Hemodynamic Stability, Patient Acceptance and Cost of Intravenous Propofol and Inhalational Sevoflurane for Induction of Anaesthesia: A Prospective, Randomized Comparative Study

Comparison of Recovery Effect for Sufentanil vs. Remifentanil Anesthesia in Elderly Patients Undergoing Curative Resection for Hepatocellular Carcinoma

INTRODUCTION

The aim of this work is to evaluate the clinical efficacy and safety of sufentanil vs. remifentanil anesthesia in elderly patients undergoing curative resection for hepatocellular carcinoma (HCC).

METHODS

Medical records of elderly patients aged ≥ 65 years who received curative resection for HCC between January 2017 and December 2020 were retrospectively reviewed. The patients were divided into either the sufentanil group or the remifentanil group according to the method of analgesia used. Vital signs including mean arterial pressure (MAP), heart rate (HR), and arterial oxygen saturation (SpO2), distribution of T-cell subsets (CD3, CD4, and CD8 lymphocytes), distribution of the stress response index [cortisol (COR), interleukin (IL)-6, C-reactive protein (CRP), and glucose (GLU)] were recorded prior to anesthesia (T0), after induction of anesthesia (T1), at the end of surgery (T2), 24 h after surgery (T3), and 72 h after surgery (T4). Postoperative adverse events were collected.

RESULTS

Repeated measure analysis of variance (ANOVA) showed that after controlling for baseline patient demographic and treatment characteristics as covariates, both between- and within-group effects were significant (all P < 0.01), and the interaction between time and treatments was also significant (all P < 0.01) in the vital signs (MAP, HR, and SpO2), distribution of T-cell subsets (CD3, CD4, and CD8 lymphocytes), and distribution of the stress response index (COR, IL-6, CRP, and GLU), indicating that sufentanil led to stable hemodynamic and respiratory functions, lower reduction of T-lymphocyte subsets, and stable stress response indices compared to remifentanil. There is no significant difference in adverse reactions between the two groups (P = 0.72).

CONCLUSIONS

Sufentanil was associated with improved hemodynamic and respiratory function, less stress response, less inhibition of cellular immunity, and similar adverse reactions compared with remifentanil.

Comparative analysis of anesthesia and clinical efficacy of inhalation anesthesia and intravenous anesthesia in Trigeminal Nerve Balloon Avulsion

Objective

To observe the anesthesia and clinical efficacy of inhalation anesthesia and intravenous anesthesia in patients with trigeminal neuralgia undergoing surgery.

Methods

This is a retrospective study. Eighty patients with trigeminal neuralgia admitted to the Affiliated Hospital of Beihua University from July 2018 to July 2021 were selected and divided into two groups according to different anesthesia methods: inhalation group and intravenous group, with 40 cases in each group. Patients in the inhalation group were given inhalation anesthesia with sevoflurane, while those in the intravenous group were given intravenous anesthesia. Hemodynamics, intubation and extubation time, postoperative consciousness recovery, adverse reactions and clinical effects of surgery were compared between the two groups during anesthesia.

Results

During the induction of anesthesia, after induction and after surgery, the levels of hemodynamic parameters in the two groups increased compared with those before induction of anesthesia, and the increase in the inhalation group was smaller (P<0.05). Patients in the inhalation group had a long time from anesthesia to endotracheal intubation but had a short time from completion of surgery to intubation, which was statistically significant compared with the intravenous group (P<0.05). Compared with the intravenous group, the postoperative consciousness recovery time of the inhalation group was significantly shorter and the incidence of adverse reactions was significantly lower (P<0.05).

Conclusion

Inhalation anesthesia with sevoflurane is more effective than intravenous anesthesia in trigeminal neuralgia patients treated with trigeminal nerve balloon avulsion, boasting satisfactory safety, less impact on hemodynamics, and shorter recovery time of consciousness.

Propofol/Fentanyl/Rocuronium or Sevoflurane Inhalational Induction for Intubation?

Introduction

Anesthesia induction and airway instrumentation are critical parts of anesthesia administration. Intravenous induction is time convenient but necessitates immediate commencement of ventilation. Inhalational sevoflurane induction takes longer but preserves spontaneous respiration. The primary aim of this study is to evaluate the intubation quality features achieved by sevoflurane as the sole induction agent compared with the standard intravenous induction, involving the use of muscle relaxants.

Methods

Sixty patients were randomly allocated into two groups: the Inhalational Vital Capacity Induction With Sevoflurane (IVCIS) group (n = 30) in which patients were intubated after sevoflurane inhalational anesthesia with the vital capacity technique and the Standard Intravenous Induction With Propofol, Fentanyl, and Rocuronium (SIPFR) group (n = 30) after propofol 1.5 mg/kg, fentanyl 2 μg/kg, and rocuronium 0.5 mg/kg administration intravenously. Group IVCIS patients were intubated when bispectral index (BIS) < 60 and end-expiratory sevoflurane ≥ 2 minimum alveolar concentration for > eight minutes. Scoring systems were used to evaluate induction and intubation conditions. The Statistical Package for the Social Sciences (SPSS) software version 25.0 (IBM Corp., Armonk, NY) was used for data analysis.

Results

Intubating and induction conditions were of equal quality in both groups. Sevoflurane induction duration was markedly prolonged. Heart rate was higher in IVCIS group patients throughout the induction, especially during laryngoscopy. Less blood pressure fluctuations were recorded in IVCIS group patients.

Conclusions

Inhalational vital capacity induction with sevoflurane provided acceptable intubating conditions and exhibited a safe hemodynamic profile, albeit the duration was more than 12 minutes.

Comparison of vital capacity rapid inhalation and tidal ventilation induction with sevoflurane in adults: a prospective cohort study

Vital capacity rapid inhalation induction (VCRII) results in faster achievement of desired minimum alveolar concentration while reducing the incidence of excitatory phenomenon compared to conventional incremental technique. This study aimed to determine whether the VCRII can achieve faster induction of anesthesia in adults compared to the traditional tidal ventilation (TV) technique. Following the approval from the Institutional Ethics Committee, Amala Institute of Medical Sciences, with an approval No. AIMSIEC/07/2017, on July 1, 2017, 51 adults belonging to American Society of Anesthesiologists physical status I–II, undergoing elective surgery at a tertiary care teaching hospital were prospectively assigned to two groups: 25 in VCRII (38.3 ± 13.3 years old, 20 (80%) females) and 26 in TV inhalation induction (35.2 ± 11.9 years old, 17 (65%) females) using 8% sevoflurane in 66% nitrous oxide. The induction time, such as time (in seconds) to the cessation of voluntary finger tapping, time to loss of eyelash reflex, time to return of regular breathing, the return of conjugate gaze, was measured. The primary outcome was time to induction as defined by time to loss of eyelash reflex. Hemodynamic effects of both methods were compared at baseline and 1, 3, 5, 10, 15-minute intervals from induction. Induction was significantly faster in the VCRII group compared with the TV group in all the measured parameters. Hemodynamic parameters were comparable in both the groups. VCRII resulted in a faster induction time compared to the TV technique in adults.