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The Eurasian Journal of Medicine Oct 2023In children, neuromuscular blockers may have different effects with various inhalation agents and incomplete reversal of the blockade continues to be a problem. The aim...
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.
PubMed: 37909186
DOI: 10.5152/eurasianjmed.2022.22090 -
Cells Oct 2023Cerebral injury is a leading cause of long-term disability and mortality. Common causes include major cardiovascular events, such as cardiac arrest, ischemic stroke, and... (Review)
Review
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.
Topics: Humans; Neuroprotection; Noble Gases; Gases; Neuroprotective Agents; Brain Injuries; Neurons
PubMed: 37887324
DOI: 10.3390/cells12202480 -
Diseases (Basel, Switzerland) Sep 2023Delayed cerebral ischemia (DCI) is an important contributor to poor outcomes in aneurysmal subarachnoid hemorrhage (SAH) patients. We previously showed that volatile...
Delayed cerebral ischemia (DCI) is an important contributor to poor outcomes in aneurysmal subarachnoid hemorrhage (SAH) patients. We previously showed that volatile anesthetics such as isoflurane, sevoflurane and desflurane provided robust protection against SAH-induced DCI, but the impact of a more commonly used intravenous anesthetic agent, propofol, is not known. The goal of our current study is to examine the neurovascular protective effects of propofol on SAH-induced DCI. Twelve-week-old male wild-type mice were utilized for the study. Mice underwent endovascular perforation SAH or sham surgery followed one hour later by propofol infusion through the internal jugular vein (2 mg/kg/min continuous intravenous infusion). Large artery vasospasm was assessed three days after SAH. Neurological outcome assessment was performed at baseline and then daily until animal sacrifice. Statistical analysis was performed via one-way ANOVA and two-way repeated measures ANOVA followed by the Newman-Keuls multiple comparison test with significance set at < 0.05. Intravenous propofol did not provide any protection against large artery vasospasm or sensory-motor neurological deficits induced by SAH. Our data show that propofol did not afford significant protection against SAH-induced DCI. These results are consistent with recent clinical studies that suggest that the neurovascular protection afforded by anesthetic conditioning is critically dependent on the class of anesthetic agent.
PubMed: 37873774
DOI: 10.3390/diseases11040130 -
Cancers Sep 2023Considerable individual differences are widely observed in the incidence of postoperative nausea and vomiting (PONV). We conducted a genome-wide association study (GWAS)...
Considerable individual differences are widely observed in the incidence of postoperative nausea and vomiting (PONV). We conducted a genome-wide association study (GWAS) to identify potential candidate single-nucleotide polymorphisms (SNPs) that contribute to PONV by utilizing whole-genome genotyping arrays with more than 950,000 markers. The subjects were 806 patients who provided written informed consent and underwent elective surgery under general anesthesia with propofol or desflurane. The GWAS showed that two SNPs, rs2776262 and rs140703637, in the and gene regions, respectively, were significantly associated with the frequency of nausea. In another GWAS conducted only on patients who received propofol, rs7212072 and rs12444143 SNPs in the and gene regions, respectively, were significantly associated with the frequency of nausea as well as the rs2776262 SNP, and the rs45574836 and rs1752136 SNPs in the and gene regions, respectively, were significantly associated with vomiting. Among these SNPs, clinical and SNP data were available for the rs45574836 SNP in independent subjects who underwent laparoscopic gynecological surgery, and the association was replicated in these subjects. These results indicate that these SNPs could serve as markers that predict the vulnerability to PONV. Our findings may provide valuable information for achieving satisfactory prophylactic treatment for PONV.
PubMed: 37835423
DOI: 10.3390/cancers15194729 -
Journal of Clinical Medicine Oct 2023Brain injured patients often need deep sedation to prevent or treat increased intracranial pressure. The mainly used IV sedatives have side effects and/or high...
Brain injured patients often need deep sedation to prevent or treat increased intracranial pressure. The mainly used IV sedatives have side effects and/or high context-sensitive half-lives, limiting their use. Inhalative sedatives have comparatively minor side effects and a brief context-sensitive half-life. Despite the theoretical advantages, evidence in this patient group is lacking. A Germany-wide survey with 21 questions was conducted to find out how widespread the use of inhaled sedation is. An invitation for the survey was sent to 226 leaders of intensive care units (ICU) treating patients with brain injury as listed by the German Society for Neurointensive Care. Eighty-nine participants answered the questionnaire, but not all items were responded to, which resulted in different absolute counts. Most of them (88%) were university or high-level hospital ICU leaders and (67%) were leaders of specialized neuro-ICUs. Of these, 53/81 (65%) use inhalative sedation, and of the remaining 28, 17 reported interest in using this kind of sedation. Isoflurane is used by 43/53 (81%), sevoflurane by 15/53 (28%), and desflurane by 2. Hypotension and mydriasis are the most common reported side effects (25%). The presented survey showed that inhalative sedatives were used in a significant number of intensive care units in Germany to treat severely brain-injured patients.
PubMed: 37835045
DOI: 10.3390/jcm12196401 -
Proceedings (Baylor University. Medical... 2023This retrospective analysis of prospectively collected data from the PROPPR study describes volatile anesthetic use in severely injured trauma patients undergoing...
BACKGROUND
This retrospective analysis of prospectively collected data from the PROPPR study describes volatile anesthetic use in severely injured trauma patients undergoing anesthesia.
METHODS
After exclusions, 402 subjects were reviewed of the original 680, and 292 had complete data available for analysis. Anesthesia was not protocolized, so analysis was of contemporary practice.
RESULTS
The small group who received no volatile anesthetic (n = 25) had greater injury burden (Glasgow Coma Scale = 0.05, Injury Severity Score = 0.001, Revised Trauma Score = 0.03), higher 6- and 24-hour mortality ( < 0.001), and higher incidence of systemic inflammatory response syndrome ( = 0.003) and ventilator-associated pneumonia ( = 0.02) than those receiving any volatile (n = 267). There were no differences in mortality volatile agents at 6 hours ( = 0.51) or 24 hours ( = 0.35). The desflurane group was less severely injured than the isoflurane group. Mean minimum alveolar concentration was < 0.6 and lowest in the isoflurane group compared to the sevoflurane and desflurane groups (both < 0.01). The incidence of systemic inflammatory response syndrome was lower in the desflurane group than in the isoflurane group ( = 0.007).
CONCLUSION
In this acutely injured trauma population, choice of volatile anesthetic did not appear to influence short-term mortality and morbidity. Subjects who received no volatile were more severely injured with greater mortality, representing hemodynamic compromise where volatile agent was limited until stable. As anesthetic was not protocolized, these findings that choice of specific volatile was not associated with short-term survival require prospective, randomized evaluation.
PubMed: 37829226
DOI: 10.1080/08998280.2023.2243204 -
Journal of Perianesthesia Nursing :... Feb 2024Anesthesia has been shown to disrupt the circadian rhythm. Recovery of the circadian rhythm after general anesthesia might help alleviate symptoms of insomnia and... (Randomized Controlled Trial)
Randomized Controlled Trial
Comparison of the Effects of Desflurane and Sevoflurane on Variations in Salivary Melatonin and Sleep Disturbance After Total Knee Arthroplasty: A Single-center, Prospective, Randomized, Controlled, Open-label Study.
PURPOSE
Anesthesia has been shown to disrupt the circadian rhythm. Recovery of the circadian rhythm after general anesthesia might help alleviate symptoms of insomnia and postoperative delirium. We hypothesized that recovery of the circadian rhythm is faster after total knee arthroplasty (TKA) with desflurane than with sevoflurane. This study compared the influence of sevoflurane versus desflurane anesthesia on the postoperative circadian rhythm of melatonin in adults undergoing TKA.
DESIGN
Single-center, prospective, randomized, controlled, open-label study.
METHODS
This study involved adult patients undergoing TKA at a university hospital in Japan from May 1, 2018 to December 31, 2019. The primary outcome of the study was the comparison of the effect of sevoflurane and desflurane on the circadian rhythm of salivary melatonin for 3 days postoperatively. The secondary outcomes were postoperative fatigue and sleep quality for 3 days postoperatively.
FINDINGS
Twenty-eight patients (American Society of Anesthesiologists physical status of I or II) were scheduled for TKA and randomized to receive sevoflurane (n = 14) or desflurane (n = 14) anesthesia. There was no significant difference in the melatonin concentration between the sevoflurane and desflurane groups. The salivary melatonin concentration after sevoflurane or desflurane anesthesia was significantly higher at 9:00 p.m. on a postoperative day (POD)0 and POD1 than on POD3 (P < .05). Patients in the desflurane group had significantly greater fatigue than those in the sevoflurane group at 7:00 a.m. and 12:00 p.m. on POD3 (P < .05). Patients in the sevoflurane group had a deeper sleep than those in the desflurane group on POD0 (P < .05). In the sevoflurane group, the sleep time during the night of POD2 was longer than that on POD0 (6.1 vs 4.2 hours, P < .05).
CONCLUSIONS
Under the current study conditions, desflurane was equivalent to sevoflurane in terms of the postoperative salivary melatonin concentration and sleep disturbance after TKA but not in terms of recovering the postoperative circadian rhythm.
Topics: Adult; Humans; Anesthetics, Inhalation; Arthroplasty, Replacement, Knee; Desflurane; Melatonin; Prospective Studies; Sevoflurane; Sleep Wake Disorders; Saliva
PubMed: 37791946
DOI: 10.1016/j.jopan.2023.07.007 -
Cureus Aug 2023The Western world has been polio-free for decades; however, many are affected by the stigmata of polio in several countries, including India. While general anesthesia...
The Western world has been polio-free for decades; however, many are affected by the stigmata of polio in several countries, including India. While general anesthesia (GA) and subarachnoid block (SAB) have been used successfully and widely, all those cases were mostly done with relatively older drugs and without additives. Therefore, further literature is needed to note the effect of newer anesthetic agents on post-polio paralytic patients for both GA, viz., propofol, fentanyl, rocuronium, and desflurane, and SAB with intrathecal hyperbaric bupivacaine and adjuvants. We report three male cases from Central India, in their 40s, with post-polio residual paralysis (PPRP), sarcopenia, and deformity of the lower limb and scoliosis; one case was managed under GA using desflurane-based low-flow anesthesia technique, and the other two under SAB, one with intrathecal fentanyl as an adjuvant to bupivacaine and the other without an adjuvant. The case series describes the effect of these modern-day anesthetic drugs and techniques.
PubMed: 37746429
DOI: 10.7759/cureus.43913 -
Journal of Pharmacy & Bioallied Sciences Jul 2023Sevoflurane and desflurane virtually equally dissolve in blood gases, yet current research suggests that desflurane helps in a quick return of airway reflex than...
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 < 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 ( = 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, = 0.008 and (14.094.30 vs. 9.824.50 min, 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.
PubMed: 37654338
DOI: 10.4103/jpbs.jpbs_497_22 -
Anesthesiology Dec 2023Processed electroencephalography (EEG) is used to monitor the level of anesthesia, and it has shown the potential to predict the occurrence of delirium. While emergence...
BACKGROUND
Processed electroencephalography (EEG) is used to monitor the level of anesthesia, and it has shown the potential to predict the occurrence of delirium. While emergence trajectories of relative EEG band power identified post hoc show promising results in predicting a risk for a delirium, they are not easily transferable into an online predictive application. This article describes a low-resource and easily applicable method to differentiate between patients at high risk and low risk for delirium, with patients at low risk expected to show decreasing EEG power during emergence.
METHODS
This study includes data from 169 patients (median age, 61 yr [49, 73]) who underwent surgery with general anesthesia maintained with propofol, sevoflurane, or desflurane. The data were derived from a previously published study. The investigators chose a single frontal channel, calculated the total and spectral band power from the EEG and calculated a linear regression model to observe the parameters' change during anesthesia emergence, described as slope. The slope of total power and single band power was correlated with the occurrence of delirium.
RESULTS
Of 169 patients, 32 (19%) showed delirium. Patients whose total EEG power diminished the most during emergence were less likely to screen positive for delirium in the postanesthesia care unit. A positive slope in total power and band power evaluated by using a regression model was associated with a higher risk ratio (total, 2.83 [95% CI, 1.46 to 5.51]; alpha/beta band, 7.79 [95% CI, 2.24 to 27.09]) for delirium. Furthermore, a negative slope in multiple bands during emergence was specific for patients without delirium and allowed definition of a test for patients at low risk.
CONCLUSIONS
This study developed an easily applicable exploratory method to analyze a single frontal EEG channel and to identify patterns specific for patients at low risk for delirium.
Topics: Humans; Middle Aged; Anesthesia Recovery Period; Anesthesia, General; Delirium; Propofol; Sevoflurane; Electroencephalography
PubMed: 37616326
DOI: 10.1097/ALN.0000000000004754