal histologic injury in rats. Also, DFE suppressed the inflammation, apoptosis and oxidative stress caused by renal I/R injury in vivo. In addition, DFE preconditioning repressed peroxide-related factors (MDA, MPO and NO) expressions and promoted antioxidant-related factors (GSH, SOD, GPx and CAT) expressions. In addition, DFE promoted Nrf2-Keap1-ARE-related proteins including Nrf2, NQO1, HO-1, γ-GCS, GSR and GCLc expressions. CONCLUSION DFE preconditioning protected the kidney as well as inhibited the inflammation, cell apoptosis and oxidative stress in renal I/R injury rats by activating the Nrf2-Keap1-ARE signaling pathway.
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Affiliation(s)
- Yan Zheng
- Department of Anesthesiology, Xiamen Haicang Hospital, Xiamen361000, People’s Republic of China
| | - Hui Lu
- Department of Anesthesiology, Xiamen Haicang Hospital, Xiamen361000, People’s Republic of China
| | - Huiqiong Huang
- Department of Anesthesiology, Women and Children’s Hospital Affiliated to Xiamen University, Xiamen361000, People’s Republic of China
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Parab SR, Khan MM. Is Day Care Tonsillectomy a Safe Procedure? Indian J Otolaryngol Head Neck Surg 2019; 71:918-922. [PMID: 31742094 PMCID: PMC6848297 DOI: 10.1007/s12070-019-01587-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Accepted: 01/08/2019] [Indexed: 11/25/2022] Open
Abstract
Tonsillectomy with or without adenoidectomy is the commonest procedure performed by an otolaryngologist. It has been performed as an in-patient procedure. To present our experience of 15 years of day care tonsillectomy with or without adenoidectomy and to assess the safety of tonsillectomy as a day care procedure. Design: retrospective study. A retrospective study of all day care tonsillectomies with or without adenoidectomies operated at a Secondary care ENT Hospital from 2002 to 2016 has been carried out. In last 15 years, we have operated 1207 tonsillectomies with or without adenoidectomies as a day care procedure. Postoperatively, the patients were discharged after observing for 6 to 8 h. Out of 1207 patients, 3 patients required readmission due to bleeding and 5 due to pain. Hence the overall readmission rate following tonsillectomy was 8/1027, which equals to 0.778 percent. Two patients with postoperative bleeding within 6 h were taken up for exploration and control of hemostasis. One patient of secondary haemorrhage was managed conservatively. None of the patients required blood transfusion. Day care tonsillectomy with or without adenoidectomy is a safe procedure as long as the patients are carefully selected. It is also cost effective. Level of evidence: Level 4.
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Affiliation(s)
- Sapna Ramkrishna Parab
- Sushrut ENT Hospital and Dr. Khan’s ENT Research Center, Talegaon Dabhade, Pune, 410507 India
| | - Mubarak M. Khan
- Sushrut ENT Hospital and Dr. Khan’s ENT Research Center, Talegaon Dabhade, Pune, 410507 India
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Geng Y, Zhu M, Liang A, Niu C, Li J, Zou D, Wu Y, Wu Y. O-Difluorodeuteromethylation of phenols using difluorocarbene precursors and deuterium oxide. Org Biomol Chem 2018; 16:1807-1811. [DOI: 10.1039/c7ob03088f] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
A convenient synthesis of difluorodeuteromethyl aryl ethers using difluorocarbene precursors and deuterium oxide is described.
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Affiliation(s)
- Yang Geng
- The College of Chemistry and Molecular Engineering
- Zhengzhou University
- Zhengzhou
- P. R. China
| | - Mingxiang Zhu
- The College of Chemistry and Molecular Engineering
- Zhengzhou University
- Zhengzhou
- P. R. China
| | - Apeng Liang
- The College of Chemistry and Molecular Engineering
- Zhengzhou University
- Zhengzhou
- P. R. China
| | - Chengshan Niu
- Tetranov Biopharm
- LLC. And Collaborative Innovation Center of New Drug Research and Safety Evaluation
- Zhengzhou
- P. R. China
| | - Jingya Li
- Tetranov Biopharm
- LLC. And Collaborative Innovation Center of New Drug Research and Safety Evaluation
- Zhengzhou
- P. R. China
| | - Dapeng Zou
- The College of Chemistry and Molecular Engineering
- Zhengzhou University
- Zhengzhou
- P. R. China
| | - Yusheng Wu
- The College of Chemistry and Molecular Engineering
- Zhengzhou University
- Zhengzhou
- P. R. China
- Tetranov Biopharm
| | - Yangjie Wu
- The College of Chemistry and Molecular Engineering
- Zhengzhou University
- Zhengzhou
- P. R. China
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Abstract
Ambulatory anesthesia allows quick recovery from anesthesia, leading to an early discharge and rapid resumption of daily activities, which can be of great benefit to patients, healthcare providers, third-party payers, and hospitals. Recently, with the development of minimally invasive surgical techniques and short-acting anesthetics, the use of ambulatory surgery has grown rapidly. Additionally, as the indications for ambulatory surgery have widened, the surgical methods have become more complex and the number of comorbidities has increased. For successful and safe ambulatory anesthesia, the anesthesiologist must consider various factors relating to the patient. Among them, appropriate selection of patients and surgical and anesthetic methods, as well as postoperative management, should be considered simultaneously. Patient selection is a particularly important factor. Appropriate surgical and anesthetic techniques should be used to minimize postoperative complications, especially postoperative pain, nausea, and vomiting. Patients and their caregivers should be fully informed of specific care guidelines and appropriate responses to emergency situations on discharge from the hospital. During this process, close communication between patients and medical staff, as well as postoperative follow-up appointments, should be ensured. In summary, safe and convenient methods to ensure the patient's return to function and recovery are necessary.
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Affiliation(s)
- Jeong Han Lee
- Department of Anesthesiology and Pain Medicine, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
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Xie Q, Ni C, Zhang R, Li L, Rong J, Hu J. Efficient Difluoromethylation of Alcohols Using TMSCF2Br as a Unique and Practical Difluorocarbene Reagent under Mild Conditions. Angew Chem Int Ed Engl 2017. [DOI: 10.1002/ange.201611823] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Qiqiang Xie
- Key Laboratory of Organofluorine Chemistry; Shanghai Institute of Organic Chemistry; University of Chinese Academy of Sciences, Chinese Academy of Sciences; 345 Ling-Ling Road Shanghai 200032 China
| | - Chuanfa Ni
- Key Laboratory of Organofluorine Chemistry; Shanghai Institute of Organic Chemistry; University of Chinese Academy of Sciences, Chinese Academy of Sciences; 345 Ling-Ling Road Shanghai 200032 China
| | - Rongyi Zhang
- Key Laboratory of Organofluorine Chemistry; Shanghai Institute of Organic Chemistry; University of Chinese Academy of Sciences, Chinese Academy of Sciences; 345 Ling-Ling Road Shanghai 200032 China
- School of Physical Science and Technology; ShanghaiTech University; 100 Haike Road Shanghai 201210 China
| | - Lingchun Li
- Key Laboratory of Organofluorine Chemistry; Shanghai Institute of Organic Chemistry; University of Chinese Academy of Sciences, Chinese Academy of Sciences; 345 Ling-Ling Road Shanghai 200032 China
| | - Jian Rong
- Key Laboratory of Organofluorine Chemistry; Shanghai Institute of Organic Chemistry; University of Chinese Academy of Sciences, Chinese Academy of Sciences; 345 Ling-Ling Road Shanghai 200032 China
| | - Jinbo Hu
- Key Laboratory of Organofluorine Chemistry; Shanghai Institute of Organic Chemistry; University of Chinese Academy of Sciences, Chinese Academy of Sciences; 345 Ling-Ling Road Shanghai 200032 China
- School of Physical Science and Technology; ShanghaiTech University; 100 Haike Road Shanghai 201210 China
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Xie Q, Ni C, Zhang R, Li L, Rong J, Hu J. Efficient Difluoromethylation of Alcohols Using TMSCF2Br as a Unique and Practical Difluorocarbene Reagent under Mild Conditions. Angew Chem Int Ed Engl 2017; 56:3206-3210. [DOI: 10.1002/anie.201611823] [Citation(s) in RCA: 78] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Revised: 01/24/2017] [Indexed: 01/26/2023]
Affiliation(s)
- Qiqiang Xie
- Key Laboratory of Organofluorine Chemistry; Shanghai Institute of Organic Chemistry; University of Chinese Academy of Sciences, Chinese Academy of Sciences; 345 Ling-Ling Road Shanghai 200032 China
| | - Chuanfa Ni
- Key Laboratory of Organofluorine Chemistry; Shanghai Institute of Organic Chemistry; University of Chinese Academy of Sciences, Chinese Academy of Sciences; 345 Ling-Ling Road Shanghai 200032 China
| | - Rongyi Zhang
- Key Laboratory of Organofluorine Chemistry; Shanghai Institute of Organic Chemistry; University of Chinese Academy of Sciences, Chinese Academy of Sciences; 345 Ling-Ling Road Shanghai 200032 China
- School of Physical Science and Technology; ShanghaiTech University; 100 Haike Road Shanghai 201210 China
| | - Lingchun Li
- Key Laboratory of Organofluorine Chemistry; Shanghai Institute of Organic Chemistry; University of Chinese Academy of Sciences, Chinese Academy of Sciences; 345 Ling-Ling Road Shanghai 200032 China
| | - Jian Rong
- Key Laboratory of Organofluorine Chemistry; Shanghai Institute of Organic Chemistry; University of Chinese Academy of Sciences, Chinese Academy of Sciences; 345 Ling-Ling Road Shanghai 200032 China
| | - Jinbo Hu
- Key Laboratory of Organofluorine Chemistry; Shanghai Institute of Organic Chemistry; University of Chinese Academy of Sciences, Chinese Academy of Sciences; 345 Ling-Ling Road Shanghai 200032 China
- School of Physical Science and Technology; ShanghaiTech University; 100 Haike Road Shanghai 201210 China
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Teng WN, Tsou MY, Chen PT, Liou JY, Yu L, Westenskow DR, Ting CK. A desflurane and fentanyl dosing regimen for wake-up testing during scoliosis surgery: Implications for the time-course of emergence from anesthesia. J Formos Med Assoc 2016; 116:606-612. [PMID: 27823923 DOI: 10.1016/j.jfma.2016.10.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Revised: 09/22/2016] [Accepted: 10/06/2016] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND/PURPOSE The Stagnara wake-up test assesses neurological deficits during scoliosis surgery, and response surface interaction models for opioids and inhaled agents predicts anesthetic drug effects. We hypothesized that there is an optimal desflurane-fentanyl dosing regimen that can provide a faster and more predictable wake-up time, while also ensuring adequate analgesia during wake-up testing. METHODS Twenty-three American Society of Anesthesiologists Class I-II scoliosis patients who received desflurane-fentanyl anesthetic regimens were enrolled in this posthoc study, and their intraoperative drug administration data were collected retrospectively. Desflurane and fentanyl effect site concentrations were calculated using pharmacokinetic models, and converted to equivalent remifentanil-sevoflurane concentrations. RESULTS Results were fitted into Greco models for predicting the probability of an Observers Assessment of Alertness/Sedation score of <2. At time of wake-up, the models correctly predicted the probability that patients would respond to voice prompts and prodding was approximately 50%. The probability of pain intensity was distributed between 50% and 95%, indicating a low degree of pain at emergence. When comparing subgroups defined by calculated effect-site fentanyl concentrations, the wake-up time in the intermediate concentration group was significantly shorter than that in the high concentration group (p = 0.024). CONCLUSION This study provides evidence that desflurane-fentanyl-based anesthesia is conducive to rapid emergence followed by an immediate neurological evaluation. Intermediate fentanyl effect-site concentrations (1-2 ng/mL) at time of wake-up were associated with good balance between rapid emergence and adequate analgesia. Furthermore, we believe that generalizing response surface models to a variety of inhalation agent-opioid combinations using simple relative potency relationships is possible and practical.
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Affiliation(s)
- Wei-Nung Teng
- Department of Anesthesiology, Taipei Veterans General Hospital and National Yang-Ming University, Taipei, Taiwan, Republic of China
| | - Mei-Yung Tsou
- Department of Anesthesiology, Taipei Veterans General Hospital and National Yang-Ming University, Taipei, Taiwan, Republic of China
| | - Pin-Tarng Chen
- Department of Anesthesiology, Taipei Veterans General Hospital and National Yang-Ming University, Taipei, Taiwan, Republic of China
| | - Jing-Yang Liou
- Department of Anesthesiology, Taipei Veterans General Hospital and National Yang-Ming University, Taipei, Taiwan, Republic of China
| | - Lu Yu
- Department of Biomedical Engineering, College of Basic Medical Sciences, China Medical University, Shenyang, Liaoning, People's Republic of China
| | - Dwayne R Westenskow
- Department of Anesthesiology and Biomedical Engineering, University of Utah, Salt Lake City, UT, USA
| | - Chien-Kun Ting
- Department of Anesthesiology, Taipei Veterans General Hospital and National Yang-Ming University, Taipei, Taiwan, Republic of China.
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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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Hua MQ, Wang W, Liu WH, Wang T, Zhang Q, Huang Y, Zhu WH. Solvent-controlled difluoromethylation of 2′-hydroxychalcones for divergent synthesis of 2′-difluoromethoxychalcones and 2,2-difluoro-3-styryl-2,3-dihydrobenzofuran-3-ols. J Fluor Chem 2016. [DOI: 10.1016/j.jfluchem.2015.11.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Jeong HJ, Baik HJ, Kim JH, Kim YJ, Bahk JH. Effect-site concentration of remifentanil for minimizing cardiovascular changes by inhalation of desflurane. Yonsei Med J 2013; 54:739-46. [PMID: 23549824 PMCID: PMC3635645 DOI: 10.3349/ymj.2013.54.3.739] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
PURPOSE This study aims to investigate the most appropriate effect-site concentration of remifentanil to minimize cardiovascular changes during inhalation of high concentration desflurane. MATERIALS AND METHODS Sixty-nine American Society of Anesthesiologists physical status class I patients aged 20-65 years were randomly allocated into one of three groups. Anesthesia was induced with etomidate and rocuronium. Remifentanil was infused at effect-site concentrations of 2, 4 and 6 ng/mL in groups R2, R4 and R6, respectively. After target concentrations of remifentanil were reached, desflurane was inhaled to maintain the end-tidal concentration of 1.7 minimum alveolar concentrations for 5 minutes (over-pressure paradigm). The systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), heart rate (HR) and end-tidal concentration of desflurane were measured for 5 minutes. RESULTS The end-tidal concentration of desflurane increased similarly in all groups. The SBP, DBP, MAP and HR within group R4 were not significantly different as compared with baseline values. However, measured parameters within group R2 increased significantly 1-3 minutes after desflurane inhalation. The MAP within group R6 decreased significantly at 1, 2, 4, and 5 minutes (p<0.05). There were significant differences in SBP, DBP, MAP and HR among the three groups 1-3 minutes after inhalation (p<0.05). The incidence of side effects such as hyper- or hypo-tension, and tachy- or brady-cardia in group R4 was 4.8% compared with 21.8% in group R2 and 15.0% in group R6. CONCLUSION The most appropriate effect-site concentration of remifentanil for blunting hemodynamic responses by inhalation of high concentration desflurane is 4 ng/mL.
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Affiliation(s)
- Hee Jin Jeong
- Department of Anesthesiology and Pain Medicine, Armed Forces Capital Hospital, Seongnam, Korea
| | - Hee Jung Baik
- Department of Anesthesiology and Pain Medicine, School of Medicine, Ewha Womans University, Seoul, Korea
| | - Jong Hak Kim
- Department of Anesthesiology and Pain Medicine, School of Medicine, Ewha Womans University, Seoul, Korea
| | - Youn Jin Kim
- Department of Anesthesiology and Pain Medicine, School of Medicine, Ewha Womans University, Seoul, Korea
| | - Jae Hyon Bahk
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Korea
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Lu CC, Lin TC, Hsu CH, Yu MH, Chen TL, Chen RM, Ku CH, Ho ST. Hyperventilation accelerates the rise of arterial blood concentrations of desflurane in gynecologic patients. Clinics (Sao Paulo) 2012; 67:1029-34. [PMID: 23018299 PMCID: PMC3438242 DOI: 10.6061/clinics/2012(09)08] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2012] [Accepted: 05/07/2012] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES Under a constant inspired concentration, the uptake of a volatile anesthetic into the arterial blood should mainly be governed by alveolar ventilation, according to the assumption that the patient's cardiac output remains stable during anesthesia. We investigated whether ventilation volume affects the rate of desflurane uptake by examining arterial blood concentrations. METHOD Thirty female patients were randomly allocated into the following three groups: hyperventilation, normal ventilation and hypoventilation. Hemodynamic variables were measured using a Finometer, inspiratory and end-tidal concentrations of desflurane were measured by infrared analysis, and the desflurane concentration in the arterial blood (Ades) was analyzed by gas chromatography. RESULTS During the first 10 minutes after the administration of desflurane, the Ades was highest in the hyperventilation group, and this value was significantly different from those obtained for the normal and hypoventilation groups. In addition, hyperventilation significantly increased the slope of Ades-over-time during the first 5 minutes compared with patients experiencing normal ventilation and hypoventilation, but there were no differences in these slopes during the periods from 5-10, 10-20 and 20-40 minutes after the administration of desflurane. This finding indicates that there were no differences in desflurane uptake between the three groups after the first 5 minutes within desflurane administration. CONCLUSIONS Hyperventilation accelerated the rate of the rise in Ades following desflurane administration, which was time-dependent with respect to different alveolar ventilations levels.
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Affiliation(s)
- Chih-Cherng Lu
- Department of Anesthesiology, Tri-Service General Hospital, Taipei, Taiwan
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dos Santos PSP, Nunes N, de Souza AP, de Rezende ML, Nishimori CTD, de Paula DP, Ferro Lopes PC. Hemodynamic effects of butorphanol in desflurane-anesthetized dogs. Vet Anaesth Analg 2011; 38:467-74. [PMID: 21831052 DOI: 10.1111/j.1467-2995.2011.00644.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To evaluate the effects of butorphanol on cardiopulmonary parameters in dogs anesthetized with desflurane and breathing spontaneously. STUDY DESIGN Prospective, randomized experimental trial. ANIMALS Twenty dogs weighing 12 ± 3 kg. METHODS Animals were distributed into two groups: a control group (CG) and butorphanol group (BG). Propofol was used for induction and anesthesia was maintained with desflurane (10%). Forty minutes after induction, the dogs in the CG received sodium chloride 0.9% (0.05 mL kg(-1) IM), and dogs in the BG received butorphanol (0.4 mg kg(-1) IM). The first measurements of body temperature (BT), heart rate (HR), arterial pressures (AP), cardiac output (CO), cardiac index (CI), central venous pressure (CVP), stroke volume index (SVI), pulmonary arterial occlusion pressure (PAOP), mean pulmonary arterial pressure (mPAP), left ventricular stroke work (LVSW), systemic (SVR) and pulmonary (PVR) vascular resistances, respiratory rate (f(R) ), and arterial oxygen (PaO(2) ) and carbon dioxide (PaCO(2) ) partial pressures were taken immediately before the administration of butorphanol or sodium chloride solution (T0) and then at 15-minute intervals (T15-T75). RESULTS In the BG, HR, AP, mPAP and SVR decreased significantly from T15 to T75 compared to baseline. f(R) was lower at T30 than at T0 in the BG. AP and f(R) were significantly lower than in the CG from T15 to T75. PVR was lower in the BG than in the CG at T30, while PaCO(2) was higher compared with T0 from T30 to T75 in the BG and significantly higher than in the CG at T30 to T75. CONCLUSIONS AND CLINICAL RELEVANCE At the studied dose, butorphanol caused hypotension and decreased ventilation during desflurane anesthesia in dogs. The hypotension (from 86 ± 10 to 64 ± 10 mmHg) is clinically relevant, despite the maintenance of cardiac index.
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Affiliation(s)
- Paulo Sérgio P dos Santos
- Department of Clinical Surgery and Animal Reproduction, College of Agricultural and Veterinary Sciences, Universidade Estadual Paulista, Araçatuba, SP, Brazil.
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Read E, Jenkins I. Desflurane and oesophageal Doppler - a perfect fit? Anaesthesia 2011; 66:143. [PMID: 21254999 DOI: 10.1111/j.1365-2044.2010.06596.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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16
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Yu D, Chai W, Sun X, Yao L. Emergence agitation in adults: risk factors in 2,000 patients. Can J Anaesth 2010; 57:843-8. [DOI: 10.1007/s12630-010-9338-9] [Citation(s) in RCA: 99] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2009] [Accepted: 05/14/2010] [Indexed: 10/19/2022] Open
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Almeida DE, Nishimori CT, Oriá AP, Paula DP, Nunes N, Laus JL. Effects of nitrous oxide on IOP and pupillary diameter in dogs anesthetized with varying concentrations of desflurane. Vet Ophthalmol 2008; 11:170-6. [DOI: 10.1111/j.1463-5224.2008.00616.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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18
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Cho HR, Kim HK, Baek SH, Jung KY. The effect of remifentanil infusion on coughing during emergence from general anesthesia with desflurane. Korean J Anesthesiol 2008. [DOI: 10.4097/kjae.2008.55.6.670] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- Hyeok-rae Cho
- Department of Anesthesia and Pain Medicine, Pusan National University School of Medicine, Busan, Korea
| | - Hae-kyu Kim
- Department of Anesthesia and Pain Medicine, Pusan National University School of Medicine, Busan, Korea
| | - Seung-hoon Baek
- Department of Anesthesia and Pain Medicine, Pusan National University School of Medicine, Busan, Korea
| | - Kyu-youn Jung
- Department of Anesthesia and Pain Medicine, Pusan National University School of Medicine, Busan, Korea
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Röhm KD, Riechmann J, Boldt J, Schöllhorn T, Piper SN. Retracted: Do patients profit from physostigmine in recovery from desflurane anaesthesia? Acta Anaesthesiol Scand 2007; 51:278-83. [PMID: 17250745 DOI: 10.1111/j.1399-6576.2006.01238.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Physostigmine is the drug of choice in the central anticholinergic syndrome, but has also been used in post-operative mental derangement secondary to sedatives and volatile anaesthetics. The aim of this double-blind, randomized, prospective study was to determine whether physostigmine alters recovery after desflurane anaesthesia. METHODS One hundred patients undergoing urologic or surgical procedures were enrolled to receive either NaCl 0.9% (n = 50) or 2 mg of physostigmine (n = 50) at the end of general anaesthesia with propofol, fentanyl, cisatracurium and desflurane. Times to extubation, stating name, birthday and place of residence, and obeying commands such as eye opening and hand squeezing were noted. Haemodynamics, Aldrete and pain scores, the analgesic requirements, and any adverse side-effects were documented until the 1st post-operative day. RESULTS Demographic, peri-operative data including duration of anaesthesia, surgery and postanaesthetic care unit (PACU) stay, and consumption of anaesthetics were comparable in both groups. No significant difference between the groups was found for extubation time or other emergence parameters. Patients undergoing anaesthesia >150 min showed after receiving physostigmine significantly (P < 0.05) faster spontaneous breathing (2.6 +/- 3.1 vs. placebo 5.0 +/- 4.2 min) and extubation time (6.2 +/- 3.7 vs. placebo 8.8 +/- 5.0 min). Women showed significantly shorter extubation times (5.5 +/- 3.4 min) and eye opening (5.5 +/- 2.6 min) with physostigmine than placebo (7.7 +/- 4.5 and 7.8 +/- 4.0 min). The incidence of post-operative nausea and vomiting (PONV) was significantly higher after physostigmine than placebo, whereas shivering occurred more often after placebo. CONCLUSION Physostigmine does not alter desflurane-based anaesthesia compared with placebo. An option is to use physostigmine in patients with a duration of anaesthesia >150 min who profit in earlier return to spontaneous breathing and shorter extubation time.
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Affiliation(s)
- K D Röhm
- Department of Anaesthesiology and Intensive Care Medicine, Klinikum Ludwigshafen, Ludwigshafen, Germany.
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Nishimori C, Nunes N, Paula D, Rezende M, Souza A, Santos P. Effects of nitrous oxide on minimum alveolar concentration of desflurane in dogs. ARQ BRAS MED VET ZOO 2007. [DOI: 10.1590/s0102-09352007000100017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Effects of nitrous oxide (N2O) on minimum alveolar concentration (MAC) of desflurane were studied. For that purpose, 30 dogs were randomly allocated into two groups: desflurane group (GD) and N2O and desflurane group (GDN). GD animals received propofol to intubation, and 11.5V% of desflurane diluted in 100% O2. After 30 minutes, they received electric stimulus and if the animal did not react to stimulus, desflurane concentration was reduced by 1.5V%. This protocol was repeated at each 15 minutes, and stimulus was interrupted when voluntary reaction was observed. GDN dogs were submitted to diluent flow 30% O2 and 70% N2O. Desflurane's MAC; heart (HR) and respiratory (RR) rates; systolic, diastolic and mean arterial pressures (SAP, DAP, and MAP, respectively); end tidal carbon dioxide (ETCO2); oxyhemoglobin saturation (SpO2) and body temperature (T) were evaluated. In both groups increase in HR and ETCO2, and decrease in RR and T were associated with administration of the highest dose of desflurane. Blood pressures decreased 30 minutes after desflurane administration in GDN, and after this measurement the values increased. Reduction in desflurane's MAC was observed as well. It is concluded that N2O associated with desflurane reduced desflurane's MAC by 16% with increase in HR and respiratory depression.
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21
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Lee IO. The Postoperative Adverse Effects of Inhalational Anesthetics: Emergence Delirium and PONV. Korean J Anesthesiol 2007. [DOI: 10.4097/kjae.2007.52.1.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- Il-Ok Lee
- Department of Anesthesiology and Pain Medicine, College of Medicine, Korea University, Seoul, Korea
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Lepousé C, Lautner CA, Liu L, Gomis P, Leon A. Emergence delirium in adults in the post-anaesthesia care unit. Br J Anaesth 2006; 96:747-53. [PMID: 16670111 DOI: 10.1093/bja/ael094] [Citation(s) in RCA: 205] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Emergence delirium in the post-anaesthesia care unit (PACU) is poorly understood. The goal of this prospective study was to determine frequency and risk factors of emergence delirium in adults after general anaesthesia. METHODS In this prospective study, 1,359 consecutive patients were included. Contextual risk factors and occurrence of delirium according to the Riker sedation scale were documented. Groups were defined for the analysis according to the occurrence or not of agitation, then after exclusion of patients with preoperative anxiety and neuroleptics, or both, and antidepressants or benzodiazepines treatments. RESULTS Sixty-four (4.7%) patients developed delirium in the PACU, which can go from thrashing to violent behaviour and removal of tubes and catheters. Preoperative anxiety was not found to be a risk factor. Preoperative medication by benzodiazepines (OR=1.910, 95% CI=1.101-3.315, P=0.021), breast surgery (OR=5.190, 95% CI=1.422-18.947, P=0.013), abdominal surgery (OR=3.206, 95% CI=1.262-8.143, P=0.014), and long duration of surgery increased the risk of delirium (OR=1.005, 95% CI=1.002-1.008, P=0.001), while a previous history of illness and long-term treatment by antidepressants decreased the risk (respectively, OR=0.544, 95% CI=0.315-0.939, P=0.029 and OR=0.245, 95% CI=0.084-0.710, P=0.010). CONCLUSIONS Preoperative benzodiazepines, breast and abdominal surgery and surgery of long duration are risk factors for emergence delirium.
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Affiliation(s)
- C Lepousé
- Department of Anaesthesiology and Intensive Care, Hôpital Robert Debré CHU Reims, REIMS Cedex, F-51092, France.
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Sakai EM, Connolly LA, Klauck JA. Inhalation Anesthesiology and Volatile Liquid Anesthetics: Focus on Isoflurane, Desflurane, and Sevoflurane. Pharmacotherapy 2005; 25:1773-88. [PMID: 16305297 DOI: 10.1592/phco.2005.25.12.1773] [Citation(s) in RCA: 77] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Clinical pharmacists rarely are involved in the selection and dosing of anesthetic agents. However, when practicing evidence-based medicine in a cost-conscious health care system, optimizing drug therapy is imperative in all areas. Thus, we provide general information on anesthesiology, including the different types of breathing systems and the components of anesthesia machines. Modern inhalation anesthetics that are predominantly used in clinical practice include one gas--nitrous oxide--and new volatile liquid agents--isoflurane, desflurane, and sevoflurane. Desflurane and sevoflurane are the low-soluble inhalation anesthetics, and they offer some clinical advantages over isoflurane, such as fast induction and faster recovery with long procedures. However, efficient use of isoflurane can match the speed of induction and recovery of the other agents in certain cases. In addition, the patient characteristics, duration and type of procedure, type of breathing system, and efficiency in monitoring must be considered when selecting the most optimal therapy for each patient. Maximizing the clinical advantages of these agents while minimizing the waste of an institution's operating room and pharmacy budget requires an understanding of the characteristics, pharmacokinetics, and pharmacodynamics of these anesthetic agents and the collaborated effort from both the anesthesia and pharmacy departments. An anesthetic agent algorithm is provided as a sample decision-process tree for selecting among isoflurane, desflurane, and sevoflurane.
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Affiliation(s)
- Eileen M Sakai
- Department of Pharmacy, Froedtert Memorial Lutheran Hospital, and the Department of Anesthesiology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.
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24
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Hamilton NM. Intravenous drugs in anaesthesia. Expert Opin Ther Pat 2005. [DOI: 10.1517/13543776.7.11.1321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Abstract
Sevoflurane has rapidly replaced halothane as the inhaled anesthetic agent of choice for the pediatric population. Benefits of sevoflurane use include a quick induction and emergence from anesthesia, a nonpungent odor, which allows for mask induction, and decreased airway irritation, which results in a decrease in the incidence of bronchospasm and laryngospasm. Despite the positive aspects of sevoflurane, there are several side effects, including seizures during induction and maintenance, elevations in plasma inorganic fluoride and compound A concentrations, and an increased incidence of emergence delirium when compared to halothane. The purpose of this article is to inform perianesthesia nurses of the common complication of emergence behavioral changes associated with sevoflurane.
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Affiliation(s)
- Daniel D Moos
- Kearney Anesthesia Associates, PC, 4615 Avenue F, Kearney, NE 68847, USA.
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Almeida DE, Rezende ML, Nunes N, Laus JL. Evaluation of intraocular pressure in association with cardiovascular parameters in normocapnic dogs anesthetized with sevoflurane and desflurane. Vet Ophthalmol 2004; 7:265-9. [PMID: 15200623 DOI: 10.1111/j.1463-5224.2004.04041.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The objective of this study was to determine intraocular pressure (IOP) and cardiac changes in normocapnic dogs maintained under controlled ventilation and anesthetized using sevoflurane or desflurane. Sixteen healthy adult mixed-breed dogs, seven males and nine females, weighing 10-15 kg were used. The dogs were randomly assigned to one of two groups composed of eight animals anesthetized with sevoflurane (SEVO) or desflurane (DESF). In both groups, anesthesia was induced with propofol (10 mg/kg), and neuromuscular blockade was achieved with rocuronium (0.6 mg/kg/h i.v.). No premedication was given. Ventilation was adjusted to maintain end-tidal carbon dioxide partial pressure at 35 mmHg. Anesthesia was maintained with 1.5 minimum alveolar concentration (MAC) of sevoflurane or desflurane. In both groups IOP was measured by applanation tonometry (Tono-Pen) before induction of anesthesia. IOP, mean arterial pressure (MAP), heart rate (HR), cardiac index (CI) and central venous pressure (CVP) were also measured 45 min after the beginning of inhalant anesthesia and then every 20 min for 60 min. A one-way repeated measures anova was used to compare data within the same group and Student's t-test was used to assess differences between groups. P < 0.05 was considered statistically significant. Measurements showed normal IOP values in both groups, even though IOP increased significantly from baseline during the use of desflurane. IOP did not differ between groups. CI in the desflurane group was significantly greater than in the sevoflurane group. Sevoflurane and desflurane have no clinically significant effects on IOP, MAP, HR, CI or VCP in the dog.
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Affiliation(s)
- D E Almeida
- Veterinary Surgery Program, São Paulo State University, Jaboticabal, Sao Paulo, Brazil
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Ting CK, Hu JS, Teng YH, Chang YY, Tsou MY, Tsai SK. Desflurane accelerates patient response during the wake-up test for scoliosis surgery. Can J Anaesth 2004; 51:393-7. [PMID: 15064271 DOI: 10.1007/bf03018246] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
PURPOSE To evaluate if desflurane possesses a shorter wake-up onset time and less incidence of recall than fentanyl-based anesthesia. METHODS Forty ASA class I-II adolescents, were enrolled into either a desflurane (DES) group, or a fentanyl (FEN) group for scoliosis surgery. Bispectral index (BIS) was monitored continuously in all patients throughout the procedure; the relationship between the wake-up time and BIS value was evaluated. RESULTS Patients in the DES group had a significantly shorter wake-up onset than patients in the FEN group (4.1 +/- 0.6 vs 8.9 +/- 2.1 min, P < 0.01). No recall occurred during the wake-up test in the DES group, while five patients had recall in the FEN group, including two patients who recalled a given colour. Extubation time was significantly shorter in the DES group than in the FEN group (7.2 +/- 0.6 vs 16 +/- 11.9 min, P < 0.01). BIS values were significantly higher in the FEN group than in the DES group during anesthesia. (62 +/- 4.5 vs 42 +/- 5.3, P < 0.05) BIS after the wake-up test was similar in both groups (90 +/- 2.9 vs 93.8 +/- 2.5). There was a latency period (3.3 +/- 1.2 min) between the maximal BIS value and wake-up time in the FEN group but not in the DES group. CONCLUSIONS DES provides a significantly shorter onset time during the wake-up test and a rapid emergence after scoliosis surgery. BIS monitoring during the wake-up test was more informative when anesthesia was maintained with DES compared to FEN infusion.
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Affiliation(s)
- Chien-Kun Ting
- Department of Anesthesiology, Veterans General Hospital-Taipei, School of Medicine, National Yang-Ming University, Taipei, Taiwan
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Cravero JP, Beach M, Thyr B, Whalen K. The effect of small dose fentanyl on the emergence characteristics of pediatric patients after sevoflurane anesthesia without surgery. Anesth Analg 2003; 97:364-367. [PMID: 12873918 DOI: 10.1213/01.ane.0000070227.78670.43] [Citation(s) in RCA: 105] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
UNLABELLED We designed this study to measure the effect of a small dose of IV fentanyl on the emergence characteristics of pediatric patients undergoing sevoflurane anesthesia without any surgical intervention. Thirty-two ASA physical status I or II pediatric outpatients receiving sevoflurane anesthesia for magnetic resonance imaging scans were enrolled and assigned in a random and double-blinded manner to receive either placebo (saline) or 1 micro g/kg IV fentanyl 10 min before discontinuation of their anesthetic. The primary outcome measure was the percentage of patients with emergence agitation. We also evaluated the duration of agitation and time to meet hospital discharge criteria. Patients who received fentanyl had a decreased incidence of agitation (12% versus 56%) when compared with placebo. There was no significant difference in time to meet hospital discharge criteria. We conclude that the addition of a small dose of fentanyl to inhaled sevoflurane anesthesia decreases the incidence of emergence agitation independent of pain control effects. IMPLICATIONS The addition of a small dose of fentanyl given to patients undergoing nonsurgical sevoflurane anesthesia resulted in a significant decrease in emergence agitation in a prospective, randomized, and controlled trial involving pediatric patients.
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Affiliation(s)
- Joseph P Cravero
- Department of Anesthesiology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
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Dogru K, Dalgic H, Yildiz K, Sezer Z, Madenoglu H. The direct depressant effects of desflurane and sevoflurane on spontaneous contractions of isolated gravid rat myometrium. Int J Obstet Anesth 2003; 12:74-8. [PMID: 15321491 DOI: 10.1016/s0959-289x(03)00010-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Our purpose was to investigate the direct depressant effects of desflurane and sevoflurane at 0.5, 1 and 2 minimum alveolar concentrations (MAC) on spontaneous contractions of isolated gravid rat myometrium. Ten gravid, albino Wistar rats, weighing 240-310 g and at 19-20 days' gestation were used. Sixty myometrial strips were obtained from 10 rats, and randomly assigned into six groups of 10. After obtaining spontaneous myometrial contractions in de Jalon solution for 45 min, 0.5, 1 or 2 MAC of desflurane or sevoflurane were continuously bubbled in the bath for 15 min and myometrial contractions evaluated during the last 10 min. Desflurane 0.5 MAC did not affect duration or amplitude of spontaneous contractions, but frequency was significantly decreased (P < 0.05). Duration, amplitude and frequency were all significantly decreased by desflurane 1 and 2 MAC (P < 0.05). Sevoflurane did not affect duration, amplitude or frequency at 0.5 MAC, but amplitude and frequency were significantly decreased at 1 MAC and all were significantly decreased at 2 MAC (P < 0.05). The frequency of contractions was decreased 21.2% with 1 MAC desflurane versus 17.1% with 1 MAC sevoflurane. The amplitude and frequency of contractions were decreased 48.2% and 48.7% with 2 MAC desflurane versus 58.9% and 49.3% with 2 MAC sevoflurane, respectively. We suggest that due to tocolytic activity, desflurane and sevoflurane can be useful in non-obstetric surgery during pregnancy.
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Affiliation(s)
- K Dogru
- Department of Anesthesiology, Erciyes University School of Medicine, Kayseri, Turkey.
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Cravero JP, Beach M, Dodge CP, Whalen K. Emergence characteristics of sevoflurane compared to halothane in pediatric patients undergoing bilateral pressure equalization tube insertion. J Clin Anesth 2000; 12:397-401. [PMID: 11025242 DOI: 10.1016/s0952-8180(00)00180-x] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
STUDY OBJECTIVE To compare the emergence characteristics of sevoflurane with halothane in pediatric patients having bilateral myringotomy and pressure equalization tube insertion using a highly standardized and common anesthetic technique. DESIGN Prospective, randomized, double-blind study. SETTING University hospital. PATIENTS 43 ASA physical status I and II healthy pediatric outpatients scheduled for initial ear tube placement by one surgeon. INTERVENTIONS Patients were randomized to receive either halothane or sevoflurane as their sole anesthetic drug for ear tube insertion. All patients as well as the research nurse grading emergence agitation were blinded to group assignment. No premedication was administered, and all patients received a standard dose of rectal acetaminophen for postoperative pain control. MEASUREMENT AND MAIN RESULTS The primary outcome was the percentage of patients with emergence agitation, defined as thrashing behavior requiring physical restraint for greater than three minutes. Time to discharge from the postanesthesia care unit (PACU) and from the hospital were also compared. Sevoflurane patients had a greater incidence of emergence delirium: 57% versus 27% [95% CI (1.7%-58.1%) p = 0.047]. Time to discharge from the PACU and the hospital were longer for patients who received sevoflurane: 62 versus 50 min [95% CI (1.4-23.6) p = 0.02] and 102 versus 79 mins [95% CI (9.6-37.1) p = 0.003]. CONCLUSION In our institution there is a trend toward greater emergence agitation in ear tube placement patients given sevoflurane versus halothane anesthesia. Further, (with our discharge criteria) patients are actually discharged from the PACU and the hospital faster when given halothane as a sole anesthetic when compared to sevoflurane.
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Affiliation(s)
- J P Cravero
- Dartmouth Hitchcock Medical Center, Department of Anesthesia, Lebanon, NH 03756, USA
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Lloyd AJ, Boyle J, Bell PR, Thompson MM. Comparison of cognitive function and quality of life after endovascular or conventional aortic aneurysm repair. Br J Surg 2000; 87:443-7. [PMID: 10759740 DOI: 10.1046/j.1365-2168.2000.01428.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
INTRODUCTION The long-term effects of endovascular aortic aneurysm repair on cognitive function and quality of life are not known. METHODS The cognitive function and quality of life of 82 patients undergoing aortic aneurysm repair (34 endovascular and 48 conventional procedures) were assessed before and 6 months after operation. Cognitive function was quantified using a battery of psychometric tests. Quality of life was assessed with the Medical Outcomes Short Form 36 (SF-36) questionnaire. RESULTS Data at 6 months were available for 78 per cent of patients. As a group the patients showed a significant decline on one cognitive function test (visual search) and on two domains of the SF-36 (physical function and vitality) when they were reassessed. There were no significant differences between patients undergoing endovascular or conventional aneurysm repair after 6 months in cognitive function or quality of life. CONCLUSION Endovascular aneurysm surgery had a similar impact on health-related quality of life and cognitive function compared with conventional aneurysm repair. Patients in both groups demonstrated a significant decline in cognitive function.
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Affiliation(s)
- A J Lloyd
- Oxford Centre for Health Care Research and Development, Oxford Brookes University, Oxford and Department of Surgery, Leicester University, Leicester, UK
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Affiliation(s)
- A J Fox
- University Department of Anaesthesia, University of Leicester, Leicester Royal Infirmary, Leicester LE1 5WW
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Sun R, Watcha MF, White PF, Skrivanek GD, Griffin JD, Stool L, Murphy MT. A Cost Comparison of Methohexital and Propofol for Ambulatory Anesthesia. Anesth Analg 1999. [DOI: 10.1213/00000539-199908000-00012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Sun R, Watcha MF, White PF, Skrivanek GD, Griffin JD, Stool L, Murphy MT. A cost comparison of methohexital and propofol for ambulatory anesthesia. Anesth Analg 1999; 89:311-6. [PMID: 10439739 DOI: 10.1097/00000539-199908000-00012] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
UNLABELLED Methohexital is eliminated more rapidly than thiopental, and early recovery compares favorably with propofol. We designed this study to evaluate the recovery profile when methohexital was used as an alternative to propofol for the induction of anesthesia before either sevoflurane or desflurane in combination with nitrous oxide. One hundred twenty patients were assigned randomly to one of four anesthetic groups: (I) methohexital-desflurane, (II) methohexital-sevoflurane, (III) propofol-desflurane, or (IV) propofol-sevoflurane. Recovery times after the anesthetic drugs, as well as the perioperative side effect profiles, were similar in all four groups. A cost-minimization analysis revealed that methohexital was less costly for the induction of anesthesia. At the fresh gas flow rates used during this study, the costs of the volatile anesthetics for maintenance of anesthesia did not differ among the four groups. However, at low flow rates (< or = 1 L/min), the methohexital-desflurane group would have been the least expensive anesthetic technique. In conclusion, methohexital is a cost-effective alternative to propofol for the induction of anesthesia in the ambulatory setting. At low fresh gas flow rates, the methohexital-desflurane combination was the most cost-effective for the induction and maintenance of general anesthesia. IMPLICATIONS Using methohexital as an alternative to propofol for the induction of anesthesia for ambulatory surgery seems to reduce drug costs. When fresh gas flow rates < or = 1 L/min are used, the combination of methohexital for the induction and desflurane for maintenance may be the most cost-effective general anesthetic technique for ambulatory surgery.
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Affiliation(s)
- R Sun
- Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Dallas 75235-9068, USA
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Abstract
The chemical and pharmacological properties of the current fluorinated inhalation anaesthetics, halothane, enflurane, isoflurane, sevoflurane and desflurane, are surveyed with implications to toxicity. Analytical methods, especially gas chromatography with head space, purge and trap, or pulse heating extraction, are reviewed in forensic toxicological and occupational/therapeutic monitoring contexts.
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Affiliation(s)
- K Pihlainen
- Department of Chemistry, University of Helsinki, Finland
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