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Goel N, Kaushal S, Dhiman D, Panda NK, Samra T. A Preliminary Feasibility Study on Hemodynamic Changes Following Feyh-Kastenbauer Retractor Insertion During Transoral Robotic Surgeries. Cureus 2023; 15:e38804. [PMID: 37303363 PMCID: PMC10250780 DOI: 10.7759/cureus.38804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/06/2023] [Indexed: 06/13/2023] Open
Abstract
Introduction Transoral robotic surgery (TORS) has become increasingly popular for the removal of pharyngeal and laryngeal cancers with the objective to improve functional and aesthetic outcomes. Feyh-Kastenbauer (FK) retractor is one such routinely used retractor during TORS. The setting up of this retractor has been seen to be accompanied by hemodynamic fluctuations. Methodology This prospective observational study was carried out on 30 patients undergoing TORS. All patients were administered general anesthesia using a pre-defined anesthesia protocol. The primary outcome was to compare hemodynamic fluctuations following endotracheal intubation with that after FK retractor insertion. Any requirement of a bolus dose of sevoflurane and fentanyl was recorded in response to hemodynamic fluctuations recorded in secondary outcomes. Results There was no statistically significant increase in mean heart rate, systolic, diastolic, and mean arterial blood pressure from baseline to endotracheal intubation and following retractor insertion (p=0.810, p=0.2, p=0.6, p=0.3 respectively). On subgroup analysis, hypertensive patients reported a greater rise in blood pressure following two minutes post FK retractor insertion compared to non-hypertensive patients (p=0.03). Out of 30 patients, five patients required a bolus dose of sevoflurane. Conclusion FK retractor insertion had a comparable hemodynamic response as endotracheal intubation during TORS. Hypertensive patients showed a rise in blood pressure at both endotracheal intubations and at FK retractor insertion.
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Affiliation(s)
- Nitika Goel
- Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, IND
| | - Sonali Kaushal
- Anaesthesia, Dr. Yashwant Singh (YS) Parmar Medical College and Hospital, Nahan, IND
| | - Deepanshu Dhiman
- Anaesthesia, Dr. Yashwant Singh (YS) Parmar Medical College and Hospital, Nahan, IND
| | - Naresh K Panda
- Otolaryngology, Postgraduate Institute of Medical Education and Research, Chandigarh, IND
| | - Tanvir Samra
- Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, IND
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Shi S, Gan L, Jin CN, Liu RF. Effects of propofol combined with lidocaine on hemodynamics, serum adrenocorticotropic hormone, interleukin-6, and cortisol in children. World J Clin Cases 2022; 10:8506-8513. [PMID: 36157832 PMCID: PMC9453372 DOI: 10.12998/wjcc.v10.i24.8506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 03/17/2022] [Accepted: 07/17/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Children are a unique patient population. Anesthesia for pediatric abdominal surgery has long been achieved mainly with intravenous amiodarone and propofol alone or combined with other anesthetics. The incidence of complications and postoperative adverse reactions is relatively high owing to the imperfect development of various protocols for children. Choosing the most appropriate anesthesia program is an important means of reducing adverse reactions.
AIM To explore the clinical value of propofol combined with lidocaine-assisted anesthesia in pediatric surgery.
METHODS A total of 120 children who underwent abdominal surgery at our hospital from January 2016 to March 2018 were selected and divided into groups A and B using the random number table method, with 60 patients in each group. Group B received ketamine for anesthesia, while group A received ketamine, propofol, and lidocaine. The pre- and postoperative heart rate (HR); mean arterial pressure (MAP); arterial oxygen saturation (SpO2); serum adrenocorticotropic hormone (ACTH), interleukin-6 (IL-6), and cortisol (Cor) levels; restlessness score during the recovery period [Paediatric Anesthesia Emergence Delirium Scale (PAED)]; and adverse reactions were compared between the two groups.
RESULTS The HR, MAP, and SpO2 Level at five minutes before initiating anesthesia were compared between groups A and B, and the difference was not statistically significant (P > 0.05). At 10 and 20 minutes after anesthesia initiation, the HR and MAP were lower in group A compared with group B (P < 0.05). The differences in preoperative serum ACTH, IL-6, and Cor levels between groups A and B were not statistically significant (P > 0.05); however, the postoperative serum ACTH, IL-6, and Cor levels in group A were lower compared with group B (P < 0.05). Furthermore, the visual analog scale scores of group A at 2 h and 8 h postoperative were lower than those in group B, and the differences were statistically significant (P < 0.05). The mean PAED score in group A was lower than that in group B (P < 0.05), and the incidence of restlessness in group A was 23.33% lower than that in group B (36.67 %) (P < 0.05). The incidence of adverse reactions was lower in group A than in group B (6.25% vs 16.25%).
CONCLUSION The anesthetic effect of propofol combined with lidocaine and ketamine in pediatric surgery was better than that of ketamine alone, and had less influence on hemodynamics and pediatric stress response indices, lower incidence of restlessness in the recovery period, and lower incidence of adverse reactions.
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Affiliation(s)
- Song Shi
- Department of Anesthesiology, Affiliated Hospital of Hebei University, Baoding 071000, Hebei Province, China
| | - Lu Gan
- Department of Anesthesiology, Affiliated Hospital of Hebei University, Baoding 071000, Hebei Province, China
| | - Chun-Nv Jin
- Department of Anesthesiology, Baoding Maternal and Child Health Hospital, Baoding 071000, Hebei Province, China
| | - Rong-Fang Liu
- Department of Anesthesiology, Affiliated Hospital of Hebei University, Baoding 071000, Hebei Province, China
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Shetabi H, Montazeri K, Ghoodjani Y. A Comparative Study of the Effect of Anesthesia Induction with the Use of Four Drug Combinations Including "Propofol," "Etomidate-Propofol," "Thiopental," and "Midazolam-Thiopental" on Hemodynamic Changes during the Insertion of Laryngeal Mask in Eye Surgery. Adv Biomed Res 2022; 11:11. [PMID: 35386541 PMCID: PMC8977609 DOI: 10.4103/abr.abr_152_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Revised: 08/25/2020] [Accepted: 10/27/2020] [Indexed: 11/09/2022] Open
Abstract
Background: This study aimed to compare the efficacies of four anesthetic induction drugs (thiopental, propofol, midazolam-thiopental, and etomidate-propofol) on cardiovascular response during laryngeal mask airway (LMA) placement in eye surgery. Materials and Methods: The present clinical trial study included 128 patients who were candidates for ophthalmic surgery in four groups. Patients in the first group were given a combination of midazolam (0.04 mg/kg) with thiopental (2.5 mg/kg) (Group T + M). We administered propofol alone (2.5 mg/kg) to patients in the second group (Group P). The third group received a combination of etomidate (0.1 mg/kg) with propofol (1 mg/kg) (ET + P group) and patients in the fourth group received thiopental drug (5 mg/kg) alone (Group T). Then, the stability of patients' hemodynamic parameters before anesthesia was evaluated and compared immediately after anesthesia, 1, 3, and 5 min after LMA placement. Results: There was no significant difference between the four groups in changes in oxygen saturation level (P > 0.05). Furthermore, the difference between decreased systolic blood pressure and diastolic blood pressure over time was not significant in 5 min in both Groups T + M and T (P > 0.05). In addition, the stability of these two groups was higher than the other two groups (P < 0.05) and the most unstable group was Group P. The changes pulse ratein the P group were significant (P < 0.05). Conclusion: According to the results of the current study, thiopental and Midazolam can be used as an effective induction compound to facilitate LMA insertion with higher hemodynamic stability compared to propofol alone, propofol and etomidate, and thiopental alone.
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Affiliation(s)
- Hamidreza Shetabi
- Department of Anesthesiology, School of Medicine, Anesthesiology and Critical Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Kamran Montazeri
- Department of Anesthesiology, School of Medicine, Anesthesiology and Critical Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Yalda Ghoodjani
- Department of Anesthesiology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
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4
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April MD, Arana A, Schauer SG, Davis WT, Oliver JJ, Fantegrossi A, Summers SM, Maddry JK, Walls RM, Brown CA. Ketamine Versus Etomidate and Peri-intubation Hypotension: A National Emergency Airway Registry Study. Acad Emerg Med 2020; 27:1106-1115. [PMID: 32592205 DOI: 10.1111/acem.14063] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Revised: 05/30/2020] [Accepted: 06/14/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND The hemodynamic impact of induction agents is a critically important consideration in emergency intubations. We assessed the relationship between peri-intubation hypotension and the use of ketamine versus etomidate as an induction agent for emergency department (ED) intubation. METHODS We analyzed ED intubation data for patients aged >14 years from the National Emergency Airway Registry performed in 25 EDs during 2016 through 2018. We excluded patients with preintubation hypotension (systolic blood pressure <100 mm Hg) or cardiac arrest prior to intubation. The primary outcome was peri-intubation hypotension. Secondary outcomes included interventions for hypotension (e.g., intravenous fluids or vasopressors). We report adjusted odds ratios (aOR) from multivariable logistic regression models controlling for patient demographics, difficult airway characteristics, and intubation modality. RESULTS There were 738 encounters with ketamine and 6,068 with etomidate. Patients receiving ketamine were more likely to have difficult airway characteristics (effect size difference = 8.8%, 95% confidence interval [CI] = 5.3% to 12.4%) and to undergo intubation with video laryngoscopy (8.1%, 95% CI = 4.4% to 12.0%). Peri-intubation hypotension incidence was 18.3% among patients receiving ketamine and 12.4% among patients receiving etomidate (effect size difference = 5.9%, 95% CI = 2.9% to 8.8%). Patients receiving ketamine were more likely to receive treatment for peri-intubation hypotension (effect size difference = 6.5%, 95% CI = 3.9% to 9.3%). In logistic regression analyses, patients receiving ketamine remained at higher risk for peri-intubation hypotension (aOR = 1.4, 95% CI = 1.2 to 1.7) and treatment for hypotension (aOR = 1.8, 95% CI = 1.4 to 2.0). There was no difference in the aOR of hypotension between patients receiving ketamine at doses ≤1.0 mg/kg versus >1.0 mg/kg or patients receiving etomidate at doses ≤0.3 mg/kg versus >0.3 mg/kg. CONCLUSIONS Pending additional data, our results suggest that clinicians should not necessarily prioritize ketamine over etomidate based on concern for hemodynamic compromise among ED patients undergoing intubation.
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Affiliation(s)
- Michael D. April
- From the 4th Infantry Division 2nd Brigade Combat Team Fort Carson CO USA
- the Department of Military and Emergency Medicine Uniformed Services University of the Health Sciences Bethesda MD USA
| | - Allyson Arana
- the United States Army Institute of Surgical Research San Antonio TX USA
| | - Steven G. Schauer
- the Department of Military and Emergency Medicine Uniformed Services University of the Health Sciences Bethesda MD USA
- the United States Army Institute of Surgical Research San Antonio TX USA
- the Department of Emergency Medicine San Antonio Military Medical Center San Antonio TX USA
| | - William T. Davis
- the Department of Military and Emergency Medicine Uniformed Services University of the Health Sciences Bethesda MD USA
- the Department of Emergency Medicine San Antonio Military Medical Center San Antonio TX USA
| | - Joshua J. Oliver
- the Department of Military and Emergency Medicine Uniformed Services University of the Health Sciences Bethesda MD USA
- the Department of Emergency Medicine San Antonio Military Medical Center San Antonio TX USA
| | - Andrea Fantegrossi
- the Department of Emergency Medicine Brigham and Women's Hospital and Harvard Medical School Boston MA USA
| | - Shane M. Summers
- the Department of Military and Emergency Medicine Uniformed Services University of the Health Sciences Bethesda MD USA
- and the Department of Emergency Medicine Ryder Trauma Center Miami FL USA
| | - Joseph K. Maddry
- the Department of Military and Emergency Medicine Uniformed Services University of the Health Sciences Bethesda MD USA
- the United States Army Institute of Surgical Research San Antonio TX USA
- the Department of Emergency Medicine San Antonio Military Medical Center San Antonio TX USA
| | - Ron M. Walls
- the Department of Emergency Medicine Brigham and Women's Hospital and Harvard Medical School Boston MA USA
| | - Calvin A. Brown
- the Department of Emergency Medicine Brigham and Women's Hospital and Harvard Medical School Boston MA USA
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5
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Kumar N, Rajan S, Kumar L. Efficacy of Ketofol in Blunting Hypotensive Effects of Propofol during Induction and Its Effect on Intraoperative Anesthetic Requirements and Recovery Profile. Anesth Essays Res 2020; 14:605-610. [PMID: 34349328 PMCID: PMC8294425 DOI: 10.4103/aer.aer_27_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 03/09/2021] [Accepted: 03/10/2021] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Major disadvantage of propofol is dose-dependent hypotension. AIM OF THE STUDY The aim of the study was comparison of changes in heart rate (HR) and mean arterial pressure (MAP) after induction with propofol versus ketofol (a combination of ketamine and propofol). SETTINGS AND DESIGN This was a prospective randomized study conducted in a tertiary care institute. SUBJECTS AND METHODS Sixty patients were recruited. Group A patients were induced with 1.5-2.5 mg.kg-1 propofol. In Group B, ketamine 1 mg.kg-1 was given intravenously followed by propofol 1-2 mg.kg-1. All patients received standardized intraoperative management. STATISTICAL TESTS USED Chi-square test, independent sample t-test, and paired t-test were used for statistical analysis. RESULTS Baseline HR and HR immediately after induction were comparable in both groups. There was a significant decrease in mean HR at 3 min postinduction in Group A compared to Group B (65.7 ± 5.4 vs. 80.8 ± 12.4). At 1 min postintubation, there was a significant rise in HR in Group A (103.5 ± 12.4 vs. 84.8 ± 9.5). HR remained comparable in both groups at other timelines. Baseline MAP was comparable between groups. Mean MAP in Group A was significantly lower than Group B immediately after induction and at 3 min postinduction. MAP was significantly higher in Group A at 1 min postintubation and remained comparable at other time points. The incidence of hypotension was significantly higher in Group A compared to Group B. CONCLUSION Combining ketamine 1 mg.kg-1 to propofol blunted hypotensive and bradycardic effects of propofol. Ketofol effectively attenuated hemodynamic responses to intubation and was associated with reduced intraoperative opioid consumption with no added risks of excessive postoperative sedation or emergence delirium.
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Affiliation(s)
- Niranjan Kumar
- Department of Anaesthesiology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
| | - Sunil Rajan
- Department of Anaesthesiology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
| | - Lakshmi Kumar
- Department of Anaesthesiology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
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6
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Elvir-Lazo OL, White PF, Yumul R, Cruz Eng H. Management strategies for the treatment and prevention of postoperative/postdischarge nausea and vomiting: an updated review. F1000Res 2020; 9. [PMID: 32913634 PMCID: PMC7429924 DOI: 10.12688/f1000research.21832.1] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/04/2020] [Indexed: 01/10/2023] Open
Abstract
Postoperative nausea and vomiting (PONV) and postdischarge nausea and vomiting (PDNV) remain common and distressing complications following surgery. The routine use of opioid analgesics for perioperative pain management is a major contributing factor to both PONV and PDNV after surgery. PONV and PDNV can delay discharge from the hospital or surgicenter, delay the return to normal activities of daily living after discharge home, and increase medical costs. The high incidence of PONV and PDNV has persisted despite the introduction of many new antiemetic drugs (and more aggressive use of antiemetic prophylaxis) over the last two decades as a result of growth in minimally invasive ambulatory surgery and the increased emphasis on earlier mobilization and discharge after both minor and major surgical procedures (e.g. enhanced recovery protocols). Pharmacologic management of PONV should be tailored to the patient’s risk level using the validated PONV and PDNV risk-scoring systems to encourage cost-effective practices and minimize the potential for adverse side effects due to drug interactions in the perioperative period. A combination of prophylactic antiemetic drugs with different mechanisms of action should be administered to patients with moderate to high risk of developing PONV. In addition to utilizing prophylactic antiemetic drugs, the management of perioperative pain using opioid-sparing multimodal analgesic techniques is critically important for achieving an enhanced recovery after surgery. In conclusion, the utilization of strategies to reduce the baseline risk of PONV (e.g. adequate hydration and the use of nonpharmacologic antiemetic and opioid-sparing analgesic techniques) and implementing multimodal antiemetic and analgesic regimens will reduce the likelihood of patients developing PONV and PDNV after surgery.
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Affiliation(s)
| | - Paul F White
- Department of Anesthesiology, Cedars-Sinai Medical Center, Los Angeles, CA, 90048, USA.,The White Mountain Institute, The Sea Ranch, Sonoma, CA, 95497, USA.,Instituto Ortopedico Rizzoli, University of Bologna, Bologna, Italy
| | - Roya Yumul
- Department of Anesthesiology, Cedars-Sinai Medical Center, Los Angeles, CA, 90048, USA.,David Geffen School of Medicine-UCLA, Charles R. Drew University of Medicine and Science, Los Angeles, CA, 90095, USA
| | - Hillenn Cruz Eng
- Department of Anesthesiology, PennState Hershey Medical Center, Hershey, PA, 17033, USA
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7
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Wu X, Li X, Xu G. Propofol suppresses the progression of non‑small cell lung cancer via downregulation of the miR‑21‑5p/MAPK10 axis. Oncol Rep 2020; 44:487-498. [PMID: 32468043 PMCID: PMC7336515 DOI: 10.3892/or.2020.7619] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 04/16/2020] [Indexed: 12/16/2022] Open
Abstract
Non‑small cell lung cancer (NSCLC) accounts for >80% of lung cancer cases and is the leading cause of cancer‑associated mortality worldwide. Propofol is an anesthetic drug frequently used during tumor resection. It is also known to exert inhibitory effects on cancer. Although the role of propofol in NSCLC has been reported, its underlying mechanisms remain unknown. The present study aimed therefore to investigate the mechanisms of propofol action on NSCLC. Starbase V3.0 project was used to analyze the expression levels of microRNA‑21‑5p (miR‑21‑5p) and mitogen‑activated protein kinase 10 (MAPK10) in NSCLC and adjacent normal tissues from patients with NSCLC and the association between miR‑21‑5p and MAPK10 expression level in NSCLC tissues. The correlation between MAPK10 expression and disease‑free survival (DFS) in patients with NSCLC was analyzed using GEPIA software version 1.0. miR‑21‑5p and MAPK10 expression in tumor and adjacent normal tissues from patients with NSCLC was evaluated by reverse transcription‑quantitative (RT‑q) PCR and western blotting. Cell viability and apoptosis were assessed by using Cell Counting Kit‑8 assay and flow cytometry, respectively. The interaction between miR‑21‑5p and MAPK10 was predicted by TargetScan/miRanda and verified by dual luciferase assay. The regulatory effect of propofol on miR‑21‑5p and MAPK10 expression in NSCLC cell lines was examined by RT‑qPCR and western blotting. Starbase V3.0 project and the results of the present study indicated that tumor tissues presented a significantly lower MAPK10 level and a higher miR‑21‑5p level compared with the normal samples, and that miR‑21‑5p expression was negatively correlated with MAPK10 expression in the tumor tissues of patients with NSCLC. Furthermore, miR‑21‑5p targeted the 3'‑untranslated region of MAPK10. In addition, compared with BEAS‑2B cells, a higher miR‑21‑5p and a lower MAPK10 expression was observed in the NSCLC cell lines A549 and H1299, which was reversed by propofol. The overexpression of miR‑21‑5p abrogated the effects of propofol on A549 and H1299 cell viability and apoptosis by targeting MAPK10. Taken together, these findings demonstrated that propofol inhibited the viability and promoted the apoptosis of NSCLC cells by downregulating the miR‑21‑5p/MAPK10 axis.
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Affiliation(s)
- Xinhua Wu
- Department of Anesthesiology, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi 830001, Xinjiang UygurAutonomous Region, P.R.China
| | - Xuebin Li
- Department of Anesthesiology, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi 830001, Xinjiang UygurAutonomous Region, P.R.China
| | - Guiping Xu
- Department of Anesthesiology, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi 830001, Xinjiang UygurAutonomous Region, P.R.China
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Hu Y, Yang XY, Zhang JH. Etomidate plus fentanyl for anesthesia in pediatric strabotomy. Med Hypotheses 2020; 140:109666. [PMID: 32193044 DOI: 10.1016/j.mehy.2020.109666] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Revised: 02/29/2020] [Accepted: 03/05/2020] [Indexed: 12/25/2022]
Abstract
Considering the side effects of etomidate, it requires additional anesthetics to reduce the side effects and improve efficacy. Ketamine is often used as an adjunct anesthetic. We hypothesized that etomidate combined with fentanyl was more effective than etomidate combined with ketamine in the anesthesia of pediatric strabotomy. To prove our hypothesis, a prospective randomized controlled clinical study was performed, in which 35 children with strabotomy received etomidate plus ketamine (group A) for anesthesia induction and maintenance and 35 children with strabotomy received etomidate combined with fentanyl (group B). Mean arterial pressure (MAP), heart rate (HR), bispectral index (BIS), anesthesia effect, and emergence agitation and pain were observed before anesthesia induction (T1), after anesthesia induction (T2), at the beginning of the operation (T3), after 10-min operation (T4), and at the end of the operation (T5). Children in group B had significantly lower MAP and HR from T3 to T5, decreased BIS from T2 to T4, better anesthesia effect, and smaller emergence agitation and pain scores at 10 min after entering into postanesthesia care unit (PACU) compared with group A (p < 0.05). The mean emergence agitation score in group B was significantly lower than that in group A when the maximum emergence in group B was at 20 min after entering into PACU (p < 0.05). In conclusion, etomidate combined with fentanyl plays a good efficacy in anesthesia of pediatric strabotomy compared with etomidate plus ketamine.
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Affiliation(s)
- Y Hu
- Department of Outpatient, Maternal and Child Health Hospital of Panzhihua, Panzhihua, Sichuan Province, China.
| | - X Y Yang
- Department of Ophthalmology, The Affiliated Hospital of Panzhihua University, Panzhihua, Sichuan Province, China
| | - J H Zhang
- Department of Ophthalmology, The 19th Metallurgical Hospital of Panzhihua, Panzhihua, Sichuan Province, China
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Etomidate Is NOT a First-Line Induction Agent in Critically Ill Patients: Primum Non Nocere-Above All, Do No Harm. Crit Care Med 2019; 46:1495-1496. [PMID: 29923932 DOI: 10.1097/ccm.0000000000003291] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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10
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Liu KP, Wang BN, Shen YY, Li WX, Li Z, Yao L. [Effects of thoracic epidural administration of lidocaine on hemodynamic and arousal responses of double lumen tracheal intubation during induction of anesthesia]. JOURNAL OF PEKING UNIVERSITY. HEALTH SCIENCES 2019; 51:742-747. [PMID: 31420633 DOI: 10.19723/j.issn.1671-167x.2019.04.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To compare the effects of thoracic epidural administration of lidocaine on hemodynamic and arousal responses of double lumen tracheal intubation during induction of anesthesia. METHODS In the study, 40 patients with American Society of Anesthesiologists (ASA) physical statuses I-II, aged 19-66 years, scheduled for elective thoracic surgeries under general anesthesia requiring orotracheal intubation were allocated to either the double-lumen endobronchial intubation (T group) or double-lumen endobronchial intubation after epidural administration of lidocaine (E group). After an intravenous anesthetic induction, the orotracheal double-lumen intubation was performed using a Macintosh direct laryngoscopy (MDLS), respectively. Invasive blood pressure (BP), heart rate (HR) and bispectral index (BIS) were recorded before and after anesthetic induction, immediately after intubation and 5 minutes after intubation with 1-minute interval and the intubation time also noted. The rate pressure product (RPP) was calculated. RESULTS After anesthetic induction, BP and RPP in the two groups decreased significantly compared with their preinduction values. In comparison with their postinduction values, the orotracheal intubation in the two groups caused significant increases in BPs, HRs and RPP. In comparison with their preinduction values, BPs decreased significantly in E group, systolic blood pressure (SBP), diastolic blood pressure (DBP) and mean arterial pressure (MAP) increased significantly and lasted for 1 min in T group. The HRs of both groups after intubation were significantly higher than their baseline values , and increased in HR and lasted for 1 min and 4 min in E group and T group, respectively. SBP, DBP, MAP, HR and RPP after intubation in T group were significantly higher than those of E group during the observation period. The values of BIS were similar between both the groups. In T group, the incidences of SBP percent increased>30% of the baseline value and RPP more than 22 000 were significantly higher than in E group. None of the patients in group E had SBP more than 130% of the baseline value and RPP more than 22 000. CONCLUSION During double-lumen endobronchial intubation, epidural administration of lidocaine can provide less hemodynamic response and similar arousal response.
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Affiliation(s)
- K P Liu
- Department of Anesthesiology, China-Japan Friendship Hospital, Beijing 100029, China.,Department of Anesthesiology, Peking University International Hospital, Beijing 102206, China
| | - B N Wang
- Department of Anesthesiology, Peking University International Hospital, Beijing 102206, China
| | - Y Y Shen
- Department of Anesthesiology, Peking University International Hospital, Beijing 102206, China
| | - W X Li
- Department of Anesthesiology, China-Japan Friendship Hospital, Beijing 100029, China
| | - Z Li
- Department of Anesthesiology, China-Japan Friendship Hospital, Beijing 100029, China
| | - L Yao
- Department of Anesthesiology, Peking University International Hospital, Beijing 102206, China
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11
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Liu H, Zhou X, Wang Y, Yang M, Xu X, Wu A. Mixed micelle as nanocarrier for etomidate: Development, in vitro characterizations, and in vivo study on toxicity and anesthetic effects. J Drug Deliv Sci Technol 2019. [DOI: 10.1016/j.jddst.2018.10.038] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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12
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Liu WZ, Liu N. Propofol Inhibits Lung Cancer A549 Cell Growth and Epithelial-Mesenchymal Transition Process by Upregulation of MicroRNA-1284. Oncol Res 2018; 27:1-8. [PMID: 29402342 PMCID: PMC7848461 DOI: 10.3727/096504018x15172738893959] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Propofol has been widely used in lung cancer resections. Some studies have demonstrated that the effects of propofol might be mediated by microRNAs (miRNAs). This study aimed to investigate the effects and mechanisms of propofol on lung cancer cells by regulation of miR-1284. A549 cells were treated with different concentrations of propofol, while transfected with miR-1284 inhibitor, si-FOXM1, and their negative controls. Cell viability, migration, and invasion, and the expression of miR-1284, FOXM1, and epithelial-mesenchymal transition (EMT) factors were detected by CCK-8, Transwell, qRT-PCR, and Western blot assays, respectively. In addition, the regulatory and binding relationships among propofol, miR-1284, and FOXM1 were assessed, respectively. Results showed that propofol suppressed A549 cell viability, migration, and invasion, upregulated E-cadherin, and downregulated N-cadherin, vimentin, and Snail expressions. Moreover, propofol significantly promoted the expression of miR-1284. miR-1284 suppression abolished propofol-induced decreases of cell viability, migration, and invasion, and increased FOXM1 expression and the luciferase activity of FOXM1-wt. Further, miR-1284 negatively regulated FOXM1 expression. FOXM1 knockdown reduced cell viability, migration, and invasion by propofol treatment plus miR-1284 suppression. In conclusion, our study indicated that propofol could inhibit cell viability, migration, invasion, and the EMT process in lung cancer cells by regulation of miR-1284.
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Affiliation(s)
- Wei-Zhen Liu
- Department of Anesthesia, Hunan Cancer Hospital and The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, P.R. China
| | - Nian Liu
- Department of Anesthesia, Hunan Cancer Hospital and The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, P.R. China
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Comparison of TIVA with different combinations of ketamine–propofol mixtures in pediatric patients. J Anesth 2017; 32:104-111. [DOI: 10.1007/s00540-017-2438-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Accepted: 12/04/2017] [Indexed: 02/06/2023]
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Baradari AG, Alipour A, Habibi MR, Rashidaei S, Zeydi AE. A randomized clinical trial comparing hemodynamic responses to ketamine-propofol combination (ketofol) versus etomidate during anesthesia induction in patients with left ventricular dysfunction undergoing coronary artery bypass graft surgery. Arch Med Sci 2017; 13:1102-1110. [PMID: 28883852 PMCID: PMC5575215 DOI: 10.5114/aoms.2016.63193] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Accepted: 08/06/2016] [Indexed: 01/14/2023] Open
Abstract
INTRODUCTION Anesthesia induction is often accompanied by a period of hemodynamic instability, which could be a significant problem in patients with compromised ventricular function. The aim of this study is to compare the hemodynamic responses to etomidate versus a combination of ketamine and propofol (ketofol) for anesthetic induction in patients with left ventricular dysfunction undergoing coronary artery bypass graft (CABG) surgery. MATERIAL AND METHODS In a double-blind randomized clinical study, a total of 84 patients with ischemic left ventricular dysfunction (EF < 40%) were randomly assigned to two groups (A and B). Patients in group A received etomidate 0.2 mg/kg and a placebo (normal saline); group B received a combination of ketamine (1 mg/kg) and propofol (1.5 mg/kg) at the induction of anesthesia. Two minutes after induction, hemodynamic variables, including systolic, diastolic, mean arterial pressure (SAP, DAP, MAP) and heart rate (HR), were measured immediately before and after the laryngoscopy, and before intubation and post-intubation at 1, 2, and 3 min. RESULTS The decrease in all hemodynamic parameters (SBP, DBP, MAP and HR) from induction time to laryngoscopy was greater in the ketofol group (group B) than in the etomidate group (group A) (p < 0.05). The ephedrine prescription rate due to hemodynamic changes was 24.4% (10 patients) and 5% (2 patients) in group B and group A, respectively (p = 0.03). CONCLUSIONS We found that etomidate provides superior hemodynamic stability as compared to ketofol in patients with left ventricular dysfunction undergoing CABG surgery under general anesthesia.
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Affiliation(s)
- Afshin Gholipour Baradari
- Department of Anesthesiology, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Abbas Alipour
- Department of Epidemiology, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Mohammad Reza Habibi
- Department of Anesthesiology, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Sajedeh Rashidaei
- Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Amir Emami Zeydi
- Department of Medical-Surgical Nursing, Faculty of Nursing and Midwifery, Mazandaran University of Medical Sciences, Sari, Iran
- Student Research Committee, Department of Medical-Surgical Nursing, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran
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Kılıc E, Demiriz B, Isıkay N, Yıldırım AE, Can S, Basmacı C. Alfentanil versus ketamine combined with propofol for sedation during upper gastrointestinal system endoscopy in morbidly obese patients. Saudi Med J 2017; 37:1191-1195. [PMID: 27761556 PMCID: PMC5303795 DOI: 10.15537/smj.2016.11.14557] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Objectives: To observe the effects of both propofol/alfentanil and propofol/ketamine on sedation during upper gastrointestinal system endoscopy in morbidly obese patients (UGSEMOP). Methods: In a prospective, double-blinded, randomized clinical study, 52 patients scheduled for UGSEMOP were assigned to either group A (n=26; 10 µg/kg intravenous [IV] alfentanil) or group K (n=26; 0.5 mg/kg IV ketamine). Each patient was administered 0.7 mg/kg propofol for induction. If it was needed, the patients were administered an additional dose of IV propofol. This study was performed in Sehitkamil State Hospital, Gaziantep, Turkey, between January 2014-2015. Total propofol consumption, time to achieve Modified Aldrete Scores (MAS) of 5 and 10 following the procedure, physician and patient satisfaction scores, and instances of side effects, such as bradycardia and hypotension were recorded. Results: Time to onset of sedation and duration of sedation were both significantly shorter in group A. Patients in group A also required less time to achieve an MAS of 5. Total propofol consumption was significantly lower in group A. Conclusion: Both propofol/alfentanil and propofol/ketamine combinations provided appropriate hypnosis and analgesia during UGSEMOP. However, propofol consumption was significantly higher using the propofol/ketamine combination.
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Affiliation(s)
- Ertugrul Kılıc
- Department of Anesthesiology, Şehitkamil State Hospital, Gaziantep, Turkey. E-mail.
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