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Caviglia M, Ucciero A, Di Filippo A, Trotta F, McTaggart S, Barone-Adesi F. Greenhouse gas emissions associated with halogenated anaesthetics: the current European landscape. Br J Anaesth 2024:S0007-0912(24)00196-X. [PMID: 38677947 DOI: 10.1016/j.bja.2024.03.037] [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: 02/06/2024] [Revised: 03/25/2024] [Accepted: 03/25/2024] [Indexed: 04/29/2024] Open
Affiliation(s)
- Marta Caviglia
- Crimedim - Center for Research and Training in Disaster Medicine, Humanitarian Aid and Global Health, Università del Piemonte Orientale, Novara, Italy; Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy.
| | | | | | | | | | - Francesco Barone-Adesi
- Crimedim - Center for Research and Training in Disaster Medicine, Humanitarian Aid and Global Health, Università del Piemonte Orientale, Novara, Italy; Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
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Lu CC, Ho ST, Hu OYP, Hsiong CH, Cheng YC, Hsu CH, Lin TC. Pharmacokinetics of desflurane uptake and disposition in piglets. Front Pharmacol 2024; 15:1339690. [PMID: 38628643 PMCID: PMC11018996 DOI: 10.3389/fphar.2024.1339690] [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: 11/17/2023] [Accepted: 03/15/2024] [Indexed: 04/19/2024] Open
Abstract
Introduction Many respiratory but few arterial blood pharmacokinetics of desflurane uptake and disposition have been investigated. We explored the pharmacokinetic parameters in piglets by comparing inspiratory, end-tidal, arterial blood, and mixed venous blood concentrations of desflurane. Methods Seven piglets were administered inspiratory 6% desflurane by inhalation over 2 h, followed by a 2-h disposition phase. Inspiratory and end-tidal concentrations were detected using an infrared analyzer. Femoral arterial blood and pulmonary artery mixed venous blood were sampled to determine desflurane concentrations by gas chromatography at 1, 3, 5, 10, 20, 30, 40, 50, 60, 80, 100, and 120 min during each uptake and disposition phase. Respiratory and hemodynamic parameters were measured simultaneously. Body uptake and disposition rates were calculated by multiplying the difference between the arterial and pulmonary artery blood concentrations by the cardiac output. Results The rates of desflurane body uptake increased considerably in the initial 5 min (79.8 ml.min-1) and then declined slowly until 120 min (27.0 ml.min-1). Similar characteristics of washout were noted during the subsequent disposition phase. Concentration-time curves of end-tidal, arterial, and pulmonary artery blood concentrations fitted well to zero-order input and first-order disposition kinetics. Arterial and pulmonary artery blood concentrations were best fitted using a two-compartment model. After 2 h, only 21.9% of the desflurane administered had been eliminated from the body. Conclusion Under a fixed inspiratory concentration, desflurane body uptake in piglets corresponded to constant zero-order infusion, and the 2-h disposition pattern followed first-order kinetics and best fitted to a two-compartment model.
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Affiliation(s)
- Chih-Cherng Lu
- Department of Anesthesiology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
- Department of Anesthesiology, Taipei Veterans General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Shung-Tai Ho
- Department of Anesthesiology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
- Department of Anesthesiology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Oliver Yao-Pu Hu
- School of Pharmacy, National Defense Medical Center, Taipei, Taiwan
| | | | - Yuan-Chen Cheng
- Internship, E-Da Hospital, I-Shou University College of Medicine, Kaohsiung, Taiwan
| | - Che-Hao Hsu
- Department of Anesthesiology, Tungs’ Taichung MetroHarbor Hospital, Taichung, Taiwan
| | - Tso-Chou Lin
- Department of Anesthesiology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
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Steyl C, Kluyts HL. A randomised controlled trial comparing quality of recovery between desflurane and isoflurane inhalation anaesthesia in patients undergoing ophthalmological surgery at a tertiary hospital in South Africa (DIQoR trial). BJA Open 2024; 9:100246. [PMID: 38193018 PMCID: PMC10772553 DOI: 10.1016/j.bjao.2023.100246] [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] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 11/21/2023] [Indexed: 01/10/2024]
Abstract
Background The patient's experience of their postoperative recovery is an important perioperative outcome, with the 15-item quality of recovery scale (QoR-15) recommended as a standardised outcomes measure. Desflurane has a faster emergence from anaesthesia compared with other volatile anaesthetics, but it is uncertain whether this translates to better subjective quality of recovery. The hypothesis for this study is that patients receiving desflurane for maintenance of anaesthesia would have better postoperative quality of recovery than patients receiving isoflurane. Methods Male and female adult patients undergoing ophthalmological surgery under general anaesthesia were randomly allocated to receive desflurane or isoflurane for maintenance of anaesthesia. The primary outcome was to compare postoperative QoR-15 scores. Secondary outcomes included comparing preoperative QoR-15 scores, volatile agent consumption, and time spent in the recovery room. Results Data from 164 patients were analysed (80 desflurane, 84 isoflurane). Median (Q1, Q3) postoperative QoR-15 scores were not significantly different (desflurane: 145 [141, 148], isoflurane: 144 [139, 147], 95% confidence interval 0-3, P=0.176, minimal clinically important difference=8). Median (Q1, Q3) volatile agent consumption was 15.4 (12.5, 19.3) ml hr-1 in the desflurane group, and 7.4 (5.9, 9.7) ml hr-1 in the isoflurane group. Median (Q1, Q3) time spent in the recovery room was significantly shorter in the desflurane group (desflurane: 18 [13, 23]; isoflurane: 25 [19, 32], 95% confidence interval -10 to 5, P<0.001). Conclusions This study found no difference in quality of recovery between patients who received desflurane or isoflurane for maintenance of general anaesthesia during ophthalmological surgery. A shorter time in the recovery room was not associated with improved QoR-15 scores. Clinical trial registration NCT04188314.
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Affiliation(s)
- Charlé Steyl
- Department of Anaesthesiology, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | - Hyla-Louise Kluyts
- Department of Anaesthesiology, Sefako Makgatho Health Sciences University, Pretoria, South Africa
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Park EJ, Bae J, Kim J, Yoon JU, Do W, Yoon JP, Shon HS, Kang Y, Kim HY, Cho AR. Reducing the carbon footprint of operating rooms through education on the effects of inhalation anesthetics on global warming: A retrospective study. Medicine (Baltimore) 2024; 103:e37256. [PMID: 38428851 PMCID: PMC10906648 DOI: 10.1097/md.0000000000037256] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 01/23/2024] [Indexed: 03/03/2024] Open
Abstract
Environmental concerns, especially global warming, have prompted efforts to reduce greenhouse gas emissions. Healthcare systems, including anesthesia practices, contribute to these emissions. Inhalation anesthetics have a significant environmental impact, with desflurane being the most concerning because of its high global warming potential. This study aimed to educate anesthesiologists on the environmental impact of inhalation anesthetics and assess changes in awareness and practice patterns, specifically reducing desflurane use. This study included data from patients who underwent surgery under general anesthesia 1 month before and after education on the effects of inhalation anesthetics on global warming. The primary endpoint was a change in inhalational anesthetic use. Secondary endpoints included changes in carbon dioxide equivalent (CO2e) emissions, driving equivalent, and medical costs. After the education, desflurane use decreased by 50%, whereas sevoflurane use increased by 50%. This shift resulted in a reduction in the overall amount of inhalational anesthetics used. The total CO2e and driving-equivalent values decreased significantly. The cost per anesthesia case decreased, albeit to a lesser extent than expected. Education on the environmental impact of inhalation anesthetics has successfully altered anesthesiologists' practice patterns, leading to reduced desflurane usage. This change has resulted in decreased CO2e emissions and has had a positive effect on mitigating global warming. However, further research is required to assess the long-term impact of such education and the variability in practice patterns across different institutions.
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Affiliation(s)
- Eun Ji Park
- Department of Anesthesia and Pain Medicine, Medical Research Institute, Pusan National University Hospital, Busan, Republic of Korea
- Department of Anesthesia and Pain Medicine, School of Medicine, Pusan National University, Yangsan, Republic of Korea
| | - Jaesang Bae
- Department of Anesthesia and Pain Medicine, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Jisu Kim
- Department of Anesthesia and Pain Medicine, Medical Research Institute, Pusan National University Hospital, Busan, Republic of Korea
| | - Ji-Uk Yoon
- Department of Anesthesia and Pain Medicine, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
- Department of Anesthesia and Pain Medicine, School of Medicine, Pusan National University, Yangsan, Republic of Korea
| | - Wangseok Do
- Department of Anesthesia and Pain Medicine, Medical Research Institute, Pusan National University Hospital, Busan, Republic of Korea
- Department of Anesthesia and Pain Medicine, School of Medicine, Pusan National University, Yangsan, Republic of Korea
| | - Jung-Pil Yoon
- Department of Anesthesia and Pain Medicine, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
- Department of Anesthesia and Pain Medicine, School of Medicine, Pusan National University, Yangsan, Republic of Korea
| | - Hong-Sik Shon
- Department of Anesthesia and Pain Medicine, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
- Department of Anesthesia and Pain Medicine, School of Medicine, Pusan National University, Yangsan, Republic of Korea
| | - Yerin Kang
- Department of Anesthesia and Pain Medicine, Medical Research Institute, Pusan National University Hospital, Busan, Republic of Korea
| | - Hee Young Kim
- Department of Anesthesia and Pain Medicine, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
- Department of Anesthesia and Pain Medicine, School of Medicine, Pusan National University, Yangsan, Republic of Korea
| | - Ah-Reum Cho
- Department of Anesthesia and Pain Medicine, Medical Research Institute, Pusan National University Hospital, Busan, Republic of Korea
- Department of Anesthesia and Pain Medicine, School of Medicine, Pusan National University, Yangsan, Republic of Korea
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Charlesworth M, Laycock H. Driving down the carbon cost of peri-operative care: old controversies, new topics, fresh perspectives and the future. Anaesthesia 2024; 79:223-225. [PMID: 38205582 DOI: 10.1111/anae.16217] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/11/2023] [Indexed: 01/12/2024]
Affiliation(s)
- M Charlesworth
- Department of Cardiothoracic Anaesthesia, Critical Care and ECMO, Wythenshawe Hospital, Manchester, UK
| | - H Laycock
- Department of Anaesthesia, Great Ormond Street Hospital, London, UK
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Affiliation(s)
- S R Moonesinghe
- University College London, London, UK
- Departments of Anaesthesia, Perioperative and Critical Care, University College London Hospitals, London, UK
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Khan MWA, Das P, Bhavani V, Thakkar S, Nagella SP, Dubey A. Analysis Comparing the Recovery of Airway Reflexes and Cognitive Ability After Sevoflurane with Desflurane Anesthesia. J Pharm Bioallied Sci 2024; 16:S305-S307. [PMID: 38595352 PMCID: PMC11001126 DOI: 10.4103/jpbs.jpbs_502_23] [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: 08/05/2023] [Revised: 09/02/2023] [Accepted: 09/11/2023] [Indexed: 04/11/2024] Open
Abstract
Introduction Although sevoflurane and desflurane have nearly identical blood-gas solubilities, current research suggests that airway reflexes recover more quickly with desflurane than sevoflurane; however, cognitive function recovery varies substantially. The current study was piloted to appraise the lengths of time needed to recover from anesthesia following desflurane and sevoflurane anesthesia. Materials and Methods A prospective clinical trial was piloted among 70 adult non-obese subjects who underwent elective surgery and were classified I-II by the "American Association of Anesthesiologists (ASA)". Sevoflurane and desflurane were tested among the subjects who were equally distributed. These agents were used in accordance with a normal general anaesthesia procedure. After they were extubated, tests for regaining cognitive function and airway reflexes were carried out, and different time intervals were recorded. The observations were calculated and P < 0.05 was used to conduct the statistical analysis. Results The average amount of time that passed between the patient's first vocal response and their first successful completion of the swallowing test was analogous between the two groups (T2) with 5.25 ± 3.11 vs 5.01 ± 2.12 in sevoflurane and desflurane, respectively. There was no significant variance at T2. For all the other time intervals of T1, T3, and T4, there was evidence of the significant variance.(P = 0.003; 0.0013; <0.001, respectively). Conclusion Desflurane causes patients to recover more quickly than sevoflurane does after laparoscopic cholecystectomy under controlled circumstances.
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Affiliation(s)
- Mohammed Wajid Ali Khan
- Consultant Anaesthetisiologist, Sai Vani Multispeciality Hospital, Hyderabad, Telangana, India
| | - Prajnyananda Das
- Department of Anaesthesiology, Acharya Harihar Post Graduate Institute of Cancer, Cuttack, Odisha, India
| | - V Bhavani
- Department of Anaesthesia, ESIC Medical College, Hyderabad, Telangana, India
| | - Smit Thakkar
- Shri M P Shah Government Medical College, Jamnagar, Gujarat, India
| | - Sai Prannoy Nagella
- Department of Pediatric Dentistry, Faculty of Dentistry, Mahsa University, Malaysia
| | - Alok Dubey
- Department of Preventive Dental Sciences, College of Dentistry, Jazan University, Jazan, Saudi Arabia
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Lee C, Lim J, Hong H, Yu H, Lee H. Effect of Remimazolam on Pain Perception and Opioid-Induced Hyperalgesia in Patients Undergoing Laparoscopic Urologic Surgery-A Prospective, Randomized, Controlled Study. Medicina (Kaunas) 2024; 60:123. [PMID: 38256384 PMCID: PMC10818426 DOI: 10.3390/medicina60010123] [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] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 12/26/2023] [Accepted: 01/05/2024] [Indexed: 01/24/2024]
Abstract
Background and Objectives: The effects of midazolam, a benzodiazepine, on pain perception are complex on both spinal and supraspinal levels. It is not yet known whether remimazolam clinically attenuates or worsens pain. The present study investigated the effect of intraoperative remimazolam on opioid-induced hyperalgesia (OIH) in patients undergoing general anesthesia. Materials and Methods: The patients were randomized into three groups: group RHR (6 mg/kg/h initial dose followed by 1 mg/kg/h remimazolam and 0.3 μg /kg/min remifentanil), group DHR (desflurane and 0.3 μg /kg/min remifentanil) or group DLR (desflurane and 0.05 µg/kg /min remifentanil). The primary outcome was a mechanical hyperalgesia threshold, while secondary outcomes included an area of hyperalgesia and clinically relevant pain outcomes. Results: Group RHR had a higher mechanical hyperalgesia threshold, a smaller hyperalgesia postoperative area at 24 h, a longer time to first rescue analgesia (p = 0.04), lower cumulative PCA volume containing morphine postoperatively consumed for 24 h (p < 0.01), and lower pain intensity for 12 h than group DHR (p < 0.001). However, there was no significant difference in OIH between groups RHR and DLR. Conclusions: Group RHR, which received remimazolam, attenuated OIH, including mechanically evoked pain and some clinically relevant pain outcomes caused by a high dose of remifentanil. Further research is essential to determine how clinically meaningful and important the small differences observed between the two groups are.
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Affiliation(s)
- Cheol Lee
- Department of Anesthesiology and Pain Medicine, Wonkwang University School of Medicine Hospital, 895 Muwang-ro, Iksan 54538, Republic of Korea; (J.L.); (H.H.); (H.Y.)
| | - Junsung Lim
- Department of Anesthesiology and Pain Medicine, Wonkwang University School of Medicine Hospital, 895 Muwang-ro, Iksan 54538, Republic of Korea; (J.L.); (H.H.); (H.Y.)
| | - Hansol Hong
- Department of Anesthesiology and Pain Medicine, Wonkwang University School of Medicine Hospital, 895 Muwang-ro, Iksan 54538, Republic of Korea; (J.L.); (H.H.); (H.Y.)
| | - Hyungjong Yu
- Department of Anesthesiology and Pain Medicine, Wonkwang University School of Medicine Hospital, 895 Muwang-ro, Iksan 54538, Republic of Korea; (J.L.); (H.H.); (H.Y.)
| | - Hayoung Lee
- Department of Nursing, Wonkwang University School of Medicine Hospital, 895 Muwang-ro, Iksan 54538, Republic of Korea
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Gasciauskaite G, Lunkiewicz J, Tucci M, Von Deschwanden C, Nöthiger CB, Spahn DR, Tscholl DW. Environmental and economic impact of sustainable anaesthesia interventions: a single-centre retrospective observational study. Br J Anaesth 2024:S0007-0912(23)00692-X. [PMID: 38177005 DOI: 10.1016/j.bja.2023.11.049] [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: 08/22/2023] [Revised: 11/03/2023] [Accepted: 11/16/2023] [Indexed: 01/06/2024] Open
Abstract
BACKGROUND Anaesthesia contributes substantially to the environmental impact of healthcare. To reduce the ecological footprint of anaesthesia, a set of sustainability interventions was implemented in the University Hospital Zurich, Switzerland. This study evaluates the environmental and economic implications of these interventions. METHODS This was a single-centre retrospective observational study. We analysed the environmental impact and financial implications of changes in sevoflurane, desflurane, propofol, and plastic consumption over 2 yr (April 2021 to March 2023). The study included pre-implementation, implementation, and post-implementation phases. RESULTS After implementation of sustainability measures, desflurane use was eliminated, there was a decrease in the consumption of sevoflurane from a median (inter-quartile range) of 25 (14-39) ml per case to 11 (6-22) ml per case (P<0.0001). Propofol consumption increased from 250 (150-721) mg per case to 743 (370-1284) mg per case (P<0.0001). Use of plastics changed: in the first quarter analysed, two or more infusion syringes were used in 62% of cases, compared with 74% of cases in the last quarter (P<0.0001). Two or more infusion lines were used in 58% of cases in the first quarter analysed, compared with 68% of cases in the last quarter (P<0.0001). This resulted in an 81% reduction in overall environmental impact from 3 (0-7) to 1 (0-3) CO2 equivalents in kg per case (P<0.0001). The costs during the final study phase were 11% lower compared with those in the initial phase: from 25 (13-41) to 21 (14-31) CHF (Swiss francs) per case (P<0.0001). CONCLUSIONS Implementing sustainable anaesthesia interventions can significantly reduce the environmental impact and cost of anaesthesia.
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Affiliation(s)
- Greta Gasciauskaite
- Institute of Anaesthesiology, University Hospital Zurich, Zurich, Switzerland.
| | - Justyna Lunkiewicz
- Institute of Anaesthesiology, University Hospital Zurich, Zurich, Switzerland
| | - Michael Tucci
- Institute of Anaesthesiology, University Hospital Zurich, Zurich, Switzerland
| | | | | | - Donat R Spahn
- Institute of Anaesthesiology, University Hospital Zurich, Zurich, Switzerland
| | - David W Tscholl
- Institute of Anaesthesiology, University Hospital Zurich, Zurich, Switzerland
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Ponsonnard S. The end of desflurane. Comment on Br J Anaesth 2022; 129: e81-2. Br J Anaesth 2023:S0007-0912(23)00670-0. [PMID: 38114356 DOI: 10.1016/j.bja.2023.11.044] [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: 10/28/2023] [Revised: 11/10/2023] [Accepted: 11/23/2023] [Indexed: 12/21/2023] Open
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Ankolekar RR, Kaur K, Jangra K, Aggarwal A, Panda NB, Bhagat H, Barik AK. Propofol versus Desflurane in Moyamoya Disease Patients-A Pilot Study. Asian J Neurosurg 2023; 18:826-830. [PMID: 38161613 PMCID: PMC10756770 DOI: 10.1055/s-0043-1775588] [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] [Indexed: 01/03/2024] Open
Abstract
Objectives The choice of inhalational or intravenous anesthetic agents is debatable in neurosurgical patients. Desflurane, a cerebral vasodilator, may be advantageous in ischemic cerebral pathologies. Hence, we planned to compare desflurane and propofol in patients with moyamoya disease (MMD) with the objective of comparing neurological outcomes. Materials and Methods This prospective pilot trial was initiated after institutional ethics committee approval. Patients with MMD undergoing revascularization surgery were randomized into two groups receiving either desflurane or propofol intraoperatively. Neurological outcomes were assessed using a modified Rankin score (mRS) at discharge and an extended Glasgow outcome score (GOS-E) at 1 month. Intraoperative parameters, including hemodynamic parameters, end-tidal carbon dioxide, entropy, intraoperative brain relaxation scores (BRS), and rescue measures for brain relaxation, were compared. Statistical Analysis The normality of quantitative data was checked using Kolmogorov-Smirnov tests of normality. Normally distributed data were compared using unpaired t -tests, skewed data using Mann-Whitney U tests, and categorical variables using chi-squared tests. Results A total of 17 patients were randomized, 10 in the desflurane and 7 in the propofol group. mRS (1.3 ± 0.6 and 1.14 ± 0.4, p = 0.450) and GOS-E (6.7 ± 0.6 and 6.85 ± 0.5, p = 0.45) were comparable between desflurane and propofol groups, respectively. BRS was significantly higher in the desflurane group (3.6 ± 0.5) compared to the propofol group (2.1 ± 0.3, p = 0.001), with a significant number of patients requiring rescue measures in the desflurane group (70%, p < 0.001). Other outcome parameters were comparable ( p > 0.05). Conclusion We conclude that postoperative neurological outcomes were comparable with using either an anesthetic agent, desflurane, or propofol in MMD patients undergoing revascularization surgery. Maintenance of anesthesia with propofol had significantly superior surgical field conditions.
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Affiliation(s)
- Ronak R. Ankolekar
- Department of Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India
- Senior Registrar Department of Critical Care Medicine, Narayana Health, Bangalore, Karnataka, India
| | - Kirandeep Kaur
- Department of Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Kiran Jangra
- Department of Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ashish Aggarwal
- Department of Neurosurgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Nidhi B. Panda
- Department of Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Hemant Bhagat
- Department of Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Amiya K. Barik
- Department of Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Hafiani EM, Teilhet M, Camus F, El Maleh Y, Burey J, Taconet C, Quesnel C. Evaluation of a protocol to reduce the environmental impact of anaesthetic gases. Br J Anaesth 2023:S0007-0912(23)00581-0. [PMID: 37980181 DOI: 10.1016/j.bja.2023.10.026] [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: 06/15/2023] [Revised: 10/16/2023] [Accepted: 10/24/2023] [Indexed: 11/20/2023] Open
Affiliation(s)
- El Mahdi Hafiani
- Department of Anesthesiology and Critical Care Medicine, Tenon Hospital, APHP Sorbonne Université, Paris, France.
| | - Marie Teilhet
- Department of Anesthesiology and Critical Care Medicine, Tenon Hospital, APHP Sorbonne Université, Paris, France
| | - Françoise Camus
- Department of Pharmacy, Tenon Hospital, APHP Sorbonne Université, Paris, France
| | - Yoann El Maleh
- Department of Anesthesiology and Critical Care Medicine, Tenon Hospital, APHP Sorbonne Université, Paris, France
| | - Julien Burey
- Department of Anesthesiology and Critical Care Medicine, Tenon Hospital, APHP Sorbonne Université, Paris, France
| | - Clémentine Taconet
- Department of Anesthesiology and Critical Care Medicine, Tenon Hospital, APHP Sorbonne Université, Paris, France
| | - Christophe Quesnel
- Department of Anesthesiology and Critical Care Medicine, Tenon Hospital, APHP Sorbonne Université, Paris, France
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Zhang C, He C, Chen Z, Chen X, Qin J, Xu Y, Ma J. The effects of volatile anesthetics and propofol in patients undergoing off-pump coronary artery bypass grafting: a systematic review and meta-analysis. Front Cardiovasc Med 2023; 10:1271557. [PMID: 38034375 PMCID: PMC10684663 DOI: 10.3389/fcvm.2023.1271557] [Citation(s) in RCA: 1] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 11/02/2023] [Indexed: 12/02/2023] Open
Abstract
Background Studies investigating the cardioprotective effect of volatile anesthetics on cardiac troponins in off-pump coronary artery bypass grafting (OPCAB) surgery remain controversial. This current study was conducted to systematically evaluate the impact of volatile anesthetics and propofol on patients undergoing OPCAB surgery. Methods A computerized search of electronic databases was conducted up to July 21, 2023, to identify relevant studies using appropriate search terms. The primary outcomes of interest were the levels of myocardial injury biomarkers (e.g., cTnI, cTnT), while secondary outcomes included extubation time, length of ICU stay, 30-day mortality, transfusion and thrombosis, and postoperative recovery, which were compared between two anesthesia techniques. Results A search of databases produced 14 relevant studies with a combined total of 703 patients. Among them, 355 were allocated to the volatile anesthetics group and 348 to the propofol group. Our study reveals a statistically significant reduction in myocardial injury biomarkers among patients who received volatile anesthetics compared to those who received propofol (P < .001). Subgroup analysis showed that patients using sevoflurane had lower postoperative cardiac troponins levels compared to propofol (P = .01). However, desflurane and isoflurane currently have no significant advantage over propofol (all P > 0.05). There was no significant difference in postoperative mechanical ventilation time, length of ICU stay, and mortality between the two groups (all P > 0.05). Conclusions This study suggested that volatile anesthetics, specifically sevoflurane, in adult OPCAB surgery provide a better cardioprotective effect than propofol. Systematic Review Registration PROSPERO (CRD42023444277).
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Affiliation(s)
- Chenghong Zhang
- School of Medicine, Hangzhou Normal University, Hangzhou, China
| | - Changlin He
- Department of Anesthesiology, Affiliated Hospital of Hangzhou Normal University, Hangzhou, China
| | - Zhengwei Chen
- Department of Anesthesiology, Affiliated Hospital of Hangzhou Normal University, Hangzhou, China
| | - Xin Chen
- Department of Anesthesiology, Affiliated Hospital of Hangzhou Normal University, Hangzhou, China
| | - Junjun Qin
- Department of Anesthesiology, Affiliated Hospital of Hangzhou Normal University, Hangzhou, China
| | - Yuhui Xu
- Department of Anesthesiology, Affiliated Hospital of Hangzhou Normal University, Hangzhou, China
| | - Jiasen Ma
- Department of Anesthesiology, Affiliated Hospital of Hangzhou Normal University, Hangzhou, China
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14
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Scheid S, Goebel U, Ulbrich F. Neuroprotection Is in the Air-Inhaled Gases on Their Way to the Neurons. Cells 2023; 12:2480. [PMID: 37887324 PMCID: PMC10605176 DOI: 10.3390/cells12202480] [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: 08/14/2023] [Revised: 09/29/2023] [Accepted: 10/13/2023] [Indexed: 10/28/2023] Open
Abstract
Cerebral injury is a leading cause of long-term disability and mortality. Common causes include major cardiovascular events, such as cardiac arrest, ischemic stroke, and subarachnoid hemorrhage, traumatic brain injury, and neurodegenerative as well as neuroinflammatory disorders. Despite improvements in pharmacological and interventional treatment options, due to the brain's limited regeneration potential, survival is often associated with the impairment of crucial functions that lead to occupational inability and enormous economic burden. For decades, researchers have therefore been investigating adjuvant therapeutic options to alleviate neuronal cell death. Although promising in preclinical studies, a huge variety of drugs thought to provide neuroprotective effects failed in clinical trials. However, utilizing medical gases, noble gases, and gaseous molecules as supportive treatment options may offer new perspectives for patients suffering neuronal damage. This review provides an overview of current research, potentials and mechanisms of these substances as a promising therapeutic alternative for the treatment of cerebral injury.
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Affiliation(s)
- Stefanie Scheid
- Department of Anesthesiology and Critical Care, Medical Center, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany;
| | - Ulrich Goebel
- Department of Anesthesiology and Critical Care Medicine, St. Franziskus-Hospital, 48145 Muenster, Germany;
| | - Felix Ulbrich
- Department of Anesthesiology and Critical Care, Medical Center, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany;
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15
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Pirinç Şaşıoğlu G, Kendigelen P, Tütüncü AÇ, Kaya G. Reversal of Rocuronium-Induced Neuromuscular Blockade by Sugammadex Under Sevoflurane and Desflurane Anesthesia in Children. Eurasian J Med 2023; 55:173-177. [PMID: 37909186 PMCID: PMC10724797 DOI: 10.5152/eurasianjmed.2022.22090] [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: 09/12/2022] [Accepted: 12/14/2022] [Indexed: 11/02/2023] Open
Abstract
OBJECTIVE In children, neuromuscular blockers may have different effects with various inhalation agents and incomplete reversal of the blockade continues to be a problem. The aim of the study is to observe the effects of sugammadex on reversing the blockade by a single dose of rocuronium, the peak inspiratory pressure, hemodynamic parameters in children under sevoflurane and desflurane anesthesia. MATERIALS AND METHODS One hundred forty-eight children aged 2-10 years old, to be operated under shortterm general anesthesia, were enrolled in this prospective randomized controlled trial. After induction, the patients were intubated at the end of TOF (Train-of-four) ratio of 1.0-0. The time taken until TOF reached 0.25 was recorded, and 2 mg/kg sugammadex was administered to the patients. The period until the TOF was at least 0.9 and in the first 10 minutes after sugammadex injection, peak inspiratory pressure, the systolic-diastolic arterial pressure, and the heart rate were monitored and possible side effects were observed in the recovery room. RESULTS Following the injection of sugammadex, the time taken for TOF of 0.25 to reach >0.9 was significantly shorter in the 2-4-year-old age group under sevoflurane anesthesia. After sugammadex injection, a small but statistically significant increase in peak inspiratory pressure values was observed in Group D at the 2nd, 5th, and 10th minutes. CONCLUSION Rapid and complete recovery was achieved from the block induced by a single dose of 0.6 mg/ kg rocuronium by the use of sugammadex which did not give rise to any side effects.
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Affiliation(s)
- Gamze Pirinç Şaşıoğlu
- Department of Anesthesiology and Intensive Care, Istanbul University-Cerrahpaşa, Cerrahpaşa Medical Faculty, Istanbul, Turkey
| | - Pınar Kendigelen
- Department of Anesthesiology and Intensive Care, Istanbul University-Cerrahpaşa, Cerrahpaşa Medical Faculty, Istanbul, Turkey
| | - Ayşe Çiğdem Tütüncü
- Department of Anesthesiology and Intensive Care, Istanbul University-Cerrahpaşa, Cerrahpaşa Medical Faculty, Istanbul, Turkey
| | - Güner Kaya
- Department of Anesthesiology and Intensive Care, Istanbul University-Cerrahpaşa, Cerrahpaşa Medical Faculty, Istanbul, Turkey
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16
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Tanabe S, Lee H, Wang S, Hudetz AG. Spontaneous and Visual Stimulation Evoked Firing Sequences Are Distinct Under Desflurane Anesthesia. Neuroscience 2023; 528:54-63. [PMID: 37473851 DOI: 10.1016/j.neuroscience.2023.07.016] [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: 05/20/2023] [Revised: 07/09/2023] [Accepted: 07/12/2023] [Indexed: 07/22/2023]
Abstract
Recurring spike sequences are thought to underlie cortical computations and may be essential for information processing in the conscious state. How anesthesia at graded levels may influence spontaneous and stimulus-related spike sequences in visual cortex has not been fully elucidated. We recorded extracellular single-unit activity in the rat primary visual cortex in vivo during wakefulness and three levels of anesthesia produced by desflurane. The latencies of spike sequences within 0-200 ms from the onset of spontaneous UP states and visual flash-evoked responses were compared. During wakefulness, spike latency patterns linked to the local field potential theta cycle were similar to stimulus-evoked patterns. Under desflurane anesthesia, spontaneous UP state sequences differed from flash-evoked sequences due to the recruitment of low-firing excitatory neurons to the UP state. Flash-evoked spike sequences showed higher reliability and longer latency when stimuli were applied during DOWN states compared to UP states. At deeper levels, desflurane altered both UP state and flash-evoked spike sequences by selectively suppressing inhibitory neuron firing. The results reveal desflurane-induced complex changes in cortical firing sequences that may influence visual information processing.
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Affiliation(s)
- Sean Tanabe
- Center for Consciousness Science, Department of Anesthesiology, University of Michigan, Ann Arbor, MI 48105, USA
| | - Heonsoo Lee
- Center for Consciousness Science, Department of Anesthesiology, University of Michigan, Ann Arbor, MI 48105, USA
| | - Shiyong Wang
- Center for Consciousness Science, Department of Anesthesiology, University of Michigan, Ann Arbor, MI 48105, USA
| | - Anthony G Hudetz
- Center for Consciousness Science, Department of Anesthesiology, University of Michigan, Ann Arbor, MI 48105, USA.
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17
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Hu EP, Yap A, Davies JF, Goyagi T, McGain F. Global practices in desflurane use. Br J Anaesth 2023:S0007-0912(23)00471-3. [PMID: 37714752 DOI: 10.1016/j.bja.2023.08.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 08/20/2023] [Accepted: 08/21/2023] [Indexed: 09/17/2023] Open
Affiliation(s)
- Elizabeth P Hu
- Department of Critical Care, Melbourne Medical School, The University of Melbourne, VIC, Australia.
| | - Andrea Yap
- Department of Anaesthesia, National University Hospital, Singapore, Singapore; Department of Anaesthesia, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Jessica F Davies
- Department of Critical Care, Melbourne Medical School, The University of Melbourne, VIC, Australia; Austin Health, Heidelberg, VIC, Australia
| | - Toru Goyagi
- Department of Anesthesiology, Tokyo Medical University, Tokyo, Japan
| | - Forbes McGain
- Department of Critical Care, Melbourne Medical School, The University of Melbourne, VIC, Australia; Western Health, Footscray, VIC, Australia
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18
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Kalmar AF, Verdonck P, Saxena S, Mulier J. Proper use of CONTRAfluran™ for optimal desorption and reuse of volatile anaesthetics. Comment on Br J Anaesth 2022; 129: e79-81. Br J Anaesth 2023; 131:e71-e72. [PMID: 37442725 DOI: 10.1016/j.bja.2023.06.046] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 05/31/2023] [Accepted: 06/11/2023] [Indexed: 07/15/2023] Open
Affiliation(s)
- Alain F Kalmar
- Department of Electronics and Information Systems, IBiTech, Ghent University, Ghent, Belgium; Department of Anesthesia and Critical Care, AZ Sint-Jan Brugge Oostende AV, Bruges, Belgium.
| | - Pascal Verdonck
- Department of Electronics and Information Systems, IBiTech, Ghent University, Ghent, Belgium
| | - Sarah Saxena
- Department of Anesthesia and Critical Care, AZ Sint-Jan Brugge Oostende AV, Bruges, Belgium
| | - Jan Mulier
- Department of Anesthesia and Critical Care, AZ Sint-Jan Brugge Oostende AV, Bruges, Belgium; Department of Anesthesia, UZGent, Ghent, Belgium; Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
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19
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Nam SW, Yim S, Choi CI, Park I, Joung KW, Song IA. Effects of remimazolam on hemodynamic changes during cardiac ablation for atrial fibrillation under general anesthesia: a propensity-score-matched retrospective cohort study. Can J Anaesth 2023; 70:1495-1503. [PMID: 37430181 DOI: 10.1007/s12630-023-02514-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [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: 09/08/2022] [Revised: 01/26/2023] [Accepted: 01/30/2023] [Indexed: 07/12/2023] Open
Abstract
PURPOSE Abrupt hemodynamic changes or life-threatening arrhythmias are frequently observed in individuals receiving anesthesia for cardiac arrhythmia ablation. Remimazolam is a novel ultra-short-acting benzodiazepine that has been associated with better hemodynamic stability than conventional anesthetic agents do. This study aimed to investigate whether remimazolam reduces vasoactive agent use compared with desflurane in individuals undergoing ablation for atrial fibrillation under general anesthesia. METHODS In a retrospective cohort study, we reviewed electronic medical records of adult patients who underwent ablation for atrial fibrillation under general anesthesia between July 2021 and July 2022. We divided patients into remimazolam and desflurane groups according to the principal agent used for anesthesia. The primary endpoint was the overall incidence of vasoactive agent use. We compared the groups using propensity-score matching (PSM) analysis. RESULTS A total of 177 patients were included-78 in the remimazolam group and 99 in the desflurane group. After PSM, 78 final patients were included in each group. The overall incidence of vasoactive agent use was significantly lower in the remimazolam group than in the desflurane group (41% vs 74% before PSM; 41% vs 73% after PSM; both, P < 0.001). The incidence rate, duration, and maximum dose of continuous vasopressor infusion were also significantly lower in the remimazolam group (P < 0.001). Use of remimazolam was not associated with increased complications after the ablation procedures. CONCLUSIONS General anesthesia using remimazolam vs desflurane was associated with significantly reduced vasoactive agent requirement and better hemodynamic stability without increased postoperative complications in patients undergoing ablation for atrial fibrillation.
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Affiliation(s)
- Sun Woo Nam
- Department of Anesthesiology and Pain Medicine, Chung-Ang University, College of Medicine, Seoul, South Korea
- Department of Anesthesiology and Pain Medicine, Chung-Ang University Gwangmyeong Hospital, Gwangmyeong-si, South Korea
| | - Subin Yim
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Chang Ik Choi
- Department of Anesthesiology and Pain Medicine, Yonsei University Wonju College of Medicine, Wonju-si, South Korea
- Department of Anesthesiology and Pain Medicine, Wonju Severance Christian Hospital, Wonju-si, South Korea
| | - Insun Park
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Kyoung-Woon Joung
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, Seoul, South Korea
- Department of Anesthesiology and Pain Medicine, University of Ulsan College of Medicine, Seoul, South Korea
| | - In-Ae Song
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
- Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul, South Korea
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20
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Nelson A, Sudhakar S, Mishra J, Tirupathi HK, Marella VG, Kudagi VS. Comparison of the Sevoflurane versus Desflurane Anaesthesia on the Recovery of Airway Reflexes and Cognitive Function: An Original Research. J Pharm Bioallied Sci 2023; 15:S288-S292. [PMID: 37654338 PMCID: PMC10466510 DOI: 10.4103/jpbs.jpbs_497_22] [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: 10/18/2022] [Revised: 01/12/2023] [Accepted: 02/20/2023] [Indexed: 09/02/2023] Open
Abstract
Background and Objectives Sevoflurane and desflurane virtually equally dissolve in blood gases, yet current research suggests that desflurane helps in a quick return of airway reflex than sevoflurane however the return of cognitive activity fluctuates greatly. In order to compare the lengths of time required to recover after sevoflurane and desflurane anesthesia, the current research was conducted. Materials and Methods Current study was randomized that included 100 subjects who were posted for cholecystectomy (elective). Only adult and non-obese subjects were included in the study. The intended anesthetic agents sevoflurane and desflurane were utilized in the study and all the protocols were followed for the surgery. After the end of the surgery, tests for regaining cognitive function and airway reflexes were carried out, and different time intervals were recorded. The values were recorded and compared for the variances while considering the P < 0.05 as significant. Results The mean T1 was 8.19 ± 3.28 min for sevoflurane and was 5.82 ± 4.02 min. There was no significant variance between the two agents for the T1, 2 (P = 0.013 and 0.110 respectively). After the inhalation anesthetics ceased at T1, desflurane patients responded to verbal commands more quickly than sevoflurane patients (5.824.02 vs. 8.193.28 min). The SOMCT and swallowing test were similarly completed more quickly by desflurane-treated patients than by sevoflurane-treated patients (T3VST4) (13.693.37 vs. 10.024.86 min, P = 0.008 and (14.094.30 vs. 9.824.50 min, P 0.001, respectively). For the T3, 4-time intervals, there was a significant difference between the sevoflurane and desflurane groups. Conclusion Desflurane causes patients to recover more quickly from laparoscopic cholecystectomy under controlled circumstances than sevoflurane does.
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Affiliation(s)
- Anish Nelson
- Department of Oral and Maxillofacial Surgery, Nitte (Deemed to be University), AB Shetty Memorial Institute of Dental Sciences (ABSMIDS), Mangalore, Karnataka, India
| | - S. Sudhakar
- Department of Anaesthesiology, Apollo Institute of Medical Sciences and Research, Murukambattu, Chittoor, Andhra Pradesh, India
| | - Jagannath Mishra
- Department of Anaesthesiology, PRM Medical College, Baripada, Odisha, India
| | - Hemanth Kumar Tirupathi
- Department of Anaesthesia and Critical Care, Pt B D Sharma University of Health Sciences, PGIMS, Rohtak, Haryana, India
| | - Vishnu Gowtham Marella
- Department of Oral and Maxillofacial Surgery, Sri Sai College of Dental Surgery, Vikarabad, Telangana, India
| | - Vishal S. Kudagi
- Department of Orthodontics, JSS Dental College and Hospital, Mysore, Karnataka, India
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21
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Kuzminskaite V, Kontrimaviciute E, Kauzonas E, Slauzgalvyte I, Bukelyte G, Bruzyte‐Narkiene G, Jatuzis D. Sevoflurane and desflurane effects on early cognitive function after low-risk surgery: A randomized clinical trial. Brain Behav 2023; 13:e3017. [PMID: 37086000 PMCID: PMC10275520 DOI: 10.1002/brb3.3017] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 09/11/2022] [Revised: 03/28/2023] [Accepted: 03/29/2023] [Indexed: 04/23/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Deleterious effects on short-term and long-term quality of life have been associated with the development of postoperative cognitive dysfunction (POCD) after general anesthesia. Yet, the progress in the field is still required. Most of the studies investigate POCD after major surgery, so scarce evidence exists about the incidence and effect different anesthetics have on POCD development after minor procedures. In this study, we compared early postoperative cognitive function of the sevoflurane and desflurane patients who experienced a low-risk surgery of thyroid gland. MATERIALS AND METHODS Eighty-two patients, 40 years and over, with no previous severe cognitive, neurological, or psychiatric disorders, appointed for thyroid surgery under general anesthesia, were included in the study. In a random manner, the patients were allocated to either sevoflurane or desflurane study arms. Cognitive tests assessing memory, attention, and logical reasoning were performed twice: the day before the surgery and 24 h after the procedure. Primary outcome, magnitude of change in cognitive testing, results from baseline. POCD was diagnosed if postoperative score decreased by at least 20%. RESULTS Median change from baseline cognitive results did not differ between the sevoflurane and desflurane groups (-2.63%, IQR 19.3 vs. 1.13%, IQR 11.0; p = .222). POCD was detected in one patient (1.22%) of the sevoflurane group. Age, duration of anesthesia, postoperative pain, or patient satisfaction did not correlate with test scores. Intraoperative temperature negatively correlated with total postoperative score (r = -0.35, p = .007). CONCLUSIONS Both volatile agents proved to be equivalent in terms of the early cognitive functioning after low-risk thyroid surgery. Intraoperative body temperature may influence postoperative cognitive performance.
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Affiliation(s)
- Vilma Kuzminskaite
- Faculty of MedicineClinic of Anesthesiology and Intensive CareInstitute of Clinical MedicineVilnius UniversityVilniusLithuania
- Faculty of MedicineVilnius UniversityVilniusLithuania
| | - Egle Kontrimaviciute
- Faculty of MedicineClinic of Anesthesiology and Intensive CareInstitute of Clinical MedicineVilnius UniversityVilniusLithuania
- Faculty of MedicineVilnius UniversityVilniusLithuania
| | | | | | | | | | - Dalius Jatuzis
- Faculty of MedicineClinic of Neurology and NeurosurgeryInstitute of Clinical MedicineVilnius UniversityVilniusLithuania
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22
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Li R, Mukherjee MB, Jin Z, Liu H, Lin K, Liu Q, Dilger JP, Lin J. The Potential Effect of General Anesthetics in Cancer Surgery: Meta-Analysis of Postoperative Metastasis and Inflammatory Cytokines. Cancers (Basel) 2023; 15:2759. [PMID: 37345096 DOI: 10.3390/cancers15102759] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Revised: 05/01/2023] [Accepted: 05/09/2023] [Indexed: 06/23/2023] Open
Abstract
Metastasis or recurrence following curative surgery is the main indicator of tumor progress and is the main cause of patient death. For more than three decades, the potential for general anesthesia to affect cancer outcomes has been a subject of concern with considerable research interest. Here, we conducted this systematic review and meta-analysis to summarize the effect of inhalational anesthesia (IHNA) vs. propofol-based total intravenous anesthesia (TIVA) on metastasis and recurrence after cancer surgery from clinical and pre-clinical studies. The relative risk for metastasis/recurrence in TIVA is 0.61 (95% confidence interval (95% CI) 0.46 to 0.82, p = 0.0009) compared to IHNA. Inflammatory cytokines have been implicated in cancer metastasis following cancer surgery, thus we analyzed inflammatory cytokines levels after surgery under IHNA or TIVA. Based on pooled analysis, a lower IL-6 level was noticed in TIVA in comparison to IHNA (standardized mean difference (SMD) = 0.77, 95% CI = 0.097 to 1.44, I2 = 92%, p = 0.02) but not TNF-α or IL-10. Preclinical animal model studies show that inhalational anesthetics increase the risk of breast cancer metastasis compared to propofol. In conclusion, the current evidence suggests intravenous anesthetic propofol is associated with less metastasis/recurrence and lower postoperative IL-6 level over inhaled anesthetics in the oncological surgery. We urge more well-designed clinical and preclinical studies in this field.
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Affiliation(s)
- Ru Li
- Department of Anesthesiology, Stony Brook University Renaissance School of Medicine, Stony Brook, NY 11794-8480, USA
| | - Mousumi Beto Mukherjee
- Department of Anesthesiology, Stony Brook University Renaissance School of Medicine, Stony Brook, NY 11794-8480, USA
| | - Zhaosheng Jin
- Department of Anesthesiology, Stony Brook University Renaissance School of Medicine, Stony Brook, NY 11794-8480, USA
| | - Hengrui Liu
- Department of Anesthesiology, Stony Brook University Renaissance School of Medicine, Stony Brook, NY 11794-8480, USA
| | - Kevin Lin
- Department of Anesthesiology, Stony Brook University Renaissance School of Medicine, Stony Brook, NY 11794-8480, USA
| | - Qiuyue Liu
- Department of Anesthesiology, Stony Brook University Renaissance School of Medicine, Stony Brook, NY 11794-8480, USA
| | - James P Dilger
- Department of Anesthesiology, Stony Brook University Renaissance School of Medicine, Stony Brook, NY 11794-8480, USA
| | - Jun Lin
- Department of Anesthesiology, Stony Brook University Renaissance School of Medicine, Stony Brook, NY 11794-8480, USA
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23
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Zhou T, Li J, Cheng A, Zuo Z. Desflurane post-treatment reduces hypoxic-ischemic brain injury via reducing transient receptor potential ankyrin 1 in neonatal rats. Neuroscience 2023; 522:121-131. [PMID: 37196978 DOI: 10.1016/j.neuroscience.2023.05.007] [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: 02/04/2023] [Revised: 05/01/2023] [Accepted: 05/09/2023] [Indexed: 05/19/2023]
Abstract
Perinatal hypoxic-ischemic (HI) brain injury leads to mortality and morbidity in neonates and children. There are no effective and practical methods to attenuate this brain injury. This study determined whether desflurane, a volatile anesthetic with limited effect on the cardiovascular system, protected against HI-induced brain damage and the role of transient receptor potential ankyrin 1 (TRPA1), a mediator for simulated ischemia-induced myelin damage, in this protection. Seven-day-old male and female Sprague-Dawley rats had brain HI. They were exposed to 4.8%, 7.6% or 11.4% desflurane immediately or 4.8% desflurane at 0.5, 1 or 2 h after the HI. Brain tissue loss was evaluated 7 days later. Neurological functions and brain structures of rats with HI and 4.8% desflurane post-treatment were evaluated 4 weeks after the HI. TRPA1 expression was determined by Western blotting. HC-030031, a TRPA1 inhibitor, was used to determine the role of TRPA1 in the HI-induced brain injury. HI induced brain tissue and neuronal loss, which was attenuated by all tested concentrations of desflurane. Desflurane post-treatment also improved motor function, learning and memory in rats with brain HI. Brain HI increased the expression of TRPA1 and this increase was inhibited by desflurane. TRPA1 inhibition reduced HI-induced brain tissue loss and impairment of learning and memory. However, the combination of TRPA1 inhibition and desflurane post-treatment did not preserve brain tissues, learning and memory better than TRPA1 inhibition or desflurane post-treatment alone. Our results suggest that desflurane post-treatment induces neuroprotection against neonatal HI. This effect may be mediated by inhibiting TRPA1.
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Affiliation(s)
- Ting Zhou
- Department of Anesthesiology, University of Virginia, Charlottesville, Virginia 22908, USA; Department of Anesthesiology, First Affiliated Hospital, Jinan University, Guangzhou 510632, China.
| | - Jun Li
- Department of Anesthesiology, University of Virginia, Charlottesville, Virginia 22908, USA.
| | - Aobing Cheng
- Department of Anesthesiology, University of Virginia, Charlottesville, Virginia 22908, USA; Department of Anesthesiology, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou 510515, China
| | - Zhiyi Zuo
- Department of Anesthesiology, University of Virginia, Charlottesville, Virginia 22908, USA.
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24
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Ouellet MF, Moore A, Williams S, Girard F, Desroches J, Ruel M, Beaulieu P. Efficacy of a propofol bolus against placebo to prevent cough at emergence from general anesthesia with desflurane: a randomized controlled trial. Can J Anaesth 2023; 70:842-850. [PMID: 36829104 DOI: 10.1007/s12630-023-02401-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: 04/19/2022] [Revised: 10/07/2022] [Accepted: 10/14/2022] [Indexed: 02/26/2023] Open
Abstract
PURPOSE Emergence from anesthesia is a critical period and cough can result in adverse effects. Propofol inhibits airway reflexes and when infused it reduces cough more than inhalation anesthesia does. We evaluated the effect of a propofol bolus given at emergence on the incidence of coughing following a desflurane-based anesthesia. METHODS One hundred and fifty-four patients scheduled for elective surgery were prospectively randomized to propofol (0.5 mg·kg-1) or normal saline (NS) administered at the end of the surgery at 1 minimum alveolar concentration (MAC) of desflurane. A "no touch" emergence technique was used until extubation. The primary outcome was the incidence of cough at the discontinuation of desflurane (T0) and reaching a MAC adjusted for age (MACage) of 0.15. Secondary outcomes included incidence and severity of cough until five minutes postextubation (T0-T5), time to extubation, nausea and vomiting, sedation, hemodynamic variations, postoperative hypoventilation, hypoxemia, and sore throat. RESULTS We could not draw inferences on the incidence of cough between T0 and MACage of 0.15 because only 27/68 (40%) patients in the NS group and 13/73 (18%) patients in the propofol group regained consciousness before reaching a MACage of 0.15. There were no significant differences between the groups in coughing incidence and severity between T0 and T5 (NS group, 57/68 [84%] vs propofol group, 70/73 [96%] ). The mean time to extubation in the propofol group was prolonged by 3 min 27 sec (95% confidence interval, 1 min 7 sec to 4 min 47 sec; P < 0.001) and more vasopressors were used at emergence (P = 0.02). The incidence of respiratory complications, nausea and vomiting, agitation, and sedation were not different between groups. CONCLUSION In the present trial, a propofol bolus administered at emergence did not reduce the incidence of cough occurring between T0 and T5 following a desflurane-based general anesthesia compared with placebo. TRIAL REGISTRATION ClinicalTrials.gov (NCT02932397); registered 13 October 2016.
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Affiliation(s)
- Marie-Félix Ouellet
- Department of Anesthesiology, Hôpital de Granby, Granby, QC, Canada
- Department of Anesthesiology, Faculty of Medicine, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Alex Moore
- Department of Anesthesiology, CHUM, Montreal, QC, Canada
- Department of Anesthesiology and Pain Medicine, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
| | - Stephan Williams
- Department of Anesthesiology, CHUM, Montreal, QC, Canada
- Department of Anesthesiology and Pain Medicine, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
| | - François Girard
- Department of Anesthesiology, CHUM, Montreal, QC, Canada
- Department of Anesthesiology and Pain Medicine, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
| | | | - Monique Ruel
- Department of Anesthesiology, CHUM, Montreal, QC, Canada
| | - Pierre Beaulieu
- Department of Anesthesiology, CHUM, Montreal, QC, Canada.
- Department of Anesthesiology and Pain Medicine, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada.
- Department of Pharmacology & Physiology, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada.
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Recchimurzo A, Balzano F, Uccello Barretta G, Gherardi L, Malanga M, Aiello F. Silylated-Acetylated Cyclodextrins as Chiral Sensors for the Enantiodiscrimination of Fluorinated Anesthetics. Molecules 2023; 28:molecules28062804. [PMID: 36985776 PMCID: PMC10058779 DOI: 10.3390/molecules28062804] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 03/17/2023] [Accepted: 03/17/2023] [Indexed: 03/30/2023] Open
Abstract
Silylated-acetylated cyclodextrin (CD) derivatives have recently been investigated, via nuclear magnetic resonance (NMR) spectroscopy, as chiral sensors for substrates that are endowed and devoid of fluorine atoms, and the importance of Si-F interaction in the discrimination phenomena has been assessed. Here, the contributions of both superficial interactions and inclusion processes were further evaluated by extending the records to other chiral fluorinated substrates of interest for pharmaceutical applications. Non-equivalences were measured for both the 1H and 19F resonances in equimolar mixtures with the CDs; the promising results also supported the use of chiral sensors in sub-stoichiometric amounts. Finally, the occurrence of inclusion processes was evaluated by analyzing the intermolecular dipolar interactions by means of ROESY (Rotating-frame Overhauser Enhancement Spectroscopy) experiments. The study confirmed that the γCD derivative is the best chiral solvating agent for the fluorinated substrates investigated, likely due to the higher number of silyl moieties that can be involved in Si-F interactions. The contribution of inclusion processes to the enantiodiscrimination was also confirmed by comparison with the α- and β-analogues. Overall, the CD derivatives proved to be able to discriminate fluorinated substrates even when used in sub-stoichiometric amounts.
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Affiliation(s)
- Alessandra Recchimurzo
- Department of Chemistry and Industrial Chemistry, University of Pisa, via G. Moruzzi 13, 56124 Pisa, Italy
| | - Federica Balzano
- Department of Chemistry and Industrial Chemistry, University of Pisa, via G. Moruzzi 13, 56124 Pisa, Italy
| | - Gloria Uccello Barretta
- Department of Chemistry and Industrial Chemistry, University of Pisa, via G. Moruzzi 13, 56124 Pisa, Italy
| | - Luca Gherardi
- Department of Chemistry and Industrial Chemistry, University of Pisa, via G. Moruzzi 13, 56124 Pisa, Italy
| | - Milo Malanga
- CycloLab, Cyclodextrin R&D Ltd., Illatos út. 7, H-1097 Budapest, Hungary
| | - Federica Aiello
- National Research Council, Institute for Chemical and Physical Processes (CNR-IPCF), via G. Moruzzi 1, 56124 Pisa, Italy
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26
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Davies JF, Seglenieks R, Cameron R, Kuruvilla NA, Grove EM, Shrivathsa A, Grobler S. Operation clean up: A model for eco-leadership and sustainability implementation. Anaesth Intensive Care 2023; 51:88-95. [PMID: 36721955 DOI: 10.1177/0310057x221102469] [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] [Indexed: 02/02/2023]
Abstract
Healthcare contributes to environmental harm. Trainee-led Research and Audit in Anaesthesia for Sustainable Healthcare (TRA2SH) is an Australasian network focused on sustainable anaesthesia practice. TRA2SH hypothesised that trainee-led audits alongside education presented on a scheduled national day, called Operation Clean Up, can improve engagement with sustainability initiatives. This paper aims to describe the first two years of Operation Clean Up in terms of goals, achievements and data collected so far. Environmental themes for Operation Clean Up were chosen based on available evidence (life cycle analyses and observational studies). The first Operation Clean Up (OCU 2020) focused on reducing the unnecessary use of single-use disposable absorbent pads (known as 'blueys' in Australia, 'greenies' in New Zealand). OCU 2021 included: refuse desflurane, reduce bluey use, reuse drug trays, and recycle paper and cardboard. TRA2SH provided an information pack to trainees who presented educational material to their department and fed back procurement figures to quantify each item. Descriptive statistics were used to analyse de-identified pooled data submitted to a centralised database.Eight departments submitted data for OCU 2020 and six provided follow-up data. Bluey use was reduced from a median of 37 to 34 blueys per ten surgical encounters. Fifteen departments submitted pre-campaign data for OCU 2021 with follow-up data to be collected during OCU 2022. Baseline data showed a median bluey use of 31 per ten surgical encounters. Volatile-related emissions were calculated; desflurane's proportion was 70% of these emissions yet was 11% of volatile procurement. Two participating departments removed desflurane from their formulary following OCU 2021. Operation Clean Up is a practical model for implementing sustainability initiatives using trainees as eco-leaders.
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Affiliation(s)
- Jessica F Davies
- Department of Anaesthesia, 3805Austin Health, Heidelberg, Australia.,Department of Critical Care, University of Melbourne, Parkville, Australia
| | - Richard Seglenieks
- Department of Critical Care, University of Melbourne, Parkville, Australia.,Department of Anaesthesia, Pain and Perioperative Medicine, Western Health, Footscray, Victoria
| | - Rose Cameron
- Department of Anaesthesia, 58991Auckland City Hospital, Auckland, New Zealand
| | - Niketh A Kuruvilla
- Department of Anaesthesia and Pain Medicine, Mercy Health, Heidelberg, Australia.,Department of Anaesthesia, Perioperative Medicine and Pain Management, Canberra Health, Canberra, Australia
| | - Emma M Grove
- Department of Anaesthesia, 4085Ipswich Hospital, West Moreton Health, Australia
| | - Archana Shrivathsa
- Department of Anaesthesia, Pain and Perioperative Medicine, Fiona Stanley and Fremantle Hospitals Group, Perth, Australia
| | - Sophia Grobler
- Department of Critical Care, University of Melbourne, Parkville, Australia
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He H, Ge FZ, Ly O, Paul J. Greener Gases Starter Pack: a tool for transitioning to more sustainable anesthetic volatile agents. Can J Anaesth 2023. [PMID: 36814056 DOI: 10.1007/s12630-022-02394-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 02/17/2022] [Accepted: 05/30/2022] [Indexed: 02/24/2023] Open
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28
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Yassen KA, Jabaudon M, Alsultan HA, Almousa H, Shahwar DI, Alhejji FY, Aljaziri ZY. Inhaled Sedation with Volatile Anesthetics for Mechanically Ventilated Patients in Intensive Care Units: A Narrative Review. J Clin Med 2023; 12. [PMID: 36769718 DOI: 10.3390/jcm12031069] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 01/23/2023] [Accepted: 01/26/2023] [Indexed: 01/31/2023] Open
Abstract
Inhaled sedation was recently approved in Europe as an alternative to intravenous sedative drugs for intensive care unit (ICU) sedation. The aim of this narrative review was to summarize the available data from the literature published between 2005 and 2023 in terms of the efficacy, safety, and potential clinical benefits of inhaled sedation for ICU mechanically ventilated patients. The results indicated that inhaled sedation reduces the time to extubation and weaning from mechanical ventilation and reduces opioid and muscle relaxant consumption, thereby possibly enhancing recovery. Several researchers have reported its potential cardio-protective, anti-inflammatory or bronchodilator properties, alongside its minimal metabolism by the liver and kidney. The reflection devices used with inhaled sedation may increase the instrumental dead space volume and could lead to hypercapnia if the ventilator settings are not optimal and the end tidal carbon dioxide is not monitored. The risk of air pollution can be prevented by the adequate scavenging of the expired gases. Minimizing atmospheric pollution can be achieved through the judicious use of the inhalation sedation for selected groups of ICU patients, where the benefits are maximized compared to intravenous sedation. Very rarely, inhaled sedation can induce malignant hyperthermia, which prompts urgent diagnosis and treatment by the ICU staff. Overall, there is growing evidence to support the benefits of inhaled sedation as an alternative for intravenous sedation in ICU mechanically ventilated patients. The indication and management of any side effects should be clearly set and protocolized by each ICU. More randomized controlled trials (RCTs) are still required to investigate whether inhaled sedation should be prioritized over the current practice of intravenous sedation.
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Song Q, Zhao X, Wang Y, Zhang Q. Comparison of the synergistic effects of sevoflurane and desflurane on muscle relaxant vecuronium in laparoscopic colon cancer surgery. Medicine (Baltimore) 2022; 101:e31569. [PMID: 36397349 PMCID: PMC9666104 DOI: 10.1097/md.0000000000031569] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Sevoflurane and desflurane are commonly used inhalation anesthetics in clinical practice. This study compared the synergistic effects of sevoflurane and desflurane on the muscarinic agent vecuronium in laparoscopic colon cancer surgery. The aim of this study was to compare sevoflurane and desflurane in a synergistic effect on the muscle relaxant vecuronium in laparoscopic colon cancer surgery. Sixty patients undergoing elective laparoscopic radical resection of colon cancer were randomly divided into sevoflurane (n = 30) and desflurane (n = 30) groups. After anesthesia and successful tracheal intubation, patients in both groups were maintained with combined remifentanil. Muscle relaxant effects were monitored in both groups using a muscle relaxant monitor (train of stimuli-Watch), the onset time, T1 and T2 recovery time, and muscle relaxant dosage of vecuronium were observed. Hemodynamic changes were observed in both groups, and the dosage of vasoactive drugs was recorded. The quality of recovery of the patients was evaluated using the Mini-Mental State Examination (MMSE) and the discharge from the Aldrete score criteria. There was no significant difference in the onset time of vecuronium between the two groups (P > .05). The desflurane group's T1 and T2 recovery times were later than that of the sevoflurane group. The dosage of vecuronium was statistically significantly less than that in the sevoflurane group (P < .05); the extubation time in the desflurane group was statistically significantly longer than that in the sevoflurane group (P < .05). There were no significant differences in preoperative and intraoperative mean arterial pressure, heart rate, ephedrine and atropine dosage, MMSE score, and Aldrete score between the 2 groups (P > .05). Compared with sevoflurane, desflurane has a stronger synergistic effect on the muscle relaxant of vecuronium without increasing the incidence of cardiovascular adverse reactions and affecting patient recovery.
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Affiliation(s)
- Qianqian Song
- Department of Anesthesiology, Binzhou Medical University Hospital, Shandong, China
| | - Xiujie Zhao
- Department of Anesthesiology, Binzhou Medical University Hospital, Shandong, China
| | - Yewen Wang
- Department of Anesthesiology, Binzhou Medical University Hospital, Shandong, China
| | - Quanyi Zhang
- Department of Anesthesiology, Binzhou Medical University Hospital, Shandong, China
- * Correspondence: Quanyi Zhang, Department of Anesthesiology, Binzhou Medical University Hospital, No. 661 Huanghe 2nd Road, Binzhou 256603, Shandong, China (e-mail: )
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Kaushal A, Bindra A, Dube SK. Effect of sevoflurane versus desflurane on blood glucose level in patients undergoing intracranial neurosurgery: A randomised controlled study. Indian J Anaesth 2022; 66:769-775. [PMID: 36590188 PMCID: PMC9795498 DOI: 10.4103/ija.ija_7_22] [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: 01/03/2022] [Revised: 10/31/2022] [Accepted: 11/02/2022] [Indexed: 11/18/2022] Open
Abstract
Background and Aims Anaesthetic agents can affect the neuroendocrine response to surgical stress. Along with affecting other parameters, this can affect blood glucose levels. This study aimed to compare the effect of sevoflurane and desflurane on hourly intraoperative blood glucose levels in non-diabetic patients undergoing intracranial surgery. Methods A total of 70 adults (18-65 years) of American Society of Anesthesiologists physical status I and II undergoing elective intracranial surgery for supratentorial and infratentorial lesions were enroled. Patients were randomised to receive either sevoflurane or desflurane as the maintenance anaesthetic agent. The blood glucose level was measured hourly after induction until the completion of surgery. Parametric tests, non-parametric tests, Friedman test, generalised estimating equations, Chi-square test, and Fisher's exact test were used to analyse the data. Results In the sevoflurane group, the mean (standard deviation) blood glucose (mg/dL) increased from 93.34 (9.33) at the baseline to a maximum of 102.00 (8.61) at the 9 hours timepoint. This change was statistically significant (P < 0.001). In the desflurane group, the mean blood sugar (mg/dL) increased from 89.34 (9.85) at the baseline to a maximum of 92.37 (9.92) at the 4 hours timepoint and then decreased to 88.50 (0.71) at 9 hours timepoint. Conclusion Desflurane caused an initial rise followed by a decline, whereas a gradual increase in intraoperative blood glucose level was seen with sevoflurane use in non-diabetic adult patients undergoing elective neurosurgery. The intraoperative change in blood sugar was statistically significant but was within the normal clinical range.
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Affiliation(s)
- Ashutosh Kaushal
- Department of Anaesthesiology, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Ashish Bindra
- Department of Neuroanaesthesiology and Critical Care, All India Institute of Medical Sciences, New Delhi, India,Address for correspondence: Dr. Ashish Bindra, Department of Neuroanaesthesiology and Critical Care, All India Institute of Medical Sciences (A.I.I.M.S), New Delhi – 110 029, India. E-mail:
| | - Surya Kumar Dube
- Department of Neuroanaesthesiology and Critical Care, All India Institute of Medical Sciences, New Delhi, India
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Park JM. Comparison of the effects of sevoflurane and desflurane on the severity score of postoperative pain and discomfort after thyroidectomy: A prospective, double-blinded, randomized controlled study. Medicine (Baltimore) 2022; 101:e31393. [PMID: 36316835 PMCID: PMC9622572 DOI: 10.1097/md.0000000000031393] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Thyroidectomy is performed under general anesthesia using inhaled anesthetics such as sevoflurane or desflurane in many cases. The objective of this study was to investigate whether the incidence of postoperative pain and discomfort after thyroidectomy differed with the type of inhaled anesthetic. METHODS Eighty-one female patients who underwent thyroidectomy were randomly assigned to the Sevo group (n = 42) or the Des group (n = 39). On the day of surgery and on the first, third, and seventh days after surgery, one registered nurse in charge of the entire questionnaire survey conducted the questionnaire assessment through face-to-face interviews or phone calls with the patients. The questionnaire evaluated the severity scores for seven items (sore throat, wound pain, nausea and vomiting, dizziness, occipital headache, posterior neck pain, and shoulder pain) regarding postoperative pain and discomfort experienced by patients and assessed which of these seven items caused the greatest discomfort to the patient on each day. RESULTS Except for the severity score for dizziness on the day of surgery, the severity scores of postoperative pain and discomfort experienced by patients on the day of surgery and on the first, third, and seventh days after surgery showed no statistically significant differences between the two groups. In addition, on the day of surgery and on the first, third, and seventh days after surgery, patients reported that sore throat caused the greatest discomfort. CONCLUSION In patients undergoing thyroidectomy under general anesthesia using sevoflurane or desflurane, except for dizziness on the day of surgery, no other manifestation of postoperative pain and discomfort was influenced by the type of inhaled anesthetic. Moreover, after thyroidectomy, postoperative sore throat caused the greatest discomfort to patients from the day of surgery to the seventh day after surgery.
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Affiliation(s)
- Jun-Mo Park
- Department of Anesthesiology and Pain Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, South Korea
- *Correspondence: Jun-Mo Park, Department of Anesthesiology and Pain Medicine, Kyungpook National University Chilgok Hospital, 807 Hoguk-ro, Bukgu, Daegu 41404, South Korea (e-mail: )
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Hinterberg J, Beffart T, Gabriel A, Holzschneider M, Tartler TM, Schaefer MS, Kienbaum P. Efficiency of inhaled anaesthetic recapture in clinical practice. Br J Anaesth 2022; 129:e79-e81. [PMID: 35589427 DOI: 10.1016/j.bja.2022.04.009] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 03/27/2022] [Accepted: 04/14/2022] [Indexed: 12/01/2022] Open
Affiliation(s)
- Jonas Hinterberg
- Department of Anaesthesiology, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Theresa Beffart
- Department of Anaesthesiology, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Andrea Gabriel
- Department of Anaesthesiology, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Marc Holzschneider
- Department of Anaesthesiology, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Tim M Tartler
- Center for Anesthesia Research Excellence, Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Maximilian S Schaefer
- Department of Anaesthesiology, University Hospital Düsseldorf, Düsseldorf, Germany; Center for Anesthesia Research Excellence, Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Peter Kienbaum
- Department of Anaesthesiology, University Hospital Düsseldorf, Düsseldorf, Germany.
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Sun TY, Hsu CL, Lee MS, Yeh TT, Lai HC, Wu KL, Wu ZF, Tseng WC. Propofol-based total intravenous anesthesia is associated with better survival than desflurane anesthesia in limb-salvage surgery for osteosarcoma: A retrospective analysis. Medicine (Baltimore) 2022; 101:e30840. [PMID: 36197229 PMCID: PMC9509143 DOI: 10.1097/md.0000000000030840] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Previous studies have demonstrated that anesthetic techniques can affect the outcomes of cancer surgery. We investigated the association between anesthetic techniques and patient outcomes after elective limb-salvage surgery for osteosarcoma (OS). This was a retrospective cohort study of patients who underwent elective limb-salvage surgery for OS between January 2007 and December 2018. Patients were grouped according to the administration of propofol-based total intravenous anesthesia (TIVA) or desflurane (DES) anesthesia. Kaplan-Meier analysis was performed, and survival curves were constructed from the date of surgery to death. Univariate and multivariate Cox regression models were applied to compare the hazard ratios (HRs) for death after propensity matching. Subgroup analyses were done for postoperative recurrence, metastasis, and tumor-node-metastasis (TNM) staging. A total of 30 patients (17 deaths, 56.7%) who received DES anesthesia and 26 (4 deaths, 15.4%) who received TIVA were eligible for analysis. After propensity matching, 22 patients were included in each group. In the matched analysis, patients who received TIVA had better survival with a HR of 0.30 (95% confidence interval [CI], 0.11-0.81; P = .018). Subgroup analyses also showed significantly better survival in the presence of postoperative metastasis (HR, 0.24; 95% CI, 0.06-0.87; P = .030) and with TNM stage II to III (HR, 0.26; 95% CI, 0.09-0.73; P = .011) in the matched TIVA group. In addition, patients administered with TIVA had lower risks of postoperative recurrence and metastasis than those administered with DES anesthesia in the matched analyses. Propofol-based TIVA was associated with better survival in patients who underwent elective limb-salvage surgery for OS than DES anesthesia. Prospective studies are needed to assess the effects of TIVA on oncological outcomes in patients with OS.
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Affiliation(s)
- Ting-Yi Sun
- Department of Orthopedic Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Chun-Liang Hsu
- Department of Orthopedic Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
- Department of Biomedical Engineering, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Meei-Shyuan Lee
- School of Public Health, National Defense Medical Center, Taipei, Taiwan
| | - Tsu-Te Yeh
- Department of Orthopedic Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Hou-Chuan Lai
- Department of Anesthesiology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Ke-Li Wu
- Department of General Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Zhi-Fu Wu
- Department of Anesthesiology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
- Department of Anesthesiology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Anesthesiology, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Center for Regional Anesthesia and Pain Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Wei-Cheng Tseng
- Department of Anesthesiology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
- *Correspondence: Wei-Cheng Tseng, Department of Anesthesiology, Tri-Service General Hospital, National Defense Medical Center, No. 325, Section 2, Chenggong Road, Neihu District 114, Taipei, Taiwan (e-mail: )
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Brooks P, Absalom AR. When will we call time on desflurane? Comment on Br J Anaesth 2022. Br J Anaesth 2022; 129:e81-e82. [PMID: 35931566 DOI: 10.1016/j.bja.2022.06.026] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 06/24/2022] [Accepted: 06/24/2022] [Indexed: 11/02/2022] Open
Affiliation(s)
- Peter Brooks
- Anaesthetic Department, Chelsea and Westminster Hospital, London, UK
| | - Anthony R Absalom
- Department of Anesthesiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
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Guerrero Orriach JL, Malo-Manso A, Nuñez Galo M, Bellido Estevez I, Ruiz Salas A, Cruz Mañas J, Garrido-Sanchez L, Gonzalez-Alvarez L. Comparison of the Use of Desflurane vs. Propofol in Aortic Valve Replacement Surgery: Differences in Nephroprotection: An Explorative and Hypothesis-Generating Study. Life (Basel) 2022; 12:1172. [PMID: 36013350 DOI: 10.3390/life12081172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 07/28/2022] [Accepted: 07/28/2022] [Indexed: 11/29/2022]
Abstract
Introduction: The cardioprotective effect of halogenated drugs in cardiac surgery has been the subject of several studies. However, there is scarcity of data on their potential nephroprotective effects. Aortic valve replacement and coronary revascularization are the most frequent cardiac surgery procedures. The objective of this explorative study was to examine the effect of desflurane vs. propofol on renal function, when administered in aortic valve replacement surgery, including the extracorporeal circulation period. Method: A quasi-experimental prospective study was performed in 60 patients, who were allocated to receive either desflurane or propofol intraoperatively during aortic valve replacement surgery. As a hypnotic, group 1 received propofol, whereas group 2 received desflurane. Markers of renal function and level of cardiac preservation were determined based on biochemical parameters (troponin I, NTProBNP). Results: In the propofol group, there were significant variations between postoperative values of urinary NGAL and creatinine and baseline values. In contrast, no variations were found in the desflurane group in terms of hemodynamic parameters and myocardial damage. Conclusions: The use of propofol vs. desflurane during aortic valve replacement surgery is associated with a decrease in renal function.
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Kim K, Jung SM. Desflurane and remifentanil anesthesia in a child with citrin deficiency: A case report. Medicine (Baltimore) 2022; 101:e28954. [PMID: 35244055 PMCID: PMC8896430 DOI: 10.1097/md.0000000000028954] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 02/11/2022] [Indexed: 01/04/2023] Open
Abstract
RATIONALE Hyperammonemia, metabolic derangement, and/or the prolonged effects of anesthetics may lead to delayed emergence from general anesthesia as well as the onset of type 2 citrullinemia, even in compensated patients with citrin deficiency. PATIENT CONCERN A 5-year-old girl with citrin deficiency was scheduled for blepharoplasty under general anesthesia. She developed hyperammonemia with temporary interruption of medication for a few days before surgery. DIAGNOSIS The patient was genetically diagnosed as citrin deficiency with a mutation in the SLC25A13 gene via newborn screening for metabolic disorders. Her citrulline and ammonia levels were well-controlled with arginine medication and protein-rich diet. Her elevated ammonia level by temporary interruption of medication was corrected with resumption of arginine medication and protein-rich diet before surgery. INTERVENTIONS We used desflurane and remifentanil for general anesthesia to avoid hyperammonemia and delayed emergence. End-tidal desflurane concentration and anesthetic depth were carefully monitored to avoid excessive anesthesia. OUTCOMES She recovered consciousness with slightly increased ammonia level immediately after anesthesia. LESSIONS General anesthesia of the shortest duration with the least metabolized drugs using desflurane and remifentanil, would be beneficial for rapid emergence in surgical patients with citrin deficiency. Maintenance of nitrogen scavenging medication, a protein-rich diet, and serial measurement of ammonia levels in the perioperative period are also important for avoiding hyperammonemia-related neurological dysfunction.
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Affiliation(s)
- Kanghui Kim
- Department of Anesthesiology and Pain Medicine, Yeungnam University College of Medicine, Daegu, Republic of Korea
| | - Sung Mee Jung
- Department of Anesthesiology and Pain Medicine, Yeungnam University College of Medicine, Daegu, Republic of Korea
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Liu Q, Li R, Lin J. No Difference Among Inhaled Anesthetics on the Growth and Metastasis of Murine 4T1 Breast Cancers in a Mouse Model of Spontaneous Metastasis. Front Pharmacol 2022; 13:794109. [PMID: 35222023 PMCID: PMC8863966 DOI: 10.3389/fphar.2022.794109] [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: 10/13/2021] [Accepted: 01/14/2022] [Indexed: 11/16/2022] Open
Abstract
Objective: This study evaluates the effect of the commonly used inhaled anesthetics isoflurane, sevoflurane, and desflurane on the viability and migration of murine 4T1 breast cancer cells, the growth, and lung metastasis in a syngenetic model of spontaneous metastasis. Methods: The murine 4T1 breast cancer cells were exposed to isoflurane (2%), sevoflurane (3.6%), or desflurane (10.3%) for 3 h. Cell viability was measured using the MTT assay. The migratory capacity of 4T1 cells was assessed using a scratch assay after 24 h incubation. Female balb/c mice were subjected to orthotopic implantation of 4T1 cells under anesthesia with one of the inhaled anesthetics: 2% isoflurane, 3.6% sevoflurane, or 10.3% desflurane. Subsequently, resection of primary tumors was performed under the identical anesthetic used during implantation for 3 h. Three weeks later, the mice were euthanized to harvest lungs for ex vivo bioluminescent imaging and histological analysis. Blood was collected for serum cytokine assays by ELISA. Results: There was no difference in cell viability among isoflurane, sevoflurane, desflurane, and control groups (n = 180 for each group, P = 0.648). Sevoflurane but not isoflurane or desflurane significantly increased the migration of 4T1 cells compared to the control group (n = 18, P = 0.024). There was no difference in the growth of the orthotopically implanted primary tumors (n = 12 for the isoflurane group, n = 11 for the sevoflurane group, and for the desflurane group, P = 0.879). Surgical dissection of primary tumors in mice under anesthesia with isoflurane, sevoflurane, or desflurane led to no difference in lung metastasis following surgery (P = 0.789). No significant difference was observed among isoflurane, sevoflurane, and desflurane groups in the serum levels of IL-6 (P = 0.284), CCL-1 (P = 0.591), MCP-1 (P = 0.135), and VEGF (P = 0.354). Conclusion: Our study demonstrated that sevoflurane increased the migration of 4T1 breast cancer cells in vitro. Inhaled anesthetics isoflurane, sevoflurane, and desflurane had no difference on the growth of primary tumor and the lung metastasis of 4T1 cells in the mouse model of spontaneous metastasis with surgical removal of primary tumors.
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Affiliation(s)
- Qiuyue Liu
- Department of Anesthesiology, Stony Brook University School of Medicine, Stony Brook, NY, United States.,Currently Department of Intensive Care Unit, Beijing Chest Hospital, Beijing Tuberculosis and Thoracic Tumor Research Institute, Capital Medical University, Beijing, China
| | - Ru Li
- Department of Anesthesiology, Stony Brook University School of Medicine, Stony Brook, NY, United States
| | - Jun Lin
- Department of Anesthesiology, Stony Brook University School of Medicine, Stony Brook, NY, United States
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Kaushal A. Abstract No.: ABS3115: Effect of sevoflurane vs desflurane on blood glucose level in patients undergoing intracranial neurosurgery: A randomised control study. Indian J Anaesth 2022. [PMCID: PMC9116764 DOI: 10.4103/0019-5049.340775] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background & Aims: Patients undergoing neurosurgery are prone to neurological damage due to the anaerobic metabolism of blood glucose. In this study we aimed to to compare the effect of sevoflurane and desflurane on blood glucose levels in patients undergoing intracranial surgery. Methods: All consenting patients of either gender 18-65 years belonging to American Society of Anesthesiologists (ASA) physical status I & II scheduled for intracranial surgery under sevoflurane or desflurane maintenance anaesthesia were included. Patients suffering from diabetes, thyroid dysfunction, renal or hepatic disease, on steroids, beta-adrenergic blocking agents, insulin or oral hypoglycaemic agents, pregnant or lactating patients, chronic alcoholic patients, and non-consenting patients were excluded from the study. The enrolled patients were randomised in the sevoflurane and desflurane groups. The periodic glucose level was measured hourly after induction until completion of surgery using the glucose oxidase peroxidase method. Results: A total of 70 patients was included in the study. Both sevoflurane and desflurane when used as maintenance anaesthetics cause changes in blood sugar levels. Sevoflurane causes a gradual increase in blood sugar intraoperatively whereas desflurane causes an initial rise in blood sugar followed by a decline in blood sugar level in euglycemic patients. There was a significant difference in the trend of blood sugar (mg/dL) over time between the two groups (p =<0.001). Conclusion: The changes in blood sugar level by both agents were statistically significant but clinically insignificant as the values remained within clinically normal range and there were no episodes of hypo or hyperglycaemia.
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Shirozu K, Nobukuni K, Umehara K, Nagamatsu M, Higashi M, Yamaura K. Comparison of the Occurrence of Postoperative Shivering Between Sevoflurane and Desflurane Anesthesia. Ther Hypothermia Temp Manag 2022; 12:177-181. [PMID: 35049406 DOI: 10.1089/ther.2021.0029] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
General anesthetic agents can change the shivering threshold. Sevoflurane and desflurane are widely used as inhalational anesthetics and have also been reported to lower the shivering threshold in a dose-dependent manner. Although the comparison of postoperative shivering (POS) between total intravenous anesthesia and inhalational anesthesia has been reported, there have been no reports on a direct comparison between sevoflurane and desflurane anesthesia and the occurrence of POS in open abdominal surgery. After obtaining approval from the Ethics Review Committee (2020-261), 683 adult patients who underwent open radical surgery for uterine, cervical, or pancreatic cancer under general anesthesia using inhalational anesthetics at Kyushu University hospital between December 2012 and March 2020 were included in this retrospective study. The odds ratio (OR) for the occurrence of POS between the two groups (sevoflurane and desflurane) was calculated. Multivariable-adjusted analysis was performed using possible factors affecting POS. Furthermore, propensity score (PS) matching was conducted using these factors. The multivariable-adjusted OR for the occurrence of shivering in the desflurane group (62 occurrences/356 patients) was 1.06 (95% confidence interval [CI]: 0.69-1.62, p = 0.79) compared with the sevoflurane group (77/327, reference). Similarly, after PS matching, the crude OR for the occurrence of shivering in the desflurane group (47/210) was 1.09 (95% CI: 0.68-1.75, p = 0.72) compared with the sevoflurane group (44/210, reference). Similar results were obtained in the stratified analysis by sex and age. The occurrence of POS is not different between sevoflurane and desflurane anesthesia.
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Affiliation(s)
- Kazuhiro Shirozu
- Department of Anesthesiology and Critical Care Medicine, Kyushu University Hospital, Fukuoka, Japan
| | - Keiko Nobukuni
- Operating Rooms, Kyushu University Hospital, Fukuoka, Japan
| | - Kaoru Umehara
- Operating Rooms, Kyushu University Hospital, Fukuoka, Japan
| | - Masako Nagamatsu
- Department of Anesthesiology and Critical Care Medicine, Kyushu University Hospital, Fukuoka, Japan
| | - Midoriko Higashi
- Department of Anesthesiology and Critical Care Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Ken Yamaura
- Department of Anesthesiology and Critical Care Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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Morita T, Yamamoto M, Sakamoto A. Factors Associated with Postoperative Nausea and Vomiting after Breast Cancer Surgery with Inhalation Anesthesia. J NIPPON MED SCH 2021; 88:418-422. [PMID: 33250474 DOI: 10.1272/jnms.jnms.2021_88-510] [Citation(s) in RCA: 3] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND The incidence and risk factors of postoperative nausea and vomiting (PONV) and early PONV (ePONV) were evaluated in patients who underwent breast surgery with volatile anesthesia. METHODS In this retrospective study, multivariate logistic regression was used to determine incidence and identify risk factors for PONV. RESULTS Among 928 patients, 166 (18%) and 220 (24%) had ePONV and PONV, respectively. In multivariate analysis, anesthesia duration and use of desflurane were independent risk factors for ePONV. For PONV, anesthesia duration and Apfel score were independent risk factors. CONCLUSIONS Our results indicate that desflurane was the main cause of ePONV. However, during the delayed phase, a higher Apfel score was the strongest predictor. In the early and delayed phases, long anesthesia duration was associated with high risk of PONV. Thus, prolonged anesthesia and desflurane use should be avoided for patients at high risk of PONV, particularly those with high Apfel scores.
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Ozdemirkan A, Kucuk A, Gunes I, Arslan M, Tuncay A, Sivgin V, Sezen SC, Boyunaga H. The effect of cerium oxide on lung injury following lower extremity ischemia-reperfusion injury in rats under desflurane anesthesia. Saudi Med J 2021; 42:1247-1251. [PMID: 34732559 PMCID: PMC9149742 DOI: 10.15537/smj.2021.42.11.20210104] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Accepted: 08/25/2021] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES To examine the effects of desflurane and cerium oxide (CO) on lung tissue following ischemia-reperfusion injury (IRI). METHODS Experiments were conducted in Gazi University Animal Laboratory, Ankara, Turkey. Thirty rats were divided into 5 groups: control (C), IRI, IRI-CO, IRI-desflurane (IRID), IRI-CO-desflurane (IRICOD). Cerium oxide was given intraperitoneally. Lower extremity IRI was induced. Desflurane was applied during IRI. Lung histopathological examinations and serum biochemical analyses were performed. RESULTS Serum nitric oxide (NO) and malondialdehyde (MDA) levels were higher in group IRI (p=0.006) than in group C (p=0.001). Serum MDA and NO levels were significantly lower in groups IRICO and IRICOD than in group IRI. Significantly greater alveolar wall thickening and neutrophil infiltration were recorded in group IRI than in group C. Co-administration of desflurane and CO significantly decreased alveolar wall thickening and neutrophil infiltration compared to group IRI. Total lung injury scores were significantly lower in groups IRID, IRICO, and IRICOD than in group IRI. CONCLUSION Intraperitoneal CO with desflurane, reduced oxidative stress and corrected the damage in lung. Cerium oxide given before and desflurane given during IRI have been shown to have protective effects on lung damage in rats.
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Affiliation(s)
- Aycan Ozdemirkan
- From the Department of Anesthesiology and Reanimation (Ozdemirkan, Arslan, Sivgin), Gazi University Faculty of Medicine, from the Department of Medical Biochemistry (Boyunaga), Ankara Medipol University, Ankara, from the Department of Physiology (Kucuk), Faculty of Medicine, Kütahya Health Science University, Kütahya, from the Department of Anesthesiology and Reanimation (Gunes), from the Department of Cardiovascular Surgery (Tuncay), Faculty of Medicine, Erciyes University, Kayseri, and from the Department of Histology and Embryology (Sezen), Faculty of Medicine, Kırıkkale University, Kırıkkale, Turkey.
| | - Aysegul Kucuk
- From the Department of Anesthesiology and Reanimation (Ozdemirkan, Arslan, Sivgin), Gazi University Faculty of Medicine, from the Department of Medical Biochemistry (Boyunaga), Ankara Medipol University, Ankara, from the Department of Physiology (Kucuk), Faculty of Medicine, Kütahya Health Science University, Kütahya, from the Department of Anesthesiology and Reanimation (Gunes), from the Department of Cardiovascular Surgery (Tuncay), Faculty of Medicine, Erciyes University, Kayseri, and from the Department of Histology and Embryology (Sezen), Faculty of Medicine, Kırıkkale University, Kırıkkale, Turkey.
| | - Isin Gunes
- From the Department of Anesthesiology and Reanimation (Ozdemirkan, Arslan, Sivgin), Gazi University Faculty of Medicine, from the Department of Medical Biochemistry (Boyunaga), Ankara Medipol University, Ankara, from the Department of Physiology (Kucuk), Faculty of Medicine, Kütahya Health Science University, Kütahya, from the Department of Anesthesiology and Reanimation (Gunes), from the Department of Cardiovascular Surgery (Tuncay), Faculty of Medicine, Erciyes University, Kayseri, and from the Department of Histology and Embryology (Sezen), Faculty of Medicine, Kırıkkale University, Kırıkkale, Turkey.
| | - Mustafa Arslan
- From the Department of Anesthesiology and Reanimation (Ozdemirkan, Arslan, Sivgin), Gazi University Faculty of Medicine, from the Department of Medical Biochemistry (Boyunaga), Ankara Medipol University, Ankara, from the Department of Physiology (Kucuk), Faculty of Medicine, Kütahya Health Science University, Kütahya, from the Department of Anesthesiology and Reanimation (Gunes), from the Department of Cardiovascular Surgery (Tuncay), Faculty of Medicine, Erciyes University, Kayseri, and from the Department of Histology and Embryology (Sezen), Faculty of Medicine, Kırıkkale University, Kırıkkale, Turkey.
- Address correspondence and reprints request to: Dr. Mustafa Arslan, Department of Anesthesiology and Reanimation, Gazi University Hospital, Ankara, Turkey. E-mail: ORCID ID: http://orcid.org/0000-0003-4882-5063
| | - Aydin Tuncay
- From the Department of Anesthesiology and Reanimation (Ozdemirkan, Arslan, Sivgin), Gazi University Faculty of Medicine, from the Department of Medical Biochemistry (Boyunaga), Ankara Medipol University, Ankara, from the Department of Physiology (Kucuk), Faculty of Medicine, Kütahya Health Science University, Kütahya, from the Department of Anesthesiology and Reanimation (Gunes), from the Department of Cardiovascular Surgery (Tuncay), Faculty of Medicine, Erciyes University, Kayseri, and from the Department of Histology and Embryology (Sezen), Faculty of Medicine, Kırıkkale University, Kırıkkale, Turkey.
| | - Volkan Sivgin
- From the Department of Anesthesiology and Reanimation (Ozdemirkan, Arslan, Sivgin), Gazi University Faculty of Medicine, from the Department of Medical Biochemistry (Boyunaga), Ankara Medipol University, Ankara, from the Department of Physiology (Kucuk), Faculty of Medicine, Kütahya Health Science University, Kütahya, from the Department of Anesthesiology and Reanimation (Gunes), from the Department of Cardiovascular Surgery (Tuncay), Faculty of Medicine, Erciyes University, Kayseri, and from the Department of Histology and Embryology (Sezen), Faculty of Medicine, Kırıkkale University, Kırıkkale, Turkey.
| | - Saban C. Sezen
- From the Department of Anesthesiology and Reanimation (Ozdemirkan, Arslan, Sivgin), Gazi University Faculty of Medicine, from the Department of Medical Biochemistry (Boyunaga), Ankara Medipol University, Ankara, from the Department of Physiology (Kucuk), Faculty of Medicine, Kütahya Health Science University, Kütahya, from the Department of Anesthesiology and Reanimation (Gunes), from the Department of Cardiovascular Surgery (Tuncay), Faculty of Medicine, Erciyes University, Kayseri, and from the Department of Histology and Embryology (Sezen), Faculty of Medicine, Kırıkkale University, Kırıkkale, Turkey.
| | - Hakan Boyunaga
- From the Department of Anesthesiology and Reanimation (Ozdemirkan, Arslan, Sivgin), Gazi University Faculty of Medicine, from the Department of Medical Biochemistry (Boyunaga), Ankara Medipol University, Ankara, from the Department of Physiology (Kucuk), Faculty of Medicine, Kütahya Health Science University, Kütahya, from the Department of Anesthesiology and Reanimation (Gunes), from the Department of Cardiovascular Surgery (Tuncay), Faculty of Medicine, Erciyes University, Kayseri, and from the Department of Histology and Embryology (Sezen), Faculty of Medicine, Kırıkkale University, Kırıkkale, Turkey.
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Han F, Zhao J, Zhao G. Prolonged Volatile Anesthetic Exposure Exacerbates Cognitive Impairment and Neuropathology in the 5xFAD Mouse Model of Alzheimer's Disease. J Alzheimers Dis 2021; 84:1551-1562. [PMID: 34690137 DOI: 10.3233/jad-210374] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND Alzheimer's disease (AD) is a progressive neurodegenerative disease which shows a set of symptoms involving cognitive changes and psychological changes. Given that AD is the most common form of dementia in aging population and the increasing demand for anesthesia/surgery with aging, there has been significant interest in the exact impact of volatile anesthetics on cognitive function and pathological alterations in AD population. OBJECTIVE This study aimed to investigate behavioral changes and neuropathology in the 5xFAD mouse model of Alzheimer's disease with short-term exposure or long-term exposure to desflurane, sevoflurane, or isoflurane. METHODS In this study, we exposed 5xFAD mouse model of AD to isoflurane, sevoflurane, or desflurane in two different time periods (30 min and 6 h), and the memory related behaviors as well as the pathological changes in 5xFAD mice were evaluated 7 days after the anesthetic exposure. RESULTS We found that short-term exposure to volatile anesthetics did not affect hippocampus dependent memory and the amyloid-β (Aβ) deposition in the brain. However, long-term exposure to sevoflurane or isoflurane significantly increased the Aβ deposition in CA1 and CA3 regions of hippocampus, as well as the glial cell activation in amygdala. Besides, the PSD-95 expression was decreased in 5xFAD mice with exposure to sevoflurane or isoflurane and the caspase-3 activation was enhanced in isoflurane, sevoflurane, and desflurane groups. CONCLUSION Our results demonstrate the time-dependent effects of common volatile anesthetics and implicate that desflurane has the potential benefits to prolonged anesthetic exposure in AD patients.
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Affiliation(s)
- Fanglei Han
- Department of Anesthesiology, China-Japan Union Hospital of Jilin University, Changchun, Jilin, P.R. China
| | - Jia Zhao
- Department of Anesthesiology, China-Japan Union Hospital of Jilin University, Changchun, Jilin, P.R. China
| | - Guoqing Zhao
- Department of Anesthesiology, China-Japan Union Hospital of Jilin University, Changchun, Jilin, P.R. China
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Tseng WC, Lee MS, Lin YC, Lai HC, Yu MH, Wu KL, Wu ZF. Propofol-Based Total Intravenous Anesthesia is Associated with Better Survival than Desflurane Anesthesia in Epithelial Ovarian Cancer Surgery: A Retrospective Cohort Study. Front Pharmacol 2021; 12:685265. [PMID: 34630078 PMCID: PMC8497698 DOI: 10.3389/fphar.2021.685265] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 09/10/2021] [Indexed: 02/01/2023] Open
Abstract
Background: Previous studies have shown that anesthetic techniques can affect outcomes of cancer surgery. We investigated the association between anesthetic techniques and patient outcomes after elective epithelial ovarian cancer surgery. Methods: This was a retrospective cohort study of patients who received elective open surgery for epithelial ovarian cancer between January 2009 and December 2014. Patients were grouped according to the administration of propofol or desflurane anesthesia. Kaplan–Meier analysis was performed, and survival curves were constructed from the date of surgery to death. Univariate and multivariate Cox regression models were used to compare hazard ratios for death after propensity matching. Subgroup analyses were performed for age, body mass index, preoperative carbohydrate antigen-125 level, International Federation of Gynecology and Obstetrics staging, and operation and anesthesia time. Results: In total, 165 patients (76 deaths, 46.1%) who received desflurane anesthesia and 119 (30 deaths, 25.2%) who received propofol anesthesia were eligible for analysis. After propensity matching, 104 patients were included in each group. In the matched analysis, patients who received propofol anesthesia had better survival with a hazard ratio of 0.52 (95% confidence interval, 0.33–0.81; p = 0.005). Subgroup analyses also showed significantly better survival with old age, high body mass index, elevated carbohydrate antigen-125 level, advanced International Federation of Gynecology and Obstetrics stage, and prolonged operation and anesthesia time in the matched propofol group. In addition, patients administered with propofol anesthesia had less postoperative recurrence and metastasis than those administered with desflurane anesthesia in the matched analysis. Conclusion: Propofol anesthesia was associated with better survival in patients who underwent elective epithelial ovarian cancer open surgery. Prospective studies are warranted to evaluate the effects of propofol anesthesia on oncological outcomes in patients with epithelial ovarian cancer.
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Affiliation(s)
- Wei-Cheng Tseng
- Department of Anesthesiology, Tri-Service General Hospital and National Defense Medical Center, Taipei, Taiwan
| | - Meei-Shyuan Lee
- School of Public Health, National Defense Medical Center, Taipei, Taiwan
| | - Ying-Chih Lin
- School of Public Health, National Defense Medical Center, Taipei, Taiwan
| | - Hou-Chuan Lai
- Department of Anesthesiology, Tri-Service General Hospital and National Defense Medical Center, Taipei, Taiwan
| | - Mu-Hsien Yu
- Department of Obstetrics and Gynecology, Tri-Service General Hospital and National Defense Medical Center, Taipei, Taiwan
| | - Ke-Li Wu
- Department of General Medicine, Tri-Service General Hospital and National Defense Medical Center, Taipei, Taiwan
| | - Zhi-Fu Wu
- Department of Anesthesiology, Tri-Service General Hospital and National Defense Medical Center, Taipei, Taiwan.,Department of Anesthesiology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Anesthesiology, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
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Tosun M, Olmez H, Unver E, Arslan YK, Cimen FK, Ozcicek A, Aktas M, Suleyman H. Oxidative and pro-inflammatory lung injury induced by desflurane inhalation in rats and the protective effect of rutin. ADV CLIN EXP MED 2021; 30:941-948. [PMID: 34418333 DOI: 10.17219/acem/136194] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Desflurane is a mainstay of general inhaled anesthetics with a methyl ethyl ether structure and is widely used in clinical practice. It has been reported to induce inflammation and lipid peroxidation in rat pulmonary parenchyma, to increase alveolar macrophages, and to cause peribronchial infiltration and edema. Rutin, a flavonoid vitamin P1, is known to have biological properties including acting as an antioxidant, an anti-inflammatory, and an inhibitor of bronchoalveolar polymorphonuclear leukocyte (PNL) infiltration. OBJECTIVES The aim of this study is to examine the effects of rutin on desflurane-induced pulmonary injury using biochemical and histopathological methods. MATERIAL AND METHODS The rats were divided into 3 groups (n = 6 each): healthy control (HC), rutin+desflurane-treated (DRT) and desflurane-only (DSF). Briefly, 50 mg/kg of rutin was given orally to the DRT group and an equal volume of normal saline was given to the DSF and HC groups. After 1 h, anesthesia was induced and maintained in the DRT and DSF groups for 2 h. After the rats had been sacrificed, the lungs were removed. Malondialdehyde (MDA), total glutathione (GSH), tumor necrosis factor alpha (TNF-α), and nuclear factor kappa B (NF-κB) levels were measured in the excised lung tissue. The removed tissues were also fixed in 10% formalin, and the obtained sections were stained with hematoxylin and eosin (H&E) and evaluated under light microscopy. The biochemical and histopathological results of the DRT group were compared with those obtained from the DSF and HC groups. RESULTS Desflurane increased MDA, TNF-α and NF-κB, and decreased GSH in lung tissue. The PNL infiltration, alveolar macrophages, hemorrhage, alveolar damage, and edema were observed in the lung tissue of the DSF group. Rutin was histopathologically shown to protect lung tissue from oxidative stress by preventing an increase in oxidant parameters and a decrease in antioxidants. CONCLUSIONS The results suggest that rutin may be useful in the treatment of desflurane-associated lung injury.
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Affiliation(s)
- Mustafa Tosun
- Department of Chest Diseases, Faculty of Medicine, Erzincan Binali Yıldırım University, Turkey
| | - Hasan Olmez
- Department of Chest Diseases, Faculty of Medicine, Erzincan Binali Yıldırım University, Turkey
| | - Edhem Unver
- Department of Chest Diseases, Faculty of Medicine, Erzincan Binali Yıldırım University, Turkey
| | - Yusuf Kemal Arslan
- Department of Biostatistics, Faculty of Medicine, Erzincan Binali Yıldırım University, Turkey
| | - Ferda Keskin Cimen
- Department of Pathology, Faculty of Medicine, Erzincan Binali Yıldırım University, Turkey
| | - Adalet Ozcicek
- Department of Internal Medicine, Faculty of Medicine, Erzincan Binali Yıldırım University, Turkey
| | - Mehmet Aktas
- Department of Biochemistry, Faculty of Medicine, Erzincan Binali Yıldırım University, Turkey
| | - Halis Suleyman
- Department of Pharmacology, Faculty of Medicine, Erzincan Binali Yıldırım University, Turkey
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Jayaraman K, Liu M, Zipfel GJ, Athiraman U. Sevoflurane and Desflurane Exposures Following Aneurysmal Subarachnoid Hemorrhage Confer Multifaceted Protection against Delayed Cerebral Ischemia. Biomedicines 2021; 9:820. [PMID: 34356884 DOI: 10.3390/biomedicines9070820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 07/05/2021] [Accepted: 07/12/2021] [Indexed: 11/17/2022] Open
Abstract
Numerous studies have demonstrated the ability of isoflurane conditioning to provide multifaceted protection against aneurysmal subarachnoid hemorrhage (SAH)-associated delayed cerebral ischemia (DCI); however, preclinical studies have not yet examined whether other commonly used inhalational anesthetics in neurological patients such as sevoflurane or desflurane are also protective against SAH-induced neurovascular deficits. We therefore sought to identify the potential for sevoflurane and desflurane conditioning to protect against DCI in an endovascular perforation mouse model of SAH. Neurological function was assessed daily via neuroscore. Large artery vasospasm and microvessel thrombosis were assessed three days after SAH or sham surgery. Four groups were examined: Sham, SAH + room air, SAH + 2% Sevoflurane, and SAH + 6% Desflurane. For the SAH groups, one hour after surgery, mice received 2% sevoflurane, 6% desflurane, or room air for one hour. We found that conditioning with sevoflurane or desflurane attenuated large artery vasospasm, reduced microvessel thrombosis, and improved neurologic function. Given their frequent clinical use and strong safety profile in patients (including those with SAH), these data strongly support further studies to validate these findings in preclinical and clinical studies and to elucidate the mechanisms by which these agents might be acting.
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Saha M, Saxena KN, Wadhwa B. Comparative study of recovery of airway reflexes and cognitive function following sevoflurane versus desflurane anaesthesia. Indian J Anaesth 2021; 65:282-288. [PMID: 34103741 PMCID: PMC8174598 DOI: 10.4103/ija.ija_1219_20] [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: 10/03/2020] [Revised: 12/15/2020] [Accepted: 02/28/2021] [Indexed: 12/15/2022] Open
Abstract
Background and Aims Sevoflurane and desflurane have almost similar blood-gas solubility but recent studies suggest that desflurane compared to sevoflurane leads to faster recovery of airway reflexes, but the recovery of cognitive function varies significantly. We conducted this study to compare the times of recovery from anaesthesia following desflurane versus sevoflurane anaesthesia. Methods This randomised double-blinded study was conducted on 60 patients of American Society of Anesthesiologists (ASA) classification I-II, age between 18 and 60 years with body mass index (BMI) ≤30 kg/m2 who underwent elective cholecystectomy. A standard general anaesthesia protocol was followed with either sevoflurane (group A = 30 patients) or desflurane (group B = 30 patients) along with bispectral index and neuromuscular monitoring. Following extubation, tests for recovery of airway reflexes and cognitive function were conducted and various time intervals were noted. Statistical analysis was carried out using Statistical Package for Social Sciences (SPSS) standard software version 17. Results The mean time from first verbal response to first passing the swallowing test was comparable in both the groups (5.50 ± 3.45 vs. 4.10 ± 3.42 min, P value = 0.120). Patients receiving desflurane showed faster response to verbal commands (5.93 ± 4.13 vs. 8.20 ± 3.39 min, P value = 0.024), passed the swallowing test earlier (10.03 ± 4.97 vs. 13.70 ± 3.48 min, P value = 0.009) and Short orientation memory concentration test (SOMCT) earlier (9.83 ± 4.51 vs. 14.10 ± 4.31 min, P value ≤0.001) compared to sevoflurane. Conclusion In patients undergoing laparoscopic cholecystectomy under controlled conditions, earlier recovery is seen with desflurane compared to sevoflurane.
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Affiliation(s)
- Mousumi Saha
- Department of Anaesthesiology and Intensive Care, Maulana Azad Medical College, New Delhi, India
| | - Kirti N Saxena
- Department of Anaesthesiology and Intensive Care, Maulana Azad Medical College, New Delhi, India
| | - Bharti Wadhwa
- Department of Anaesthesiology and Intensive Care, Maulana Azad Medical College, New Delhi, India
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Acosta ISM, de Cos GV, Fernández MT. Malignant Hyperthermia Syndrome: A Clinical Case Report. EJIFCC 2021; 32:286-291. [PMID: 34421497 PMCID: PMC8343040] [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] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Malignant hyperthermia is a pharmacogenetic disorder. It manifests as a hypercatabolic skeletal muscle syndrome linked to inhaled volatile anesthetics or depolarizing muscle relaxants. Its clinical signs and symptoms are tachycardia, hyperthermia, hypercapnia, acidosis, muscle rigidity, rhabdomyolysis, hyperkalemia, arrhythmia and renal failure. Mortality without specific treatment is 80% and decreases to 5% with the use of dantrolene sodium. This article presents the case of a 39-year-old patient admitted to the Intensive Care Unit for malignant hyperthermia after surgery for septoplasty plus turbinoplasty.
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Moody AE, Beutler BD, Moody CE. Predicting cost of inhalational anesthesia at low fresh gas flows: impact of a new generation carbon dioxide absorbent. Med Gas Res 2021; 10:64-66. [PMID: 32541130 PMCID: PMC7885709 DOI: 10.4103/2045-9912.285558] [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] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
It is well known that low fresh gas flows result in lower cost of inhalational agents. A new generation of carbon dioxide absorbents allows low flow anesthesia with all anesthetics but these new compounds are more expensive. This study examines the cost of inhalational anesthesia at different fresh gas flows combined with the cost of absorbent. The cost of sevoflurane and desflurane is lower at low fresh gas flows. Paradoxically the cost of isoflurane is cheaper at 2 L/min than at lower fresh gas flows due to increased cost of carbon dioxide absorbent. Therefore low fresh gas flows should be used when feasible with sevoflurane and desflurane, but higher fresh gas flows up to 2 L/min may be more economical with isoflurane during maintenance phase of anesthesia.
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Affiliation(s)
- Alastair E Moody
- Department of Anesthesiology, University of Utah, Salt Lake City, UT, USA
| | - Bryce D Beutler
- Department of Internal Medicine, University of Nevada Reno, Reno, NV, USA
| | - Catriona E Moody
- Department of Anesthesiology, University of Utah, Salt Lake City, UT, USA
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Wetterkamp M, Meiser A, Weber TP, Vogelsang H, Lange T, Trost M, Bellgardt M. Spontaneous breathing for managing analgesia during balanced anesthesia with remifentanil and desflurane: a prospective, single center randomized controlled trial. Med Gas Res 2021; 11:94-99. [PMID: 33942778 PMCID: PMC8174411 DOI: 10.4103/2045-9912.310606] [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] [Indexed: 12/02/2022] Open
Abstract
The main goal of anesthesiology is to achieve the best level of analgesia and a fast recovery of consciousness following anesthesia. The preservation of spontaneous breathing during general anesthesia with anesthetic gases is practiced by many anesthetists. However, very few studies have dealt with these positive properties of volatile anesthetics such as sevoflurane or desflurane. Remifentanil is a very short half-life opiate that combines sufficient intra-operative analgesia with a fast post-operative recovery time. We tested the hypothesis that spontaneous breathing can reduce overdosing with remifentanil during desflurane anesthesia. In this prospective, single center, multiple anesthetist study, 30 patients were randomized into two groups (volume-controlled ventilation mode and spontaneous breathing). The spontaneous breathing group showed a significantly lower post-operative pain level than the volume-controlled ventilation mode group. Furthermore, less remifentanil as well as less piritramide was needed in the spontaneous breathing group compared with volume-controlled ventilation mode. It was possible to achieve spontaneous breathing in all patients with 0.6 minimum alveolar concentration desflurane, in order to control the remifentanil rate and prevent an overdose. All spontaneous breathing patients had low intra- and post-operative pain levels and the need for analgesics was equal to or lower than that in the volume-controlled ventilation mode group. By reducing the intra-operative amount of opiates, both the post-operative pain and the amount of post-operative analgesia required can be reduced. A balanced anesthesia with spontaneous intra-operative breathing is needed to determine the required amount of opiates. This study was approved by the Ethic Committee of the Ruhr-University of Bochum (approval No. 2435) in September, 2004.
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Affiliation(s)
- Mark Wetterkamp
- Department of Orthopedics and Traumatology, St. Josef-Hospital, Ruhr-University of Bochum, Bochum, Germany
| | - Andreas Meiser
- Department of Anesthesiology, Intensive Care Medicine and Pain Medicine, Saarland University Medical Center, Homburg/Saar, Germany
| | - Thomas Peter Weber
- Department of Anesthesiology and Intensive Care Medicine, St. Josef-Hospital, Ruhr-University of Bochum, Bochum, Germany
| | - Heike Vogelsang
- Department of Anesthesiology and Intensive Care Medicine, St. Josef-Hospital, Ruhr-University of Bochum, Bochum, Germany
| | - Tobias Lange
- Department of Orthopedics and Traumatology, St. Josef-Hospital, Ruhr-University of Bochum, Bochum, Germany
| | - Matthias Trost
- Department of Orthopedics and Traumatology, St. Josef-Hospital, Ruhr-University of Bochum, Bochum, Germany
| | - Martin Bellgardt
- Department of Anesthesiology and Intensive Care Medicine, St. Josef-Hospital, Ruhr-University of Bochum, Bochum, Germany
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Ishikawa M, Iwasaki M, Zhao H, Saito J, Hu C, Sun Q, Sakamoto A, Ma D. Inhalational Anesthetics Inhibit Neuroglioma Cell Proliferation and Migration via miR-138, -210 and -335. Int J Mol Sci 2021; 22:ijms22094355. [PMID: 33919449 PMCID: PMC8122527 DOI: 10.3390/ijms22094355] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Revised: 04/17/2021] [Accepted: 04/20/2021] [Indexed: 01/01/2023] Open
Abstract
Inhalational anesthetics was previously reported to suppress glioma cell malignancy but underlying mechanisms remain unclear. The present study aims to investigate the effects of sevoflurane and desflurane on glioma cell malignancy changes via microRNA (miRNA) modulation. The cultured H4 cells were exposed to 3.6% sevoflurane or 10.3% desflurane for 2 h. The miR-138, -210 and -335 expression were determined with qRT-PCR. Cell proliferation and migration were assessed with wound healing assay, Ki67 staining and cell count kit 8 (CCK8) assay with/without miR-138/-210/-335 inhibitor transfections. The miRNA downstream proteins, hypoxia inducible factor-1α (HIF-1α) and matrix metalloproteinase 9 (MMP9), were also determined with immunofluorescent staining. Sevoflurane and desflurane exposure to glioma cells inhibited their proliferation and migration. Sevoflurane exposure increased miR-210 expression whereas desflurane exposure upregulated both miR-138 and miR-335 expressions. The administration of inhibitor of miR-138, -210 or -335 inhibited the suppressing effects of sevoflurane or desflurane on cell proliferation and migration, in line with the HIF-1α and MMP9 expression changes. These data indicated that inhalational anesthetics, sevoflurane and desflurane, inhibited glioma cell malignancy via miRNAs upregulation and their downstream effectors, HIF-1α and MMP9, downregulation. The implication of the current study warrants further study.
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Affiliation(s)
- Masashi Ishikawa
- Department of Anesthesiology and Pain medicine, Graduate School of Medicine, Nippon Medical School, Tokyo 113-8603, Japan; (M.I.); (A.S.)
- Division of Anaesthetics, Pain Medicine and Intensive Care, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, Chelsea & Westminster Hospital, London SW10 9NH, UK; (H.Z.); (J.S.); (C.H.); (Q.S.)
- Correspondence: (M.I.); (D.M.)
| | - Masae Iwasaki
- Department of Anesthesiology and Pain medicine, Graduate School of Medicine, Nippon Medical School, Tokyo 113-8603, Japan; (M.I.); (A.S.)
- Division of Anaesthetics, Pain Medicine and Intensive Care, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, Chelsea & Westminster Hospital, London SW10 9NH, UK; (H.Z.); (J.S.); (C.H.); (Q.S.)
| | - Hailin Zhao
- Division of Anaesthetics, Pain Medicine and Intensive Care, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, Chelsea & Westminster Hospital, London SW10 9NH, UK; (H.Z.); (J.S.); (C.H.); (Q.S.)
| | - Junichi Saito
- Division of Anaesthetics, Pain Medicine and Intensive Care, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, Chelsea & Westminster Hospital, London SW10 9NH, UK; (H.Z.); (J.S.); (C.H.); (Q.S.)
- Department of Anesthesiology, Graduate School of Medicine, Hirosaki University, Hirosaki, Aomori 036-8562, Japan
| | - Cong Hu
- Division of Anaesthetics, Pain Medicine and Intensive Care, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, Chelsea & Westminster Hospital, London SW10 9NH, UK; (H.Z.); (J.S.); (C.H.); (Q.S.)
| | - Qizhe Sun
- Division of Anaesthetics, Pain Medicine and Intensive Care, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, Chelsea & Westminster Hospital, London SW10 9NH, UK; (H.Z.); (J.S.); (C.H.); (Q.S.)
| | - Atsuhiro Sakamoto
- Department of Anesthesiology and Pain medicine, Graduate School of Medicine, Nippon Medical School, Tokyo 113-8603, Japan; (M.I.); (A.S.)
| | - Daqing Ma
- Division of Anaesthetics, Pain Medicine and Intensive Care, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, Chelsea & Westminster Hospital, London SW10 9NH, UK; (H.Z.); (J.S.); (C.H.); (Q.S.)
- Correspondence: (M.I.); (D.M.)
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