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Surgical Neurology International 2024Following aneurysmal subarachnoid hemorrhage, 40-50% of survivors experience cognitive dysfunction, which affects their quality of life. Anesthetic agents play a pivotal...
BACKGROUND
Following aneurysmal subarachnoid hemorrhage, 40-50% of survivors experience cognitive dysfunction, which affects their quality of life. Anesthetic agents play a pivotal role in aneurysm surgeries. However, substantial evidence regarding their effects on neurocognitive function is lacking. This study evaluated the effects of propofol and desflurane on postoperative neurocognitive function and serum S-100B levels.
METHODS
One hundred patients were equally randomized to receive either propofol (Group P) or desflurane (Group D). Cognitive function was assessed using the Montreal Cognitive Assessment scale at three different time points: Preoperatively, at the time of discharge, and one month after surgery. Perioperative serum levels of S-100B were also measured.
RESULTS
The preoperative mean cognitive score in Group P was 21.64 + 4.46 and in Group D was 21.66 + 4.07 ( = 0.79). At discharge, a significant decrease in cognitive scores was observed compared to preoperative scores (Group P- 20.91 + 3.94, = 0.03 and Group D-19.28 + 4.22, = 0.00); however, scores were comparable between the two groups ( = 0.09). One month following surgery, mean cognitive scores were 22.63 + 3.57 in Group P and 20.74 + 3.89 in Group D, and the difference was significant ( = 0.04). Higher memory and orientation scores were observed in Group P than in Group D at one month ( < 0.05) in the subgroup analysis. Both groups had similar serum S-100B levels.
CONCLUSION
The mean cognitive scores one month after surgery improved significantly with propofol compared with desflurane, but without clinical significance. Individual domain analysis demonstrated that orientation and memory scores were better preserved with propofol.
PubMed: 38628512
DOI: 10.25259/SNI_788_2023 -
Canadian Journal of Anaesthesia =... Apr 2024Maintaining hemodynamic stability during cardiac ablation under general anesthesia is challenging. Remimazolam, a novel ultrashort-acting benzodiazepine, is...
PURPOSE
Maintaining hemodynamic stability during cardiac ablation under general anesthesia is challenging. Remimazolam, a novel ultrashort-acting benzodiazepine, is characterized by maintaining comparatively stable blood pressure and does not influence the cardiac conduction system, which renders it a reasonable choice for general anesthesia for cardiac ablation. We aimed to evaluate whether remimazolam is associated with a decreased incidence of intraoperative hypotension compared with desflurane.
METHODS
In this single-centre, parallel-group, prospective, single-blind, randomized clinical trial, we randomized patients (1:1) into a remimazolam group (remimazolam-based total intravenous anesthesia) or desflurane group (propofol-induced and desflurane-maintained inhalational anesthesia) during cardiac ablation procedures for arrhythmia. The primary outcome was the incidence of intraoperative hypotensive events, defined as mean arterial pressure of < 60 mm Hg at any period.
RESULTS
Overall, we enrolled 96 patients between 2 August 2022 and 19 May 2023 (47 and 49 patients in the remimazolam and desflurane groups, respectively). The remimazolam group showed a significantly lower incidence of hypotensive events (14/47, 30%) than the desflurane group (29/49, 59%; relative risk [RR], 0.5; 95% confidence interval [CI], 0.31 to 0.83; P = 0.004). Remimazolam was associated with a lower requirement for bolus or continuous vasopressor infusion than desflurane was (23/47, 49% vs 43/49, 88%; RR, 0.56; 95% CI, 0.41 to 0.76; P < 0.001). No between-group differences existed in the incidence of perioperative complications such as nausea, vomiting, oxygen desaturation, delayed emergence, or pain.
CONCLUSIONS
Remimazolam was a viable option for general anesthesia for cardiac ablation. Remimazolam-based total intravenous anesthesia was associated with significantly fewer hypotensive events and vasopressor requirements than desflurane-based inhalational anesthesia was, without significantly more complications.
STUDY REGISTRATION
ClinicalTrials.gov (NCT05486377); first submitted 1 August 2022.
PubMed: 38609684
DOI: 10.1007/s12630-024-02735-z -
Journal of Pharmacy & Bioallied Sciences Feb 2024Although sevoflurane and desflurane have nearly identical blood-gas solubilities, current research suggests that airway reflexes recover more quickly with desflurane...
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 " (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 < 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.( = 0.003; 0.0013; <0.001, respectively).
CONCLUSION
Desflurane causes patients to recover more quickly than sevoflurane does after laparoscopic cholecystectomy under controlled circumstances.
PubMed: 38595352
DOI: 10.4103/jpbs.jpbs_502_23 -
Journal of Anesthesia Jun 2024As the COVID-19 pandemic increased the use of propofol in the intensive care unit for the management of respiratory sequelae and supply had become a major issue. Indeed,... (Review)
Review
As the COVID-19 pandemic increased the use of propofol in the intensive care unit for the management of respiratory sequelae and supply had become a major issue. Indeed, most hospitals in Japan were forced to use propofol only for induction of anesthesia with inhalational maintenance. Large amounts of propofol remain in the syringe which exacerbates the problems by increased waste. I propose that use of low dose propofol in combination with a low concentration inhaled anesthetic as an alternative and call this hybrid anesthesia. Several advantages of hybrid anesthesia are evident in the literature. Volatile anesthesia has several disadvantages such as cancer progression, emergence agitation, marked reduction in motor evoked potentials (MEP), laryngospasm with desflurane and postoperative nausea and vomiting (PONV). Volatile anesthesia exerts some beneficial actions such as myocardial protection and fast emergence with desflurane. In contrast, total intravenous anesthesia (TIVA) provides better survival in patients undergoing radical cancer surgery, reduction in emergence agitation, laryngospasm, PONV and better MEP trace Intraoperative awareness occurs more often during TIVA. When intravenous and volatile anesthesia are combined (hybrid anesthesia), the disadvantages of both methods may be offset by clear advantages. Thus, hybrid anesthesia may, therefore, be a viable anesthetic choice.
Topics: Humans; Anesthetics, Inhalation; COVID-19; Propofol; Anesthetics, Intravenous; Anesthesia, Intravenous; Anesthesia, Inhalation
PubMed: 38551676
DOI: 10.1007/s00540-024-03310-y -
PloS One 2024Although sevoflurane is one of the most commonly used inhalational anesthetic agents, the popularity of desflurane is increasing to a level similar to that of...
Although sevoflurane is one of the most commonly used inhalational anesthetic agents, the popularity of desflurane is increasing to a level similar to that of sevoflurane. Inhalational anesthesia generally activates and represses the expression of genes related to xenobiotic metabolism and immune response, respectively. However, there has been no comprehensive comparison of the effects of sevoflurane and desflurane on the expression of these genes. Thus, we used a next-generation sequencing method to compare alterations in the global gene expression profiles in the livers of rats subjected to inhalational anesthesia by sevoflurane or desflurane. Our bioinformatics analyses revealed that sevoflurane and, to a greater extent, desflurane significantly activated genes related to xenobiotic metabolism. Our analyses also revealed that both anesthetic agents, especially sevoflurane, downregulated many genes related to immune response.
Topics: Animals; Rats; Sevoflurane; Desflurane; Isoflurane; Methyl Ethers; Transcriptome; Xenobiotics; Anesthetics, Inhalation; Anesthesia, Inhalation
PubMed: 38547201
DOI: 10.1371/journal.pone.0298264 -
Minerva Anestesiologica Mar 2024Anesthesia contributes significantly to a hospital's carbon footprint. Climate-smart actions have the potential to reduce greenhouse gas emissions. Prerequisites for...
BACKGROUND
Anesthesia contributes significantly to a hospital's carbon footprint. Climate-smart actions have the potential to reduce greenhouse gas emissions. Prerequisites for sustainable behavior of providers are knowledge and awareness. We aimed to assess the change in anesthesiologists' climate-friendly behavior before and after educational interventions in three areas that every anesthesiologist can address in their daily clinical routine: 1) energy use; 2) recycling opportunities; 3) consumption of volatile anesthetics.
METHODS
We performed a cross-sectional before-and-after single center sub-study within the multicenter "Provider Education and Evaluation Project" at the Department of Anesthesiology, RWTH Aachen University hospital from May3 2021 to May 1 2022. Educational interventions consisted of stickers, posters and a presentation on climate-smart actions in anesthesiologists' work routine between the first and the second assessment. For each cross-sectional assessment, all central 28 ORs were observed for one week. During the before-and-after comparison we analyzed: 1) energy wasted in unoccupied ORs because of running computers and turned-on lights at 9 p.m.; 2) feasibility of recycling preoperative anesthesia plastic packaging by determining the difference between calculated weight of unseparated preoperative plastic waste in the first assessment and the weight of actual separated waste in the second assessment; 3) fresh gas flow in balanced anesthesia cases in steady state at 9 a.m., and purchased hypnotics converted to bottles/1000 general anesthesia cases in 2018-2022.
RESULTS
We observed a reduction of wasted energy by 44% in unoccupied ORs. Usage of low fresh gas flow settings increased from 55% to 75%. The average of purchased desflurane in 2018-2020 decreased by 72% in 2022. We calculated 10.33 kg of preoperative plastic waste per week but were unable to implement waste separation for infrastructural and logistical reasons.
CONCLUSIONS
We found that environment-friendly working behaviors increased after the implementation of educational interventions. The causality between the interventions and the observed improvements remains to be proven.
Topics: Humans; Cross-Sectional Studies; Anesthesia, General; Anesthesiologists; Drug Packaging; Educational Status
PubMed: 38535970
DOI: 10.23736/S0375-9393.23.17767-4 -
Heliyon Mar 2024Anesthesia is regarded as an important milestone in medicine. However, the negative effect on memory and learning has been observed. In addition, the impact of...
Anesthesia is regarded as an important milestone in medicine. However, the negative effect on memory and learning has been observed. In addition, the impact of anesthetics on postoperative cognitive functions is still discussed. In this work, experiment simulating a general anesthesia and ICU sedation was designed to assess the impact of two intravenous (midazolam, dexmedetomidine) and two inhalational (isoflurane, desflurane) agents on neuronal centers for cognition (neocortex), learning, and memory (hippocampus). More than 3600 proteins were quantified across both neocortex and hippocampus. Proteomic study revealed relatively mild effects of anesthetics, nevertheless, protein dysregulation uncovered possible different effect of isoflurane (and midazolam) compared to desflurane (and dexmedetomidine) to neocortical and hippocampal proteins. Isoflurane induced the upregulation of hippocampal NMDAR and other proteins of postsynaptic density and downregulation of GABA signaling, whereas desflurane and dexmedetomidine rather targeted mitochondrial VDAC isoforms and protein regulating apoptotic activity.
PubMed: 38509933
DOI: 10.1016/j.heliyon.2024.e27638 -
Cureus Feb 2024Volatile anesthetic agents like sevoflurane, isoflurane, and desflurane are widely used for maintaining general anesthesia (GA). Their effect on the autonomic system is...
Effect of Sevoflurane, Isoflurane, and Desflurane on the Random Blood Glucose Levels in Non-diabetic Patients Undergoing General Anesthesia: A Randomized, Single-Blind Study.
BACKGROUND
Volatile anesthetic agents like sevoflurane, isoflurane, and desflurane are widely used for maintaining general anesthesia (GA). Their effect on the autonomic system is different and can impact the blood sugar homeostasis. This study compares the intraoperative blood glucose levels in non-diabetic patients undergoing non-cardiac surgery under GA with the three volatile agents.
METHODS
A randomized, single-blind, parallel-arm study recruited 105 non-diabetic patients into three groups. GA induction and maintenance were standardized except for the volatile agent. Capillary blood sugar levels were measured at different time points and compared between and within the groups. A p-value of <0.05 was considered significant.
RESULTS
Entire participants completed the study, and their baseline characteristics were statistically indifferent. Intraoperative blood glucose rise and variation were the highest in the desflurane group and the lowest in the isoflurane group; the differences were statistically significant at 15, 30, and 45 minutes. The highest blood sugar level was noted at 60 minutes in all groups; after that, the level started falling. However, none of the raises were beyond 140 mg% to categorize them as hyperglycemia.
CONCLUSION
Intraoperative glycemic variation was evident with isoflurane, sevoflurane, and desflurane. The maximum increase from the pre-induction level was noted at 60 minutes. However, none of the readings reached the hyperglycemia level. The rise was significantly higher in desflurane-based anesthesia than in isoflurane. This study was, however, conducted in non-diabetic patients; hence, results might not be extrapolated to diabetic patients.
PubMed: 38496133
DOI: 10.7759/cureus.54216 -
Cureus Feb 2024In this systematic review, the perioperative outcomes of total intravenous anesthesia (TIVA) and volatile anesthesia were compared in obese adults (BMI ≥ 30 kg/m²)... (Review)
Review
In this systematic review, the perioperative outcomes of total intravenous anesthesia (TIVA) and volatile anesthesia were compared in obese adults (BMI ≥ 30 kg/m²) undergoing elective surgery. The review analyzed data from 12 randomized-controlled trials involving 935 patients, sourced from PubMed/MEDLINE (Medical Literature Analysis and Retrieval System Online), Cochrane, Scopus, and Web of Science databases. The focus was on intraoperative vital signs, emergence time, postoperative nausea and vomiting (PONV), duration of post-anesthesia care unit (PACU) stay, and ICU admission rates. Findings showed that TIVA (using propofol) might reduce PONV, but there were no significant differences in other outcomes compared to volatile anesthesia (with desflurane as the most common agent). The review highlights the need for more research, especially comparing sevoflurane with TIVA, to establish clear clinical guidelines for anesthesia in obese patients.
PubMed: 38487133
DOI: 10.7759/cureus.54094 -
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