Desflurane Research Articles

The effect of desflurane on hemodynamics and myocardial protection in patients undergoing off-pump coronary artery bypass grafting surgery

Objective To evaluate the effect of desflurane on hemodynamics and myocardial protection in patients undergoing off-pump coronary artery bypass grafting surgery (OPCABG). Methods Fifty patients, scheduled for OPCABG, were randomly assigned to two groups: the desflurane group (D group, n=25) and the propofol group (P group, n=25). For all patients, 10 mg morphine and 3-5 mg midazolam were intramuscularly injected before anesthesia. 0.1-0.2 mg/kg etomidate was used for anesthesia induction followed by rocuronium 0.6 mg/kg and sufentanil 1-2 μg/kg for all patients. For all patients, sufentanil 0.5-1.0 μg/(kg·h) and Cisatr-curium 0.5- 1.0 mg/(kg·h) were maintained. Desflurane 0.7-1.5 MAC was maintained in D group. Propofol 2-8 mg/kg was maintained in P group. Manometry was conducted through puncture in radial artery and right internal jugular vein for all patiens. The changes in cardiac index (CI), heart rate (HR), blood pressure (ABP), right atrial pressure (CVP), pulmonary arterial pressure (PAP) and pulmonary artery wedge pressure (PAWP) were monitored perioperatively. Bispectral index (BIS) was maintained at 40- 60. Temperature and urine were monitorred routinely. Before and 6, 12, 24 and 36 h after operation, blood samples were collected to measure troponin Ⅰ (cTnⅠ) and creatine kinase isoenzyme (CK-MB). Results Plasma cTnⅠ and CK-MB levels in postoperative period were higher than the preoperative baseline in both groups. cTnⅠ and CK-MB level were significantly higher in P group than in D group [(0.77±0.38) vs. (0.96±0.42), P=0.034; (23.79±5.96) vs. (28.13±7.51), P=0.042]. Conclusion Our results suggest that desflurane combined sufentanil anesthesia provides better management of reduced myocardial injury and less intropic agents usage in OPCABG. Key words: Desflurane; Off-pump coronary artery bypass; Hemodynamic; Myocardial protection

Planning for operating room efficiency and faster anesthesia wake-up time in open major upper abdominal surgery.

Reducing anesthesia-controlled time (ACT) 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 major upper abdominal surgery under general anesthesia (GA) is not available in the literature.This retrospective study uses our hospital database to analyze the ACT of open major upper abdominal surgery without liver resection after either desflurane/fentanyl-based anesthesia or TIVA via target-controlled infusion 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 postanesthetic care unit (PACU) stay time and percentage of prolonged extubation (≥15 minutes) were compared between these 2 anesthetic techniques.We included data from 343 patients, with 159 patients receiving TIVA and 184 patients receiving DES. The only significant difference is extubation time, TIVA was faster than the DES group (8.5 ± 3.8 vs 9.4 ± 3.7 minutes; P = 0.04). The factors contributed to prolonged extubation were age, gender, body mass index, DES anesthesia, and anesthesia time.In our hospital, propofol-based TIVA by target-controlled infusion provides faster emergence compared with DES anesthesia; however, it did not improve OR efficiency in open major abdominal surgery. Older, male gender, higher body mass index, DES anesthesia, and lengthy anesthesia time were factors that contribute to extubation time.

Effect of dexmedetomidine infusion on desflurane requirement and perioperative hemodynamic changes during laparoscopic gastric sleeve operations: a study based on entropy

Context Obese patients undergoing laparoscopic gastric sleeve operations are sensitive to the respiratory depressant effect of opioid analgesics. Alternative methods for analgesia may be beneficial for intraoperative management of those patients. Dexmedetomidine is a highly selective α2 agonist with anesthetic and analgesic sparing properties that makes it an adjuvant in general anesthesia. Aim The aim of this study was to assess the effect of intravenous administration of dexmedetomidine during laparoscopic gastric sleeve operations on desflurane requirements, perioperative hemodynamic changes, and also postoperative recovery. This study was based on entropy to monitor the depth of anesthesia. Patients and methods Eighty patients of American Society of Anesthesiologists II and III who were scheduled for laparoscopic gastric sleeve operations were randomly allocated to two groups of 40 patients each. Dexmedetomidine at a loading dose of 1 μg/kg was given over 10 min before anesthesia induction, followed by 0.5 μg/kg/h maintenance throughout the operation in group II, and saline (placebo) was given in group I at the same volume and rate. Routine induction with propofol, fentanyl, and cisatracurium was carried out. Anesthesia was maintained with desflurane that was adjusted to maintain adequate depth of general anesthesia with response entropy between 40 and 60 and a difference of less than 10 with the state entropy. Desflurane inspired fraction and desflurane expired fraction were monitored. Results End-tidal concentration of desflurane was significantly low at 15, 30, 45, and 60 min of operation. End-tidal concentration of desflurane decreased by 13.2–21.8% with the use of dexmedetomidine in comparison with group I. Systolic blood pressure, diastolic blood pressure, and heart rate were significantly decreased with the use of dexmedetomidine at different time intervals throughout the operation in comparison with group I and in comparison with the baseline in group II. Perioperative fentanyl consumption was significantly low with the use of dexmedetomidine in group II in comparison with group I. It was 325±55 μg in group II in comparison with 178±45 μg in group I. There was no significant difference between the two study groups as regards the extubation time. Pain score was significantly higher in group I in comparison with group II on admission to the postoperative acute care unit, and at 1 and 2 hlater. Conclusion In conclusion, the use of dexmedetomidine as preanesthetic medication followed by infusion during laparoscopic sleeve gastrectomy reduces desflurane requirement, maintains hemodynamic stability due to attenuation of stress response, and reduces the fentanyl requirement during intraoperative and early postoperative period, with decreased risk for respiratory depression in the postoperative acute care unit for morbidly obese patients who are at great risk for obstructive sleep apnea and oxygen desaturation.

Consideraciones prácticas sobre epilepsia y manejo anestésico

Epilepsia, enfermedad caracterizada por la alteración de la actividad eléctrica cerebral. Las crisis epilépticas se clasifican en: parciales, generalizadas y desconocidas. El diagnóstico se establece mediante la correlación clínica y electroencefalografía. El tratamiento de mantenimiento depende del tipo específico de crisis. El estatus constituye la persistencia de crisis convulsiva por más de cinco minutos (para efectos clínicos) que requiere un manejo farmacológico intensivo con benzodiacepinas, fenitoína, fenobarbital y otros medicamentos. El manejo anestésico del paciente con epilepsia, requiere una adecuada valoración preoperatoria para indagar la existencia de comorbilidades, características de las crisis, farmacoterapia que recibe y sus interacciones con determinados agentes anestésicos. En pacientes epilépticos se debe evitar la administración de aquellos anestésicos proconvulsivantes (etomidato, ketamina, enflurano, sevoflurano, fentanil, alfentanil, remifentanil, meperidina, entre otros). Considerándose como agentes anestésicos seguros: benzodiacepina, tiopental, propofol (a pesar de su efecto proconvulsivante en algunos casos), isofurano, halotano, desflurano, entre otros.

Correction: Comparison of Anesthesia-Controlled Operating Room Time between Propofol-Based Total Intravenous Anesthesia and Desflurane Anesthesia in Open Colorectal Surgery: A Retrospective Study

[This corrects the article DOI: 10.1371/journal.pone.0165407.].

A low dose of droperidol decreases the desflurane concentration needed during breast cancer surgery: a randomized double-blinded study.

BackgroundDroperidol (DHB) reportedly reduces the dose of propofol needed to achieve hypnosis when anesthesia is induced and decreases the bispectral index (BIS) in propofol-sedated patients during spinal anesthesia. We reported previously that supplemental DHB decreased the BIS after the administration of sevoflurane and remifentanil. This study investigated the effect of DHB on desflurane (DES) consumption in a clinical setting.MethodsWe conducted a prospective, randomized double-blinded study of 35 women with American Society of Anesthesiologist physical status I or II who underwent a mastectomy. Either DHB (20 µg/kg) or a saline placebo was administered to patients 30 min after the induction of anesthesia. A blinded anesthesiologist maintained a BIS value of 50 during anesthesia by modulating inhaled DES concentrations that changed 0.5% at 2.5 min intervals and maintained analgesia via the constant administration of remifentanil by referring to vital signs. The primary endpoint was the effect of DHB on DES consumption. The secondary endpoints included blood circulatory parameters, the time from the end of surgery to extubation, and discharge time between the groups.ResultsThe characteristics of the patients did not differ between the groups. The DHB group used a mean of 27.2 ± 6.0 ml of DES compared with 41.4 ± 9.5 ml by the placebo group (P < 0.05).ConclusionsA small dose of DHB reduced the DES concentration needed to maintain a BIS of 50. Our results show that DHB reduced the consumption of DES without adverse effects.

Electrical Changes in Deeper Cortical Structures During Balanced General Anesthesia with the Aim on Inhalation Anesthetics Effects

Abstract There are many theories that attempt to explain the mechanisms of the effects of inhalation anesthetics - from simpler, pursuing individual effects of anesthetics on the level of the ion channels, to more complex that are looking for uniform global changes in brain activity common to several agents. However, we still don’t have satisfactory and adequate conclusions. We examined a sample of 39 patients undergoing thoracic surgery at the Clinic of Thoracic Surgery under general anesthesia (GA) and we registered their electroencephalographic (EEG) signals before and during operation. After induction of GA by intravenous (i.v.), we used inhalation anesthetics to maintain GA. We used sevoflurane (SEV) in 20 patients and desflurane (DES) in 19 patients. Then we obtained the EEG data and processed them through mathematical and statistical analysis, to discover any changes of electrical activity in the brain during thoracic surgery under GA. The era of digital recording EEG and present possibilities of modern computer techniques allow quantitative analysis of obtained data. We performed the analysis with the software LORETA (low resolution brain electromagnetic tomography). It is a relatively new research method, which in a similar way as computed tomography (CT) or magnetic resonance imaging (MRI) displays even deeper brain electrical activity, which is hiddeen for a classical EEG approach. We described the general changes in brain electrical activity of the deeper cortical structures within the traditional frequency bands (d, q, a, b and g) during GA at 5 mm spatial resolution. We have shown that the source of the well-known cortical EEG changes after the effect of used inhalation anesthetics is caused by changes situated in the deeper brain structures, particularly the limbic system. Significant changes occurred in the cingulate gyrus for most of an EEG frequency ranges. When comparing the data of patients anesthetised with SEV and DES we found similar changes within the d and q rhythms and then the global changes of EEG activity followed during GA.

Effects of methacholine infusion on desflurane pharmacokinetics in piglets.

The data of a corresponding animal experiment demonstrates that nebulized methacholine (MCh) induced severe bronchoconstriction and significant inhomogeneous ventilation and pulmonary perfusion (V̇A/Q̇) distribution in pigs, which is similar to findings in human asthma. The inhalation of MCh induced bronchoconstriction and delayed both uptake and elimination of desflurane (Kretzschmar et al., 2015) [1].The objective of the present data is to determine V̇A/Q̇ matching by Multiple Inert Gas Elimination Technique (MIGET) in piglets before and during methacholine- (MCh-) induced bronchoconstriction, induced by MCh infusion, and to assess the blood concentration profiles for desflurane (DES) by Micropore Membrane Inlet Mass Spectrometry (MMIMS).Healthy piglets (n=4) under general anesthesia were instrumented with arterial, central venous, and pulmonary artery lines. The airway was secured via median tracheostomy with an endotracheal tube, and animals were mechanically ventilated with intermittent positive pressure ventilation (IPPV) with a FiO2 of 0.4, tidal volume (VT)=10 ml/kg and PEEP of 5cmH2O using an open system. The determination of V.A/Q. was done by MIGET: before desflurane application and at plateau in both healthy state and during MCh infusion. Arterial blood was sampled at 0, 1, 2, 5, 10, 20, and 30 min during wash-in and washout, respectively.Bronchoconstriction was established by MCH infusion aiming at doubling the peak airway pressure, after which wash-in and washout of the anesthetic gas was repeated. Anesthesia gas concentrations were measured by MMIMS. Data were analyzed by ANOVA, paired t-test, and by nonparametric Friedman׳s test and Wilcoxon׳s matched pairs test.We measured airway pressures, pulmonary resistance, and mean paO2 as well as hemodynamic variables in all pigs before desflurane application and at plateau in both healthy state and during methacholine administration by infusion. By MIGET, fractional alveolar ventilation and pulmonary perfusion in relation to the V.A/Q. compartments, data of logSDQ̇ and logSDV̇ (the second moments describing global dispersion, i.e. heterogeneity of distribution) were estimated prior to and after MCh infusion. The uptake and elimination of desflurane was determined by MMIMS.

Faster extubation time with more stable hemodynamics during extubation and shorter total surgical suite time after propofol-based total intravenous anesthesia compared with desflurane anesthesia in lengthy lumbar spine surgery

OBJECT Anesthesia techniques can contribute to the reduction of anesthesia-controlled time and may therefore improve operating room efficiency. However, little is known about the difference in anesthesia-controlled time between propofol-based total intravenous anesthesia (TIVA) and desflurane (DES) anesthesia techniques for prolonged lumbar spine surgery under general anesthesia. METHODS A retrospective analysis was conducted using hospital databases to compare the anesthesia-controlled time of lengthy (surgical time > 180 minutes) lumbar spine surgery in patients receiving either TIVA via target-controlled infusion (TCI) with propofol/fentanyl or DES/fentanyl-based anesthesia, between January 2009 and December 2011. A variety of time intervals (surgical time, anesthesia time, extubation time, time in the operating room, postanesthesia care unit [PACU] length of stay, and total surgical suite time) comprising perioperative hemodynamic variables were compared between the 2 anesthesia techniques. RESULTS Data from 581 patients were included in the analysis; 307 patients received TIVA and 274 received DES anesthesia. The extubation time was faster (12.4 ± 5.3 vs 7.0 ± 4.5 minutes, p < 0.001), and the time in operating room and total surgical suite time was shorter in the TIVA group than in the DES group (326.5 ± 57.2 vs 338.4 ± 69.4 minutes, p = 0.025; and 402.6 ± 60.2 vs 414.4 ± 71.7 minutes, p = 0.033, respectively). However, there was no statistically significant difference in PACU length of stay between the groups. Heart rate and mean arterial blood pressure were more stable during extubation in the TIVA group than in the DES group. CONCLUSIONS Utilization of TIVA reduced the mean time to extubation and total surgical suite time by 5.4 minutes and 11.8 minutes, respectively, and produced more stable hemodynamics during extubation compared with the use of DES anesthesia in lengthy lumbar spine surgery.

Effects of propofol or desflurane on post-operative spirometry in elderly after knee surgery: a double-blind randomised study.

Intravenous or volatile agents reduce respiratory function, which can result in respiratory complications in geriatric patients. We hypothesised that there would be no differences in lung function between anaesthesia established using either drug. Elderly patients were randomly assigned to receive either propofol with remifentanil (n = 48) or desflurane (DES) with remifentanil (n = 52) for knee surgery. Spirometry tests including forced expiratory volume in 1 s (FEV1 ), forced vital capacity (FVC), forced mid-expiratory flow (FEF25-75), and FEV1 /FVC ratio were performed preoperatively, and 30 min, 60 min, and 24 h after awakening. Emergence time and post-operative pain scores were also measured. Time to emergence was significantly longer in the propofol than in the DES group (17.0 vs. 12.5 min, P = 0.04). Post-operative FEV1 (1.6 or 1.4 l, P = 0.68 between groups) were significantly lower than preoperative values (2.1 or 2.0 l, P = 0.001 vs. post-operative values, respectively) in both groups. Reduced FEV1 lasted for 24 h after surgery (1.7 or 1.6 l, P = 0.001 vs. preoperative values, respectively). Post-operative FVC or FEF25-75 were lower than preoperative values. FEV1 /FVC ratio did not change during the study period in both groups. There was no difference in FEV1 , FVC, FEF25-75, FEV1 /FVC, and post-operative pain between the two anaesthetic techniques. Although there is a delay in awakening when using propofol, the effects of propofol on post-operative spirometry parameters are similar to those of DES when anaesthesia duration is approximately 3 h. Decreased respiratory parameters persisted up to 24 h after anaesthesia, irrespective of the choice of anaesthetic.

Analysis of anesthesia-controlled operating room time after propofol-based total intravenous anesthesia compared with desflurane anesthesia in gynecologic laparoscopic surgery: A retrospective study

Background: Anesthesia technique may contribute to the improvement of operation room (OR) efficiency by reducing anesthesia-controlled time (ACT). We compared the difference between propofol-based total intravenous anesthesia (TIVA) and desflurane (DES) anesthesia for gynecologic laparoscopic surgery undergoing general anesthesia. Materials and Methods: We performed a retrospective study using data collected in our hospital to compare the ACT of gynecologic laparoscopic surgery using either TIVA via target-controlled infusion (TCI) with propofol/fentanyl or DES/fentanyl-based anesthesia between January 2010 and December 2011. The various time intervals (waiting for anesthesia, operation time, anesthesia time, emergence time, exit from OR after extubation, total OR time and postanesthesia care unit stay time) and the incidence of prolonged extubation (≥15 min) were compared between the two anesthetic techniques. Results: We included data from 926 patients, with 377 patients receiving TIVA and 549 patients receiving DES. The only significant difference is emergence time, TIVA was faster than the DES group (7.3 ± 3.3 min vs. 8.3 ± 3.1 min; P < 0.001). The factors of prolonged extubation are DES anesthesia, body mass index, surgical time, and anesthesia time. Conclusion: In our hospital, propofol-based TIVA by TCI provide faster emergence compared with DES anesthesia in gynecologic laparoscopic surgery.

Automated control of end-tidal volatile anaesthetic concentration using the MIRUS™ system: a comparison of isoflurane, sevoflurane and desflurane in anaesthesia

The new MIRUS™ system as well as the established AnaConDa® system uses a reflector to conserve volatile anaesthetics (VA) [1]. Both systems act with commercially available ICU ventilators. In contrast to AnaConDa®, MIRUS™ includes an automated control of end-tidal VA concentrations. In this study we compared feasibility, costs and recovery times after anaesthesia with isoflurane (ISO), sevoflurane (SEVO) or desflurane (DES) in ventilated and spontaneously breathing patients.

Efficacy of different doses of dezocine for decreasing minimum alveolar concentration of desflurane

Objective To evaluate the efficacy of different doses of dezocine for decreasing the minimum alveolar concentration (MAC) of desflurane.Methods ASA physical status Ⅰ or Ⅱ patients of both sexes,aged 50-70 yr,undergoing elective lower abdominal surgery performed under general anesthesia,were divided into 4 groups:control group (group C)and different doses of dezocine groups (D1,D2 and D3 groups).Before induction of anesthesia,in D1,D2 and D3 groups,dezocine 0.050,0.075 and 0.100 mg/kg were intravenously infused,respectively,while in group C,the equal volume of normal saline was given instead of dezocine.The adverse reactions were observed.Propofol 3 mg/kg was given for induction of anesthesia 15 min later until patient' s consciousness and spontaneous respiration disappeared.Laryngeal mask airway was inserted and the patients were mechanically ventilated.Up-and-down sequential allocation was used to determine the MAC of desflurane during maintenance of anesthesia.The end-tidal concentration of desflurane was set at 8.0％ and maintained at this level for at least 5 min before skin incision in the first patient.Each time the concentration of desflurane increased/decreased in the next patient depending on whether or not the body movement developed.The ratio between the two successive concentrations was 0.9.The point between the positive response and negative response served as a cross-over point.After at least 7 independent cross-over points were observed in each group,the experiment was stopped.The MAC and 95 ％ confidence interval of desflurane were calculated.Results No adverse reactions developed in each group.The MAC of desflurane was significantly lower in D1-3 groups than in group C,in groups D2.3 than in group D1,and in group D3 than in group D2.Conclusion Dezocine 0.100 mg/kg injected intravenously at 15 min before induction of anesthesia provides a better efficacy for decreasing the MAC of desflurane in the patients. Key words: Analgesics,opioid; Anesthetics, inhalation; Dose-response relationship, drug

Effects of different target effect-site concentrations of sufentanil on MACBAR of desflurane in patients undergoing abdominal surgery

Objective To evaluate the effects of different target effect-site concentrations (Ces) of sufentanil on the minimum alveolar concentration of desflurane inhibiting stress responses to skin incision (MACsAR) in 50％ of patients undergoing abdominal surgery.Methods Eighty-three patients,aged 20-60 yr,scheduled for elective abdominal surgery with an expected incision longer than 10 cm,were enrolled in the study.All the patients were randomly allocated to one of three groups using a random number table:control group (group C,n =28),sufentanil with target Ce of 0.1 ng/ml group (group S1,n =27),and sufentanil with target Ce of 0.3 ng/ml group (group S2,n =28).After tracheal intubation,desflurane inhalation was started,and sufentanil was infused at the preset target Ces in S1 and S2 groups.The initial end-tidal concentration of desflurane was 9.0％ in group C,and 6.0％ in S1 and S2 groups.The target concentration was maintained at least for 15 min.The modified up-and-down method was used to perform the test.The end-tidal concentration of desflurane was adjusted in the next patients according to the response to skin incision.The MACBAR and 95％ confidence interval of desflurane was calculated according to the up-and-down method.Mean arterial pressure and heart rate were monitored and recorded and rate-pressure product was calculated.Results The MACBAR (95％ confidence interval) ofdesflurane was 11.2％ (11.1％-11.3％),7.8％ (7.7％-7.9％),and 4.2％ (4.1％-4.3％) in C,S1 and S2 groups,respectively.MACBAR and rate-pressure product of desflurane were significantly lower in S1 and S2 groups than in C group,and in S2 group than in S1 group (P ＜ 0.05 or 0.01).Conclusion The optimum target Ce of sufentanil is 0.3 ng/ml when combined with desflurane in the patients undergoing abdominal surgery. Key words: Anesthetics, inhalation ; Sufentanil; Dose-response relationship, drug; Stress

The effects of general anesthetics on brain development of children

Background Children are on the peak stage of mental development,and their nervous system is highly plastic.Any medicine that has effect on the brain could impair the mental development of children.So we should pay more attention to the anesthetics used on children.Many researches have proved that general anesthetics may induce harm to the developing brain.Objective This article aims to reveal the adverse effects of general anesthetics to the developing brain by generalizing recent clinical and basic researches.Content Taking propofol,ketamine,sevoflurane and desflurane as examples,this article will briefly highlight the possible toxic effects of the general anesthetics to mental development,the mechanism and the prevention.Trend This review provides possible directions for future researches and guidance for children anesthetic medication by summarizing the results of relevant studies.Although the details of the mechanisms are not completely clear,further research is needed to explore this aspect,I thought it does provide guidance on the anesthetic medication and push the development of the studies on prevention of this impairment. Key words: General anesthetics; Development of nerve system; Developing brain; Neurotoxic effect

Reversal effect of sugammadex in isoflurane, sevoflurane, and desflurane induced anesthesia: a randomized-controlled clinical study

Amac. Bu calismada sugamadeksin noromuskuler blokor etkisini geri dondurucu etkisine isofluran, sevofluran ve desfluranin etkilerini kiyaslamayi amacladik. Yontem. Genel anestezi altinda elektif alt batin operasyonu planlanan 90 hasta calismaya alindi ve rasgele 15 er kisilik 6 gruba ayrildi. Entubasyondan sonra, grup I1 ve I2 hastalar izofluran, grup S1 ve S2 hastalarda sevofluran ve grup D1 ve D2 hastalarda desfluran volatil anestetik olarak 1.25 MAC den aldi. TOF degerleri gruplardan habersiz bir anestezist tarafindan operasyonda 10, 20, 30, 60. ve 90. dakikalarda kaydedildi. I1, S1 ve D1 grubu hastalara son rokuronyum dozunun ardindan TOF a alinan ikinci yanitin tekrar gozelnmesi sonrasi 2 mg kg-1 sugamadeks ve I2, S2 ve D2 grubu hastalarada yine ayni sekilde neostigmine verildi. Her hastaya, sugamadeks uygulanmasi ile % 10,% 25 ve% 90 TOF orani arasindaki sure kaydedildi. Bulgular. Gruplar arasinda TOF un %10 a ulasmasina kadar gecen sure acisindan fark bulunamazken TOF un % 90 a ulasma suresi sevofluran grubunda kisa ve izofluran grubunda en uzun oldugu bulunmustur. Sonuc. Genel anestezi pratiginde kullanilan inhalasyon anesteziklerinin sugamamdeksin noromuskuler blokaj geri dondurucu etkinligini farkli oranlarda etkiledigini ve sevofluran anestezisinde sugamadeksin geri dondurucu etkisinin en hizli oldugunu dusunmekteyiz.

Do Anesthetic Techniques Affect Operating Room Efficiency? Comparison of Target-Controlled Infusion of Propofol and Desflurane Anesthesia in Breast Cancer Surgery

Background: Anesthetic techniques may contribute to the reduction of operating room (OR) costs by decreasing anesthesia-controlled time. Anesthesia induction and emergence have to be time-optimized without neglecting patient care. The purpose of this study was to compare total intravenous anesthesia (TIVA group) and desflurane anesthesia (desflurane group) with respect to OR efficiency and the incidence of postoperative nausea and vomiting (PONV) in breast cancer surgery. Design: Retrospective clinical study. Methods: Information from the anesthesia database of the Tri-Service General Hospital for January 2010 to December 2011 was retrieved for patients who underwent breast cancer surgery. Three hundred and sixteen patients were included in the TIVA group (n = 196) or the desflurane group (n = 120). Emergence from anesthesia, OR time, and PONV were compared. Results: Emergence time was significantly shorter in the TIVA group than in the desflurane group (4.5±4.6 min vs. 10.4±6.4 min; P ＜ 0.01). There were no significant differences in postanesthesia recovery (PAR) discharge time between the groups. However, the total OR stay time was significantly shorter in the TIVA group than in the desflurane group (167±34 min vs. 173 ± 33 min; P ＜ 0.05). Increased PONV (30.9% vs. 12.2%; P ＜ 0.01) and antiemetic usage (19 vs. 5; P ＜ 0.05) were reported in the desflurane group compared with the TIVA group. Conclusion: TIVA provided faster emergence, increased OR efficiency, and decreased PONV compared with desflurane anesthesia in breast cancer surgery.

Timpanoplasti Cerrahisinde Desfluran ve Sevofluran Anestezisinin Kan Glukoz Düzeyleri Üzerine Etkilerinin Karşılaştırılması

Introduction: The effects of intravenous anesthetic drugs and inhaled anesthetics to the blood glucose (GLC) levels were investigated. Unfortunately, there is no adequate studies comparing these effects with new agents such as sevoflurane and desflurane drugs. In this study, blood GLC level changes among the the patients undergoing general anesthesia with sevoflurane and desflurane during the tympanoplasty surgery, were investigated. Material and methods: 60 patients,ages ranging between 18-65 in the ASA I-II risk group were randomly allocated to one of the two groups; The sevoflurane-remifentanyl drugs combination was applied to the group S and the desfluran-remifentanyl drugs combination was used for the group D. After fasting for 8 hours at the preoperative period, the blood GLC levels were measured before induction, at the 5 th , 10 th , 30 th , 60 th , 90 th , 120 th minutes, during the intraoperative period and 30 minutes after the extubation. Blood lactate levels were measured intraoperatively at 5th and 120th minutes.Results: There was no statistically significant difference between groups in terms of mean glucose levels (p>0,05). A statistically significant difference was observed between the T1-T6 and T0 values obtained in the desflurane groups according to the mean GLC level. In the sevoflurane group; there was no statistically significant difference at the third measurement time (p=0,223). In all other measurement times, the mean GLC levels were statistically significantly higher than the first measurement time.Conclusion: There was no difference between the two groups, in terms of blood GLC levels, representing patients who underwent anesthesia with sevoflurane and desflurane during tympanoplasty surgery.

デスフルラン：やはり覚醒の質は高かった

デスフルランは，血液／ガス分配係数が従来の吸入麻酔薬の中で最も小さく，速やかな麻酔作用の調節と早期の覚醒が可能である．本邦では，使用可能となって間もないが，実際に使用した麻酔科医の多くが，従来の麻酔薬と比較して，覚醒が早いだけではなく“覚醒の質”がよいという印象を持っているようである．1990年代から，欧米，アジアの多くの国々で使用が認められており，他の吸入麻酔薬や静脈麻酔薬と比較した臨床研究がすでに数多く報告されている．本稿では，デスフルランの物理化学的特性，これまでに海外から報告された臨床データを提示し，本邦での臨床試験結果から見えてきたデスフルラン麻酔の特徴と今後の展望について述べる．

Application of caudal block combined anesthesia with sevoflurane in pediatric hernia

Objective To investigate the clinical application of caudal block combined anesthesia with sevoflurane in pediatric hernia.Methods 102 patients were randomly divided into three groups:caudal block combined with sevoflurane (A group),caudal block combined with isoflurane and sevoflurane combined with ketamine.HR,MAP,SpO2,anaesthetic effect,the recovery time,the awake time and the adverse reaction were observed.Results The HR,MAP,SpO2 in A and B group had no significant difference before and after anesthesia (P ＞ 0.05).The HR,MAP,SpO2 in C group had statistically significant difference before and after anesthesia(t =10.121,6.681,4.469,all P ＜ 0.05).Compared with A and B group,the recovery time and the awake time in C group were longer significantly(t =8.240,11.693,all P ＜0.05).Compared with B group,the recovery time and the awake time in A group had no statistically significant difference(P ＞ 0.05).Compared with C group,the adverse reaction in A group had no statistically significant difference (P ＞ 0.05).Compared with B group,the adverse reaction in A group had statistically significant difference (x2 =3.923,P ＜ 0.05).Conclusion The caudal block combined anesthesia with sevoflurane in pediatric hernia has a good effect and security. Key words: Anesthesia, caudal ; Desflurane; Hernia, inguinal