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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 -
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 Review For Medical and... Feb 2024This study aims to evaluate the effects of total intravenous anesthesia (propofol), volatile anesthesia (desflurane), and spinal anesthesia on intraocular pressure (IOP)... (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVE
This study aims to evaluate the effects of total intravenous anesthesia (propofol), volatile anesthesia (desflurane), and spinal anesthesia on intraocular pressure (IOP) during lumbar disc herniation surgery in the prone position.
PATIENTS AND METHODS
This randomized controlled trial was conducted between January 2022 and January 2023. The study included 75 patients with lumbar disc herniation between the ages of 18-75, with the American Society of Anesthesiologists (ASA) 1-2. The patients were randomly divided into 3 groups: propofol, desflurane, and spinal. IOP was measured at 5-time points throughout surgery, including baseline (T1), 10 minutes after anesthesia (T2), 10 minutes after prone positioning (T3: early prone), 30 minutes after prone positioning (T4: late prone), and 10 minutes after returning to the supine position (T5). Hemodynamic parameters were measured at these time points. Hemoglobin and hematocrit values were measured preoperatively and on the first postoperative day.
RESULTS
There were 25 patients in each group. The groups were similar in terms of all characteristics except for weight and body mass index, which were lower in the spinal group. Propofol recipients had significantly higher T3 (prone) IOP compared to desflurane recipients (p = 0.001). We found no significant differences between groups in terms of T1, T2, T4, and T5 IOP. Multivariable linear regression revealed that diabetes mellitus (p = 0.016) and high T1 IOP (p = 0.001) were independently associated with higher T3 IOP. In addition, we found that the desflurane (p < 0.001) and spinal (p = 0.002) groups had significantly lower T3 IOP compared to propofol recipients after adjusting for diabetes mellitus and T1 IOP.
CONCLUSIONS
Our findings suggest that volatile anesthesia (desflurane) and spinal anesthesia are linked to lower IOP in the prone position among patients undergoing spinal surgery, in comparison to those receiving total intravenous anesthesia. There is a need to test the results with more comprehensive, population-based studies in different patient groups. ClinicalTrials gov ID: NCT06070480.
Topics: Humans; Adolescent; Young Adult; Adult; Middle Aged; Aged; Intraocular Pressure; Anesthesia, Spinal; Desflurane; Propofol; Intervertebral Disc Displacement; Eye Diseases; Diabetes Mellitus
PubMed: 38436174
DOI: 10.26355/eurrev_202402_35462 -
Medicine Mar 2024Environmental concerns, especially global warming, have prompted efforts to reduce greenhouse gas emissions. Healthcare systems, including anesthesia practices,...
Environmental concerns, especially global warming, have prompted efforts to reduce greenhouse gas emissions. Healthcare systems, including anesthesia practices, contribute to these emissions. Inhalation anesthetics have a significant environmental impact, with desflurane being the most concerning because of its high global warming potential. This study aimed to educate anesthesiologists on the environmental impact of inhalation anesthetics and assess changes in awareness and practice patterns, specifically reducing desflurane use. This study included data from patients who underwent surgery under general anesthesia 1 month before and after education on the effects of inhalation anesthetics on global warming. The primary endpoint was a change in inhalational anesthetic use. Secondary endpoints included changes in carbon dioxide equivalent (CO2e) emissions, driving equivalent, and medical costs. After the education, desflurane use decreased by 50%, whereas sevoflurane use increased by 50%. This shift resulted in a reduction in the overall amount of inhalational anesthetics used. The total CO2e and driving-equivalent values decreased significantly. The cost per anesthesia case decreased, albeit to a lesser extent than expected. Education on the environmental impact of inhalation anesthetics has successfully altered anesthesiologists' practice patterns, leading to reduced desflurane usage. This change has resulted in decreased CO2e emissions and has had a positive effect on mitigating global warming. However, further research is required to assess the long-term impact of such education and the variability in practice patterns across different institutions.
Topics: Humans; Anesthetics, Inhalation; Desflurane; Retrospective Studies; Global Warming; Carbon Footprint; Isoflurane; Operating Rooms
PubMed: 38428851
DOI: 10.1097/MD.0000000000037256 -
Die Anaesthesiologie Apr 2024Anesthesiology has a relevant carbon footprint, mainly due to volatile anesthetics (scope 1 emissions). Additionally, energy used in the operating theater (scope...
BACKGROUND
Anesthesiology has a relevant carbon footprint, mainly due to volatile anesthetics (scope 1 emissions). Additionally, energy used in the operating theater (scope 2 emissions) contributes to anesthesia-related greenhouse gas (GHG) emissions.
OBJECTIVES
Optimizing the electricity use of medical devices might reduce both GHG emissions and costs might hold potential to reduce anaesthesia-related GHG-emissions and costs. We analyzed the electricity consumption of six different anesthesia workstations, calculated their GHG emissions and electricity costs and investigated the potential to reduce emissions and cost by using the devices in a more efficient way.
METHODS
Power consumption (active power in watt , W) was measured with the devices off, in standby mode, or fully on with the measuring instrument SecuLife ST. Devices studied were: Dräger Primus, Löwenstein Medical LeonPlus, Getinge Flow C, Getinge Flow E, GE Carestation 750 and GE Aisys. Calculations of GHG emissions were made with different emission factors, ranging from very low (0.09 kg CO-equivalent/kWh) to very high (0.660 kg CO-equivalent/kWh). Calculations of electricity cost were made assuming a price of 0.25 € per kWh.
RESULTS
Power consumption during operation varied from 58 W (GE CareStation 750) to 136 W (Dräger Primus). In standby, the devices consumed between 88% and 93% of the electricity needed during use. The annual electricity consumption to run 96 devices in a large clinical department ranges between 45 and 105 Megawatt-hours (MWh) when the devices are left in standby during off hours. If 80% of the devices are switched off during off hours, between 20 and 46 MWh can be saved per year in a single institution. At the average emission factor of our hospital, this electricity saving corresponds to a reduction of GHG emissions between 8.5 and 19.8 tons CO-equivalent. At the assumed prices, a cost reduction between 5000 € and 11,600 € could be achieved by this intervention.
CONCLUSION
The power consumption varies considerably between the different types of anesthesia workstations. All devices exhibit a high electricity consumption in standby mode. Avoiding standby mode during off hours can save energy and thus GHG emissions and cost. The reductions in GHG emissions and electricity cost that can be achieved with this intervention in a large anesthesiology department are modest. Compared with GHG emissions generated by volatile anesthetics, particularly desflurane, optimization of electricity consumption of anesthesia workstations holds a much smaller potential to reduce the carbon footprint of anesthesia; however, as switching off anesthesia workstations overnight is relatively effortless, this behavioral change should be encouraged from both an ecological and economical point of view.
Topics: Carbon Dioxide; Greenhouse Gases; Electricity; Anesthesia; Anesthetics
PubMed: 38349537
DOI: 10.1007/s00101-024-01388-3