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Yang L, Hubert J, Gitundu S, Brovman E, Cobey F. Carbon Footprint of Total Intravenous and Inhalation Anesthesia in the Transcatheter Aortic Valve Replacement Procedure. J Cardiothorac Vasc Anesth 2024; 38:1314-1321. [PMID: 38490897 DOI: 10.1053/j.jvca.2024.02.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 02/11/2024] [Accepted: 02/18/2024] [Indexed: 03/17/2024]
Abstract
OBJECTIVES To quantify and compare the emissions for deep sedation with total intravenous anesthesia (TIVA) and general anesthesia with inhaled agents during the transcatheter aortic valve replacement procedure. DESIGN A retrospective study. SETTING A tertiary hospital in Boston, Massachusetts. PARTICIPANTS The anesthesia records of 604 consecutive patients who underwent the transcatheter aortic valve replacement procedure between January 1, 2018, and March 31, 2022, were reviewed and analyzed. INTERVENTIONS Data were examined and compared in the following 2 groups: general anesthesia with inhaled agents and deep sedation with TIVA. MEASUREMENTS AND MAIN RESULTS The gases, drugs, airway management devices, and anesthesia machine electricity were collected and converted into carbon dioxide emissions (CO2e). The carbon emissions of intravenous medications were converted with the CO2e data for anesthetic pharmaceuticals from the Parvatker et al. study. For inhaled agents, inhaled anesthetics and oxygen/air flow rate were collected at 15-minute intervals and calculated using the anesthetic gases calculator provided by the Association of Anesthetists. The airway management devices were converted based on life-cycle assessments. The electricity consumed by the anesthesia machine during general anesthesia was estimated from the manufacturer's data (Dräger, GE) and local Energy Information Administration data. The data were analyzed in the chi-squared test or Wilcoxon rank-sum test. There were no significant differences in the patients' demographic characteristics, such as age, sex, weight, height, and body mass index. The patients who received general anesthesia with inhaled agents had statistically higher total CO2e per case than deep sedation with TIVA (16.188 v 1.518 kg CO2e; p < 0.001), primarily due to the inhaled agents and secondarily to airway management devices. For deep sedation with TIVA, the major contributors were intravenous medications (71.02%) and airway management devices (16.58%). A subgroup study of patients who received sevoflurane only showed the same trend with less variation. CONCLUSIONS The patients who received volatile anesthesia were found to have a higher CO2e per case. This difference remained after a subgroup analysis evaluating those patients only receiving sevoflurane and after accounting for the differences in the duration of anesthesia. Data from this study and others should be collectively considered as the healthcare profession aims to provide the best care possible for their patients while limiting the harm caused to the environment.
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Affiliation(s)
- Lei Yang
- Department of Anesthesiology and Perioperative Medicine, Tufts Medical Center, Boston, MA.
| | - Joshua Hubert
- Department of Anesthesiology and Perioperative Medicine, Tufts Medical Center, Boston, MA
| | - Samwel Gitundu
- Department of Anesthesiology and Perioperative Medicine, Tufts Medical Center, Boston, MA
| | - Ethan Brovman
- Department of Anesthesiology and Perioperative Medicine, Tufts Medical Center, Boston, MA
| | - Frederick Cobey
- Department of Anesthesiology and Perioperative Medicine, Tufts Medical Center, Boston, MA
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Jabaudon M, Vallabh B, Bacher HP, Badenes R, Kehl F. Balancing Patient Needs With Environmental Impacts for Best Practices in General Anesthesia: Narrative Review and Clinical Perspective. Anaesth Crit Care Pain Med 2024:101389. [PMID: 38710324 DOI: 10.1016/j.accpm.2024.101389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 04/09/2024] [Accepted: 04/17/2024] [Indexed: 05/08/2024]
Abstract
Discussions of the environmental impacts of general anesthetics have focused on greenhouse gas (GHG) emissions from inhaled agents, with those of total intravenous anesthesia (TIVA) recently coming to the forefront. Clinical experts are calling for the expansion of research toward life cycle assessment (LCA) to comprehensively study the impact of general anesthetics. We provide an overview of proposed environmental risks, including direct GHG emissions from inhaled anesthetics and non-GHG impacts and indirect GHG emissions from propofol. A practical description of LCA methodology is also provided, as well as how it applies to the study of general anesthesia. We describe available LCA studies comparing the environmental impacts of a lower carbon footprint inhaled anesthetic, sevoflurane, to TIVA/propofol and discuss their life cycle steps: manufacturing, transport, clinical use, and disposal. Significant hotspots of GHG emission were identified as the manufacturing and disposal of sevoflurane and use (attributed to the manufacture of the required syringes and syringe pumps) for propofol. However, the focus of these studies was solely on GHG emissions, excluding other environmental impacts of wasted propofol, such as water/soil toxicity. Other LCA gaps included a lack of comprehensive GHG emission estimates related to the manufacturing of TIVA plastic components, high-temperature incineration of propofol, and gas capture technologies for inhaled anesthetics. Considering that scarce LCA evidence does not allow for a definite conclusion to be drawn regarding the overall environmental impacts of sevoflurane and TIVA, we conclude that current anesthetic practice involving these agents should focus on patient needs and established best practices as more LCA research is accumulated.
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Affiliation(s)
- Matthieu Jabaudon
- Department of Perioperative Medicine, CHU Clermont-Ferrand and iGReD, Université Clermont Auvergne, CNRS, INSERM, Clermont-Ferrand, France.
| | - Bhadrish Vallabh
- Global Medical Affairs, AbbVie Biopharmaceuticals GmbH, Dubai, United Arab Emirates
| | - H Peter Bacher
- Global Medical Affairs, AbbVie Inc., North Chicago, IL, USA
| | - Rafael Badenes
- Department of Anesthesiology and Surgical-Trauma Intensive Care and Pain Clinic, Hospital Clínico Universitario de Valencia, University of Valencia, Valencia, Spain
| | - Franz Kehl
- Department of Anesthesia and Intensive Care Medicine, Klinikum Karlsruhe, Karlsruhe, Germany
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Jakobsdottir H, Tomasson AM, Karason S, Sigurdsson MI. Postoperative nausea and vomiting at Landspitali: A prospective study. Acta Anaesthesiol Scand 2024; 68:457-465. [PMID: 38262610 DOI: 10.1111/aas.14375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 11/21/2023] [Accepted: 12/19/2023] [Indexed: 01/25/2024]
Abstract
BACKGROUND In the last decade, anaesthesia practice has changed at Landspitali, where the majority of patients now receive antiemetic prophylaxis, and the use of total intravenous anaesthesia is the dominant mode for maintenance of anaesthesia. The aim of this study was to assess the incidence of postoperative nausea and vomiting (PONV) in a prospective way, the use of PONV prophylaxis, and clinical risk factors associated with PONV during this era. METHODS A prospective cohort study using a convenience sample of 438 patients ≥18 years old admitted to the postoperative care unit (PACU) after elective or emergency operations in May-July 2022 at Landspitali University Hospital in Iceland. Patients answered questionnaires in the PACU and 24 h after discharge from PACU. RESULTS The incidence of self-reported moderate/severe nausea (5/10 or higher on NRS) in PACU was 4% and 3% on postoperative day 1. A total of 91% of delivered anaesthetics were with intravenous medications only, and 82% of patients received at least one prophylactic medication for PONV. When asked to rate the worst nausea experienced, this was described as moderate/severe by 7% in PACU and 17% on postoperative day 1. Risk factors associated with PONV were female gender (OR 1.90, 95% CI 1.04-3.53) and a history of motion sickness or PONV (2.74, 1.51-4.94), but increasing age was protective (0.83 per decade, 0.71-0.98). Despite a more liberal administration of antiemetics, patients with more risk factors per Apfel PONV risk classification had a higher incidence of PONV. CONCLUSION The incidence of PONV is generally low in this diverse surgical population where anaesthesia is mostly maintained with total intravenous anaesthesia and PONV prophylaxis is common. PONV remains a predictable complication following anaesthesia, suggesting further improvement in its prevention is possible.
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Affiliation(s)
| | | | - Sigurbergur Karason
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland
- Department of Anaesthesiology and Critical Care, The National University Hospital of Iceland, Reykjavik, Iceland
| | - Martin I Sigurdsson
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland
- Department of Anaesthesiology and Critical Care, The National University Hospital of Iceland, Reykjavik, Iceland
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Song T, Wu LJ, Li L. Comparison of combined intravenous and inhalation anesthesia and total intravenous anesthesia in laparoscopic surgery and the identification of predictive factors influencing the delayed recovery of neurocognitive function. Front Med (Lausanne) 2024; 11:1353502. [PMID: 38590312 PMCID: PMC10999530 DOI: 10.3389/fmed.2024.1353502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Accepted: 02/26/2024] [Indexed: 04/10/2024] Open
Abstract
Background Compare the anesthesia effects of combined intravenous and inhalation anesthesia (CIVIA) and total intravenous anesthesia (TIVA) in laparoscopic surgery. Furthermore, our objective is to examine the elements that contribute to the delay in postoperative recovery of neurocognitive function and anticipate the manifestation of delayed recovery by analyzing serum cytokines. Methods The CIVIA group and the TIVA group both consisted of 130 patients who were scheduled to have elective major abdominal surgery through laparoscopy. The criteria taken into account by the observational and record-keeping study were the patients' ages, sexes, body masses, heights, and the presence or absence of any preexisting problems. Both groups also had their anesthetic depth, duration, and per-unit-of-time muscle relaxant and analgesic dosages recorded. Finally, the length of each patient's stay in the hospital as well as their overall length of stay were tracked. By using the Mini-Mental State Examination (MMSE) to measure cognitive function, we assessed the mental states of the subjects. Additionally, we wanted to identify any biomarkers that could be linked to postoperative cognitive decline or delays in neurocognitive recovery. Results A total of 51 participants from the CIVIA group and 53 participants from the TIVA group satisfactorily completed the necessary neuropsychological exam for identifying delayed neurocognitive recovery at the study's completion. In the initial data of the two groups, no significant discrepancies were found (p > 0.05). The CIVIA group exhibited noteworthy reductions in the quantity of administered analgesics and muscle relaxants per unit of time in comparison to the TIVA group (p < 0.05). In addition to this, the duration from the sevoflurane tank being closed to the extubation period demonstrated a significant reduction in the CIVIA group compared to the TIVA group (p < 0.05). Moreover, no statistically notable distinction was observed in terms of postoperative hospitalization duration and overall hospitalization duration among both groups (p > 0.05). According to the study, both the CIVIA group and the TIVA group had a total of 7 (13.72%) and 17 (32.07%) individuals, respectively, who met the criteria for neurocognitive delayed recovery (Odds Ratio: 0.336; 95% CI: 0.134-0.864; p = 0.026). According to the research findings, it is indicated that there is a possibility for an increased presence of IL-6 in the bloodstream within 60 min following the incision made on the skin. This occurrence subsequently leads to the prolonged restoration of neurocognitive capabilities. Conclusion The CIVIA technique outperforms the TIVA method in terms of overall assessment in the setting of laparoscopic surgery. It's also important to remember that an increased blood IL-6 level during laparoscopy may operate as a separate risk factor for a delay in the restoration of neurocognitive function.
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Affiliation(s)
| | | | - Li Li
- Department of Anesthesiology, Tongling Municipal Hospital, Tongling, China
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Bernat M, Boyer A, Roche M, Richard C, Bouvet L, Remacle A, Antonini F, Poirier M, Pastene B, Hammad E, Fond G, Bruder N, Leone M, Zieleskiewicz L. Reducing the carbon footprint of general anaesthesia: a comparison of total intravenous anaesthesia vs. a mixed anaesthetic strategy in 47,157 adult patients. Anaesthesia 2024; 79:309-317. [PMID: 38205529 DOI: 10.1111/anae.16221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/14/2023] [Indexed: 01/12/2024]
Abstract
Global warming is a major public health concern. Volatile anaesthetics are greenhouse gases that increase the carbon footprint of healthcare. Modelling studies indicate that total intravenous anaesthesia is less carbon intensive than volatile anaesthesia, with equivalent quality of care. In this observational study, we aimed to apply the findings of previous modelling studies to compare the carbon footprint per general anaesthetic of an exclusive TIVA strategy vs. a mixed TIVA-volatile strategy. This comparative retrospective study was conducted over 2 years in two French hospitals, one using total intravenous anaesthesia only and one using a mixed strategy including both intravenous and inhalation anaesthetic techniques. Based on pharmacy procurement records, the quantity of anaesthetic sedative drugs was converted to carbon dioxide equivalents. The primary outcome was the difference in carbon footprint of hypnotic drugs per intervention between the two strategies. From 1 January 2021 to 31 December 2022, 25,137 patients received general anaesthesia in the hospital using the total intravenous anaesthesia strategy and 22,020 in the hospital using the mixed strategy. The carbon dioxide equivalent footprint of hypnotic drugs per intervention in the hospital using the total intravenous anaesthesia strategy was 20 times lower than in the hospital using the mixed strategy (emissions of 2.42 kg vs. 48.85 kg carbon dioxide equivalent per intervention, respectively). The total intravenous anaesthesia strategy significantly reduces the carbon footprint of hypnotic drugs in general anaesthesia in adult patients compared with a mixed strategy. Further research is warranted to assess the risk-benefit ratio of the widespread adoption of total intravenous anaesthesia.
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Affiliation(s)
- M Bernat
- Department of Anaesthesia and Intensive Care Medicine, Hôpital de la Conception, Assistance Publique des Hôpitaux de Marseille, Aix Marseille University, Marseille, France
| | - A Boyer
- Department of Anaesthesia and Intensive Care Medicine, Hôpital de la Conception, Assistance Publique des Hôpitaux de Marseille, Aix Marseille University, Marseille, France
| | - M Roche
- Pharmacy Department, Service Central des Opérations Pharmaceutiques, Hôpital de la Conception, Assistance Publique des Hôpitaux de Marseille, Aix Marseille University, Marseille, France
| | - C Richard
- Department of Anaesthesia and Intensive Care Medicine, Hôpital de la Conception, Assistance Publique des Hôpitaux de Marseille, Aix Marseille University, Marseille, France
| | - L Bouvet
- Department of Anesthesia and Critical Care, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Lyon, France
| | - A Remacle
- Departement of Medical Information, Hôpital Nord, Marseille, France
| | - F Antonini
- Department of Anaesthesia and Intensive Care Medicine, Hôpital de la Conception, Assistance Publique des Hôpitaux de Marseille, Aix Marseille University, Marseille, France
| | - M Poirier
- Department of Anaesthesia and Intensive Care Medicine, Hôpital de la Conception, Assistance Publique des Hôpitaux de Marseille, Aix Marseille University, Marseille, France
| | - B Pastene
- Department of Anaesthesia and Intensive Care Medicine, Hôpital de la Conception, Assistance Publique des Hôpitaux de Marseille, Aix Marseille University, Marseille, France
| | - E Hammad
- Department of Anaesthesia and Intensive Care Medicine, Hôpital de la Conception, Assistance Publique des Hôpitaux de Marseille, Aix Marseille University, Marseille, France
| | - G Fond
- CEReSS-Health Service Research and Quality of Life Center, Aix-Marseille University, Marseille, France
| | - N Bruder
- Department of Anaesthesia and Intensive Care Medicine, Hôpital de la Conception, Assistance Publique des Hôpitaux de Marseille, Aix Marseille University, Marseille, France
| | - M Leone
- Department of Anaesthesia and Intensive Care Medicine, Hôpital de la Conception, Assistance Publique des Hôpitaux de Marseille, Aix Marseille University, Marseille, France
| | - L Zieleskiewicz
- Department of Anaesthesia and Intensive Care Medicine, Hôpital de la Conception, Assistance Publique des Hôpitaux de Marseille, Aix Marseille University, Marseille, France
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Ndege MR, Clanton A, Lacy T, Doan A. Effects of Anesthetic Choice on the Incidence of Transcranial-Motor Potential-Induced Oral Trauma. Neurodiagn J 2024; 64:11-23. [PMID: 38437032 DOI: 10.1080/21646821.2024.2319508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 02/12/2024] [Indexed: 03/06/2024]
Abstract
Transcranial motor-evoked potentials (TcMEPs) play an integral role in assessing motor tract function in surgical procedures where motor function is at risk. However, transcranial stimulation creates a risk for oral trauma. Several studies have reported on distinct factors that can influence the rate of TcMEP-induced oral trauma, but little is known about how an anesthetic regimen can influence this rate. In this retrospective review, we investigated the incidence of oral injury under total intravenous anesthesia (TIVA) and balanced anesthesia in 66,166 cases from 2019 to 2021. There were 295 oral injuries in our sample, yielding an incidence of 0.45%, which is in line with ranges reported in the literature. A total of 222 of the injured patients were sedated with balanced anesthesia, while the remaining 73 were under TIVA anesthetics. This difference in distribution was statistically significant (p < 0.0002). Our findings suggest TIVA is associated with lower risk of oral trauma when TcMEPs are monitored, thereby improving patient safety.
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Affiliation(s)
| | | | - Tammy Lacy
- NuVasive Clinical Services, Columbia, Maryland
| | - Adam Doan
- NuVasive Clinical Services, Columbia, Maryland
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Dubowitz J, Riedel B, Blaas C, Hiller J, Braat S. On the horns of a dilemma: choosing total intravenous anaesthesia or volatile anaesthesia for cancer surgery, an enduring controversy. Br J Anaesth 2024; 132:5-9. [PMID: 37884407 DOI: 10.1016/j.bja.2023.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 10/01/2023] [Indexed: 10/28/2023] Open
Abstract
Two methods for administering general anaesthesia are widely used: propofol-based total intravenous anaesthesia (propofol-TIVA) and inhalation volatile agent-based anaesthesia. Both modalities, which have been standards of care for several decades, boast a robust safety profile. Nevertheless, the potential differential effects of these anaesthetic techniques on immediate, intermediate, and extended postoperative outcomes remain a subject of inquiry. We discuss a recently published longitudinal analysis stemming from a multicentre randomised controlled trial comparing sevoflurane-based inhalation anaesthesia with propofol-TIVA in older patients with cancer, which showed a reduced incidence of emergence and postoperative delirium, comparable postoperative complication rates within 30 days after surgery, and comparable long-term survival rates. We undertake an assessment of the trial's methodological strengths and limitations, contextualise its results within the broader scientific evidence, and explore avenues for resolving the extant controversies in anaesthetic choice for cancer surgery. We aim to pave the way for the incorporation of precision medicine paradigms into the evolving landscape of perioperative care for patients with cancer.
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Affiliation(s)
- Julia Dubowitz
- Department of Anaesthesia, Perioperative Medicine, and Pain Medicine, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia; Department of Critical Care, University of Melbourne, Melbourne, VIC, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC, Australia.
| | - Bernhard Riedel
- Department of Anaesthesia, Perioperative Medicine, and Pain Medicine, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia; Department of Critical Care, University of Melbourne, Melbourne, VIC, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC, Australia
| | - Celia Blaas
- Department of Anaesthesia, Perioperative Medicine, and Pain Medicine, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Jonathan Hiller
- Department of Anaesthesia, Perioperative Medicine, and Pain Medicine, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Sabine Braat
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia; MISCH (Methods and Implementation Support for Clinical Health) Research Hub, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, VIC, Australia
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Huang YY, Hui CK, Lau NC, Ng YT, Lin TY, Chen CH, Wang YC, Tang HC, Chen DWC, Chang CW. Total intravenous anesthesia for geriatric hip fracture with severe systemic disease. Eur J Trauma Emerg Surg 2023; 49:2139-2145. [PMID: 37354341 PMCID: PMC10520204 DOI: 10.1007/s00068-023-02291-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 05/23/2023] [Indexed: 06/26/2023]
Abstract
PURPOSE Our study aimed to determine the impact of a novel technique of anesthesia administration on the clinical outcomes and complications in geriatric patients with severe systemic disease undergoing hip surgery. METHODS We retrospectively identified patients aged > 65 years with severe systemic disease that was a constant of life [American Society of Anesthesiologists (ASA) IV] who underwent surgery for hip fracture between January 2018 and January 2020. The patients were divided into two groups: Group I [fascia iliaca compartment block plus propofol-based total intravenous anesthesia (FICB + TIVA)] and Group II [general anesthesia (GA)]. The primary outcomes were 30-day and 1-year mortality. The secondary outcomes included length of hospital stay, length of intensive care unit (ICU) stay, postoperative morbidity, Visual Analog Scale score, and consumption of analgesics. RESULTS There was no significant difference in the 30-day mortality (5 vs. 3.8%, p = 0.85) and 1-year mortality (15 vs. 12%, p = 0.73) between the groups. Group I had significantly lower ICU requirements (p = 0.01) and shorter lengths of ICU stay (p < 0.001) and hospital stay (p < 0.001). Moreover, a smaller proportion of patients in Group I required postoperative morphine or oral opiates. CONCLUSION Geriatric patients who underwent hip surgery under FICB + TIVA required fewer ICU admissions, shorter lengths of ICU and hospital stay, and had lesser postoperative opioid consumption than those who were under GA. Hence, we recommend the novel FICB + TIVA technique for hip fracture surgery in geriatric patients with poor general health status and high surgical risks (ASA IV).
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Affiliation(s)
- Yu-Yi Huang
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Keelung Branch, No. 222, Maijin Rd., Anle Dist., Keelung City, 204 Taiwan
- College of Medicine, Chang Gung University, No. 259, Wunhua 1st Rd., Guishan Dist., Taoyuan City, 333 Taiwan
| | - Chung-Kun Hui
- Department of Anesthesiology, Chang Gung Memorial Hospital, No. 222, Maijin Rd., Anle Dist., Keelung City, 204 Taiwan
| | - Ngi-Chiong Lau
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Keelung Branch, No. 222, Maijin Rd., Anle Dist., Keelung City, 204 Taiwan
- College of Medicine, Chang Gung University, No. 259, Wunhua 1st Rd., Guishan Dist., Taoyuan City, 333 Taiwan
| | - Yuet-Tong Ng
- Department of Anesthesiology, Chang Gung Memorial Hospital, No. 222, Maijin Rd., Anle Dist., Keelung City, 204 Taiwan
| | - Tung-Yi Lin
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Keelung Branch, No. 222, Maijin Rd., Anle Dist., Keelung City, 204 Taiwan
- College of Medicine, Chang Gung University, No. 259, Wunhua 1st Rd., Guishan Dist., Taoyuan City, 333 Taiwan
| | - Chien-Hao Chen
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Keelung Branch, No. 222, Maijin Rd., Anle Dist., Keelung City, 204 Taiwan
- College of Medicine, Chang Gung University, No. 259, Wunhua 1st Rd., Guishan Dist., Taoyuan City, 333 Taiwan
| | - Ying-Chih Wang
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Keelung Branch, No. 222, Maijin Rd., Anle Dist., Keelung City, 204 Taiwan
- College of Medicine, Chang Gung University, No. 259, Wunhua 1st Rd., Guishan Dist., Taoyuan City, 333 Taiwan
| | - Hao-Che Tang
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Keelung Branch, No. 222, Maijin Rd., Anle Dist., Keelung City, 204 Taiwan
- College of Medicine, Chang Gung University, No. 259, Wunhua 1st Rd., Guishan Dist., Taoyuan City, 333 Taiwan
| | - Dave Wei-Chih Chen
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Keelung Branch, No. 222, Maijin Rd., Anle Dist., Keelung City, 204 Taiwan
- College of Medicine, Chang Gung University, No. 259, Wunhua 1st Rd., Guishan Dist., Taoyuan City, 333 Taiwan
| | - Chia-Wei Chang
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Keelung Branch, No. 222, Maijin Rd., Anle Dist., Keelung City, 204 Taiwan
- College of Medicine, Chang Gung University, No. 259, Wunhua 1st Rd., Guishan Dist., Taoyuan City, 333 Taiwan
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Shimizu T, Takasusuki T, Yamaguchi S. Remimazolam Compared to Propofol for Total Intravenous Anesthesia with Remifentanil on the Recovery of Psychomotor Function: A Randomized Controlled Trial. Adv Ther 2023; 40:4395-4404. [PMID: 37490257 PMCID: PMC10499674 DOI: 10.1007/s12325-023-02615-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 07/13/2023] [Indexed: 07/26/2023]
Abstract
INTRODUCTION This study aimed to compare remimazolam to propofol in psychomotor recovery after total intravenous anesthesia (TIVA) using the Trieger dot test. METHODS Sixty-six patients who were scheduled to undergo endoscopic sinus surgery with American Society of Anesthesiologists (ASA) physical status I or II were randomly allocated to the remimazolam (group R) or propofol group (group P). In group R, all patients received flumazenil postoperatively. After discontinuation of anesthetic agents, the time to eye opening, response to verbal commands, extubation, and discharge from the operation room were measured. Psychomotor recovery was assessed using the Trieger dot test before induction and at 0, 30, 60, 90, 120, 150, and 180 min after anesthesia. RESULTS The time to eye opening, response to verbal commands, extubation, and discharge from the operation room were significantly longer in group P compared to group R (group P: 9.8 ± 3.2 min, 11.5 ± 3.4 min, 12.7 ± 3.4 min, 18.1 ± 4.2 min; group R: 6.5 ± 2 min, 7.3 ± 2.6 min, 8.4 ± 2.9 min, 13.2 ± 3.2 min; respectively, p < 0.05). In the Trieger dot test, the number of dots missed was significantly increased in group R compared to group P at 30, 60, 90, and 120 min after discharge from the operation room (group R: 20.5 ± 9.3, 16 ± 8.8, 14.9 ± 11.1, 14.3 ± 10.8; group P: 14.6 ± 7.8, 10 ± 7.1, 8.7 ± 7.3, 7.3 ± 5.7; respectively, p < 0.05). The maximum distance of dots missed was significantly increased in group R compared to group P at 30 min after discharge from the operation room (group R: 3.9 ± 2.8; group P: 2.7 ± 1.6; p < 0.05). CONCLUSION Our results suggest that remimazolam with flumazenil leads to rapid recovery following anesthesia; however, it may cause delayed psychomotor decline. CLINICAL TRIAL REGISTRATION This trial is registered with the University Hospital Medical Information Network (registration number UMIN000044900).
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Affiliation(s)
- Takahito Shimizu
- Department of Anesthesiology, School of Medicine, Dokkyo Medical University, Kitakobayashi 880, Mibu, Tochigi, 321-0293, Japan
| | - Toshifumi Takasusuki
- Department of Anesthesiology, School of Medicine, Dokkyo Medical University, Kitakobayashi 880, Mibu, Tochigi, 321-0293, Japan.
| | - Shigeki Yamaguchi
- Department of Anesthesiology, School of Medicine, Dokkyo Medical University, Kitakobayashi 880, Mibu, Tochigi, 321-0293, Japan
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Ma Y, Ren J, Chen Z, Chen J, Wei M, Wang Y, Chen H, Wang L. Outcomes of intravenous and inhalation anesthesia on patients undergoing esophageal cancer surgery: a retrospective observational study. BMC Anesthesiol 2023; 23:66. [PMID: 36864402 PMCID: PMC9979524 DOI: 10.1186/s12871-023-02023-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Accepted: 02/17/2023] [Indexed: 03/04/2023] Open
Abstract
BACKGROUND Different anesthetics may have opposite effects on the immune system, thus affecting the prognosis of tumor patients. Cell-mediated immunity forms the primary defense against the invasion of tumor cells, so manipulation of the immune system to produce an enhanced anti-tumor response could be utilized as an adjuvant oncological therapy. Sevoflurane has proinflammatory effects, while propofol, has anti-inflammatory and antioxidant effects. Therefore, we compared the overall survival (OS) and disease-free survival (DFS) of patients with esophageal cancer under total intravenous anesthesia and inhalation anesthesia. METHODS This study collected the electronic medical records of patients undergoing esophagectomy from January 1, 2014 to December 31, 2016. According to the intraoperative anesthetics, the patients were divided into total intravenous anesthesia (TIVA) group or inhalational anesthesia (INHA) group. Stabilized inverse probability of treatment weighting (SIPTW) was used to minimize differences. Kaplan-Meier survival curve was established to evaluate the correlation between different anesthesia methods in overall survival and disease-free survival of patients undergoing esophageal cancer surgery. RESULTS A total of 420 patients with elective esophageal cancer were collected, including 363 patients eligible for study (TIVA, n = 147, INHA, n = 216). After SIPTW there were no significant differences between two groups in overall survival and disease-free survival. However, the adjuvant therapy was statistically significant in improving OS, and the degree of differentiation was correlated with OS and DFS. CONCLUSIONS In conclusion, there were no significant difference in overall survival and disease-free survival between total intravenous anesthesia and inhalational anesthesia in patients undergoing esophageal cancer surgery.
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Affiliation(s)
- Yue Ma
- Department of Anesthesiology, Harbin Medical University Cancer Hospital, No. 150 Haping Rd., Nangang District, Harbin, 150081, China
| | - Jie Ren
- Department of Anesthesiology, Guizhou Provincial People's Hospital, No. 83 Zhongshan East Road, Nanming District, Guiyang, 550002, Guizhou, China
| | - Zhuo Chen
- Department of Anesthesiology, Harbin Medical University Cancer Hospital, No. 150 Haping Rd., Nangang District, Harbin, 150081, China
| | - Jingwen Chen
- Department of Anesthesiology, Harbin Medical University Cancer Hospital, No. 150 Haping Rd., Nangang District, Harbin, 150081, China
| | - Ming Wei
- Department of Anesthesiology, Harbin Medical University Cancer Hospital, No. 150 Haping Rd., Nangang District, Harbin, 150081, China
| | - Yu Wang
- Department of Anesthesiology, Harbin Medical University Cancer Hospital, No. 150 Haping Rd., Nangang District, Harbin, 150081, China.
| | - Hong Chen
- Department of Anesthesiology, Harbin Medical University Cancer Hospital, No. 150 Haping Rd., Nangang District, Harbin, 150081, China.
| | - Liping Wang
- Department of Anesthesiology, Harbin Medical University Cancer Hospital, No. 150 Haping Rd., Nangang District, Harbin, 150081, China.
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11
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Kane AD, Soar J, Armstrong RA, Kursumovic E, Davies MT, Oglesby FC, Cortes L, Taylor C, Moppett IK, Agarwal S, Cordingley J, Dorey J, Finney SJ, Kunst G, Lucas DN, Nickols G, Mouton R, Nolan JP, Patel B, Pappachan VJ, Plaat F, Scholefield BR, Smith JH, Varney L, Cook TM. Patient characteristics, anaesthetic workload and techniques in the UK: an analysis from the 7th National Audit Project (NAP7) activity survey. Anaesthesia 2023; 78:701-711. [PMID: 36857758 DOI: 10.1111/anae.15989] [Citation(s) in RCA: 30] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/06/2023] [Indexed: 03/03/2023]
Abstract
Detailed contemporary knowledge of the characteristics of the surgical population, national anaesthetic workload, anaesthetic techniques and behaviours are essential to monitor productivity, inform policy and direct research themes. Every 3-4 years, the Royal College of Anaesthetists, as part of its National Audit Projects (NAP), performs a snapshot activity survey in all UK hospitals delivering anaesthesia, collecting patient-level encounter data from all cases under the care of an anaesthetist. During November 2021, as part of NAP7, anaesthetists recorded details of all cases undertaken over 4 days at their site through an online survey capturing anonymous patient characteristics and anaesthetic details. Of 416 hospital sites invited to participate, 352 (85%) completed the activity survey. From these, 24,177 reports were returned, of which 24,172 (99%) were included in the final dataset. The work patterns by day of the week, time of day and surgical specialty were similar to previous NAP activity surveys. However, in non-obstetric patients, between NAP5 (2013) and NAP7 (2021) activity surveys, the estimated median age of patients increased by 2.3 years from median (IQR) of 50.5 (28.4-69.1) to 52.8 (32.1-69.2) years. The median (IQR) BMI increased from 24.9 (21.5-29.5) to 26.7 (22.3-31.7) kg.m-2 . The proportion of patients who scored as ASA physical status 1 decreased from 37% in NAP5 to 24% in NAP7. The use of total intravenous anaesthesia increased from 8% of general anaesthesia cases to 26% between NAP5 and NAP7. Some changes may reflect the impact of the COVID-19 pandemic on the anaesthetic population, though patients with confirmed COVID-19 accounted for only 149 (1%) cases. These data show a rising burden of age, obesity and comorbidity in patients requiring anaesthesia care, likely to impact UK peri-operative services significantly.
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Affiliation(s)
- A D Kane
- Royal College of Anaesthetists, Red Lion Square, UK.,Department of Anaesthesia, James Cook University Hospital, South Tees NHS Foundation Trust, Middlesbrough, UK
| | - J Soar
- Department of Anaesthesia and Intensive Care Medicine, Southmead Hospital, Bristol, UK
| | - R A Armstrong
- Royal College of Anaesthetists, Red Lion Square, UK.,Department of Anaesthesia, Severn Deanery, Bristol, UK
| | - E Kursumovic
- Royal College of Anaesthetists, Red Lion Square, UK.,Department of Anaesthesia and Intensive Care Medicine, Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
| | - M T Davies
- Department of Critical Care and Anaesthesia, North West Anglia NHS Trust, UK
| | - F C Oglesby
- University Hospitals Bristol and Weston NHS Foundation Trust, UK
| | - L Cortes
- Royal College of Anaesthetists, Red Lion Square, UK
| | - C Taylor
- Royal College of Anaesthetists, Red Lion Square, UK
| | - I K Moppett
- Royal College of Anaesthetists, Red Lion Square, UK.,University of Nottingham, UK
| | - S Agarwal
- Department of Anaesthesia, Manchester University Hospitals Foundation Trust, Manchester, UK
| | - J Cordingley
- Department of Critical Care and Anaesthesia, Barts Health NHS Trust, UK
| | - J Dorey
- Royal College of Anaesthetists, Red Lion Square, UK
| | - S J Finney
- Department of Critical Care and Anaesthesia, Barts Health NHS Trust, UK
| | - G Kunst
- Department of Cardiovascular Anaesthesia, Kings College London, UK
| | - D N Lucas
- Department of Anaesthesia, London North West University Healthcare NHS Trust, UK
| | - G Nickols
- Department of Anaesthesia, North Bristol NHS Trust, Bristol, UK
| | - R Mouton
- Department of Anaesthesia, North Bristol NHS Trust, Bristol, UK
| | - J P Nolan
- Resuscitation Medicine, Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
| | - B Patel
- Royal College of Anaesthetists, Red Lion Square, UK
| | - V J Pappachan
- Southampton Children's Hospital, NIHR Biomedical Research Centre, Department of Paediatric Anaesthesia and Intensive Care Medicine, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - F Plaat
- Department of Anaesthesia, Imperial College Healthcare NHS Trust, London, UK
| | - B R Scholefield
- Institute of Inflammation and Ageing, University of Birmingham, UK
| | - J H Smith
- Department of Anaesthesia, Great Ormond Street Hospital, London, UK
| | - L Varney
- Department of Anaesthesia, University College London Hospitals, London, UK
| | - T M Cook
- Department of Anaesthesia and Intensive Care Medicine, Royal United Hospitals Bath NHS Foundation Trust, Bath, UK.,University of Bristol, UK
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12
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Hashemi SR, Vesal N. Ketamine-propofol for total intravenous anaesthesia in rabbits: a comparison of premedication with acepromazine-medetomidine, acepromazine-midazolam or acepromazine-morphine. Vet Anaesth Analg 2023; 50:263-272. [PMID: 36894406 DOI: 10.1016/j.vaa.2023.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 02/03/2023] [Accepted: 02/04/2023] [Indexed: 02/12/2023]
Abstract
OBJECTIVE To describe ketamine-propofol total intravenous anaesthesia (TIVA) following premedication with acepromazine and either medetomidine, midazolam or morphine in rabbits. STUDY DESIGN Randomized, crossover experimental study. ANIMALS A total of six healthy female New Zealand White rabbits (2.2 ± 0.3 kg). METHODS Rabbits were anaesthetized on four occasions, each separated by 7 days: an intramuscular injection of saline alone (treatment Saline) or acepromazine (0.5 mg kg-1) in combination with medetomidine (0.1 mg kg-1), midazolam (1 mg kg-1) or morphine (1 mg kg-1), treatments AME, AMI or AMO, respectively, in random order. Anaesthesia was induced and maintained with a mixture containing ketamine (5 mg mL-1) and propofol (5 mg mL-1) (ketofol). Each trachea was intubated and the rabbit administered oxygen during spontaneous ventilation. Ketofol infusion rate was initially 0.4 mg kg-1 minute-1 (0.2 mg kg-1 minute-1 of each drug) and was adjusted to maintain adequate anaesthetic depth based on clinical assessment. Ketofol dose and physiological variables were recorded every 5 minutes. Quality of sedation, intubation and recovery times were recorded. RESULTS Ketofol induction doses decreased significantly in treatments AME (7.9 ± 2.3) and AMI (8.9 ± 4.0) compared with treatment Saline (16.8 ± 3.2 mg kg-1) (p < 0.05). The total ketofol dose to maintain anaesthesia was significantly lower in treatments AME, AMI and AMO (0.6 ± 0.1, 0.6 ± 0.2 and 0.6 ± 0.1 mg kg-1 minute-1, respectively) than in treatment Saline (1.2 ± 0.2 mg kg-1 minute-1) (p < 0.05). Cardiovascular variables remained at clinically acceptable values, but all treatments caused some degree of hypoventilation. CONCLUSIONS AND CLINICAL RELEVANCE Premedication with AME, AMI and AMO, at the doses studied, significantly decreased the maintenance dose of ketofol infusion in rabbits. Ketofol was determined to be a clinically acceptable combination for TIVA in premedicated rabbits.
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Affiliation(s)
- Seyed Reza Hashemi
- Department of Veterinary Clinical Sciences, School of Veterinary Medicine, Shiraz University, Shiraz, Iran
| | - Nasser Vesal
- Department of Veterinary Clinical Sciences, School of Veterinary Medicine, Shiraz University, Shiraz, Iran.
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13
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Chan WK, Liu CY. Improvising humidified rapid-insufflation ventilatory exchange during rigid bronchoscopy. Br J Anaesth 2023; 130:e27-e29. [PMID: 35738940 DOI: 10.1016/j.bja.2022.05.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 05/22/2022] [Accepted: 05/24/2022] [Indexed: 01/06/2023] Open
Affiliation(s)
| | - Chian Yong Liu
- Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
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14
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Hughes LM, Irwin MG, Nestor CC. Alternatives to remifentanil for the analgesic component of total intravenous anaesthesia: a narrative review. Anaesthesia 2022; 78:620-625. [PMID: 36562193 DOI: 10.1111/anae.15952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/06/2022] [Indexed: 12/24/2022]
Abstract
Propfol-remifentanil-based total intravenous anaesthesia has dominated recent clinical practice due to its favourable pharmacokinetic profile. Interruption in remifentanil supply has presented an opportunity to diversify or even avoid the use of opioids and consider adjuncts to propofol-based total intravenous anaesthesia. Propofol, while a potent hypnotic, is not an effective analgesic. The administration of opioids, along with other adjuncts such as α-2 adrenoceptor agonists, magnesium, lidocaine, ketamine and nitrous oxide provide surgical anaesthesia and avoids large doses of propofol being required. We provide an overview of both target-control and manual infusion regimes for the alternative opioids: alfentanil, sufentanil and fentanyl. The optimal combination of hypnotic-opioid dose, titration sequence and anticipated additional postoperative analgesia required depend on the chosen combination. In addition, we include a brief discussion on the role of non-opioid adjuncts in total intravenous anaesthesia, suggested doses and expected reduction in propofol dose.
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Affiliation(s)
- L M Hughes
- Department of Anaesthesia, Critical Care and Pain Medicine, Tallaght University Hospital, Dublin, Ireland
| | - M G Irwin
- Department of Anaesthesiology, University of Hong Kong, Hong Kong Special Administrative Region, China
| | - C C Nestor
- Department of Anaesthesia, Critical Care and Pain Medicine, Tallaght University Hospital, Dublin, Ireland
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15
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Cho HB, Park SY, Kim N, Choi SJ, Song S, Yoo JH, Kim MG, Chung JW. Effect of anesthetics on postoperative nausea and vomiting after peripheral vascular surgery in end-stage renal disease patients: A retrospective observational study. Front Surg 2022; 9:1054670. [PMID: 36504578 PMCID: PMC9727076 DOI: 10.3389/fsurg.2022.1054670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 10/28/2022] [Indexed: 11/24/2022] Open
Abstract
Background Propofol-based total intravenous anesthesia (TIVA) is considered a prophylactic approach to decrease postoperative nausea and vomiting (PONV). Despite general anesthesia commonly being performed in end-stage renal disease (ESRD) patients, PONV in ESRD patients has not been well-described. We investigated PONV in peripheral vascular surgery under general anesthesia in ESRD patients. Methods To compare PONV between propofol-based TIVA and anesthesia with volatile anesthetics, we collected retrospective data from patients who underwent peripheral vascular surgery under general anesthesia from July 2018 to April 2020. We performed univariable and multivariable analyses, including factors that could be associated with PONV and those previously shown to affect PONV. Result A total of 1,699 peripheral vascular surgeries under general anesthesia in ESRD patients were eligible for analysis. Based on the multivariable analysis, TIVA (odds ratio [OR], 0.45; 95% confidence interval [CI], 0.35-0.60; P < 0.001) significantly decreased PONV. Female sex (OR, 1.85; 95% CI, 1.44-2.38; P < 0.001) and anesthetic duration (OR, 1.01; 95% CI, 1.00-1.01; P < 0.001) were associated with increased PONV. Conclusion Propofol-based TIVA is the most influential factor decreasing PONV after peripheral vascular surgery in ESRD patients. Anesthesiologists can apply propofol-based TIVA as an alternative to anesthesia with volatile anesthetics.
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16
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Jansen L, Dubois BFH, Hollmann MW. The Effect of Propofol versus Inhalation Anesthetics on Survival after Oncological Surgery. J Clin Med 2022; 11:jcm11226741. [PMID: 36431218 PMCID: PMC9696269 DOI: 10.3390/jcm11226741] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 11/07/2022] [Accepted: 11/08/2022] [Indexed: 11/16/2022] Open
Abstract
Every year, 19.3 million patients worldwide are diagnosed with cancer. Surgical resection represents a major therapeutical option and the vast majority of these patients receive anesthesia. However, despite surgical resection, almost one third of these patients develop local recurrence or distant metastases. Perioperative factors, such as surgical stress and anesthesia technique, have been suggested to play a role to a greater or lesser extent in the development of recurrences, but oncology encompasses a complicated tumor biology of which much is still unknown. The effect of total intravenous anesthesia (TIVA) or volatile anesthesia (VA) on survival after oncological surgery has become a popular topic in recent years. Multiple studies conclude in favor of propofol. Despite the a priori probability that relevant differences in postoperative outcomes are due to the anesthesia technique employed, TIVA or VA, is extremely small. The existing literature includes mainly hypothesis-forming retrospective studies and small randomized trials with many methodological limitations. To date, it is unlikely that use of TIVA or VA affect cancer-free survival days to a clinically relevant extent. This review addresses all relevant studies in the field and provides a substantiated different view on this deeply controversial research topic.
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17
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Lu T, Li R, Sun J, Chen J. Evaluation of penehyclidine for prevention of post operative nausea and vomitting in patients undergoing total thyroidectomy under total intravenous anaesthesia with propofol-remifentanil. BMC Anesthesiol 2022; 22:317. [PMID: 36241968 PMCID: PMC9563181 DOI: 10.1186/s12871-022-01857-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 09/30/2022] [Indexed: 11/13/2022] Open
Abstract
Backgroud Postoperative nausea and vomiting (PONV) is one of the most common complications after total thyroidectomy under general anesthesia. Total intravenous anesthesia (TIVA) has been documented to prevent PONV in patients undergoing total thyroidectomy. Penehyclidine, an anticholinergic agent with an elimination half-life of over 10 h, is widely used as premedication to reduce glandular secretion. This study aimed to explore the preventative effects of penehyclidine with propofol-remifentanil-TIVA to single-TIVA on PONV in patients undergoing total thyroidectomy. Methods A total of 100 patients scheduled for total thyroidectomy were randomly assigned to either the penehyclidine group (n = 50) or TIVA group (n = 50). Propofol and remifentanil were was used for TIVA in all patients. No patients who received premedication. Patients were administrated with either 5 ml of normal saline or 0.5 mg of penehyclidine soon after anesthesia induction. The incidence of nausea and vomiting, the severity of nausea, the requirement of rescue antiemetics, and adverse effects were investigated during the first 24 h in two time periods (0–2 h and 2–24 h). Results The overall PONV incidence during the 24 h after surgery was significantly lower in the penehyclidine group compared with the TIVA group (12% vs 36%, P < 0.005). Besides, the incidence of nausea and the incidence of vomiting were significantly lower in the penehyclidine group compared with the TIVA group at 2–24 h after surgery. However, there was no significant difference between the two groups at 0–2 h after surgery. Conclusions Administration of penehyclidine under TIVA with propofol-remifentanil is more effective for prevention of PONV than TIVA alone, especially 2–24 h after total thyroidectomy. Trial registration https://www.chictr.org.cn/edit.aspx?pid=132463&htm=4 (Ref: ChiCTR2100050278, the full date of first registration: 25/08/2021).
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Affiliation(s)
- Ting Lu
- Department of Anesthesiology and Perioperative Medicine, First Affiliated Hospital with Nanjing Medical University, Nanjing, 210029, Jiangsu, China
| | - Rongrong Li
- Department of Anesthesiology and Perioperative Medicine, First Affiliated Hospital with Nanjing Medical University, Nanjing, 210029, Jiangsu, China
| | - Jiacheng Sun
- Department of Anesthesiology and Perioperative Medicine, First Affiliated Hospital with Nanjing Medical University, Nanjing, 210029, Jiangsu, China
| | - Jing Chen
- Department of Anesthesiology and Perioperative Medicine, First Affiliated Hospital with Nanjing Medical University, Nanjing, 210029, Jiangsu, China.
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18
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Riedel B, Dubowitz J, Yeung J, Jhanji S, Kheterpal S, Avidan MS. On the horns of a dilemma: choosing total intravenous anaesthesia or volatile anaesthesia. Br J Anaesth 2022; 129:284-289. [PMID: 35835606 DOI: 10.1016/j.bja.2022.06.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 06/01/2022] [Accepted: 06/03/2022] [Indexed: 11/02/2022] Open
Abstract
There are two established techniques of delivering general anaesthesia: propofol-based total intravenous anaesthesia (TIVA) and volatile agent-based inhaled anaesthesia. Both techniques are offered as standard of care and have an established safety track record lasting more than 30 years. However, it is not currently known whether the choice of anaesthetic technique results in a fundamentally different patient experience or affects early, intermediate-term, and longer-term postoperative outcomes. This editorial comments on a recently published study that suggests that inhaled volatile anaesthesia might be associated with fewer postoperative surgical complications than propofol-based TIVA for patients undergoing colorectal cancer surgery. We consider the strengths and limitations of the study, place these findings in the context of the broader evidence, and discuss how the current controversies regarding anaesthetic technique can be resolved, thereby helping to bring precision medicine into the modern practice of perioperative care.
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Affiliation(s)
- Bernhard Riedel
- Department of Anaesthesia, Perioperative Medicine and Pain Medicine, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia; Department of Critical Care, University of Melbourne, Melbourne, VIC, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC, Australia.
| | - Julia Dubowitz
- Department of Anaesthesia, Perioperative Medicine and Pain Medicine, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia; Department of Critical Care, University of Melbourne, Melbourne, VIC, Australia
| | - Joyce Yeung
- Department of Critical Care Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK; Warwick Medical School, University of Warwick, Coventry, UK
| | - Shaman Jhanji
- Department of Anaesthesia, Perioperative Medicine and Critical Care, Royal Marsden Hospital, London, UK; Division of Cancer Biology, Institute of Cancer Research, London, UK
| | - Sachin Kheterpal
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA; Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
| | - Michael S Avidan
- Department of Anesthesiology, Washington University School of Medicine in St Louis, St Louis, MO, USA
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19
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Uitenbosch G, Sng D, Carvalho HN, Cata JP, De Boer HD, Erdoes G, Heytens L, Lois FJ, Rousseau AF, Pelosi P, Forget P, Nesvadba D. Expert Multinational Consensus Statement for Total Intravenous Anaesthesia ( TIVA) Using the Delphi Method. J Clin Med 2022; 11:3486. [PMID: 35743557 DOI: 10.3390/jcm11123486] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 06/13/2022] [Accepted: 06/15/2022] [Indexed: 02/01/2023] Open
Abstract
Introduction: The use of total intravenous anaesthesia (TIVA) has been well established as an anaesthetic technique over the last few decades. Significant variation in practice exists however, and volatile agents are still commonly used. This study aims to determine the motivations and barriers for using TIVA over the use of volatile agents by analysing the opinion of several international anaesthetists with specific expertise or interests. Methods and participants: The Delphi method was used to gain the opinions of expert panellists with a range of anaesthetic subspecialty expertise. Twenty-nine panellists were invited to complete three survey rounds containing statements regarding the use of TIVA. Anonymised data were captured through the software REDCap and analysed for consensus and prioritisation across statements. Starting with 12 statements, strong consensus was defined as ≥75% agreement. Stability was assessed between rounds. Results: Strong consensus was achieved for four statements regarding considerations for the use of TIVA. These statements addressed whether TIVA is useful in paediatric anaesthesia, the importance of TIVA in reducing the incidence of postoperative nausea and vomiting, its positive impact on the environment and effect on patient physiology, such as airway and haemodynamic control. Conclusions: Using the Delphi method, this international consensus showed that cost, lack of familiarity or training and the risk of delayed emergence are not considered obstacles to TIVA use. It appears, instead, that the primary motivations for its adoption are the impact of TIVA on patient experience, especially in paediatrics, and the benefit to the overall procedure outcome. The effect of TIVA on postoperative nausea and vomiting and patient physiology, as well as improving its availability in paediatrics were considered as priorities. We also identified areas where the debate remains open, generating new research questions on geographical variation and the potential impact of local availability of monitoring equipment.
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20
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Wylie N, Beale L, Westley I. Consistency of remifentanil concentrations in propofol-Remifentanil infusions. A laboratory-based study. Paediatr Anaesth 2022; 32:727-731. [PMID: 35234322 DOI: 10.1111/pan.14427] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 01/12/2022] [Accepted: 01/19/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND There is increasing interest in two-agent single-pump intravenous infusions for anesthesia and sedation in pediatric patients. Propofol-remifentanil is one such mixture. The poor miscibility of such admixtures when remifentanil is added in very high concentrations and when the admixtures are maintained in static conditions has been demonstrated; however, these physiochemical properties have not been examined in clinically relevant concentrations or settings. AIM To examine if propofol-remifentanil admixtures maintain consistent remifentanil delivery when mixed in clinically relevant remifentanil concentrations and subjected to the physical effects of an actively infusing, directly-engaged syringe driver system with an extension line, as occurs when propofol-remifentanil is administered to a patient. METHODS A propofol 10 mg.ml-1 combined with remifentanil 5 mcg.ml-1 solution was run using a Paedfusor® propofol target-controlled infusion model for 10 kg and 20 kg children for 57 min at a target plasma concentration of 3 mcg.ml-1 through a 30 ml syringe, 180 cm minimum volume extension line, lever lock cannula, interlink injection site, and 22 g intravenous cannula into sample pots. Samples were taken at the completion of the loading bolus, 1 and 2 min postcompletion of loading bolus, and every 5 min thereafter. The remifentanil concentration in these samples was then assayed using chromatography. RESULTS There was no difference in the concentration of remifentanil in the samples based on the duration of infusion to the endpoint of 1 h, or on the patient weight model used. The concentration remained 5 mcg.ml-1 +/- 0.5 mcg.ml-1 per sample. The measurement uncertainty for the assay at 0.5 mcg.ml-1 is +/- 0.2 mcg.ml-1 . CONCLUSION The concentration of remifentanil was 5 mcg.ml-1 +/- 0.5 mcg.ml-1 and was consistent across 57 min of infusion, and two different pediatric weight profiles.
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Affiliation(s)
- Nicole Wylie
- Women's and Children's Hospital, Adelaide, SA, Australia.,Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA, Australia
| | - Lee Beale
- Women's and Children's Hospital, Adelaide, SA, Australia
| | - Ian Westley
- Pharmacology, Chemical Pathology, SA Pathology, Adelaide, SA, Australia.,School of Pharmacy and Biomedical Sciences, UniSA, Adelaide, SA, Australia
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Ren J, Wang J, Chen J, Ma Y, Yang Y, Wei M, Wang Y, Wang L. The outcome of intravenous and inhalation anesthesia after pancreatic cancer resection: a retrospective study. BMC Anesthesiol 2022; 22:169. [PMID: 35637441 PMCID: PMC9150331 DOI: 10.1186/s12871-022-01703-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Accepted: 05/18/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Different types of anesthesia may affect cancer patient's outcomes, we compared the overall survival (OS) and disease-free survival (DFS) of patients with pancreatic cancer under total intravenous and inhalation anesthesia. METHODS The authors collected the electronic medical records of patients who had accepted at a pancreatectomy from January 1, 2010 to December 31, 2016. Patients respectively received total intravenous anesthesia (TIVA) or inhalational anesthesia (INHA). Stabilized inverse probability of treatment weighting (SIPTW)was used to minimize differences. Kaplan-Meier survival was established to analyze the influence of sort of anesthesia on disease-free and overall survival. We compare the effects of each sort of anesthesia on cancer recurrence or metastasis and all-cause mortality. RESULTS A total of 463 patients who had undergone pancreatic cancer resection were collected in this study, of which 421 patients were available (TIVA group, n = 114 INHA group, n = 307). After SIPTW there were no significant differences between the two groups in disease-free survival (hazard ratio, 1.01, 95%CI, 0.78 to 1.29, P = 0.959) or overall survival (hazard ratio, 1.11, 95%CI, 0.87 to 1.42, P = 0.405). CONCLUSIONS In conclusion, the present study showed no significant difference in overall survival and disease-free survival between total intravenous anesthesia and volatile anesthesia.
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Affiliation(s)
- Jie Ren
- Department of Anesthesiology, Harbin Medical University Cancer Hospital, No.150 Haping Rd., Nangang District, Harbin, 150081 China
| | - Junli Wang
- Department of Anesthesiology, Harbin Medical University Cancer Hospital, No.150 Haping Rd., Nangang District, Harbin, 150081 China
| | - Jingwen Chen
- Department of Anesthesiology, Harbin Medical University Cancer Hospital, No.150 Haping Rd., Nangang District, Harbin, 150081 China
| | - Yue Ma
- Department of Anesthesiology, Harbin Medical University Cancer Hospital, No.150 Haping Rd., Nangang District, Harbin, 150081 China
| | - Yutong Yang
- Department of Anesthesiology, Harbin Medical University Cancer Hospital, No.150 Haping Rd., Nangang District, Harbin, 150081 China
| | - Ming Wei
- Department of Anesthesiology, Harbin Medical University Cancer Hospital, No.150 Haping Rd., Nangang District, Harbin, 150081 China
| | - Yu Wang
- Department of Anesthesiology, Harbin Medical University Cancer Hospital, No.150 Haping Rd., Nangang District, Harbin, 150081 China
| | - Liping Wang
- Department of Anesthesiology, Harbin Medical University Cancer Hospital, No.150 Haping Rd., Nangang District, Harbin, 150081 China
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22
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Morse JD, Cortinez LI, Anderson BJ. Pharmacokinetic Pharmacodynamic Modelling Contributions to Improve Paediatric Anaesthesia Practice. J Clin Med 2022; 11:jcm11113009. [PMID: 35683399 PMCID: PMC9181587 DOI: 10.3390/jcm11113009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 05/24/2022] [Accepted: 05/25/2022] [Indexed: 12/10/2022] Open
Abstract
The use of pharmacokinetic-pharmacodynamic models has improved anaesthesia practice in children through a better understanding of dose-concentration-response relationships, developmental pharmacokinetic changes, quantification of drug interactions and insights into how covariates (e.g., age, size, organ dysfunction, pharmacogenomics) impact drug prescription. Simulation using information from these models has enabled the prediction and learning of beneficial and adverse effects and decision-making around clinical scenarios. Covariate information, including the use of allometric size scaling, age and consideration of fat mass, has reduced population parameter variability. The target concentration approach has rationalised dose calculation. Paediatric pharmacokinetic-pharmacodynamic insights have led to better drug delivery systems for total intravenous anaesthesia and an expectation about drug offset when delivery is stopped. Understanding concentration-dependent adverse effects have tempered dose regimens. Quantification of drug interactions has improved the understanding of the effects of drug combinations. Repurposed drugs (e.g., antiviral drugs used for COVID-19) within the community can have important effects on drugs used in paediatric anaesthesia, and the use of simulation educates about these drug vagaries.
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Affiliation(s)
- James D. Morse
- Department of Anaesthesiology, University of Auckland, Park Road, Auckland 1023, New Zealand;
| | - Luis Ignacio Cortinez
- División Anestesiología, Escuela de Medicina, Pontificia Universidad Católica de Chile, San Diego de Chile 8331150, Chile;
| | - Brian J. Anderson
- Department of Anaesthesiology, University of Auckland, Park Road, Auckland 1023, New Zealand;
- Correspondence: ; Tel.: +64-9-3074903; Fax: +64-9-3078986
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23
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Nevešćanin Biliškov A, Gulam D, Žaja M, Pogorelić Z. Total Intravenous Anesthesia with Ketofol versus Combination of Ketofol and Lidocaine for Short-Term Anesthesia in Pediatric Patients; Double Blind, Randomized Clinical Trial of Effects on Recovery. Children (Basel) 2022; 9:children9020282. [PMID: 35205002 PMCID: PMC8870771 DOI: 10.3390/children9020282] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 02/12/2022] [Accepted: 02/16/2022] [Indexed: 11/27/2022]
Abstract
Background: Ketofol admixture has been proposed to be useful for sedation and general anesthesia. The beneficial effect of the combination of ketofol with lidocaine may be a shortened time of anesthesia and recovery period. This study aimed to establish the effect of total intravenous anesthesia (TIVA) with ketofol and ketofol with lidocaine on recovery in children. Methods: Two hundred children from the ages of 1–12 years who underwent short surgical procedures were randomly allocated into two groups. Propofol mixtures (ketofol) were prepared for group l. A ratio of 1:4 of ketofol was used for induction and for the maintenance of anesthesia a ratio of was used 1:7. For the induction and maintenance of anesthesia ketofol with lidocaine (lidoketofol) was used in group II. The McFarlan infusion regimen was used with reduction. The extubating time, anesthesia duration and the length of stay in the post-anesthesia care unit (PACU) were recorded. Results: Extubation time showed to be considerably shorter in the lidoketofol group than in the ketofol group (120 s versus 240 s; p < 0.00001). The anesthesia duration was also significantly shorter in the lidoketofol group (35 min vs. 50 min; p < 0.00001). The lidoketofol group showed to have a lower length of stay in the post-anesthesia care unit (PACU) than the ketofol group (20 min vs. 35 min; p < 0.00001). The lidoketofol group showed lower fentanyl consumption per kg (2.1 µg per kg vs. 2.3 µg per kg; p < 0.056) and lower propofol consumption (6.6 mg per kg vs. 7.6 mg per kg; p < 0.032). Conclusion: The recovery in pediatric anesthesia can improve with usage of TIVA with ketofol plus lidocaine admixture with a reduced McFarlan dose regimen.
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Affiliation(s)
- Ana Nevešćanin Biliškov
- Department of Anesthesiology, Reanimatology and Intensive Care, University Hospital of Split, Spinčićeva 1, 21000 Split, Croatia; (A.N.B.); (M.Ž.)
- School of Medicine, University of Split, Šoltanska 2, 21000 Split, Croatia;
| | - Danijela Gulam
- School of Medicine, University of Split, Šoltanska 2, 21000 Split, Croatia;
- Department of Anesthesiology, Reanimatology and Intensive Care, General Hospital Šibenik, Stjepana Radića 83, 22000 Šibenik, Croatia
| | - Marija Žaja
- Department of Anesthesiology, Reanimatology and Intensive Care, University Hospital of Split, Spinčićeva 1, 21000 Split, Croatia; (A.N.B.); (M.Ž.)
| | - Zenon Pogorelić
- School of Medicine, University of Split, Šoltanska 2, 21000 Split, Croatia;
- Department of Pediatric Surgery, University Hospital of Split, Spinčićeva 1, 21000 Split, Croatia
- Correspondence: ; Tel.: +385-21-556654
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24
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Negrini D, Wu A, Oba A, Harnke B, Ciancio N, Krause M, Clavijo C, Al-Musawi M, Linhares T, Fernandez-Bustamante A, Schmidt S. Incidence of Postoperative Cognitive Dysfunction Following Inhalational vs Total Intravenous General Anesthesia: A Systematic Review and Meta-Analysis. Neuropsychiatr Dis Treat 2022; 18:1455-1467. [PMID: 35874550 PMCID: PMC9296882 DOI: 10.2147/ndt.s374416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 07/09/2022] [Indexed: 11/23/2022] Open
Abstract
Postoperative cognitive dysfunction (POCD) has been increasingly recognized as a contributor to postoperative complications. A consensus-working group recommended that POCD should be distinguished between delayed cognitive recovery, ie, evaluations up to 30 days postoperative, and neurocognitive disorder, ie, assessments performed between 30 days and 12 months after surgery. Additionally, the choice of the anesthetic, either inhalational or total intravenous anesthesia (TIVA) and its effect on the incidence of POCD, has become a focus of research. Our primary objective was to search the literature and conduct a meta-analysis to verify whether the choice of general anesthesia may impact the incidence of POCD in the first 30 days postoperatively. As a secondary objective, a systematic review of the literature was conducted to estimate the effects of the anesthetic on POCD between 30 days and 12 months postoperative. For the primary objective, an initial review of 1913 articles yielded ten studies with a total of 3390 individuals. For the secondary objective, four studies with a total of 480 patients were selected. In the first 30 days postoperative, the odds-ratio for POCD in TIVA group was 0.46 (95% CI = 0.26-0.81; p = 0.01), compared to the inhalational group. TIVA was associated with a lower incidence of POCD in the first 30 days postoperatively. Regarding the secondary objective, due to the small number of selected articles and its high heterogeneity, a metanalysis was not conducted. Given the heterogeneity of criteria for POCD, future prospective studies with more robust designs should be performed to fully address this question.
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Affiliation(s)
- Daniel Negrini
- Division of Surgical Oncology, Department of Surgery, University of Colorado, Anschutz Medical Campus, Aurora, CO, USA.,Department of Anesthesiology, Federal University of the State of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Andrew Wu
- Division of Surgical Oncology, Department of Surgery, University of Colorado, Anschutz Medical Campus, Aurora, CO, USA
| | - Atsushi Oba
- Division of Surgical Oncology, Department of Surgery, University of Colorado, Anschutz Medical Campus, Aurora, CO, USA.,Department of Hepatobiliary and Pancreatic Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Ben Harnke
- Strauss Health Sciences Library, University of Colorado, Anschutz Medical Campus, Aurora, CO, USA
| | - Nicholas Ciancio
- Division of Surgical Oncology, Department of Surgery, University of Colorado, Anschutz Medical Campus, Aurora, CO, USA
| | - Martin Krause
- Department of Anesthesiology, University of California San Diego, La Jolla, CA, USA
| | - Claudia Clavijo
- Department of Anesthesiology, University of Colorado, Anschutz Medical Campus, Aurora, CO, USA
| | - Mohammed Al-Musawi
- Department of Surgery-Division of Cardiothoracic Surgery, School of Medicine, University of Colorado, Aurora, CO, USA
| | - Tatiana Linhares
- Division of Surgical Oncology, Department of Surgery, University of Colorado, Anschutz Medical Campus, Aurora, CO, USA
| | | | - Sergio Schmidt
- Department of Neurology, Federal University of the State of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
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Bustamante R, Canfrán S, Gómez de Segura IA, Aguado D. Intraoperative effect of low doses of ketamine or dexmedetomidine continuous rate infusions in healthy dogs receiving propofol total intravenous anaesthesia and epidural anaesthesia: A prospective, randomised clinical study. Res Vet Sci 2021; 143:4-12. [PMID: 34953409 DOI: 10.1016/j.rvsc.2021.12.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 12/02/2021] [Accepted: 12/16/2021] [Indexed: 11/29/2022]
Abstract
The present study aimed to determine the effect of either ketamine or dexmedetomidine constant rate infusion (CRI) on intraoperative propofol anaesthetic requirements during total intravenous anaesthesia (TIVA) in healthy dogs undergoing hindlimbs orthopaedic procedures receiving epidural anaesthesia. In this randomised, blinded clinical study, thirty-nine healthy client-owned dogs were premedicated intramuscularly (dexmedetomidine 4 μg/kg and methadone 0.3 mg/kg). General anaesthesia was induced to effect with propofol administered as intravenous bolus, and maintained with propofol TIVA (18 mg/kg/h), adjusted to meet the suitable clinical anaesthetic depth (indicatively±20%) based on clinical judgement. Lumbosacral epidural anaesthesia was performed using bupivacaine (1 mg/kg) and morphine preservative free (0.1 mg/kg). Dogs randomly received either saline (SP; loading dose 1 mL/kg, CRI 1 mL/kg/h), or ketamine (KP; loading dose 1.5 mg/kg, CRI 1.5 mg/kg/h), or dexmedetomidine (DP; loading dose 1 μg/kg/, CRI 1 μg/kg/h). Physiological variables were recorded intraoperatively at 5-min intervals using standard-of-care monitoring. Recovery quality and duration were recorded. Treatment groups were compared with parametric and non-parametric tests as appropriate, p < 0.05. Propofol rates and recovery scores were similar between groups. Overall mean and diastolic blood pressures were higher in group DP compared to group KP (12-14 mmHg, p = 0.016 and p = 0.015, respectively). More dogs required mechanical ventilation in group KP (12 dogs) than in either group SP or DP (7 dogs per group, p = 0.037). Ketamine or dexmedetomidine CRIs, at the studied rates, did not reduce propofol TIVA requirements in dogs undergoing orthopaedic surgery with epidural anaesthesia.
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Affiliation(s)
- Rocío Bustamante
- Anaesthesiology Service, Vetsia Veterinary Hospital, Calle Galileo 3, 28914, Leganés, Madrid, Spain.
| | - Susana Canfrán
- Anaesthesiology Service, Department of Animal Medicine and Surgery, Veterinary Teaching Hospital, Veterinary Faculty, Complutense University of Madrid, Avda. Puerta de Hierro s/n, 28040 Madrid, Spain.
| | - Ignacio A Gómez de Segura
- Anaesthesiology Service, Department of Animal Medicine and Surgery, Veterinary Teaching Hospital, Veterinary Faculty, Complutense University of Madrid, Avda. Puerta de Hierro s/n, 28040 Madrid, Spain.
| | - Delia Aguado
- Anaesthesiology Service, Department of Animal Medicine and Surgery, Veterinary Teaching Hospital, Veterinary Faculty, Complutense University of Madrid, Avda. Puerta de Hierro s/n, 28040 Madrid, Spain.
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26
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Faroni E, Sabattini S, Lenzi J, Guerra D, Comazzi S, Aresu L, Mazzanti A, Zanardi S, Cola V, Lotito E, Marconato L. Sleeping Beauty: Anesthesia May Promote Relapse in Dogs With Diffuse Large B-Cell Lymphoma in Complete Remission After Chemo-Immunotherapy. Front Vet Sci 2021; 8:760603. [PMID: 34881319 PMCID: PMC8645585 DOI: 10.3389/fvets.2021.760603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 10/28/2021] [Indexed: 11/20/2022] Open
Abstract
Surgery-induced stress and anesthesia-related immunosuppression are believed to play a critical role in human oncology patients. Studies have hypothesized that anesthesia influences patients' outcome, promoting tumor recurrence and metastasis. Aim of the study was to investigate whether anesthesia promoted relapse in dogs with diffuse large B-cell lymphoma (DLBCL). Medical records were searched for dogs with DLBCL, that were in complete remission (CR) after the same chemo-immunotherapy protocol. Dogs receiving anesthesia were included if the procedure was performed while in CR. Time to relapse (TTR) was obtained via Kaplan–Meier method. Association between anesthesia and relapse was assessed using a nested case-control design and estimated using conditional logistic regression. Sixty-one dogs with DLBCL were included. Overall median TTR was 329 days (95% CI, 281–377). Forty-eight (79%) dogs relapsed during the study period, while 13 (21%) were still in CR at data analysis closure. Eighteen (30%) dogs received anesthesia with opioids, propofol, and isoflurane or sevoflurane. The relative risk of lymphoma relapse for dogs undergoing anesthesia was significantly higher compared with dogs not undergoing anesthesia, with an odds ratio of 3.09 (P = 0.019) on multivariable analysis. Anesthesia may promote relapse in dogs with DLBCL treated with chemo-immunotherapy, although a role of perioperative stress cannot be ultimately excluded. Considering the high frequency of anesthetic procedures required for diagnostic and therapeutic protocols among oncology patients, it is of utmost interest to characterize the effects of single anesthetic agents on the immune system. Further prospective studies are needed to better define the impact of anesthesia on patients' outcome.
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Affiliation(s)
- Eugenio Faroni
- Department of Veterinary Medical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Silvia Sabattini
- Department of Veterinary Medical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Jacopo Lenzi
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Dina Guerra
- Department of Veterinary Medical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Stefano Comazzi
- Department of Veterinary Medicine, University of Milano, Lodi, Italy
| | - Luca Aresu
- Department of Veterinary Sciences, University of Torino, Turin, Italy
| | - Alessia Mazzanti
- Department of Veterinary Medical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Stefano Zanardi
- Department of Veterinary Medical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Veronica Cola
- Department of Veterinary Medical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Emilio Lotito
- Clinica Veterinaria Dell'Orologio, Sasso Marconi, Bologna, Italy
| | - Laura Marconato
- Department of Veterinary Medical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy
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27
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Ryden A, Fisichella S, Perchiazzi G, Nyman G. Comparison of two injectable anaesthetic techniques on induction and subsequent anaesthesia in pigs. Lab Anim 2021; 55:540-550. [PMID: 34325556 DOI: 10.1177/00236772211029810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Pig experiments often require anaesthesia, and a rapid stress-free induction is desired. Induction drugs may alter the subsequent anaesthesia. Therefore, the aim of the present study was to compare, in pigs, the effects of two different injectable anaesthetic techniques on the induction and on the physiological variables in a subsequent eight hours of total intravenous anaesthesia (TIVA). Twelve domestic castrates (Swedish Landrace/Yorkshire) 27‒31 kg were used. The pigs were randomly assigned to different induction drug combinations of zolazepam-tiletamine and medetomidine intramuscularly (ZTMe) or midazolam, ketamine intramuscularly and fentanyl intravenously (MiKF). Time from injection to unconsciousness was recorded and the ease of endotracheal intubation assessed. The TIVA infusion rate was adjusted according to the response exhibited from the nociceptive stimulus delivered by mechanically clamping the dewclaw. The time from injection to unconsciousness was briefer and intubation was easier in the ZTMe group. Results from the recorded heart rate, cardiac index and arterial blood pressure variables were satisfactorily preserved and cardiovascular function was maintained in both groups. Shivering was not observed in the ZTMe group, but was observed in four of the pigs in the MiKF group. The requirement of TIVA was lower in the ZTMe group. In conclusion, ZTMe had better results than MiKF in areas such as shorter induction time, better intubation scoring results and less adjustment and amount of TIVA required up to six hours of anaesthesia. The results may have been due to a greater depth of anaesthesia achieved with the ZTMe combination at the dose used.
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Affiliation(s)
- Anneli Ryden
- Department of Clinical Sciences, Swedish University of Agricultural Sciences, Sweden
| | - Sheila Fisichella
- Department of Clinical Sciences, Swedish University of Agricultural Sciences, Sweden
| | - Gaetano Perchiazzi
- Hedenstierna Laboratory, Uppsala University, Sweden
- Department of Anaesthesia, Operation and Intensive Care, Uppsala University Hospital, Sweden
| | - Görel Nyman
- Department of Clinical Sciences, Swedish University of Agricultural Sciences, Sweden
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28
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Wilent WB, Tesdahl EA, Trott JT, Tassone S, Harrop JS, Klineberg EO, Sestokas AK. Impact of inhalational anesthetic agents on the baseline monitorability of motor evoked potentials during spine surgery: a review of 22,755 cervical and lumbar procedures. Spine J 2021; 21:1839-1846. [PMID: 34274500 DOI: 10.1016/j.spinee.2021.07.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 06/01/2021] [Accepted: 07/02/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT During spine surgery, motor evoked potentials (MEPs) are often utilized to monitor both spinal cord function and spinal nerve root or plexus function. While there are reports evaluating the impact of anesthesia on the ability of MEPs to monitor spinal cord function, less is known about the impact of anesthesia on the ability of MEPs to monitor spinal nerve root and plexus function. PURPOSE To compare the baseline monitorability and amplitude of MEPs during cervical and lumbar procedures between two cohorts based on the maintenance anesthetic regimen: a total intravenous anesthesia (TIVA) versus a regimen balanced with volatile inhalational and intravenous agents. STUDY DESIGN Baseline MEP data from a total of 16,559 cervical and 6,196 lumbar extradural spine procedures utilizing multimodality intraoperative neuromonitoring (IONM) including MEPs between January 2017 and March 2020 were obtained from a multi-institutional database. Two cohorts for each region of spine surgery were delineated based on the anesthetic regimen: a TIVA cohort and a Balanced anesthesia cohort. PATIENT SAMPLE Age 18 and older. Fellowship support for 65,000 for year 2021. OUTCOME MEASURES Percent monitorability and amplitudes of baseline MEPs. METHODS The baseline monitorability of each muscle MEP was evaluated by the IONM team in real-time and recorded in the patient's electronic medical record. The relation between anesthetic regimen and baseline monitorability was estimated using mixed effects logistic regression, with distinct models for cervical and lumbar procedures. Subsets of cervical and lumbar procedures from each anesthesia cohort in which all MEPs were deemed monitorable were randomly selected and the average peak-to-trough amplitude of each muscle MEP was retrospectively measured. Mixed-effects linear regression models were estimated (one each for cervical and lumbar procedures) to assess possible differences in average amplitude associated with anesthesia regimen. RESULTS At the time of surgery, baseline MEPs were reported monitorable from all targeted muscles in 86.8% and 83.0% of cervical and lumbar procedures, respectively, for the TIVA cohort, but were reported monitorable in just 59.3% and 61.0% of cervical and lumbar procedures, respectively, in the Balanced cohort, yielding disparities of 27.5% and 22.0%, respectively. The model-adjusted monitorability disparity between cohorts for a given muscle MEP ranged from 0.2% to 16.6% but was smallest for distal intrinsic hand and foot muscle MEPs (0.2%-1.1%) and was largest for proximal muscle MEPs (deltoid: 10.8%, biceps brachii: 8.8%, triceps: 13.0%, quadriceps: 16.6%, gastrocnemius: 7.8%, and tibialis anterior: 3.7%) where the monitorability was significantly decreased in the Balanced cohort relative to the TIVA cohort (p<.0001). Relative to the TIVA cohort, the model-adjusted amplitude of an MEP in the Balanced cohort was smaller for all muscles measured, ranging from 27.5% to 78.0% smaller. Relative to the TIVA cohort, the model-adjusted amplitude of an MEP was significantly decreased (p<.01) in the Balanced cohort for the most proximal muscles (Percent smaller: deltoid: 74.3%, biceps: 78.0%, triceps: 54.9%, quadriceps: 54.8%). CONCLUSIONS TIVA is the preferred anesthetic regimen for optimizing MEP monitoring during spine surgery. Inhalational agents significantly decrease MEP monitorability and amplitudes for most muscles, and this effect is especially pronounced for proximal limb muscles such as the deltoid, biceps, triceps, and quadriceps.
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Affiliation(s)
- W Bryan Wilent
- SpecialtyCare, 3 Maryland Farms, Suite 200, Brentwood, TN 37027.
| | - Eric A Tesdahl
- SpecialtyCare, 3 Maryland Farms, Suite 200, Brentwood, TN 37027
| | - Julie T Trott
- SpecialtyCare, 3 Maryland Farms, Suite 200, Brentwood, TN 37027
| | - Shakira Tassone
- SpecialtyCare, 3 Maryland Farms, Suite 200, Brentwood, TN 37027
| | - James S Harrop
- Jefferson University Hospital, 909 Walnut Street Clinical Office Building: 2nd Floor, Philadelphia, PA 19107
| | - Eric O Klineberg
- University of California Davis, 3301 C St., Suite 1500, Sacramento, CA 95816
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Morse JD, Cortinez LI, Anderson BJ. Pharmacokinetic concepts for dexmedetomidine target-controlled infusion pumps in children. Paediatr Anaesth 2021; 31:924-931. [PMID: 34085357 DOI: 10.1111/pan.14235] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Revised: 05/26/2021] [Accepted: 05/31/2021] [Indexed: 12/15/2022]
Abstract
Pharmacokinetic parameter estimates are used in mathematical equations (pharmacokinetic models) to describe concentration changes with time in a population and are specific to that population. Simulation using these models and their parameter estimates can enrich understanding of drug behavior and serve as a basis for study design. Pharmacokinetic concepts are presented pertaining to future designs of dexmedetomidine target-controlled infusion pumps in children. This manuscript provides the pediatric anesthesiologist with an understanding of the nuances that should be considered when using target-controlled infusion pumps; how the central volume may differ between populations, how clearance changes with age, and the impact of adverse effects on dose. In addition, the ideal loading dose and rate of delivery to achieve target concentration without adverse cardiovascular effects are reviewed, and finally, dose considerations for obese children, based on contact-sensitive half-time, are introduced. An understanding of context-sensitive half-time changes with age enables anesthetic practitioners to better estimate duration of effect after cessation of dexmedetomidine infusion. Use of these known pharmacokinetic parameters and covariate information for the pediatric patient could readily be incorporated into commercial target-controlled infusion pumps to allow effective and safe open-loop administration of dexmedetomidine in children.
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Affiliation(s)
- James D Morse
- Department of Pharmacology & Clinical Pharmacology, Auckland University, Auckland, New Zealand
| | - Luis Ignacio Cortinez
- División Anestesiología, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago de Chile, Chile
| | - Brian J Anderson
- Department of Anaesthesiology, University of Auckland, Auckland, New Zealand
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30
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Biliškov AN, Ivančev B, Pogorelić Z. Effects on Recovery of Pediatric Patients Undergoing Total Intravenous Anesthesia with Propofol versus Ketofol for Short-Lasting Laparoscopic Procedures. Children (Basel) 2021; 8:children8070610. [PMID: 34356589 PMCID: PMC8303649 DOI: 10.3390/children8070610] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 06/25/2021] [Accepted: 07/15/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Combining ketamine and propofol (ketofol) was suggested as a new concept for sedation and general anesthesia in pediatric populations for various conditions. The aim of the present study was to determine the effect of total intravenous anesthesia (TIVA) with propofol and ketofol on recovery after laparoscopic surgery in pediatric patients. METHODS Two hundred children with median age of 5 years who underwent laparoscopic surgery were randomized into two groups. Propofol 1% was used for induction and maintenance of anesthesia in group I, while ketamine-propofol combination (ketofol) was used in group II. Ketamine-propofol combination (ketofol) was prepared in the same applicator for group II. Ketofol ratios of 1:4 and 1:7 were used for induction and maintenance of anesthesia, respectively. A reduced McFarlan infusion dose was used in group I (1.2, 1.0, and 0.8 mL/kg/h for 15, 15, and 30 min, respectively), while a McFarlan infusion dose was used in group II (1.5, 1.3, and 1.1 mL/kg/h for 15, 15, and 30 min, respectively). Extubating time, duration of anesthesia, and length of stay in post-anesthesia care unit (PACU) were recorded. RESULTS Extubating time was significantly lower in the ketofol group than in the propofol group (240 s vs. 530 s; p < 0.00001). Significantly shorter duration of anesthesia (47 min vs. 60 min; p < 0.00001) as well as length of stay in the PACU (35 min vs. 100 min; p < 0.00001) were recorded in ketofol compared to the propofol group. Total fentanyl (100 µg (interquartile range, IQR 80, 125) vs. 50 µg (IQR 40, 60); p < 0.00001) and propofol (260 mg (IQR 200, 350) vs. 160 mg (IQR 120, 210); p < 0.00001) consumption per body weight were significantly lower in the ketofol group. CONCLUSIONS TIVA with ketamine-propofol combination (ketofol) using a reduced McFarlan dose regimen shortened extubating time, duration of anesthesia, as well as length of stay in the PACU in pediatric anesthesia after laparoscopic surgery.
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Affiliation(s)
- Ana Nevešćanin Biliškov
- Department of Anesthesiology, Reanimatology and Intensive Care, University Hospital of Split, Spinčićeva 1, 21000 Split, Croatia
- Correspondence: ; Tel.: +385-21-556111
| | - Božena Ivančev
- Department of Pediatric Surgery, University Hospital of Split, Spinčićeva 1, 21000 Split, Croatia; (B.I.); (Z.P.)
| | - Zenon Pogorelić
- Department of Pediatric Surgery, University Hospital of Split, Spinčićeva 1, 21000 Split, Croatia; (B.I.); (Z.P.)
- Department of Surgery, School of Medicine, University of Split, Šoltanska 2, 21000 Split, Croatia
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Gomes VH, da Silva MFA, Carregaro AB, de Oliveira RLS, Neves DM. Evaluation of anaesthetic depth and cardiopulmonary effects of propofol infusion rate in Sapajus apella previously chemically contained with dextroketamine-midazolam. J Med Primatol 2021; 50:207-211. [PMID: 34043241 DOI: 10.1111/jmp.12529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 04/19/2021] [Accepted: 05/04/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND This study evaluated the cardiopulmonary effects and anaesthetic depth induced by a propofol infusion rate of 0.8 mg/kg/min in monkeys (Sapajus apella). MATERIALS AND METHODS Five capuchin monkeys received dextroketamine-midazolam intramuscularly. After a maximum duration of 5 min, the values of the physiological parameters were recorded, and a venous catheter was placed. After recovery from chemical restraint, the animals were anaesthetized with propofol intravenously, which was maintained for 1 h. Physiological parameters, anaesthetic depth, the time and quality of anaesthetic recovery were evaluated. RESULTS Heart and respiratory rates, systolic blood pressure and rectal temperature during propofol infusion were lower than those during anaesthesia induction with dextroketamine-midazolam. Unconsciousness, muscle relaxation and lack of response to tail clamping were observed during propofol infusion. No animals showed excitement or vocalization during anaesthetic recovery. CONCLUSION Propofol infusion rate of 0.8 mg/kg/min promoted surgical general anaesthesia, with transient hypotension, which showed excellent anaesthetic recovery.
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Heiderich S, Ghasemi T, Dennhardt N, Sümpelmann R, Rigterink V, Nickel K, Keil O, Böthig D, Beck CE. Correlation of exhaled propofol with Narcotrend index and calculated propofol plasma levels in children undergoing surgery under total intravenous anesthesia - an observational study. BMC Anesthesiol 2021; 21:161. [PMID: 34039280 PMCID: PMC8149920 DOI: 10.1186/s12871-021-01368-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 05/04/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Exhaled propofol concentrations correlate with propofol concentrations in adult human blood and the brain tissue of rats, as well as with electroencephalography (EEG) based indices of anesthetic depth. The pharmacokinetics of propofol are however different in children compared to adults. The value of exhaled propofol measurements in pediatric anesthesia has not yet been investigated. Breathing system filters and breathing circuits can also interfere with the measurements. In this study, we investigated correlations between exhaled propofol (exP) concentrations and the Narkotrend Index (NI) as well as calculated propofol plasma concentrations. METHODS A multi-capillary-column (MCC) combined with ion mobility spectrometry (IMS) was used to determine exP. Optimal positioning of breathing system filters (near-patient or patient-distant) and sample line (proximal or distal to filter) were investigated. Measurements were taken during induction (I), maintenance (M) and emergence (E) of children under total intravenous anesthesia (TIVA). Correlations between ExP concentrations and NI and predicted plasma propofol concentrations (using pediatric pharmacokinetic models Kataria and Paedfusor) were assessed using Pearson correlation and regression analysis. RESULTS Near-patient positioning of breathing system filters led to continuously rising exP values when exP was measured proximal to the filters, and lower concentrations when exP was measured distal to the filters. The breathing system filters were therefore subsequently attached between the breathing system tubes and the inspiratory and expiratory limbs of the anesthetic machine. ExP concentrations significantly correlated with NI and propofol concentrations predicted by pharmacokinetic models during induction and maintenance of anesthesia. During emergence, exP significantly correlated with predicted propofol concentrations, but not with NI. CONCLUSION In this study, we demonstrated that exP correlates with calculated propofol concentrations and NI during induction and maintenance in pediatric patients. However, the correlations are highly variable and there are substantial obstacles: Without patient proximal placement of filters, the breathing circuit tubing must be changed after each patient, and furthermore, during ventilation, a considerable additional loss of heat and moisture can occur. Adhesion of propofol to plastic parts (endotracheal tube, breathing circle) may especially be problematic during emergence. TRIAL REGISTRATION The study was registered in the German registry of clinical studies (DRKS-ID: DRKS00015795 ).
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Affiliation(s)
- Sebastian Heiderich
- Clinic of Anesthesiology and Intensive Care Medicine, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
| | - Tara Ghasemi
- Clinic of Anesthesiology and Intensive Care Medicine, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Nils Dennhardt
- Clinic of Anesthesiology and Intensive Care Medicine, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Robert Sümpelmann
- Clinic of Anesthesiology and Intensive Care Medicine, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Vanessa Rigterink
- Clinic of Anesthesiology and Intensive Care Medicine, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Katja Nickel
- Clinic of Anesthesiology and Intensive Care Medicine, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Oliver Keil
- Clinic of Anesthesiology and Intensive Care Medicine, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Dietmar Böthig
- Department for Pediatric Cardiology and Intensive Care, Hannover Medical School, Hannover, Germany
| | - Christiane E Beck
- Clinic of Anesthesiology and Intensive Care Medicine, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
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Lervik A, Forr Toverud S, Bohlin J, Haga HA. Macrocirculatory Parameters and Oxygen Debt Indices in Pigs During Propofol Or Alfaxalone Anesthesia When Subjected to Experimental Stepwise Hemorrhage. Front Vet Sci 2021; 8:664112. [PMID: 34095276 PMCID: PMC8173164 DOI: 10.3389/fvets.2021.664112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 03/30/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Pigs are anesthetized when used for emergency procedures live tissue training (LTT) of civilian and military medical personnel or for experimental purposes, but there is a paucity in the literature regarding anesthesia of pigs for this purpose. Objective(s): The main goals of the study were to compare oxygen debt, macrocirculatory parameters, and time to cardiac arrest between pigs in hemorrhagic shock and anesthetized with propofol-ketamine-dexmedetomidine or alfaxalone-ketamine-dexmedetomidine. Design: A prospective, non-blinded randomized study design was used. Sixteen pigs were randomized in blocks of four to be anesthetized with either propofol-ketamine-dexmedetomidine (n = 8) or alfaxalone-ketamine-dexmedetomidine (n = 8) as a continuous infusion. Interventions: Premedication with ketamine 15 mg kg-1 and midazolam 1 mg kg-1 was given i.m. Anesthesia was maintained with propofol 8 mg kg-1 h-1 or alfaxalone 5 mg kg-1 h-1 combined with ketamine 5 mg kg-1 h-1 and dexmedetomidine 4 μg kg-1 h-1 i.v. A stepwise, volume-controlled model for hemorrhage was created by exsanguination. Main Outcome Measures: Indices of oxygen debt (lactate, base excess, and oxygen extraction), macrocirculatory (PR, SAP, DAP, MAP, and CI, SVI, and TPR) variables, and time to death was compared between groups. Results: Pigs in the alfaxalone group had significantly higher SAP than pigs given propofol. No difference in other macrocirculatory variables or indices of oxygen debt could be found. A blood loss of 50% of the total blood volume or more was possible in most pigs with both anesthetic regimes. Conclusions: Pigs anesthetized with propofol or alfaxalone combined with ketamine and dexmedetomidine tolerated substantial blood loss.
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Affiliation(s)
- Andreas Lervik
- Department of Companion Animal Clinical Sciences, Faculty of Veterinary Medicine, Norwegian University of Life Sciences, Ås, Norway
| | - Simen Forr Toverud
- Animal Health and Welfare Branch, Veterinary Inspectorate, Norwegian Armed Forces Joint Medical Services, Sessvollmoen, Norway
| | - Jon Bohlin
- Division of Infection Control and Environmental Health, Department for Method Development and Analysis, Norwegian Institute of Public Health, Oslo, Norway.,Center for Fertility and Health Analysis, Norwegian Institute of Public Health, Oslo, Norway
| | - Henning Andreas Haga
- Department of Companion Animal Clinical Sciences, Faculty of Veterinary Medicine, Norwegian University of Life Sciences, Ås, Norway
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Sepúlveda PO, Epulef V, Campos G. Why do We Use the Concepts of Adult Anesthesia Pharmacology in Developing Brains? Will It Have an Impact on Outcomes? Challenges in Neuromonitoring and Pharmacology in Pediatric Anesthesia. J Clin Med 2021; 10:2175. [PMID: 34069896 PMCID: PMC8157588 DOI: 10.3390/jcm10102175] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 05/07/2021] [Accepted: 05/07/2021] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Pediatric sedation and anesthesia techniques have plenty of difficulties and challenges. Data on the pharmacologic, electroencephalographic, and neurologic response to anesthesia at different brain development times are only partially known. New data in neuroscience, pharmacology, and intraoperative neuromonitoring will impact changing concepts and clinical practice. In this article, we develop a conversation to guide the debate and search for a view more attuned to the updated knowledge in neurodevelopment, electroencephalography, and clinical pharmacology for the anesthesiologic practice in the pediatric population.
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Affiliation(s)
- Pablo O. Sepúlveda
- Hospital Base San José de Osorno, Service Anesthesiology and Pain, Faculty of Medicine, University Austral, Los Lagos 529000, Chile
| | - Valeria Epulef
- Department of Surgery, Traumatology and Anesthesiology, Medicine Faculty, Universidad de La Frontera, Temuco 4780000, Chile;
- Hospital Hernán Henriquez Aravena, Temuco 4780000, Chile
| | - Gustavo Campos
- Hospital Pediatrico Niño Jesús, Service of Anesthesiology, Córdoba 5500, Argentina;
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Vigneswaran P, Clancy R, Choo SY, Love-Jones S, Jackson PC, Wilson SM. Seeing White: Management of TIVA during autologous breast reconstruction. J Plast Reconstr Aesthet Surg 2021; 74:2392-2442. [PMID: 33895092 DOI: 10.1016/j.bjps.2021.03.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 03/11/2021] [Indexed: 11/27/2022]
Abstract
Total IntraVenous Anaesthesia is frequently the anaesthetic of choice for enhanced recovery after surgery pathways during breast reconstruction free flap surgery. This relies upon the continuous intravenous infusion of propofol. We describe our experience of two patients where augmentation of a venously congested DIEP flap with a cephalic vein transposition procedure, risked interruption of the intravenous delivery of anaesthesia to the patient. We also share our steps taken to mitigate this risk going forward.
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Affiliation(s)
- Piranavhan Vigneswaran
- Department of Plastic Surgery, North Bristol NHS Trust, Southmead Road, Westbury-on-Trym, Bristol BS10 5NB.
| | - Rachel Clancy
- Department of Plastic Surgery, North Bristol NHS Trust, Southmead Road, Westbury-on-Trym, Bristol BS10 5NB
| | - S Y Choo
- Department of Plastic Surgery, North Bristol NHS Trust, Southmead Road, Westbury-on-Trym, Bristol BS10 5NB
| | - Sarah Love-Jones
- Department of Plastic Surgery, North Bristol NHS Trust, Southmead Road, Westbury-on-Trym, Bristol BS10 5NB
| | - Philippa C Jackson
- Department of Plastic Surgery, North Bristol NHS Trust, Southmead Road, Westbury-on-Trym, Bristol BS10 5NB
| | - Sherif M Wilson
- Department of Plastic Surgery, North Bristol NHS Trust, Southmead Road, Westbury-on-Trym, Bristol BS10 5NB
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Bustamante R, Ortiz-Díez G, Canfrán S, Gómez de Segura IA, Aguado D. Attitudes of Spanish-speaking veterinarians interested in anaesthesia towards use of total intravenous anaesthesia in dogs: a survey study. Vet Anaesth Analg 2021; 48:422-431. [PMID: 33811004 DOI: 10.1016/j.vaa.2020.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 06/30/2020] [Accepted: 10/21/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVES To describe Spanish-speaking veterinary anaesthetists' attitudes towards use of total intravenous anaesthesia (TIVA) in dogs. STUDY DESIGN Prospective online voluntary survey. POPULATION Data from 300 answered surveys. METHODS An anonymous questionnaire was sent via e-mail to representatives of the four largest Spanish-speaking veterinary anaesthesia and analgesia associations. It was distributed through mailing lists (Spain, Argentina, Mexico) or social media (Spain, Chile) to gather information on the use, opinions and perceived advantages of TIVA, as well as on preferred alternatives to isoflurane for providing general anaesthesia. Logistic regression was used to test for response associations. RESULTS A total of 275 (92%) respondents had used TIVA (24% rarely, 36% sometimes, 40% very often or always). There was an association between a higher rate of TIVA usage and a low specialization level, less clinical experience and unavailability of anaesthetic gas scavenging systems. The main reasons for not using TIVA were lack of familiarity with the technique (92%), unavailability of infusion pumps (32%), established institutional anaesthetic protocol (32%), and technical difficulty (20%). Among frequent TIVA users, a higher proportion reported the greater ease of TIVA use (52%) compared to those that did not perceive such benefit (17%) [odds ratio (OR) = 5.2; 95% confidence interval (CI95), 1.7-16.6; p = 0.004). More respondents did not consider TIVA more expensive (60%) (OR = 2.1; CI95, 1.0-4.3; p = 0.034), more difficult to perform (59%) (OR = 2.5; CI95, 1.3-4.9; p = 0.006) or to manage the equipment (53%) (OR = 3.3; CI95, 1.4-7.8; p = 0.008), than inhalational anaesthetics. During isoflurane shortages, respondents reportedly preferred using an alternative inhalational agent (59%) rather than TIVA (47%). CONCLUSIONS AND CLINICAL RELEVANCE TIVA use is widespread among veterinarians within the surveyed associations. Frequent TIVA users reported greater perceived advantages. In situations of isoflurane shortage, an alternative inhalational anaesthetic was preferred over TIVA.
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Affiliation(s)
- Rocío Bustamante
- Department of Animal Medicine and Surgery, Veterinary Teaching Hospital, Veterinary Faculty, Complutense University of Madrid, Madrid, Spain
| | - Gustavo Ortiz-Díez
- Department of Animal Medicine and Surgery, Veterinary Teaching Hospital, Veterinary Faculty, Complutense University of Madrid, Madrid, Spain
| | - Susana Canfrán
- Department of Animal Medicine and Surgery, Veterinary Teaching Hospital, Veterinary Faculty, Complutense University of Madrid, Madrid, Spain.
| | - Ignacio A Gómez de Segura
- Department of Animal Medicine and Surgery, Veterinary Teaching Hospital, Veterinary Faculty, Complutense University of Madrid, Madrid, Spain
| | - Delia Aguado
- Department of Animal Medicine and Surgery, Veterinary Teaching Hospital, Veterinary Faculty, Complutense University of Madrid, Madrid, Spain
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Dubowitz JA, Cata JP, De Silva AP, Braat S, Shan D, Yee K, Hollande F, Martin O, Sloan EK, Riedel B. Volatile anaesthesia and peri-operative outcomes related to cancer: a feasibility and pilot study for a large randomised control trial. Anaesthesia 2021; 76:1198-1206. [PMID: 33440019 DOI: 10.1111/anae.15354] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/09/2020] [Indexed: 12/14/2022]
Abstract
Published data suggest that the type of general anaesthesia used during surgical resection for cancer may impact on patient long-term outcome. However, robust prospective clinical evidence is essential to guide a change in clinical practice. We explored the feasibility of conducting a randomised controlled trial to investigate the impact of total intravenous anaesthesia with propofol vs. inhalational volatile anaesthesia on postoperative outcomes of patients undergoing major cancer surgery. We undertook a randomised, double-blind feasibility and pilot study of propofol total intravenous anaesthesia or volatile-based maintenance anaesthesia during cancer resection surgery at three tertiary hospitals in Australia and the USA. Patients were randomly allocated to receive propofol total intravenous anaesthesia or volatile-based maintenance anaesthesia. Primary outcomes for this study were successful recruitment to the study and successful delivery of the assigned anaesthetic treatment as per randomisation arm. Of the 217 eligible patients approached, 146 were recruited, a recruitment rate of 67.3% (95%CI 60.6-73.5%). One hundred and forty-five patients adhered to the randomised treatment arm, 99.3% (95%CI 96.2-100%). Intra-operative patient characteristics and postoperative complications were comparable between the two intervention groups. This feasibility and pilot study supports the viability of the protocol for a large, randomised controlled trial to investigate the effect of anaesthesia technique on postoperative cancer outcomes. The volatile anaesthesia and peri-operative outcomes related to cancer (VAPOR-C) study that is planned to follow this feasibility study is an international, multicentre trial with the aim of providing evidence-based guidelines for the anaesthetic management of patients undergoing major cancer surgery.
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Affiliation(s)
- J A Dubowitz
- Department of Anaesthesia, Peri-operative and Pain Medicine, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - J P Cata
- Department of Anesthesiology and Peri-operative Medicine, Division of Anesthesiology and Critical Care, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - A P De Silva
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, Melbourne, Australia
| | - S Braat
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, Melbourne, Australia
| | - D Shan
- Department of Anaesthesia, Peri-operative and Pain Medicine, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - K Yee
- Department of Anaesthesia, Peri-operative and Pain Medicine, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - F Hollande
- Department of Clinical Pathology and University of Melbourne Centre for Cancer Research, Melbourne, Australia
| | - O Martin
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia
| | - E K Sloan
- Drug Discovery Biology, Monash Institute of Pharmaceutical Sciences, Parkville, Australia
| | - B Riedel
- Department of Anaesthesia, Peri-operative and Pain Medicine, Peter MacCallum Cancer Centre, Melbourne, Australia
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Mirallave Pescador A, Pérez Lorensu PJ, Saponaro González Á, Darias Delbey B, Pérez Burkhardt JL, Ucelay Gómez R, González Tabares EF, Ibrahim Achi Z, Guerrero Ramírez CS, Padrón Encalada CE, Jiménez Sosa A, Plata Bello J. Anaesthesia and multimodality intraoperative neuromonitoring in carotid endarterectomy. Chronological evolution and effects on intraoperative neurophysiology. J Clin Monit Comput 2021; 35:1429-1436. [PMID: 33389357 DOI: 10.1007/s10877-020-00621-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 11/18/2020] [Indexed: 10/22/2022]
Abstract
Contingency data was retrospectively collected to evaluate the historical and current ability to provide multimodality intraoperative neurophysiological monitoring during carotid endarterectomy under two conditions: total intravenous anaesthesia (TIVA) and low dose halogenated anaesthesia (SEVO). 229 patients were monitored during carotid endarterectomy procedures under general anaesthesia between 2012 and 2020. 121 Patients were monitored with SEVO at a minimum alveolar concentration less than 0.7 and 108 were monitored using TIVA, according to common anaesthetic practice standards in our hospital across the years. Multimodality IONM was established with electroencephalography, somatosensory evoked potentials and motor evoked potentials. As compared to TIVA, patients monitored with SEVO showed significantly higher motor evoked potential thresholds (313.52 ± 77.74 SEVO and 218.93 V ± 103.2 V TIVA p < 0.05) and lower reproducibility. Electroencephalography and somatosensory evoked potentials showed no significant differences among the groups. When using SEVO, multimodality intraoperative neurophysiological monitoring during carotid endarterectomy could mask or miss a motor isolated change in patients in spite of low dose minimum alveolar concentration and of apparently adequate electroencephalography and somatosensory evoked potentials for monitoring. Given these difficulties, we believe the chronological transfer to TIVA could have improved our ability to establish multimodality intraoperative neurophysiological monitoring during carotid endarterectomy in recent times.
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Affiliation(s)
| | - Pedro Javier Pérez Lorensu
- Unidad de Monitorización Neurofisiológica Intraoperatoria, Hospital Universitario de Canarias, Santa Cruz de Tenerife, España
| | - Ángel Saponaro González
- Unidad de Monitorización Neurofisiológica Intraoperatoria, Hospital Universitario de Canarias, Santa Cruz de Tenerife, España
| | - Beneharo Darias Delbey
- Servicio de Anestesia, Hospital Universitario de Canarias, Santa Cruz de Tenerife, España
| | | | - Roberto Ucelay Gómez
- Servicio de Cirugía Vascular, Hospital Universitario de Canarias, Santa Cruz de Tenerife, España
| | | | - Zeina Ibrahim Achi
- Servicio de Cirugía Vascular, Hospital Universitario de Canarias, Santa Cruz de Tenerife, España
| | | | | | - Alejandro Jiménez Sosa
- Unidad de Investigación, Hospital Universitario de Canarias, Santa Cruz de Tenerife, España
| | - Julio Plata Bello
- Servicio de Neurocirugía, Hospital Universitario de Canarias, Santa Cruz de Tenerife, España
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Schmoch T, Jungk C, Bruckner T, Haag S, Zweckberger K, von Deimling A, Brenner T, Unterberg A, Weigand MA, Uhle F, Herold-Mende C. The anesthetist's choice of inhalational vs. intravenous anesthetics has no impact on survival of glioblastoma patients. Neurosurg Rev 2020; 44:2707-2715. [PMID: 33354749 PMCID: PMC8490243 DOI: 10.1007/s10143-020-01452-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 11/09/2020] [Accepted: 12/01/2020] [Indexed: 11/25/2022]
Abstract
Recent data suggest that the type of anesthesia used during the resection of solid tumors impacts the long-term survival of patients favoring total-intravenous-anesthesia (TIVA) over inhalative-anesthesia (INHA). Here we sought to query this impact on survival in patients undergoing resection of glioblastoma (GBM). All patients receiving elective resection of a newly diagnosed, isocitrate-dehydrogenase-1-(IDH1)-wildtype GBM under general anesthesia between January 2010 and June 2017 in the Department of Neurosurgery, Heidelberg University Hospital, were included. Patients were grouped according to the applied anesthetic technique. To adjust for potential prognostic confounders, patients were matched in a 1:2 ratio (TIVA vs. INHA), taking into account the known prognostic factors: age, extent of resection, O-6-methylguanine-DNA-methyltransferase-(MGMT)-promoter-methylation-status, pre-operative Karnofsky-performance-index and adjuvant radio- and chemotherapy. The primary endpoint was progression-free-survival (PFS) and the secondary endpoint was overall-survival (OS). In the study period, 576 patients underwent resection of a newly diagnosed, IDH-wildtype GBM. Patients with incomplete follow-up-data, on palliative treatment, having emergency or awake surgery; 54 patients remained in the TIVA-group and 417 in the INHA-group. After matching, 52 patients remained in the TIVA-group and 92 in the INHA-group. Median PFS was 6 months in both groups. The median OS was 13.5 months in the TIVA-group and 13.0 months in the INHA-group. No significant survival differences associated with the type of anesthesia were found either before or after adjustment for known prognostic factors. This retrospective study supports the notion that the current anesthetic approaches employed during the resection of IDH-wildtype GBM do not impact patient survival.
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Affiliation(s)
- Thomas Schmoch
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Essen, Hufelandstraße 55, 45147, Essen, Germany.
- Department of Anesthesiology, University Hospital Heidelberg, Heidelberg, Germany.
| | - Christine Jungk
- Division of Neurosurgical Research, Department of Neurosurgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Thomas Bruckner
- Institute of Medical Biometry and Informatics (IMBI), University of Heidelberg, Heidelberg, Germany
| | - Sabine Haag
- Department of Anesthesiology, University Hospital Heidelberg, Heidelberg, Germany
| | - Klaus Zweckberger
- Division of Neurosurgical Research, Department of Neurosurgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Andreas von Deimling
- Department of Neuropathology, University Hospital Heidelberg and Clinical Cooperation Unit (CCU) Neuropathology, DKFZ, Heidelberg, Germany
| | - Thorsten Brenner
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Essen, Hufelandstraße 55, 45147, Essen, Germany
| | - Andreas Unterberg
- Division of Neurosurgical Research, Department of Neurosurgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Markus A Weigand
- Department of Anesthesiology, University Hospital Heidelberg, Heidelberg, Germany
| | - Florian Uhle
- Department of Anesthesiology, University Hospital Heidelberg, Heidelberg, Germany
| | - Christel Herold-Mende
- Division of Neurosurgical Research, Department of Neurosurgery, University Hospital Heidelberg, Heidelberg, Germany
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Yu H, Xu Z, Dai SH, Jiang JL, He LL, Zheng JQ, Yu H. The Effect of Propofol Versus Volatile Anesthetics on Persistent Pain After Cardiac Surgery: A Randomized Controlled Trial. J Cardiothorac Vasc Anesth 2020; 35:2438-2446. [PMID: 33183935 DOI: 10.1053/j.jvca.2020.10.025] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 10/01/2020] [Accepted: 10/14/2020] [Indexed: 02/08/2023]
Abstract
OBJECTIVES Sternal incisions can generate persistent and intense post-sternotomy pain. Propofol has been shown to improve postoperative analgesia, but the preventive effect on persistent pain after cardiac surgery is unknown. The hypothesis of the present study was that intraoperative propofol-based anesthesia compared with volatile anesthesia could reduce the risk of chronic pain after cardiac surgery. DESIGN A single-center, two-arm, patient-and-evaluator-blinded, randomized controlled trial. SETTING A single major urban teaching and university hospital. PATIENTS Five-hundred adult patients undergoing cardiac surgery via sternotomy randomly were assigned. With six withdrawals from the study and five from surgery, 244 in the total intravenous anesthesia group and 245 in the volatile group were included in the modified intention-to-treat analysis. INTERVENTIONS Patients randomly were assigned to receive either propofol-based total intravenous anesthesia or volatile anesthesia during surgery. MEASUREMENTS AND MAIN RESULTS The primary outcomes were the incidence of pain at three, six, and 12 months after surgery defined as pain score >0 on the numeric rating scale. The secondary outcomes included acute pain, opioid use during the first 72 hours after surgery, and quality of life. The use of propofol did not significantly affect chronic pain at three months (55.4% v 52.9%, difference 2.5%, 95% confidence interval [CI] -6.6 to 11.6; p = 0.656), six months (35.5% v 37.5%, difference -2.0%, 95% CI -10.9 to 6.9; p = 0.657), or 12 months (18.2% v 20.7%, difference -2.5%, 95% CI -9.8 to 4.8; p = 0.495) compared with volatile anesthetics. Furthermore, there were no differences in acute pain score; morphine-equivalent consumption during the first 72 hours; and quality of life at three, six, and 12 months after surgery. CONCLUSIONS Intraoperative administration of propofol did not reduce persistent pain after cardiac surgery compared with volatile anesthetics.
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Affiliation(s)
- Hong Yu
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, China; The Research Units of West China (2018RU012), Chinese Academy of Medical Sciences, Chengdu, China
| | - Zhao Xu
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, China; The Research Units of West China (2018RU012), Chinese Academy of Medical Sciences, Chengdu, China
| | - Shun-Hui Dai
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, China; The Research Units of West China (2018RU012), Chinese Academy of Medical Sciences, Chengdu, China
| | - Jia-Li Jiang
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, China; The Research Units of West China (2018RU012), Chinese Academy of Medical Sciences, Chengdu, China
| | - Lei-Lei He
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, China; The Research Units of West China (2018RU012), Chinese Academy of Medical Sciences, Chengdu, China
| | - Jian-Qiao Zheng
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, China; The Research Units of West China (2018RU012), Chinese Academy of Medical Sciences, Chengdu, China
| | - Hai Yu
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, China; The Research Units of West China (2018RU012), Chinese Academy of Medical Sciences, Chengdu, China.
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Demirel I, Yildiz Altun A, Bolat E, Kilinc M, Deniz A, Aksu A, Bestas A. Effect of Patient State Index Monitoring on the Recovery Characteristics in Morbidly Obese Patients: Comparison of Inhalation Anesthesia and Total Intravenous Anesthesia. J Perianesth Nurs 2020; 36:69-74. [PMID: 33012596 DOI: 10.1016/j.jopan.2020.07.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 07/03/2020] [Accepted: 07/05/2020] [Indexed: 12/11/2022]
Abstract
PURPOSE Obese patients have a significantly higher risk of adverse effects associated with general anesthesia. The purpose of this study was to evaluate the effects of Patient State Index (PSI) monitoring on recovery from anesthesia and the incidence of any postoperative complications among patients undergoing bariatric surgery with total intravenous anesthesia (TIVA) and inhalational anesthesia. DESIGN This prospective, double-blind, and randomized controlled trial was conducted between February 2017 and August 2017 and included 120 morbidly obese patients (body mass index >40 kg/m2). METHODS Patients were randomly divided into four groups; group P-PSI (n = 30): TIVA with PSI monitoring; group P (n = 30): TIVA without PSI monitoring; group D-PSI (n = 30): desflurane with PSI monitoring; and group D (n = 30): desflurane without PSI monitoring. The discharge time from the postanesthesia care unit (PACU), postoperative complications, and hemodynamic parameters were recorded and evaluated. FINDINGS No significant differences were found in demographic data, duration of anesthesia, admittance to PACU, discharge from PACU, modified Aldrete scores, and perioperative mean blood pressure and heart rate. Nausea and vomiting scores were significantly lower in group P-PSI, group P, and group D-PSI compared with group D. CONCLUSIONS Although TIVA and inhalational anesthesia can be safely used for obese patients, intraoperative PSI monitoring may decrease the discharge time from PACU and reduces incidence of postoperative nausea and vomiting caused by inhalation anesthetics.
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Affiliation(s)
- Ismail Demirel
- Medicine Faculty, Anesthesiology and Reanimation Department, Firat University, Elazig, Turkey.
| | - Aysun Yildiz Altun
- Medicine Faculty, Anesthesiology and Reanimation Department, Firat University, Elazig, Turkey
| | - Esef Bolat
- Medicine Faculty, Anesthesiology and Reanimation Department, Firat University, Elazig, Turkey
| | - Mikail Kilinc
- Medicine Faculty, Anesthesiology and Reanimation Department, Firat University, Elazig, Turkey
| | - Ahmet Deniz
- Medicine Faculty, Anesthesiology and Reanimation Department, Firat University, Elazig, Turkey
| | - Ahmet Aksu
- Medicine Faculty, Anesthesiology and Reanimation Department, Firat University, Elazig, Turkey
| | - Azize Bestas
- Medicine Faculty, Anesthesiology and Reanimation Department, Firat University, Elazig, Turkey
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Bakhet WZ, Wahba HA, El Fiky LM, Debis H. Preemptive local anesthetic infiltration reduces opioid requirements without attenuation of the intraoperative electrical stapedial reflex threshold in pediatric cochlear implant surgery. J Anaesthesiol Clin Pharmacol 2020; 36:366-370. [PMID: 33487904 PMCID: PMC7812956 DOI: 10.4103/joacp.joacp_18_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 04/26/2019] [Accepted: 07/11/2019] [Indexed: 11/26/2022] Open
Abstract
Background and Aims: Total intravenous anesthesia using remifentanil provides good surgical condition without affecting the intraoperative electrical stapedial reflex threshold (ESRT). However, remifentanil results in hyperalgesia and increases postoperative opioid requirements. Local anesthetic infiltration is alternative methods to opioid for providing analgesia. However, otologists avoids its use as it can abolish the ESRT. We investigated the effect of the preemptive local anesthetic infiltration on intraoperative ESRT and opioid requirements in pediatric cochlear implant surgery performed under TIVA. Material and Methods: Prospective, randomized, double-blinded, controlled study including 70 child undergoing cochlear implant under TIVA were randomly assigned to a local anesthesia (LA group, n = 35) or control (CT group, N = 35). The primary outcome was the total tramadol consumption during the first 24 h postoperative, and the secondary outcomes were time to first analgesia request, postoperative pain scores, the ESRT and, propofol and remifentanil requirements. The incidence of postoperative vomiting was recorder as well. Results: The total tramadol consumption during the first 24 h after surgery was significantly less in the LA group than in CT group (8.25 [4.3] vs. 16.5 [6.57] mg, P < 0.01). The time to first analgesic request was significantly prolonged in the LA group as compared with the CT group [8 [2–12] vs. 3 [0–8] h, P < 0.01). The postoperative Faces, Legs, Activity, Cry Consolability pain scores were significantly lower in the LA group at 15 min, 30 min, 2, 4 and 6 h postoperative. Mean remifentanil infusion rate [mean (standard deviation)] was significantly higher in in the CT group than in the LA group [0.7 (0.3) vs. 0.5 (0.2) μg/kg/min; P = 0.001).The ESRT response, propofol requirements, and the incidence of postoperative vomiting had no significant differences between both groups. Conclusion: Preemptive local anesthetic infiltration reduced opioid requirements without attenuation of the ESRT in pediatric cochlear implant surgery performed under TIVA.
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Affiliation(s)
- Wahba Z Bakhet
- Department of Anesthesia, Ain Shams University, Cairo, Egypt
| | - Hassan A Wahba
- Department of Otolaryngology, Ain Shams University, Cairo, Egypt
| | - Lobna M El Fiky
- Department of Otolaryngology, Ain Shams University, Cairo, Egypt
| | - Hossam Debis
- Software Test Engineer, MED-EL Medical Electronics, Cairo, Egypt
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Efune PN, Longanecker JM, Alex G, Saynhalath R, Khan U, Rivera K, Jerome AP, Boone W, Szmuk P. Use of dexmedetomidine and opioids as the primary anesthetic in infants and young children: A retrospective cohort study. Paediatr Anaesth 2020; 30:1013-1019. [PMID: 32510703 DOI: 10.1111/pan.13945] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2019] [Revised: 05/25/2020] [Accepted: 05/30/2020] [Indexed: 01/10/2023]
Abstract
BACKGROUND Anesthetic regimens using dexmedetomidine and short-acting opioids have been suggested as potential alternatives to sevoflurane-based anesthesia in children. The primary aim of this study is to compare demographics, intraoperative characteristics, and complications of general anesthetics in which dexmedetomidine and opioids were used without sevoflurane, or in combination with a low sevoflurane concentration, in children 36 months old and younger. The secondary aim is to evaluate intraoperative bispectral index (BIS) values when available in these patients. METHODS General anesthetics performed between January 1, 2017, and May 1, 2018, in children 2 years and younger who received dexmedetomidine and remifentanil, with or without sevoflurane, were identified. Additional anesthetics performed during this time in children 36 months and younger who received dexmedetomidine and opioids and had BIS monitoring were also identified. Charts were reviewed for demographic and intraoperative variables, including drug administration and hemodynamic data. RESULTS A total of 244 patients were identified. All but 22 patients received remifentanil. Ninety-two patients received sevoflurane with a mean end-tidal concentration of 0.84% (SD 0.43). Compared to the sevoflurane group, the nonsevoflurane group received more remifentanil (median dose 0.4 μg/kg/min vs 0.2 μg/kg/min, difference of 0.1 μg/kg/min, 95% CI 0.1-0.3, P < .001) and more dexmedetomidine (median dose 0.9 μg/kg/h vs 0.3 μg/kg/h, difference of 0.6 μg/kg/h, 95% CI 0.4-0.8, P < .001), and had a higher mean arterial pressure (median 53 mm Hg vs 42 mm Hg, difference of 11 mm Hg, 95% CI 8.1-14.8, P < .001). Complications between the two groups were comparable. The median percent intraoperative time with BIS reading <60 was 71.6% (95% CI: 63.3%-79.8%). CONCLUSION Dexmedetomidine and opioids can effectively be used in young children as an alternative total intravenous anesthesia technique with or without <1 minimum alveolar concentration of sevoflurane. Bispectral index monitoring reveals a likely sufficient depth of hypnosis.
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Affiliation(s)
- Proshad N Efune
- Department of Anesthesiology and Pain Management, University of Texas Southwestern, Dallas, Texas, USA.,Outcomes Research Consortium, Cleveland, Ohio, USA
| | | | - Gijo Alex
- Department of Anesthesiology and Pain Management, University of Texas Southwestern, Dallas, Texas, USA
| | - Rita Saynhalath
- Department of Anesthesiology and Pain Management, University of Texas Southwestern, Dallas, Texas, USA.,Outcomes Research Consortium, Cleveland, Ohio, USA
| | - Umar Khan
- Department of Pediatric Anesthesiology, Children's Medical Center Dallas, Dallas, Texas, USA
| | - Kevin Rivera
- Department of Anesthesiology and Pain Management, University of Texas Southwestern, Dallas, Texas, USA
| | - Aveline P Jerome
- Department of Anesthesiology and Pain Management, University of Texas Southwestern, Dallas, Texas, USA
| | - Weiwei Boone
- Department of Pediatric Anesthesiology, Children's Medical Center Dallas, Dallas, Texas, USA
| | - Peter Szmuk
- Department of Anesthesiology and Pain Management, University of Texas Southwestern, Dallas, Texas, USA.,Outcomes Research Consortium, Cleveland, Ohio, USA
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Gollapudy S, Gashkoff DA, Poetker DM, Loehrl TA, Riess ML. Surgical Field Visualization during Functional Endoscopic Sinus Surgery: Comparison of Propofol- vs Desflurane-Based Anesthesia. Otolaryngol Head Neck Surg 2020; 163:835-842. [PMID: 32450733 DOI: 10.1177/0194599820921863] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVE To assess if the type of general anesthetic affects bleeding and field visualization during endoscopic sinus surgery. STUDY DESIGN Prospective, randomized, controlled trial. SETTING Academic teaching hospital and Veterans Affairs hospital in the United States. SUBJECTS AND METHODS Seventy patients were randomized to 1 of 3 anesthetic regimens: (1) the volatile anesthetic desflurane (n = 22), (2) intravenous anesthesia with propofol (n = 25), or (3) a combination of propofol and desflurane (n = 23). Intravenous remifentanil was titrated to decrease the mean arterial pressure to 60 to 70 mm Hg but not ≥30% from baseline. Surgical bleeding scores were recorded along with bleeding rates and hemodynamic parameters, including cardiac output and systemic vascular resistance through pulse contour analysis from a radial arterial line. Statistics: multiple comparison tests and regression analyses; α = .05. RESULTS There were no differences in bleeding rate (median, 0.58, 0.85, 0.57 mL min-1), bleeding score (2.1, 2.0, 2.0), surgery duration (79, 81, 86 minutes), extubation time (9, 7, 8 minutes), recovery room time (65, 61, 61 minutes), or any hemodynamic parameters among groups 1 through 3, respectively. Group 1 required lower remifentanil infusions than group 2 (0.11 vs 0.26 µg kg-1 min-1; P = .01). The bleeding score correlated positively with height (P = .014) and the Lund-MacKay score (P = .013). Bilateral vs unilateral surgery led to longer surgery duration (P = .001) and recovery room time (P = .004). CONCLUSION When remifentanil is used for controlled hypotension, propofol has no advantage over desflurane to improve surgical field visualization during functional endoscopic sinus surgery.
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Affiliation(s)
- Suneeta Gollapudy
- Department of Anesthesiology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Drake A Gashkoff
- Medical School, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - David M Poetker
- Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.,Department of Surgery, Division of ENT, Clement J. Zablocki VA Medical Center, Milwaukee, Wisconsin, USA
| | - Todd A Loehrl
- Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.,Department of Surgery, Division of ENT, Clement J. Zablocki VA Medical Center, Milwaukee, Wisconsin, USA
| | - Matthias L Riess
- Anesthesiology, TVHS VA Medical Center, Nashville, Tennessee, USA.,Departments of Anesthesiology and Pharmacology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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Talih G, Yüksek A, Şahin E. Evaluation of emergence agitation after general anaesthesia in rhinoplasty patients: Inhalation anaesthesia versus total intravenous anaesthesia. Am J Otolaryngol 2020; 41:102387. [PMID: 31926597 DOI: 10.1016/j.amjoto.2020.102387] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 01/03/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Emergence agitation (EA) is a clinical condition that occurs early in recovery from general anaesthesia, and reduces patient comfort. The aim of this study was to compare the effects of low-flow sevoflurane anaesthesia and total intravenous anaesthesia (TIVA) on agitation in rhinoplasty patients, and to determine the frequency of EA in low flow sevoflurane anaesthesia after rhinoplasty. MATERIAL AND METHODS A total of 90 rhinoplasty patients, under general anaesthesia were included in this prospective randomised study. After induction of anaesthesia, propofol infusion was initiated in the TIVA group (n = 45), and sevoflurane was administered in the SEVO group with a fresh gas flow of 1 l/min and MAC (minimum alveolar concentration) 1-1.1 (n = 45). Early emergence times, Richmond agitation-sedation scale (RASS), Boezaart scale, Likert scale and incidences of nausea/vomiting were recorded at the end of surgery. RESULTS Early emergence time was significantly shorter in the TIVA group, than in the SEVO group (p < 0.001). İntraoperative bleeding was significantly lower in the TIVA group, than in the SEVO group (p = 0.005), and surgical field image quality and surgeon satisfaction were better in the TIVA group (p = 0.016, p < 0.001). The ratio of patients with RASS > +1 for all patients was 35.6% at 0 min, postoperatively. This rate was 12.2% (n = 11) in the TIVA group, and 23.3% (n = 21) in the SEVO group (p = 0.028). CONCLUSIONS In rhinoplasty, TIVA caused shorter early emergence times, less bleeding, high surgeon satisfaction, and lower EA scores when compared with low flow sevoflurane anaesthesia.
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Park YS, Kim JY. Anesthetic management of a patient with large atrial septal defect undergoing laparoscopic cholecystectomy: A case report. Saudi J Anaesth 2020; 14:249-252. [PMID: 32317887 PMCID: PMC7164463 DOI: 10.4103/sja.sja_638_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 11/12/2019] [Indexed: 11/10/2022] Open
Abstract
A 51-year-old woman presented with symptomatic GB stone was planned for elective laparoscopic cholecystectomy. She had known osteum secondum type atrial septal defect, moderate pulmonary hypertension, and atrial fibrillation. We report the case of a patient with a large atrial septal defect (65 mm) and hemodynamic instability who underwent laparoscopic cholecystectomy under total intravenous anesthesia with careful hemodynamic monitoring. Thorough surveillance and effort could help to make the surgery successful.
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Affiliation(s)
- Yeon Soo Park
- Department of Anesthesiology and Pain Medicine, Ilsan Paik University Hospital, Inje University School of Medicine, Ilsan, Korea
| | - Ji Yeon Kim
- Department of Anesthesiology and Pain Medicine, Ilsan Paik University Hospital, Inje University School of Medicine, Ilsan, Korea
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Bustamante R, Gómez de Segura IA, Canfrán S, Aguado D. Effects of ketamine or midazolam continuous rate infusions on alfaxalone total intravenous anaesthesia requirements and recovery quality in healthy dogs: a randomized clinical trial. Vet Anaesth Analg 2020; 47:437-446. [PMID: 32340894 DOI: 10.1016/j.vaa.2019.10.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 09/18/2019] [Accepted: 10/06/2019] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To determine the alfaxalone dose reduction during total intravenous anaesthesia (TIVA) when combined with ketamine or midazolam constant rate infusions and to assess recovery quality in healthy dogs. STUDY DESIGN Prospective, blinded clinical study. ANIMALS A group of 33 healthy, client-owned dogs subjected to dental procedures. METHODS After premedication with intramuscular acepromazine 0.05 mg kg-1 and methadone 0.3 mg kg-1, anaesthetic induction started with intravenous alfaxalone 0.5 mg kg-1 followed by either lactated Ringer's solution (0.04 mL kg-1, group A), ketamine (2 mg kg-1, group AK) or midazolam (0.2 mg kg-1, group AM) and completed with alfaxalone until endotracheal intubation was achieved. Anaesthesia was maintained with alfaxalone (6 mg kg-1 hour-1), adjusted (±20%) every 5 minutes to maintain a suitable level of anaesthesia. Ketamine (0.6 mg kg-1 hour-1) or midazolam (0.4 mg kg-1 hour-1) were employed for anaesthetic maintenance in groups AK and AM, respectively. Physiological variables were monitored during anaesthesia. Times from alfaxalone discontinuation to extubation, sternal recumbency and standing position were calculated. Recovery quality and incidence of adverse events were recorded. Groups were compared using parametric analysis of variance and nonparametric (Kruskal-Wallis, Chi-square, Fisher's exact) tests as appropriate, p < 0.05. RESULTS Midazolam significantly reduced alfaxalone induction and maintenance doses (46%; p = 0.034 and 32%, p = 0.012, respectively), whereas ketamine only reduced the alfaxalone induction dose (30%; p = 0.010). Recovery quality was unacceptable in nine dogs in group A, three dogs in group AK and three dogs in group AM. CONCLUSIONS AND CLINICAL RELEVANCE Midazolam, but not ketamine, reduced the alfaxalone infusion rate, and both co-adjuvant drugs reduced the alfaxalone induction dose. Alfaxalone TIVA allowed anaesthetic maintenance for dental procedures in dogs, but the quality of anaesthetic recovery remained unacceptable irrespective of its combination with ketamine or midazolam.
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Affiliation(s)
- Rocío Bustamante
- Department of Animal Medicine and Surgery, Veterinary Teaching Hospital, Veterinary Faculty, Complutense University of Madrid, Madrid, Spain
| | - Ignacio A Gómez de Segura
- Department of Animal Medicine and Surgery, Veterinary Teaching Hospital, Veterinary Faculty, Complutense University of Madrid, Madrid, Spain
| | - Susana Canfrán
- Department of Animal Medicine and Surgery, Veterinary Teaching Hospital, Veterinary Faculty, Complutense University of Madrid, Madrid, Spain
| | - Delia Aguado
- Department of Animal Medicine and Surgery, Veterinary Teaching Hospital, Veterinary Faculty, Complutense University of Madrid, Madrid, Spain.
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Lervik A, Toverud SF, Krontveit R, Haga HA. A comparison of respiratory function in pigs anaesthetised by propofol or alfaxalone in combination with dexmedetomidine and ketamine. Acta Vet Scand 2020; 62:14. [PMID: 32164761 PMCID: PMC7066810 DOI: 10.1186/s13028-020-0512-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Accepted: 02/29/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND General anaesthesia in pigs maintained with intravenous drugs such as propofol may cause respiratory depression. Alfaxalone gives less respiratory depression than propofol in some species. The aim of the investigation was to compare respiratory effects of propofol-ketamine-dexmedetomidine and alfaxalone-ketamine-dexmedetomidine in pigs. Sixteen pigs premedicated with ketamine 15 mg/kg and midazolam 1 mg/kg intramuscularly were anaesthetised with propofol or alfaxalone to allow endotracheal intubation, followed by propofol 8 mg/kg/h or alfaxalone 5 mg/kg/h in combination with ketamine 5 mg/kg/h and dexmedetomidine 4 µg/kg/h given as a continuous infusion for 60 min. The pigs breathed spontaneously with an FIO2 of 0.21. Oxygen saturation (SpO2), end-tidal CO2 concentration (PE'CO2), respiratory rate (fR) and inspired tidal volume (VT) were measured, and statistically compared between treatments. If the SpO2 dropped below 80% or if PE'CO2 increased above 10.0 kPa, the pigs were recorded as failing to complete the study, and time to failure was statistically compared between treatments. RESULTS Alfaxalone treated pigs had significantly higher respiratory rates and lower PE'CO2 than propofol treated pigs, with a fR being 7.3 /min higher (P = 0.01) and PE'CO2 0.8 kPa lower (P = 0.05). SpO2 decreased by 0.6% and fR by 1.0 /min per kg increase in body weight in both treatment groups. Three of eight propofol treated and two of eight alfaxalone treated pigs failed to complete the study, and times to failure were not significantly different between treatments (P = 0.75). CONCLUSIONS No major differences in respiratory variables were found when comparing treatments. Respiratory supportive measures must be available when using both protocols.
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Lauder GR, Thomas M, von Ungern-Sternberg BS, Engelhardt T. Volatiles or TIVA: Which is the standard of care for pediatric airway procedures? A pro-con discussion. Paediatr Anaesth 2020; 30:209-220. [PMID: 31886922 DOI: 10.1111/pan.13809] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 12/24/2019] [Accepted: 12/26/2019] [Indexed: 12/21/2022]
Abstract
Anesthesia for pediatric airway procedures constitutes a true art form that requires training and experience. Communication between anesthetist and surgeon to establish procedure goals is essential in determining the most appropriate anesthetic management. But does the mode of anesthesia have an impact? Traditionally, inhalational anesthesia was the most common anesthesia technique used during airway surgery. Introduction of agents used for total intravenous anesthesia (TIVA) such as propofol, short-acting opioids, midazolam, and dexmedetomidine has driven change in practice. Ongoing debates abound as to the advantages and disadvantages of volatile-based anesthesia versus TIVA. This pro-con discussion examines both volatiles and TIVA, from the perspective of effectiveness, safety, cost, and environmental impact, in an endeavor to justify which technique is the best specifically for pediatric airway procedures.
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Affiliation(s)
- Gillian R Lauder
- Department of Anesthesia, BC Children's Hospital, Vancouver, Canada.,Department of Anesthesiology, Pharmacology & Therapeutics, University of British Columbia, Vancouver, Canada
| | - Mark Thomas
- Department of Anaesthesia, Great Ormond St Hospital, London, UK
| | - Britta S von Ungern-Sternberg
- Department of Anaesthesia and Pain Management, Perth Children's Hospital, Perth, Australia.,Medical School, The University of Western Australia, Perth, Australia.,Telethon Kids Institute, Perth, Australia
| | - Thomas Engelhardt
- Department of Anesthesia, McGill University Health Centre, Montreal Children's Hospital, Montreal, QC, Canada
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50
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Santos EA, Monteiro ER, Herrera JR, Mombach VS, Boos MZ, Gutierrez LG, Alievi MM. Total intravenous anesthesia in domestic chicken (Gallus gallus domesticus) with propofol alone or in combination with methadone, nalbuphine or fentanyl for ulna osteotomy. Vet Anaesth Analg 2020; 47:347-355. [PMID: 32222345 DOI: 10.1016/j.vaa.2020.01.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 01/24/2020] [Accepted: 01/25/2020] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To compare the propofol infusion rate and cardiopulmonary effects during total intravenous anesthesia with propofol alone and propofol combined with methadone, fentanyl or nalbuphine in domestic chickens undergoing ulna osteotomy. STUDY DESIGN Prospective, randomized, experiment trial. ANIMALS A total of 59 healthy Hissex Brown chickens weighing 1.5 ± 0.2 kg. METHODS Anesthesia was induced with propofol (9 mg kg-1) administered intravenously (IV) and maintained with propofol (1.2 mg kg-1 minute-1) for 30 minutes. Birds were intubated and supplemented with 100% oxygen through a nonrebreathing circuit under spontaneous ventilation. Thereafter, each animal was randomly assigned to one of four groups: group P, no treatment; group PM, methadone (6 mg kg-1) intramuscularly (IM); group PN, nalbuphine IM (12.5 mg kg-1); and group PF, fentanyl IV (30 μg kg-1 loading dose, 30 μg kg-1 hour-1 constant rate infusion). During the osteotomy surgery, the propofol infusion rate was adjusted to avoid movement of birds and provide adequate anesthesia. Pulse rate, invasive blood pressure, respiratory frequency, end-tidal carbon dioxide partial pressure (Pe'CO2) and hemoglobin oxygen saturation (SpO2) were recorded. RESULTS Data were available from 58 chickens. The mean ± standard deviation propofol infusion rate (mg kg-1 minute-1) for the duration of anesthesia was: group P, 0.81 ± 0.15; group PM, 0.66 ± 0.11; group PN, 0.60 ± 0.14; and group PF, 0.80 ± 0.07. Significant differences were P versus PM (p = 0.042), P versus PN (p = 0.002) and PF versus PN (p = 0.004). Pulse rate, blood pressure and SpO2 remained acceptable for anesthetized birds with minor differences among groups. Values of Pe'CO2 >60 mmHg (8 kPa) were observed in all groups. CONCLUSIONS AND CLINICAL RELEVANCE Methadone and nalbuphine, but not fentanyl, decreased the propofol infusion rate required for anesthesia maintenance, but resulted in no obvious benefit in physiological variables.
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Affiliation(s)
- Eduardo Ar Santos
- Department of Animal Medicine, Faculty of Veterinary Medicine, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Eduardo R Monteiro
- Department of Animal Medicine, Faculty of Veterinary Medicine, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil.
| | - José R Herrera
- Department of Animal Medicine, Faculty of Veterinary Medicine, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Verônica S Mombach
- Department of Animal Medicine, Faculty of Veterinary Medicine, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Mariana Z Boos
- Department of Animal Medicine, Faculty of Veterinary Medicine, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Letícia G Gutierrez
- Department of Animal Medicine, Faculty of Veterinary Medicine, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Marcelo M Alievi
- Department of Animal Medicine, Faculty of Veterinary Medicine, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil
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