Recent advances in intravenous anesthesia and anesthetics

Anesthesiology, as a field, has made promising advances in the discovery of novel, safe, effective, and efficient methods to deliver care. This review explores refinement in the technology of soft drug development, unique anesthetic delivery systems, and recent drug and device failures.

Analysis of Infusion Patterns of Propofol and Remifentanil During Rigid Bronchoscopy Under Total Intravenous Anesthesia

OBJECTIVES

We analyzed the dosage pattern of anesthetic drugs administered to maintain anesthesia during rigid bronchoscopy.

METHODS

We enrolled a total of 81 patients who underwent rigid bronchoscopy under total intravenous anesthesia between April 2015 and March 2019. Anesthesia was maintained using propofol (target brain concentration 2.0 - 6.0 µg/mL) and remifentanil (target brain concentration 2.0 - 6.0 ng/mL). We analyzed the dosage patterns of the anesthetic agents during the procedure, as well as the changes in the dose of the anesthetic agents and the number of procedures repeated in the same patient.

RESULTS

The dose of propofol administered per minute to maintain anesthesia was inversely correlated with the total operation time (r² = 0.355, β = -0.067, P < 0.000) but was not significantly correlated with the number of times the procedure was repeated. The dose of remifentanil did not significantly differ during repeated procedures in the same patient.

CONCLUSIONS

The dose of propofol infusion tended to decrease over time during the rigid bronchoscopy procedure. This pattern was specific to propofol but not to remifentanil using TIVA. Understanding the pharmacokinetic properties of anesthetic drugs will help in their appropriate administration.

Comparison of Two Clinical Protocols for Total Intravenous Anesthesia (TIVA) for Breast Surgery Using Propofol Combined With Either Sufentanil or Alfentanil

BACKGROUND

Sufentanil and alfentanil have pharmacokinetic and dynamic properties which make them favourable substances for total intravenous anesthesia (TIVA) in combination with propofol.

OBJECTIVES

We planned to compare two clinical protocols for TIVA with propofol, and either sufentanil or alfentanil in regards to postoperative pain, hemodynamic stability during the case and time for emergence from anesthesia.

PATINETS AND METHODS

Treaty eight patients scheduled for general anesthesia for breast surgery were included in this Double-blind, randomized, controlled trial. All patients received a standardized TIVA with propofol and either 0.2 µg kg(-1) sufentanil or 20 µg kg(-1) alfentanil for induction and 0.3 µg kg(-1) h(-1) sufentanil or 30 µg kg(-1) h(-1) alfentanil for maintenance with additional propofol boluses as needed. During anesthesia, heart rate, non-invasive blood-pressure, peripheral oxygen saturation and depth of anesthesia, were recorded. In the post anesthesia care unit, pain scores, nausea and vomiting as well as medications were recorded.

RESULTS

Patients in the sufentanil group required less often additional opioid and propofol boluses to maintain adequate anesthesia. We did not observe a significant difference in time to extubation. Postoperatively, patients in the sufentanil group had less pain (P = 0.03) and required less i.v. opioids (0.4 vs. 1.9 mg piritramid, P = 0.04).

CONCLUSIONS

Both protocols provide excellent anesthesia, but patients receiving sufentnail had more stable anesthesia and less postoperative pain.

Rise and decline of the barbiturate methitural for intravenous anesthesia: A systematic search and narrative synthesis

BACKGROUND

Within the history of intravenous anesthesia, barbiturates represent a chapter of considerable importance. Although the reference barbiturate thiopental had several limitations, it dominated the scene of the intravenous anesthesia until the mid-1980s, when propofol was introduced on the market. In the meantime, several barbiturate derivatives were placed on the market and abounded. This work is aimed at evaluating the clinical impact of the barbiturate derivatives methitural, analyzing the reasons for its rapid abandonment, in the late 1950s.

METHODS

A systematic methodology of the search was associated with a descriptive analysis of the bibliography found. A computer-operated search strategy using Medline and Google Scholar databases was implemented. The algorithm was composed by using the words "Diogenal" OR "Thiogenal" OR "Methitural" OR "Metigenal" OR "Neraval" including biochemical and marketed terms. A manual search of the sources was carried out, and precise inclusion and exclusion criteria were established. The narrative synthesis was conducted taken into account the historical context of anesthesia.

RESULTS

The database search yielded 3645 records. Nineteen records were identified through other sources. After duplicates removing (n = 238), and exclusion of not pertinent 3027 records, 314 full-text articles were assessed for eligibility. Of those, other 225 papers were excluded and 89 articles were included in the qualitative synthesis.

CONCLUSION

Although methitural could be useful in particular surgical settings such as short-acting surgery, and in patients with liver diseases, a limited advantage over thiopental, and its scarce market diffusion due to increased costs, have limited its use. Through a critical analysis of literature, the lack of high-quality studies does not allow us to draw definitive conclusions on the drug.

Patient-controlled sedation using remimazolam during third molar extraction: a case report

Dental sedation plays a pivotal role in alleviating patient anxiety during various procedures. Remimazolam, a benzodiazepine derivative, stands out for its distinctive attributes, particularly its rapid onset of sedation coupled with a brief duration, making it an invaluable option for dental applications. The patient was admitted for the extraction of impacted third molars via patient-controlled sedation and not only demonstrated stable vital signs but also expressed a high level of satisfaction with the procedure. An in-depth analysis of plasma remimazolam concentrations and changes in the Patient State Index revealed negative correlation patterns, highlighting the inherent potential of remimazolam in achieving effective sedation. This expanded research scope aims to provide a more nuanced understanding of the pharmacological responses to remimazolam in dental sedation scenarios. This case report offers valuable insights into the evolving landscape of dental sedation methodologies and paves the way for a more informed and evidence-based approach to the use of remimazolam in patient-controlled sedation.

COMPARISON OF COINDUCTION ADJUVANTS TO PROPOFOL IN HEALTHY CATS SEDATED WITH DEXMEDETOMIDINE

This study aimed to compare the effects of different coinduction agents on the duration and dose of propofol in healthy cats. Six cats aged 4.8 ± 1.0 years and weighing 4.4 ± 1.1 kg participated in four treatment groups of propofol combined with: saline or control group (TC); ketamine 2 mg/kg (Tket); fentanyl 1 µg/kg (Tfen); or midazolam 0.3 mg/kg (Tmid). Twenty minutes following premedication with dexmedetomidine at 10 µg/kg, induction followed the same protocol in all groups, starting with a propofol bolus of 1 mg/kg over 1 minute followed by an adjuvant, then propofol again at 1 mg/kg/minute for orotracheal intubation. Variables recorded were (in minutes): time of extubation, time to return of palpebral reflex, eye recentralization, recovery of consciousness, quadrupedal position and total propofol dose used (mg/kg). A comparison between the four groups was performed by analysis of variance followed by Dunnett test under 5% significance. There was no significant difference in any of the times evaluated during anesthetic recovery between the groups. The propofol dose used to allow orotracheal intubation was significantly lower in all groups compared to TC (p<0.05). Ketamine, midazolam and fentanyl are indicated as suitable choices for coinduction with propofol in cats.

Postoperative analgesia in patients undergoing thoracotomy: A comparison between total intravenous anesthesia and inhalation anesthesia

Objective

Propofol is more effective than inhalational anesthesia; however, the results for the management of acute pain remain controversial. Therefore, this study aimed to determine the incidence of acute pain after inhalation anesthesia and total intravenous anesthesia among patients who underwent thoracotomy at our hospital.

Methods

We conducted a single center retrospective observational study using data from electronic medical records. Sixty patients aged ≥20 years with American Society of Anesthesiologists physical status class I or II who underwent regular and emergency thoracotomy between January 1, 2016, and January 1, 2020, at Chungbuk National University Hospital were included in this study. The anesthesia and postoperative pain records of those who received total intravenous anesthesia (n=30) and inhalation anesthesia (n=30) were retrospectively reviewed. The pain score on the numeric rating scale (NRS) was evaluated at 2, 8, 24, and 30 hours postoperatively.

Results

The average NRS score of patients who received total intravenous anesthesia was lesser than that of those who received inhalational anesthesia. Moreover, the difference in the NRS scores at eight hours postoperatively was statistically significant (P <0.05). Patients who received inhalational anesthesia had a higher pain score and experienced more severe pain than those who received intravenous anesthesia.

Conclusions

Total intravenous anesthesia with propofol-remifentanil provided better analgesia for acute postoperative pain in patients who underwent thoracotomy than inhalational anesthesia, suggesting it may be considered the combination of choice for thoracic surgery.

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

Objective

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

Methods

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

Results

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

Conclusion

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