Desflurane Research Articles

The deleterious impact of exposure to different inhaled anesthetics is time dependent

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.

Propofol-based total intravenous anesthesia is associated with better survival than desflurane anesthesia in limb-salvage surgery for osteosarcoma: A retrospective analysis.

Previous studies have demonstrated that anesthetic techniques can affect the outcomes of cancer surgery. We investigated the association between anesthetic techniques and patient outcomes after elective limb-salvage surgery for osteosarcoma (OS). This was a retrospective cohort study of patients who underwent elective limb-salvage surgery for OS between January 2007 and December 2018. Patients were grouped according to the administration of propofol-based total intravenous anesthesia (TIVA) or desflurane (DES) anesthesia. Kaplan–Meier analysis was performed, and survival curves were constructed from the date of surgery to death. Univariate and multivariate Cox regression models were applied to compare the hazard ratios (HRs) for death after propensity matching. Subgroup analyses were done for postoperative recurrence, metastasis, and tumor–node–metastasis (TNM) staging. A total of 30 patients (17 deaths, 56.7%) who received DES anesthesia and 26 (4 deaths, 15.4%) who received TIVA were eligible for analysis. After propensity matching, 22 patients were included in each group. In the matched analysis, patients who received TIVA had better survival with a HR of 0.30 (95% confidence interval [CI], 0.11–0.81; P = .018). Subgroup analyses also showed significantly better survival in the presence of postoperative metastasis (HR, 0.24; 95% CI, 0.06–0.87; P = .030) and with TNM stage II to III (HR, 0.26; 95% CI, 0.09–0.73; P = .011) in the matched TIVA group. In addition, patients administered with TIVA had lower risks of postoperative recurrence and metastasis than those administered with DES anesthesia in the matched analyses. Propofol-based TIVA was associated with better survival in patients who underwent elective limb-salvage surgery for OS than DES anesthesia. Prospective studies are needed to assess the effects of TIVA on oncological outcomes in patients with OS.

Quality of Recovery of Patients Who Underwent Curative Pancreatectomy: Comparison of Total Intravenous Anesthesia Versus Inhalation Anesthesia Using the QOR-40 Questionnaire.

There has been increasing attention on the subjective recovery of patients undergoing cancer surgery. Total intravenous anesthesia (TIVA) and inhaled anesthesia with volatile anesthetics (INHA) are safe and common anesthetic techniques. Currently, TIVA and INHA have only been compared for less invasive and less complex surgeries. This prospective randomized trial aimed to compare the quality of recovery between TIVA and INHA in patients undergoing pancreatoduodenectomy (PD) or distal pancreatectomy (DP) using the Quality of Recovery (QOR)-40 questionnaire. We enrolled 132 patients who were randomly assigned to either the desflurane (DES) (INHA, balanced anesthesia with DES and remifentanil infusion) or TIVA (effect-site target-controlled infusion of propofol and remifentanil) groups and completed the QOR-40 questionnaire postoperatively. The mean global QOR-40 score on postoperative day 3 was significantly higher in the TIVA group than in the DES group. In the PD group, the total QOR-40 score was significantly higher in the TIVA group than in the DES group. Moreover, the TIVA group had significantly higher scores in the physical comfort and psychological support QOR-40 dimensions than the DES group. TIVA provides better quality of recovery scores on POD 3 for patients undergoing curative pancreatectomy. NCT03447691.

Inhibitory effect of desflurane on degranulation of mast cells induced by lateral ventricular injection of stimulator-C48/80 in C57BL/6 male mice

Inhalation of anesthetic agents have been observed to confer neuroprotection for decades. The present study was intended to determine whether desflurane (DES) prohibits mast cells (MCs) from degranulation induced by lateral ventricular injection (LVC) with Compound 48/80 (C48/80) in C57BL/6. Total 100 mice were recruited to this study, but only 88 male mice (20–24 weeks) were survived from the procedure, and randomized and allocated into four groups: (A) the saline group; (B) the C48/80 group; (C) the sodium cromoglycate (CRO + C48/80) group; (D) 7.5% DES preconditioning for 2 h + C48/80 lateral ventricular injection (DES + C48/80) group. The slices of mice brain thalamus were performed for toluidine blue staining (MCs) and immunochemistry (fluorescence of Iba1 and GFAP, respectively), and brain tissues were extracted to probe IL-6, TNF-α, NF-κB (p65), and TLR4 against GAPDH by western blotting. Our results demonstrated that administration of C48/80 provoked degranulation of mast cells at thalamus, increasing the fluorescence intensities of Iba1 and GFAP, and over-expressing IL-6, TNF-α, NF-κB(p65), and TLR4. However, pre-conditioning inhalation of DES prohibited MCs from degranulation, diminishing the fluorescent intensities of Iba1 and GFAP, decreasing expressed levels of IL-6, TNF-α, NF-κB(p65), as well as TLR4. It suggests inhalation DES could inhibit the neuroinflammation and deactivate glial and astrocytes via direct prohibiting degranulation of MCs at thalamus in the central nervous system (CNS).

Utilization of O/S-doped graphene nanoclusters for ultrasensitive detection of flurane derivatives-DFT investigations

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

Effects of desflurane and sevoflurane anesthesia on postoperative recovery after long-term tumor surgery

Objective: To analyze the effects of desflurane and sevoflurane anesthesia on postoperative recovery after long lasting tumor surgery. Methods: One hundred and sixty patients undergoing endoscopic radical esophagectomy and gastrectomy (80 cases of each surgical type) from November 2019 to March 2020 at Henan Cancer Hospital, were randomized into 4 groups(n=40): group CS (esophageal cancer+sevoflurane anesthesia), group DS (esophageal cancer+desflurane anesthesia),group CW (stomach cancer+sevoflurane anesthesia) and group DW (gastric cancer+desflurane anesthesia). General anesthesia was induced by intravenous agents in all four groups, which were maintained by inhaled anesthetic during the operation. The mean arterial pressure (MAP), heart rate (HR), and surplus pulse O(2) (SpO(2)) immediately before induction (T(1)), the moment of operation begin (T(2)), operation end (T(3)) and extubation (T(4)) were recorded. Also, the duration required for inhalation anesthetic alveolar concentration reaching 0.5 minimum alveolar concentration (MAC) during induction, the alveolar anesthetic concentration at the beginning of the operation, the duration required for XMAC (patients specific alveolar concentration) declining to 0.5 MAC on recovery period, and the duration of alveolar concentration of 0.5 MAC declining to 0.2 MAC were determined. Additionally, the durations of spontaneous breathing recovery, eyes opening, extubation and recovery of consciousness were recorded. Finally, restlessness score (RS) during recovery period was used to evaluate postoperative agitation. Results: Compared with group CS and group CW, no significant differences in MAP, HR, SpO(2) in group DS and group DW at T(1) to T(4) were found (all P>0.05). The durations required for inhalation anesthetic alveolar concentration reaching 0.5 MAC were (5.6±1.3), (5.8±2.1), (3.5±1.5) and (3.8±1.0) min in group CS, group CW, group DS and group DW, where the durations in group DS and group DW were significantly shorter than those in group CS and group CW (F=32.538, P<0.05). The durations of alveolar concentration of 0.5 MAC declining to 0.2 MAC were (6.4±2.2), (7.0±1.5), (4.2±2.2) and (4.1±1.5) min in group CS, group CW, group DS and group DW, and the durations in group DS and group DW were significantly shortened as compared with group CS and group CW (F=42.113, P<0.05). Compared with group CS and group CW, group DS and group DW required significantly shorter time for spontaneous breathing recovery, eye opening,extubation, and directional force recovery after operation (all P<0.05). Conclusions: Both desflurane and sevoflurane anesthesia can achieve satisfactory anesthesia depth during long lasting tumor surgery. Desflurane can shorten the recovery time and early extubation, and improve the quality of recovery.

Comparison of Anesthesia-Controlled Operating Room Time Between Propofol-Based Total Intravenous Anesthesia and Desflurane Anesthesia in Open Liver Resection: A Retrospective Study.

Reducing anesthesia-controlled time (ACT) such as extubation time may improve operation room (OR) efficiency result from different anesthetic techniques. However, the information about the difference in ACT between desflurane (DES) anesthesia and propofol-based total intravenous anesthesia (TIVA) techniques for open liver resection under general anesthesia is not available in the literature. This retrospective study uses our hospital database to analyze the ACT of open liver resection after either DES/fentanyl-based anesthesia or TIVA via target-controlled infusion (TCI) with fentanyl/propofol from January 2010 to December 2011. The various time intervals including waiting for anesthesia time, anesthesia time, surgical time, extubation time, exit from OR after extubation, total OR time, and post-anesthetic care unit stay time and percentage of prolonged extubation (≥ 15 minutes) were compared between the two anesthetic techniques. We included 143 hepatocellular carcinoma patients, with 82 patients receiving TIVA and 61 patients receiving DES. The extubation time was faster (10.1 ± 3.2 min vs. 11.8 ± 5.2 min; P = 0.03), and the incidence of prolonged extubation was lower (9.8% vs. 26.8%; P = 0.02) in the DES group than in the TIVA group. The factors contributed to prolonged extubation were age, sex, anesthetic technique, and anesthesia time. The DES anesthesia provided faster extubation time and lower incidence of prolonged extubation compared with propofol-based TIVA by TCI in elective open liver resection. Besides, older age, male, TIVA, and lengthy anesthesia time were factors affecting prolonged extubation.

Kedi ve Köpeklerde Sezaryen ve Piyometra Operasyonlarında Anestezi Teknikleri

Veteriner doğum ve jinekolojide sıklıkla uygulanan sezaryen ve piyometra operasyonlarında hem hastanın ağrı ve acı hissini ortadan kaldırmak hem de hekim ve yardımcılarının güvenliğini sağlamak amacıyla anestezik maddeler kullanılmaktadır. Sezaryen ve piyometra operasyonlarında yapılan premedikasyon, preoperatif dönemde yapılacak intravenöz kateterizasyon ve oksijenizasyon sırasında annede oluşabilecek stres ve kaygıyı önler. Bununla birlikte dengeli ve etkili bir premedikasyon, indüksiyon için kullanılacak anestezik madde miktarının azalmasına neden olur. İndüksiyon için sedatif-hipnotik (tiyopental, propofol, alfaksalon, etomidat), dissosiyatif (Ketamin HCL) ve inhalasyon ajanlar (izofluran, sevofluran, desfluran) sıklıkla kullanılmaktadır. Gebe hayvanlarda kullanılacak anestezik ve analjezik maddeler fiziko-kimyasal özellikleri nedeniyle etkilerini kan-beyin bariyerini geçerek gösterir. Bu durum anestezik maddelerin, plasental bariyeri de kolayca geçerek fetüs üzerinde olumsuz etkiler görülmesine yol açar. Yavruları etkilemeden sadece anneyi anesteziye alabilecek bir protokol yoktur. Bu nedenle hem anneyi hem de yavruyu en az şekilde etkileyen bir anestezi protokol seçilmelidir. Piyometralı hayvanlarda ise başlıca; böbrek yetmezliği, kardiyak aritmi ve hepatik işlev bozukluğu gözlendiğinden, bu sorunlara karşı uygun anestezi protokolü seçilmelidir. Bu derleme sezaryen ve piyometra operasyonlarına alınacak hastalarda kullanılabilecek güvenli ve etkili anestezik maddeler ve anestezi protokolleri hakkında bilgi vermek amacıyla hazırlanmıştır.

Desflurane Preconditioning Protects Against Renal Ischemia-Reperfusion Injury and Inhibits Inflammation and Oxidative Stress in Rats Through Regulating theNrf2-Keap1-ARE Signaling Pathway.

ObjectiveKidney is sensitive to ischemia–reperfusion (I/R) injury because of its special structure and function. In this study, we aimed to explore the mechanism of desflurane (DFE) preconditioning effecting on renal I/R injury in rats.MethodsRenal I/R injury rats model was constructed, and the expressions of serum renal function parameters (blood urea nitrogen (BUN) and serum creatinine (SCr)) and lipid peroxidation-related factors were detected using corresponding commercial kits to assess the degrees of renal functional damage and oxidative stress. Hematoxylin–-eosin (HE) staining and Masson trichrome staining were applied to measure the renal histologic damage. The expressions of inflammation-related factors were determined by ELISA assay. The cell apoptosis was analyzed using TUNEL, Western blot and immunohistochemistry (IHC). IHC was also used to detect the number of myeloperoxidase (MPO)-positive cells. The expressions of proteins associated with the Nrf2-Keap1-ARE pathway were assessed by Western blot and IHC.ResultsDFE preconditioning inhibited I/R injury-induced BUN and SCr increase and renal histologic injury in rats. Also, DFE suppressed the inflammation, apoptosis and oxidative stress caused by renal I/R injury in vivo. In addition, DFE preconditioning repressed peroxide-related factors (MDA, MPO and NO) expressions and promoted antioxidant-related factors (GSH, SOD, GPx and CAT) expressions. In addition, DFE promoted Nrf2-Keap1-ARE-related proteins including Nrf2, NQO1, HO-1, γ-GCS, GSR and GCLc expressions.ConclusionDFE preconditioning protected the kidney as well as inhibited the inflammation, cell apoptosis and oxidative stress in renal I/R injury rats by activating the Nrf2-Keap1-ARE signaling pathway.

How to resolve a dilemma about desflurane?

How to resolve a dilemma about desflurane?

Desflurane pretreatment can reduce sepsis-evoked lung injury in rats via inhibiting STAT3 pathway.

The purpose of this study was to investigate the effect of desflurane (Des) pretreatment on sepsisevoked lung injury in rats and its mechanism. The rat model of sepsis-evoked lung injury was prepared using lipopolysaccharide (LPS), while rat lung mesenchymal cell (MSC) model was cultured in vitro, followed by Des pretreatment or inhibitor S31-201 culture. The degree of lung tissue injury was analyzed by Hematoxylin-eosin (HE) staining. The expression levels of interleukin (IL)-6, IL-1β and tumor necrosis factor (TNF)-α in the serum of rats were detected by enzyme-linked immunosorbent assay (ELISA). One-step terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling (TUNEL) assay was utilized to determine the apoptosis levels of lung tissues and MSCs cultured in vitro. The expressions of the signal transducer and activator of transcription 3 (STAT3) pathway in rat lung tissues and MSCs were detected by Western blotting. After modeling, LPS induced the lung injury in rats, the expression levels of IL-6, IL-1β and TNF-α were up-regulated (P<0.05), the apoptosis rate was increased (P<0.05), and phosphorylated-Janus kinase 2 (p-JAK2) and phosphorylated-STAT3 (p-STAT3) protein expressions were up-regulated (P<0.05). Des pretreatment can alleviate LPS-induced lung injury, down-regulate IL-6, IL-1β and TNF-α expression levels (P<0.05), reduce apoptosis (P<0.05), and downregulate p-JAK2 and p-STAT3 protein levels (P<0.05). LPS induced an increase in apoptosis rate of MSCs (P<0.05) and the up-regulation of p-STAT3 protein expression (P<0.05). Both Des pretreatment and S31-201 inhibitor culture could reduce the apoptosis rate (P<0.05) and down-regulate p-STAT3 protein level (P<0.05). Des pretreatment can reduce sepsis-evoked lung injury in rats, which may be related to the inhibition of protein expressions of STAT3 pathway.

Investigation on development of bronchoscope diagnosis and treatment under general anesthesia in five provinces and cities in China

Objective To investigate the development of painless bronchoscope diagnosis and treatment under general anesthesia in five provinces and cities in China. Methods From December 2018 to February 2019, a self-designed electronic questionnaire was sent to related personnels in a department of anesthesiology in hospitals within the range of survey through the WeChat platform.The survey mainly included three aspects: basic information of hospital, development of bronchoscope diagnosis and treatment under general anesthesia and the specific management plan. Results Questionnaires were sent to 326 hospitals in total, and 261 hospitals responded with a response rate of 80.06%.Among the 261 hospitals involved in the survey, 34 hospitals responded that no related diseases were found, and thus the number of valid questionnaires was 227, and the rate of valid questionnaires was 87.0%.Among the 261 hospitals, 161 hospitals were tertiary hospitals, and 66 hospitals were secondary hospitals, with a constituent ratio of 70.9% to 29.1%.The average development rate of painless bronchoscopy was 34.8%, the highest rate was 54.0% in Beijing, and the lowest rate was 27.5% in Hebei province.The average development rate of painless bronchoscopy was significantly higher in tertiary hospitals than in secondary hospitals (P 0.05); the number of hospitals applying sevoflurane was larger as compared with that of hospitals applying desflurane(P 0.05). Conclusion At present, the development rate of painless bronchoscopy in China is lower, and the greatest difficulty in further development is the shortage of personnel.Bronchoscope diagnosis and treatment under laryngeal mask or under monitoring anesthesia is the most commonly used method in clinic, and general anesthesia under tracheal intubation is more suitable for highly difficult bronchoscope diagnosis and treatment.Opioids combined with propofol is the most commonly used anesthesia method. Key words: Bronchoscopy; Surveys and questionnaires

Comparision of desflurane and propofol for maintaining general anaesthesia in cataract surgery of elder patients

Objective To compare the application of desflurane and propofol as maintenance anesthetics to maintain intraoperative haemodynamics and quality of recovery in elder patients during cataract surgery. Methods After consent form obtained, 60 elder patients, from Jan.2017 to Dec.2017 scheduled for cataract surgery were randomized into 2 groups, 30 cases in each group.The desflurane group (D group) received desflurane inhalation and the propofol group (P group) received propofol using effect-site target-controlled infusion (TCI). The adequate depth of anaesthesia were monitored with narcotrend to ensure equipotency of anaesthetic administration in both groups. The Narcotrend Index maintained between 40 and 55 by titrating the anaesthetic agents. Cardiovascular drug intervention, the time of spontaneous breathing, the time of awakening and recovery adverse events were analysed. Results There was no difference of the time of spontaneous respiration or awakening between the two groups(P>0.05). The times of cardiovascular drug intervention in D group were fewer than that of P group (t=2.32, P=0.03). However, the adverse events of nausea and vomiting in lucid interval in D group were significantly more than those of P group (t=2.47, P=0.04). Conclusion Application of desflurane maintains general anaesthesia in elder patients during cataract surgery. There is no difference in spontaneous respiration or awakening between the two groups. However, desflurane inhalation anesthesia provides more stable haemodynamics during the operation. Propofol total intravenous anesthesia provides significantly better quality of recovery than desflurane inhalation anesthesia. Key words: Desflurane; Propofol; Cataract surgery, elder patients; General anaesthesia; Recovery

Effects of different concentrations of desflurane on electrophysiological stability of hearts in female patients

Objective To evaluate the effects of different concentrations of desflurane on the electrophysiological stability of hearts in female patients. Methods Forty female patients, of American Society of Anesthesiologists physical status Ⅰor Ⅱ, aged 20-50 yr, weighing 45-77 kg, scheduled for elective surgery with general anesthesia, were divided into 2 groups (n=20 each) using a random number table method: 0.6 MAC group (group D1) and 1.3 MAC group (group D2). The intravenous access was opened after admission to the operating room, midazolam 0.1 mg/kg, vecuronium 0.1 mg/kg, fentanyl 3 μg/kg and etomidate 0.3 mg/kg were injected intravenously, and mechanical ventilation was performed after tracheal intubation.The concentrations of desflurane reached 0.6 and 1.3 MAC in D1 and D2 groups, respectively.Twelve-lead electrocardiograms were collected before anesthesia induction (T1), at 5 min after intubation (T2) and at 20 min after reaching the set concentration of desflurane (T3). The QT interval and Tp-e interval were measured, the QTc interval, Tp-e/QT ratio and index of cardiac electrophysiological balance were calculated, and the development of arrhythmia was also observed. Results The QT interval and QTc interval were significantly longer, and the Tp-e/QT ratio was lower at T3 than at T1, 2 in two groups (P 0.05). No arrhythmia was found in neither group. Conclusion The clinical concentration of desflurane affects the electrophysiological stability of hearts to some extent in female patients without causing arrhythmia. Key words: Anesthetics, inhalation; Femininity; Cardiac electrophysiology

Lower incidence of prolonged extubation in propofol-based total intravenous anesthesia compared with desflurane anesthesia in laparoscopic cholecystectomy: A retrospective study

Background: Reducing anesthesia-controlled time (ACT) such as extubation time may improve operating room (OR) efficiency result from different anesthetic techniques. However, the information about the difference in ACT between desflurane (DES) anesthesia and propofol-based total intravenous anesthesia (TIVA) techniques for laparoscopic cholecystectomy (LC) under general anesthesia (GA) is not available in the literature. Methods: This retrospective study uses our hospital database to analyze the ACT of elective LC after either DES anesthesia or TIVA via target-controlled infusion (TCI) with propofol from January 2010 to December 2011. The various time intervals including waiting for anesthesia time, anesthesia time, surgical time, extubation time, exit from OR after extubation, total OR time, postanesthetic care unit (PACU) stay time, and percentage of prolonged extubation (≥15 min) were compared between the two anesthetic techniques. Results: We included data from 622 patients undergoing LC, with 286 patients receiving TIVA and 336 patients receiving DES anesthesia. The extubation time was faster (7.8 ± 0.4 vs. 10.9 ± 0.4 min; P

Quality of recovery in patients undergoing endoscopic sinus surgery after general anesthesia: total intravenous anesthesia vs desflurane anesthesia.

For sinus surgery, some centers favor total intravenous anesthesia (TIVA) over inhalation anesthesia. However, whether TIVA affects the patient's perceived quality of recovery remains unclear. This study used the Quality of Recovery-40 questionnaire (QoR-40) to compare patient recovery between surgical patients who received TIVA and those who received desflurane (DES) anesthesia. Eighty patients (20 to 65 years old) undergoing endoscopic sinus surgery were prospectively enrolled and randomized to either the TIVA (propofol and remifentanil infusion) or DES (desflurane inhalation and remifentanil infusion) group. The QoR-40 was administered before surgery, at 6 hours after surgery, and on postoperative day 1 (POD1). Incidence of nausea and vomiting, remifentanil consumption, blood loss, and pain treatment were recorded. The influence of lesion extent (indexed as Lund-Mackay [LM] score) on recovery quality was also assessed. Forty patients were randomized into the TIVA group, and 40 patients were randomized into the DES group. The QoR-40 score at 6 hours after surgery was significantly higher in the TIVA group compared with the DES group (188.2 vs 182.6, respectively; p = 0.049), indicating a better quality of recovery in the TIVA group. TIVA resulted in less blood loss (p < 0.0001). A high LM score (≥12) was associated with lower QoR-40 scores at 6 hours after surgery (180.2 vs 187.2, p = 0.028) and on POD1 (181.5 vs 190.3, p = 0.003). This study shows that the quality of recovery for endoscopic sinus surgery patients was better with TIVA than with desflurane anesthesia. A high LM score was related to poorer recovery quality.

Early postoperative recovery in operating room after desflurane anesthesia combined with Bispectral index (BIS) monitoring and warming in lengthy abdominal surgery: a randomized controlled study

BackgroundThis study aimed to determine whether the use of desflurane (DES) anesthesia combined with bispectral index (BIS) monitoring and warming is effective in reducing anesthesia-controlled operating room time (ACT) in patients undergoing lengthy abdominal surgery.MethodsSeventy patients, 40 years of age or older, undergoing abdominal surgery expected to last three to five hours were randomly assigned to the DES group (n = 35) or the control group (n = 35). Patients in the DES group were maintained with desflurane anesthesia and received BIS monitoring and warming. Patients in the control group were given non-desflurane anesthesia for maintenance, and the usage of BIS monitoring and warming were not mandatory and determined by anesthesia care providers. Early postoperative recovery times were recorded.ResultsThe times to extubation (8.8 ± 8.5 vs 14.7 ± 13.7 min, P = 0.035), eye opening (8.4 ± 8.6 vs 14.4 ± 13.4 min, P = 0.028), responds on command (8.2 ± 8.5 vs 14.4 ± 13.0 min, P = 0.022), and the ACT (23.8 ± 11.4 vs 32.7 ± 15.4 min, P = 0.009) were significantly less in the DES group than that in the control group. The postanesthesia care unit (PACU) length of stay, incidence of prolonged extubation, and surgeon and anesthesiologist satisfaction were similar in two groups. Also, the result of multivariable linear regressions showed that patients who were younger, female, lower BMI and non-DES anesthesia regimen resulted in prolonged extubation.ConclusionsDesflurane anesthesia combined with BIS monitoring and warming is associated with early postoperative recovery in lengthy abdominal surgery.Trial registrationChiCTR-INR-17013333. Date of registration: November 11, 2017.

Effects of closed-loop intravenous anesthesia guided by Bispectral Index in adult patients on emergence delirium: a randomized controlled study.

Emergence delirium (ED) is an acute change in cognition after general anesthesia (GA) occurring in operative room, recovery room or in postanesthesia care. The automated propofol-remifentanil titration by Bispectral Index (BIS) (AutoTIVA) avoids period of deep (BIS<40) anesthesia and could potentially decrease the ED. The aim of this study was to evaluate ED in surgical patients under AutoTIVA, manual titration of propofol-remifentanil (ManualTIVA) or volatile BIS-guided GA. Moreover, we aimed to evaluate age-related postoperative Mini-Mental State Examination (MMSE) changes. One hundred and thirty-two adult patients scheduled for elective urologic surgery were randomized in: AutoTIVA, desflurane (DES), sevoflurane (SEVO), ManualTIVA anesthesia. The MMSE was performed before GA and 15 minutes after tracheal extubation. The percentage of BIS 40-60 was significantly higher in the AutoTIVA compared to DES, SEVO and ManualTIVA (87% vs. 78 %, 58%, 39%, respectively; P≤0.001). The percentage of BIS<40 was significantly lower in AutoTIVA than in the other groups (P<0.001). No difference in hemodynamics was found among groups. Postoperative MMSE scores were similar to baseline in the AutoTIVA (26 [24-28] vs. 26 [23-28]) while they markedly decreased in all other groups (P<0.001). Postoperative MMSE decreased at any age. None experienced awareness was recorded. Our results suggest that patients treated with AutoTIVA performed better in the cognitive test compared to the other groups receiving manual target-controlled GA due to a higher adequate level of anesthesia measured by BIS. Cognitive tests should be performed to test ED in all patients undergoing GA.

Efficacy of different low-doses of nalmefene in preventing remifentanil-induced postoperative hyperalgesia

Objective To evaluate the efficacy of different low-doses of nalmefene in preventing remifentanil-induced postoperative hyperalgesia. Methods One hundred American Society of Anesthesiologist physical status Ⅰor Ⅱpatients, aged 20-64 yr, wih body mass index of 18-25 kg/m2, scheduled for elective gynecological laparoscopic surgery under general anesthesia, were divided into 4 groups(n=25 each)using a random number table: control group(group C)and different doses of nalmefene groups(N1, N2 and N3 groups). In N1, N2 and N3 groups, nalmefene 0.2, 0.3 and 0.5 μg/kg(diluted to 5 ml in normal saline)were intravenously injected, respectively, at 5 min before anesthesia induction, while the equal volume of normal saline was given in group C. Anesthesia was induced with midazolam 0.05 mg/kg, sufentanil 0.3 μg/kg, etomidate 0.3 mg/kg and rocuronium 0.6 mg/kg.The patients were mechanically ventilated after tracheal intubation.Anesthesia was maintained by IV infusion of remifentanil 0.3 μg·kg-1·min-1 and inhalation of 4%-6% desflurane, bispectral index value was maintained at 45-60, and muscle relaxation was maintained with intermittent IV boluses of rocuronium.After admission to postanesthesia care unit, patient-controlled analgesia(PCA)was performed, and PCA solution contained sufentanil 1 μg/ml in 100 ml of normal saline.PCA pump was programmed to deliver a 0.5 ml bolus dose with a lockout interval of 15 min and background infusion at 2 ml/h.Numeric rating scale score was maintained <4.The time for remifentanil infusion was recorded.The consumption of sufentanil was recorded in 0-1, 1-3, 3-6, 6-12 and 12-24 h periods after surgery, and the occurrence of nausea, vomiting, tachycardia, hypertension and shivering was also recorded within 24 h after surgery. Results Compared with group C, the postoperative consumption of sufentanil was significantly reduced in 0-1 h and 1-3 h periods after surgery in group N1 and in 0-1, 1-3, 3-6 and 6-12 h periods after surgery in group N2, and the incidence of postoperative nausea was significantly decreased in N1, N2 and N3 groups(P<0.05). The consumption of sufentanil in 3-6 h period after surgery was significantly lower in group N2 than in group N1(P<0.05). Conclusion The optimal dose of nalmefene is 0.3 μg/kg when used to prevent remifentanil-induced postoperative hyperalgesia. Key words: Morphinane; Piperidines; Hyperalgesia

The in vitro zebrafish heart as a model to investigate the chronotropic effects of vapor anesthetics.

In addition to their intended clinical actions, all general anesthetic agents in common use have detrimental intrasurgical and postsurgical side effects on organs and systems, including the heart. The major cardiac side effect of anesthesia is bradycardia, which increases the probability of insufficient systemic perfusion during surgery. These side effects also occur in all vertebrate species so far examined, but the underlying mechanisms are not clear. The zebrafish heart is a powerful model for studying cardiac electrophysiology, employing the same pacemaker system and neural control as do mammalian hearts. In this study, isolated zebrafish hearts were significantly bradycardic during exposure to the vapor anesthetics sevoflurane (SEVO), desflurane (DES), and isoflurane (ISO). Bradycardia induced by DES and ISO continued during pharmacological blockade of the intracardiac portion of the autonomic nervous system, but the chronotropic effect of SEVO was eliminated during blockade. Bradycardia evoked by vagosympathetic nerve stimulation was augmented during DES and ISO exposure; nerve stimulation during SEVO exposure had no effect. Together, these results support the hypothesis that the cardiac chronotropic effect of SEVO occurs via a neurally mediated mechanism, while DES and ISO act directly upon cardiac pacemaker cells via an as yet unknown mechanism.