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Veterinarni Medicina Nov 2023Malignant hyperthermia (MH) is a clinical syndrome exhibiting elevation of expired carbon dioxide, hyperthermia, muscle rigidity, rhabdomyolysis, acidosis and...
Malignant hyperthermia (MH) is a clinical syndrome exhibiting elevation of expired carbon dioxide, hyperthermia, muscle rigidity, rhabdomyolysis, acidosis and hyperkalaemia, as well as cardiac dysrhythmia and renal failure. The syndrome manifests itself as a response to anaesthetic agents, such as e.g., halothane, desflurane, and succinylcholine. Depending on the animal species, MH is characterised by autosomal dominant or recessive inheritance, and so far two genes have been identified whose mutations can be linked to MH: and . In different species, various mutations of the gene have been described which may underlie MH. One of these mutations in dogs is T1640C, which results in the substitution of alanine for valine of the amino acid 547 (V547A) in the RYR1 protein. In our work, we aimed to investigate MH at the DNA level by identifying the T1640C mutation in a group of 50 dogs. For this purpose we used the PCR-RFLP technique, and in six dogs also direct sequencing of PCR products and subsequent comparison of their sequences with the RYR1 gene sequence in an online database. The results of our study show that none of the dogs analysed had any mutant allele of the RYR1 gene, indicating that none should be affected by MH.
PubMed: 38163044
DOI: 10.17221/46/2023-VETMED -
Asian Journal of Neurosurgery Dec 2023The choice of inhalational or intravenous anesthetic agents is debatable in neurosurgical patients. Desflurane, a cerebral vasodilator, may be advantageous in...
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. 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. The normality of quantitative data was checked using Kolmogorov-Smirnov tests of normality. Normally distributed data were compared using unpaired -tests, skewed data using Mann-Whitney U tests, and categorical variables using chi-squared tests. 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, = 0.450) and GOS-E (6.7 ± 0.6 and 6.85 ± 0.5, = 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, = 0.001), with a significant number of patients requiring rescue measures in the desflurane group (70%, < 0.001). Other outcome parameters were comparable ( > 0.05). 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.
PubMed: 38161613
DOI: 10.1055/s-0043-1775588 -
Journal of Clinical Anesthesia May 2024Intraoperative electroencephalogram (EEG) patterns associated with postoperative delirium (POD) development have been studied, but the differences in EEG recordings...
STUDY OBJECTIVE
Intraoperative electroencephalogram (EEG) patterns associated with postoperative delirium (POD) development have been studied, but the differences in EEG recordings between sevoflurane- and desflurane-induced anesthesia have not been clarified. We aimed to distinguish the EEG characteristics of sevoflurane and desflurane in relation to POD development.
DESIGN AND PATIENTS
We collected frontal four-channel EEG data during the maintenance of anesthesia from 148 elderly patients who received sevoflurane (n = 77) or desflurane (n = 71); 30 patients were diagnosed with delirium postoperatively. The patients were divided into four subgroups based on anesthetics and delirium status: sevoflurane delirium (n = 17), sevoflurane non-delirium (n = 60), desflurane delirium (n = 13), and desflurane non-delirium (n = 58). We compared spectral power, coherence, and pairwise phase consistency (PPC) between sevoflurane and desflurane, and between non-delirium and delirium groups for each anesthetic.
MAIN RESULTS
In patients without POD, the sevoflurane non-delirium group exhibited higher EEG spectral power across 8.5-35 Hz (99.5% CI bootstrap analysis) and higher PPC from alpha to gamma bands (p < 0.005) compared to the desflurane non-delirium group. Conversely, in patients with POD, no significant EEG differences were observed between the sevoflurane and desflurane delirium groups. For the sevoflurane-induced patients, the sevoflurane delirium group had significantly lower power within 7.5-31.5 Hz (99.5% CI bootstrap analysis), reduced coherence over 8.9-23.8 Hz (99.5% CI bootstrap analysis), and lower PPC values in the alpha band (p < 0.005) compared with the sevoflurane non-delirium group. For the desflurane-induced patients, there were no significant differences in the EEG patterns between delirium and non-delirium groups.
CONCLUSIONS
In normal patients without POD, sevoflurane demonstrates a higher power spectrum and prefrontal connectivity than desflurane. Furthermore, reduced frontal alpha power, coherence, and connectivity of intraoperative EEG could be associated with an increased risk of POD. These intraoperative EEG characteristics associated with POD are more noticeable in sevoflurane-induced anesthesia than in desflurane-induced anesthesia.
Topics: Humans; Aged; Sevoflurane; Desflurane; Anesthetics, Inhalation; Emergence Delirium; Isoflurane; Methyl Ethers; Electroencephalography
PubMed: 38157663
DOI: 10.1016/j.jclinane.2023.111368 -
British Journal of Anaesthesia Dec 2023
PubMed: 38114356
DOI: 10.1016/j.bja.2023.11.044 -
Journal of Anesthesia Feb 2024Various basic and clinical studies have investigated the association between the types of anesthetic agents and prognosis. However, the results have varied among studies... (Observational Study)
Observational Study
The association between intraoperative anesthesia methods used during gastric cancer surgery and long-term mortality: A retrospective observational study using a Japanese claims database.
PURPOSE
Various basic and clinical studies have investigated the association between the types of anesthetic agents and prognosis. However, the results have varied among studies and remain controversial. In the present study, we aimed to investigate whether the risk of all-cause mortality differs between inhaled or intravenous anesthetics in patients with gastric cancer undergoing gastrectomy.
METHODS
Using a Japanese nationwide insurance claims database, we analyzed patients who underwent gastrectomy under general anesthesia for gastric cancer between January 2005 and September 2019. Postoperative outcomes were compared between two groups: those who received inhaled anesthetics (Sevoflurane, Isoflurane, or Desflurane) and those who received intravenous anesthetics (propofol), using a multivariable Cox proportional hazards model. The primary outcome was overall survival.
RESULTS
Among 2671 eligible patients, 2105 were in the inhaled anesthetic group, and 566 were in the intravenous anesthetic group. The median (interquartile range) age was 58 (51-63) years, and 1979 (74.1%) were men. The median follow-up period was 795 days. We identified 56 (2.7%) and 16 (2.8%) deaths during the follow-up period in the inhaled and intravenous anesthetic use groups, respectively. There was no difference in postoperative overall survival between the two groups (hazard ratio, 0.97; 95% confidence interval, 0.56-1.70; P = 0.93).
CONCLUSIONS
We found no significant difference in the postoperative risks of overall survival between inhaled and intravenous anesthesia in patients with gastric cancer undergoing gastrectomy.
Topics: Female; Humans; Male; Middle Aged; Anesthesia, Intravenous; Anesthetics, Inhalation; Anesthetics, Intravenous; Desflurane; Japan; Propofol; Stomach Neoplasms; Retrospective Studies
PubMed: 38102529
DOI: 10.1007/s00540-023-03288-z -
Pediatric Quality & Safety 2023The emission and entrapment of greenhouse gases (GHG) inside the atmosphere is one of the leading causes of global warming. Commonly administered anesthetics have global...
BACKGROUND
The emission and entrapment of greenhouse gases (GHG) inside the atmosphere is one of the leading causes of global warming. Commonly administered anesthetics have global warming potential up to 2,000 times greater than carbon dioxide. This Quality Improvement (QI) initiative aimed to develop a set of sustainability standards to reduce volatile anesthetic GHG emissions and costs at a children's hospital.
METHODS
In January 2020, the QI project team implemented education sessions for clinical staff on the environmental impact of volatile anesthetics, bedside clinical reminders, resource guides on sustainable anesthesia practices, preset low-flow gas levels on anesthesia machines, relocated and reduced the number of available vaporizers, and implemented policies to standardize clinical practice. Using hospital pharmacy purchase order data between 2018 and 2022, GHG emissions and costs from three commonly used volatile anesthetics (Isoflurane, Sevoflurane, and Desflurane) were compared using metric ton carbon dioxide equivalents.
RESULTS
During 3 years, GHG emissions from volatile anesthetics were significantly reduced by 77%, with most of the reduction attributed to the reduced use and eventual elimination of Desflurane. Purchase costs were also significantly reduced during this period by 41%.
CONCLUSIONS
This QI project successfully decreased GHG emissions over 3 years by simultaneously reducing the use of costly and environmentally harmful volatile anesthetic, Desflurane, and increasing the use of low-flow anesthesia. This study addresses our anesthesia practices and healthcare system's impact on the pediatric population and proposes simple interventions to mitigate the negative consequences of current practices.
PubMed: 38089832
DOI: 10.1097/pq9.0000000000000708 -
Frontiers in Veterinary Science 2023Never has the anatomy, the procedure of the transversus abdominis plane (TAP) block, or the perioperative analgesic effects of a bupivacaine TAP block been described in...
INTRODUCTION
Never has the anatomy, the procedure of the transversus abdominis plane (TAP) block, or the perioperative analgesic effects of a bupivacaine TAP block been described in goats.
METHODS
This report details the relevant anatomy in a cadaveric study combined with the description/use of a TAP block in a controlled, randomized, prospective, blinded clinical study in which 20 goats with urolithiasis presenting for either ventral midline or paramedian celiotomy were enrolled. Anesthesia was induced with ketamine and midazolam and maintained with desflurane in oxygen. An ultrasound-guided TAP block was performed using 0.25% bupivacaine (4 sites, 0.4 mL/kg each site) (bupivacaine-TAP, = 10) or equal volume of saline (control-TAP, = 10). When indicated, urethral amputation was performed followed by celiotomy with cystotomy or tube cystostomy. Urethrotomy was performed if warranted. Intraoperatively, a 20% increase in mean arterial pressure (MAP), heart rate (HR) and/or respiratory frequency was treated with an increase in desflurane concentration of 0.5 Vol.%. Goats received ketamine boluses (0.2 mg/kg IV) when moving spontaneously. At 2, 12, and 24 h post-extubation, pain was scored with a descriptive scale. Data were analyzed with an analysis of variance (ANOVA) or the Wilcoxon signed-rank test, and < 0.05 was considered statistically significant.
RESULTS
Bupivacaine-TAP goats exhibited lower end-tidal desflurane concentration requirements ( = 0.03), lower pain scores at 2-h post-extubation ( = 0.02), shorter anesthetic recovery times ( = 0.03) and decreased HR and MAP during surgical stimulation. Goats receiving a bupivacaine TAP block experienced less intraoperative nociceptive input requiring less inhalant anesthetic leading to faster anesthetic recoveries and decreased postoperative pain.
DISCUSSION
Ultrasound-guided TAP block is a simple technique to decrease anesthetic requirement while providing additional postoperative comfort in goats undergoing celiotomy.
PubMed: 38076561
DOI: 10.3389/fvets.2023.1197728 -
Frontiers in Cardiovascular Medicine 2023Studies investigating the cardioprotective effect of volatile anesthetics on cardiac troponins in off-pump coronary artery bypass grafting (OPCAB) surgery remain... (Review)
Review
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 ( < .001). Subgroup analysis showed that patients using sevoflurane had lower postoperative cardiac troponins levels compared to propofol ( = .01). However, desflurane and isoflurane currently have no significant advantage over propofol (all > 0.05). There was no significant difference in postoperative mechanical ventilation time, length of ICU stay, and mortality between the two groups (all > 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).
PubMed: 38034375
DOI: 10.3389/fcvm.2023.1271557 -
Medicine Nov 2023Angiotensin II receptor blockers (ARBs) are currently considered first-line antihypertensive drugs, effectively inhibiting the renin-angiotensin-aldosterone system....
RATIONALE
Angiotensin II receptor blockers (ARBs) are currently considered first-line antihypertensive drugs, effectively inhibiting the renin-angiotensin-aldosterone system. However, ARBs have been associated with intraoperative hypotension during general anesthesia. Although it is recommended to discontinue ARBs for 24 hours before surgery, the optimal duration of discontinuation remains unclear. We present a severe refractory hypotension encountered during general anesthesia despite discontinuing ARBs for 48 hours before anesthesia.
PATIENT CONCERNS
A severe refractory hypotension occurred during the induction of general anesthesia for cranioplasty in a 66-year-old male patient (170 cm/75 kg). The patient was taking azilsartan, angiotensin receptor blocker, for hypertension, which was discontinued 48 hours before anesthesia induction. Despite repeated administration of ephedrine and continuous infusion of norepinephrine, hemodynamic instability did not improve. Therefore, the surgery was postponed.
DIAGNOSIS
The patient was diagnosed with angiotensin receptor blocker-induced refractory hypotension.
INTERVENTIONS
Before the second surgery, the angiotensin receptor blocker was discontinued 96 hours prior to the surgery. Invasive blood pressure monitoring was performed before anesthesia induction, and vasopressin was prepared. General anesthesia was induced using remimazolam and maintained with desflurane.
OUTCOMES
The surgery was completed successfully without occurrence of refractory hypotension.
LESSONS
Refractory hypotension induced by Angiotensin receptor blockers can still occur even after discontinuing the medication for 48 hours before induction of general anesthesia. Despite withholding the medication, caution should be practiced regarding hypotension during general anesthesia in patient taking ARBs.
Topics: Male; Humans; Aged; Angiotensin-Converting Enzyme Inhibitors; Angiotensin Receptor Antagonists; Hypotension; Anesthesia, General
PubMed: 38013296
DOI: 10.1097/MD.0000000000036126 -
British Journal of Anaesthesia Nov 2023
PubMed: 37980181
DOI: 10.1016/j.bja.2023.10.026