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Journal of Clinical Monitoring and... Feb 2023This study was designed to investigate qCON and qNOX variations during outpatient laparoscopic cholecystectomy using remifentanil and desflurane without muscle relaxants... (Observational Study)
Observational Study
Relationship between ANI and qNOX and between MAC and qCON during outpatient laparoscopic cholecystectomy using remifentanil and desflurane without muscle relaxants: a prospective observational preliminary study.
This study was designed to investigate qCON and qNOX variations during outpatient laparoscopic cholecystectomy using remifentanil and desflurane without muscle relaxants and compare these indices with ANI and MAC. Adult patients undergoing outpatient laparoscopic cholecystectomy were included in this prospective observational study. Maintenance of anesthesia was performed using remifentanil targeted to ANI 50-80 and desflurane targeted to MAC 0.8-1.2 without muscle relaxants. The ANI, qCON and qNOX and desflurane MAC values were collected at different time-points and analyzed using repeated measures ANOVA. The relationship between ANI and qNOX and between qCON and MAC were analyzed by linear regression. The ANI was comprised between 50 and 80 during maintenance of anesthesia. Higher values of qNOX and qCON were observed at induction and extubation than during all other time-points where they were comprised between 40 and 60. A poor but significant negative linear relationship (r = 0.07, p < 0.001) was observed between ANI and qNOX. There also was a negative linear relationship between qCON and MAC (r = 0.48, p < 0.001) and between qNOX and remifentanil infusion rate (r = 0.13, p < 0.001). The linear mixed-effect regression correlation (r) was 0.65 for ANI-qNOX and 0.96 for qCON-MAC. The qCON and qNOX monitoring seems informative during general anesthesia using desflurane and remifentanil without muscle relaxants in patients undergoing ambulatory laparoscopic cholecystectomy. While qCON correlated with MAC, the correlation of overall qCON and ANI was poor but significant. Additionally, the qNOX weakly correlated with the remifentanil infusion rate. This observational study suggests that the proposed ranges of 40-60 for both indexes may correspond to adequate levels of hypnosis and analgesia during general anesthesia, although this should be confirmed by further research.
Topics: Adult; Humans; Remifentanil; Desflurane; Anesthetics, Intravenous; Outpatients; Cholecystectomy, Laparoscopic; Piperidines; Anesthesia, General; Vasodilator Agents; Muscles; Isoflurane; Anesthetics, Inhalation
PubMed: 35445895
DOI: 10.1007/s10877-022-00861-x -
Journal of Biomolecular Structure &... Aug 2022Nanocluster based drug delivery systems are very useful in modern medical treatment and interaction mechanism of desflurane (DES), isoflurane ISO), sevoflurane (SEV)...
Nanocluster based drug delivery systems are very useful in modern medical treatment and interaction mechanism of desflurane (DES), isoflurane ISO), sevoflurane (SEV) over carboxyl substituted graphene-doped with O and S atoms were investigated in the present study. Different electronic and chemical properties of adsorbed desflurane, isoflurane and sevoflurane with nanoclusters are analyzed. To track the drugs, SERS is used as an efficient method and drug's detection was analyzed using SERS. DES's energy over GQD-S is greater than that over GQD-O nanocluster and for ISO and SEV, adsorption energies over the O/S nanoclusters are same. The title drugs work on the reactives sites and got adsorbed. For ISO, there is an increase in fluorine atom charges and for DES and SEV, the fluorine atom charge decreases due to adsorption in both O/S nanoclusters. Changes in chemical descriptors are identified for the sensing property of drug-nanoclusters.Communicated by Ramaswamy H. Sarma.
Topics: Desflurane; Fluorine; Graphite; Isoflurane; Sevoflurane
PubMed: 33410367
DOI: 10.1080/07391102.2020.1870155 -
Anaesthesia and Intensive Care Mar 2023Anaesthetic agents have various financial and environmental impacts. Climate change is one of the biggest threats to human health, and anaesthetic gases contribute to...
Anaesthetic agents have various financial and environmental impacts. Climate change is one of the biggest threats to human health, and anaesthetic gases contribute to global heating by acting as greenhouse gases. The primary aim of this study was to quantify the financial and environmental impacts of anaesthesia maintenance agents used during surgery in an Australian university teaching hospital. The volume of desflurane, sevoflurane, isoflurane and propofol purchased by a university teaching hospital between 2010 and 2020 was analysed and described in terms of financial and environmental impact. Estimated carbon emissions and financial costs of each agent per annum were calculated using the volumes purchased for each agent. A model of ideal anaesthetic agent usage was used to hypothesise the financial and environmental impact of replacing desflurane (the most environmentally damaging and expensive agent) with alternative agents. Using 2019 as an example year at our health service, replacing desflurane with low flow sevoflurane would save greenhouse gas emissions equivalent to driving over 1.4 million kilometres in an average petrol car. Removing desflurane from machines at our institution could save an estimated A$14,630 per annum through reduced machine testing alone. Our findings and calculations indicate that reducing the use of desflurane would have both financial and environmental benefits for healthcare.
Topics: Humans; Sevoflurane; Desflurane; Methyl Ethers; Tertiary Care Centers; Australia; Anesthetics, Inhalation; Isoflurane; Greenhouse Gases; Environment
PubMed: 36722013
DOI: 10.1177/0310057X221129291 -
Life Sciences Nov 2022In this study, the effects of exposure to isoflurane, sevoflurane and desflurane on the oxidative response and inflammation at different times was analyzed in the lungs...
In this study, the effects of exposure to isoflurane, sevoflurane and desflurane on the oxidative response and inflammation at different times was analyzed in the lungs of adult C57BL/6 mice. 120 animals were divided into 3 groups (n = 40): Isoflurane (ISO), Sevoflurane (SEV) and Desflurane (DES) and exposed to these anesthetics for 1 h (n = 10), 2 h (n = 10) and 3 h (n = 10), at a minimum alveolar concentration (MAC) equal to 1. The control group (CG) (n = 10) was exposed to ambient air. 24 h after the experimental protocol, the animals were euthanized and the bronchoalveolar lavage fluid (BALF), blood and lung tissue samples were collected. In the BALF, animals exposed to isoflurane for 2 h and 3 h showed a greater influx of leukocytes, especially macrophages compared to the CG. The ISO3h had lower leukocyte counts in the peripheral blood compared to CG, ISO1h and ISO2h. There was an increase in CCL-2 levels in the ISO3h compared to the CG. Superoxide dismutase activity was higher in ISO1h compared to CG. The activity of catalase was higher in the ISO1h and ISO2h compared to the CG. The lipid peroxidation, as well as carbonylated protein were higher in the ISO3h compared to the CG (p < 0.05). Similar results were observed in the exposure of SEV and DES compared to inflammation and redox imbalance in different periods. This study demonstrated that time is a determinant to promote a local and systemic inflammatory response to different inhalational anesthetics in a healthy murine model.
Topics: Mice; Animals; Isoflurane; Sevoflurane; Desflurane; Catalase; Mice, Inbred C57BL; Anesthetics, Inhalation; Superoxide Dismutase; Inflammation; Methyl Ethers
PubMed: 36170891
DOI: 10.1016/j.lfs.2022.121004 -
Journal of Clinical Monitoring and... Dec 2022Soda lime-based CO absorbents are safe, but not ideal for reasons of ecology, economy, and dust formation. The Memsorb™ is a novel CO removal device that uses...
Soda lime-based CO absorbents are safe, but not ideal for reasons of ecology, economy, and dust formation. The Memsorb™ is a novel CO removal device that uses cardiopulmonary bypass oxygenator technology instead: a sweep gas passes through semipermeable hollow fibers, adding or removing gas from the circle breathing system. We studied the in vitro performance of a prototype Memsorb™ used with a Zeus IE® anesthesia machine when administering sevoflurane and desflurane in O/air mixtures. The Zeus IE® equipped with Memsorb™ ventilated a 2L breathing bag with a CO inflow port in its tip. CO kinetics were studied by using different combinations of CO inflow (VCO), Memsorb™ sweep gas flow, and Zeus IE® fresh gas flow (FGF) and ventilator settings. More specifically, it was determined under what circumstances the inspired CO concentration (FCO) could be kept < 0.5%. O kinetics were studied by measuring the inspired O concentration (FO) resulting from different combinations of Memsorb™ sweep gas flow and O concentrations, and Zeus IE® FGFs and O concentrations. Memsorb™'s sevoflurane and desflurane waste was determined by measuring their injection rates during target-controlled closed-circuit anesthesia (TCCCA), and were compared to historical controls when using a soda lime absorbent (Draegersorb 800+) under identical conditions. With 160 mL/min VCO and 5 L/min minute ventilation (MV), lowering the sweep gas flow at any fixed Zeus IE® FGF increased FCO in a non-linear manner. Sweep gas flow adjustments kept FCO < 0.5% over the entire Zeus IE® FGF range tested with VCO up to 280 mL/min; tidal volume and respiratory rate affected the required sweep gas flow. At 10 L/min MV and low FGF (< 1.5 L/min), even a maximum sweep flow of 43 L/min was unable to keep FCO ≤ 0.5%. When the O concentration in the Zeus IE® FGF and the Memsorb™ sweep gas flow differed, FO drifted towards the sweep gas O concentration, and more so as FGF was lowered; this effect was absent once FGF > minute ventilation. During sevoflurane and desflurane TCCCA, the Zeus IE® FGF remained zero while agent usage per % end-expired agent increased with increasing end-expired target agent concentrations and with a higher target FO. Agent waste during target-controlled delivery was higher with Memsorb™ than with the soda lime product, with the difference remaining almost constant over the FGF range studied. With a 5 L/min MV, Memsorb™ successfully removes CO with inflow rates up to 240 mL/min if an FCO of 0.5% is accepted, but at 10 L/min MV and low FGF (< 1.5 L/min), even a maximum sweep flow of 43 L/min was unable to keep FCO ≤ 0.5%. To avoid FO deviating substantially from the O concentration in the fresh gas, the O concentration in the fresh gas and sweep gas should match. Compared to the use of Ca(OH) based CO absorbent, inhaled agent waste is increased. The device is most likely to find its use integrated in closed loop systems.
Topics: Humans; Sevoflurane; Carbon Dioxide; Desflurane; Anesthesia, Closed-Circuit; Anesthetics, Inhalation
PubMed: 35089526
DOI: 10.1007/s10877-021-00802-0 -
European Journal of Anaesthesiology Nov 2021Rapid emergence from general anaesthesia is desirable only if safety is not sacrificed. Mechanical hyperventilation during hypercapnia produced by carbon dioxide... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Rapid emergence from general anaesthesia is desirable only if safety is not sacrificed. Mechanical hyperventilation during hypercapnia produced by carbon dioxide infusion into the inspired gas mixture or by rebreathing was reported to shorten emergence time from inhalation anaesthesia.
OBJECTIVES
To test the hypothesis that hypercapnia produced by hypoventilation before desflurane cessation shortens emergence time from general anaesthesia (primary hypothesis) and reduces undesirable cardiorespiratory events.
DESIGN
A single-blinded randomised controlled study.
SETTING
A single university hospital.
PATIENTS
Fifty adult patients undergoing elective abdominal surgery under general anaesthesia using desflurane inhalation and intra-operative epidural anaesthesia.
INTERVENTION
The patients were randomly assigned to either the normocapnia or hypercapnia group.
MAIN OUTCOME MEASURES
Emergence time from desflurane anaesthesia and comparison of the incidence of 11 predefined undesirable cardiorespiratory events during and after emergence from anaesthesia between the groups.
RESULTS
Forty-six patients were included in the analysis. End-tidal carbon dioxide concentrations at cessation of desflurane were 35 ± 6 mmHg (mean ± SD) and 52 ± 6 mmHg in normocapnia (n = 23) and hypercapnia groups (n = 23), respectively. Emergence time was significantly faster in the hypercapnia group than the normocapnia group: 9.4 ± 2.4 min, hypercapnia: 5.5 ± 2.6 min, (P < 0.001) with a difference of 3.8 min on average (95% CI: 2.4 to 5.3). Spontaneous breathing established before recovery of consciousness was more evident in hypercapnia patients (normocapnia: 13%, hypercapnia: 96%, P < 0.001). Hypercapnia patients had more episodes of bradypnoea and apnoea before emergence of consciousness. In contrast, after tracheal extubation, incidences of bradypnoea and hypopnoea were more common in the normocapnia group. Undesirable cardiovascular events were not common, and no group differences were observed during emergence and postextubation periods.
CONCLUSION
Hypoventilation-induced hypercapnia before desflurane cessation shortens the emergence time without causing additional clinically significant undesirable events.
TRIAL REGISTRATION
UMIN Clinical Trials Registry (UMIN000020143) https://upload.umin.ac.jp/cgi-open-bin/ctr/ctr.cgi?function=brows&recptno=R000023266&language=E.
Topics: Adult; Anesthesia Recovery Period; Anesthesia, Inhalation; Anesthetics, Inhalation; Desflurane; Humans; Hypercapnia; Isoflurane
PubMed: 34313609
DOI: 10.1097/EJA.0000000000001574 -
European Journal of Pharmacology May 2024Inhalational anesthetics target the inhibitory extrasynaptic γ-aminobutyric acid type A (GABA) receptors. Both neuronal and glial GABA mediate tonic inhibition of the...
BACKGROUND
Inhalational anesthetics target the inhibitory extrasynaptic γ-aminobutyric acid type A (GABA) receptors. Both neuronal and glial GABA mediate tonic inhibition of the extrasynaptic GABA receptors. However, the role of glial GABA during inhalational anesthesia remains unclear. This study aimed to evaluate whether astrocytic GABA contributes to the action of different inhalational anesthetics.
METHODS
Gene knockout of monoamine oxidase B (MAOB) was used to reduce astrocytic GABA levels in mice. The hypnotic and immobilizing effects of isoflurane, sevoflurane, and desflurane were assessed by evaluating the loss of righting reflex (LORR) and tail-pinch withdrawal response (LTWR) in MAOB knockout and wild-type mice. Minimum alveolar concentration (MAC) for LORR, time to LORR, MAC for LTWR and time to LTWR of isoflurane, sevoflurane, and desflurane were assessed.
RESULTS
Time to LORR and time to LTWR with isoflurane were significantly longer in MAOB knockout mice than in wild-type mice (P < 0.001 and P = 0.032, respectively). Time to LORR with 0.8 MAC of sevoflurane was significantly longer in MAOB knockout mice than in wild-type mice (P < 0.001), but not with 1.0 MAC of sevoflurane (P=0.217). MAC for LTWR was significantly higher in MAOB knockout mice exposed to sevoflurane (P < 0.001). With desflurane, MAOB knockout mice had a significantly higher MAC for LORR (P = 0.003) and higher MAC for LTWR (P < 0.001) than wild-type mice.
CONCLUSIONS
MAOB knockout mice showed reduced sensitivity to the hypnotic and immobilizing effects of isoflurane, sevoflurane, and desflurane. Behavioral tests revealed that the hypnotic and immobilizing effects of inhalational anesthetics would be mediated by astrocytic GABA.
Topics: Mice; Animals; Isoflurane; Sevoflurane; Desflurane; Anesthetics, Inhalation; gamma-Aminobutyric Acid; Hypnotics and Sedatives; Mice, Knockout; Receptors, GABA-A; Methyl Ethers
PubMed: 38484926
DOI: 10.1016/j.ejphar.2024.176494 -
Clinical Transplantation Feb 2021Ischemia-reperfusion injury (IRI) is a common cause of allograft dysfunction and patient morbidity in solid organ transplantation. This study compares the effect of...
BACKGROUND
Ischemia-reperfusion injury (IRI) is a common cause of allograft dysfunction and patient morbidity in solid organ transplantation. This study compares the effect of different inhaled anesthetics on early IRI and clinical outcomes in pancreas allograft recipients.
METHODS
Data were extracted retrospectively for pancreas transplants at a single center over a 15-year period. Early postoperative pancreatic amylase and lipase levels were used as a marker for graft injury. Clinical outcomes measured included length of hospital stay, readmission, and graft survival.
RESULTS
There were 625 pancreas transplants included in the analysis with 3 primary inhaled anesthetics: sevoflurane (53%), desflurane (35%), and isoflurane (12%). In the first 30 days post-transplant, peak amylase was lowest for sevoflurane (147) followed by desflurane (159) and isoflurane (229) (p = .03). Peak lipase levels followed the same trend (peak values 118, 131, and 135, respectively; p = .02). Early graft loss, length of hospital stay, and readmission within 3 months were similar among all three anesthetic groups. There was no difference in 10-year graft survival by Cox regression.
CONCLUSIONS
Sevoflurane and desflurane are associated with lower peak amylase and lipase levels postoperatively in pancreas transplantation. Short- and long-term clinical outcomes were equivalent for the three agents.
Topics: Anesthetics, Inhalation; Desflurane; Humans; Methyl Ethers; Pancreas Transplantation; Retrospective Studies
PubMed: 33185894
DOI: 10.1111/ctr.14153 -
Anesthesiology Nov 2017Increasing numbers of patients with obstructive lung diseases need anesthesia for surgery. These conditions are associated with pulmonary ventilation/perfusion (VA/Q)...
BACKGROUND
Increasing numbers of patients with obstructive lung diseases need anesthesia for surgery. These conditions are associated with pulmonary ventilation/perfusion (VA/Q) mismatch affecting kinetics of volatile anesthetics. Pure shunt might delay uptake of less soluble anesthetic agents but other forms of VA/Q scatter have not yet been examined. Volatile anesthetics with higher blood solubility would be less affected by VA/Q mismatch. We therefore compared uptake and elimination of higher soluble isoflurane and less soluble desflurane in a piglet model.
METHODS
Juvenile piglets (26.7 ± 1.5 kg) received either isoflurane (n = 7) or desflurane (n = 7). Arterial and mixed venous blood samples were obtained during wash-in and wash-out of volatile anesthetics before and during bronchoconstriction by methacholine inhalation (100 μg/ml). Total uptake and elimination were calculated based on partial pressure measurements by micropore membrane inlet mass spectrometry and literature-derived partition coefficients and assumed end-expired to arterial gradients to be negligible. VA/Q distribution was assessed by the multiple inert gas elimination technique.
RESULTS
Before methacholine inhalation, isoflurane arterial partial pressures reached 90% of final plateau within 16 min and decreased to 10% after 28 min. By methacholine nebulization, arterial uptake and elimination delayed to 35 and 44 min. Desflurane needed 4 min during wash-in and 6 min during wash-out, but with bronchoconstriction 90% of both uptake and elimination was reached within 15 min.
CONCLUSIONS
Inhaled methacholine induced bronchoconstriction and inhomogeneous VA/Q distribution. Solubility of inhalational anesthetics significantly influenced pharmacokinetics: higher soluble isoflurane is less affected than fairly insoluble desflurane, indicating different uptake and elimination during bronchoconstriction.
Topics: Anesthetics, Inhalation; Animals; Animals, Newborn; Bronchoconstriction; Desflurane; Isoflurane; Pulmonary Ventilation; Respiration, Artificial; Swine; Ventilation-Perfusion Ratio
PubMed: 28857808
DOI: 10.1097/ALN.0000000000001847 -
BMC Anesthesiology Apr 2022This study evaluated whether desflurane improved lung collapse during one-lung ventilation (OLV) more than propofol, and whether it could reduce the operation time of... (Randomized Controlled Trial)
Randomized Controlled Trial
Desflurane improves lung collapse more than propofol during one-lung ventilation and reduces operation time in lobectomy by video-assisted thoracic surgery: a randomized controlled trial.
BACKGROUND
This study evaluated whether desflurane improved lung collapse during one-lung ventilation (OLV) more than propofol, and whether it could reduce the operation time of video-assisted thoracic surgery.
METHODS
Sixty patients undergoing lobectomy by video-assisted thoracic surgery (VATS) were randomly assigned to general anesthesia with desflurane or propofol. Lungs were inspected by thoracoscope at 10, 30, and 60 min after initiation of OLV. After surgery, the Lung Collapse Score, a composite of lung color and volume assessments, was assigned by two clinicians blinded to the anesthetic regimen. The primary outcome was operation time. The secondary outcome included the complication rate.
RESULTS
Of the 60 participants, 50 completed the study, 26 in Desflurane group and 24 in Propofol group. The Lung Collapse Scores at 30 and 60 min after OLV initiation were significantly better in Desflurane group than in Propofol group, and operation time was significantly shorter in Desflurane group (214 (57) min vs. 262 (72) min [mean (SD)], difference in means, -48; 95% CI, -85 to -11; P = 0.01). The incidence of multiple complications was 1/26 (3%) and 6/24 (25%) in Desflurane and Propofol group, respectively (relative risk, 0.1; 95% CI, 0.02 to 1.18; P = 0.04).
CONCLUSIONS
Desflurane improved lung collapse during OLV and significantly shortened VATS lobectomy operation time compared to propofol in our studied patients. Desflurane resulted in fewer postoperative complications. Thus, desflurane may be an appropriate anesthetic during lobectomy by VATS requiring OLV.
TRIAL REGISTRATION
The study was registered with the University Hospital Medical Information Network ( UMIN000009412 ). The date of disclosure of this study information is 27/11/2012. On this date, we registered the study into UMIN; patients were included from 2013 to 2014. However, on 11/27/2015, the UMIN system administrator suggested a detailed description. Thereafter, we added it to the Randomization Unit. Despite being prospective, it was retrospectively registered on UMIN for the above reasons.
Topics: Anesthetics; Desflurane; Humans; Isoflurane; Lung; One-Lung Ventilation; Propofol; Prospective Studies; Pulmonary Atelectasis; Thoracic Surgery, Video-Assisted
PubMed: 35488195
DOI: 10.1186/s12871-022-01669-7