Fentanyl Anesthesia Research Articles

High-Frequency Imaging Reveals Synchronised Delta- and Theta-Band Ca2+ Oscillations in the Astrocytic Soma In Vivo.

One of the major breakthroughs of neurobiology was the identification of distinct ranges of oscillatory activity in the neuronal network that were found to be responsible for specific biological functions, both physiological and pathological in nature. Astrocytes, physically coupled by gap junctions and possessing the ability to simultaneously modulate the functions of a large number of surrounding synapses, are perfectly positioned to introduce synchronised oscillatory activity into the neural network. However, astrocytic somatic calcium signalling has not been investigated to date in the frequency ranges of common neuronal oscillations, since astrocytes are generally considered to be slow responders in terms of Ca2+ signalling. Using high-frequency two-photon imaging, we reveal fast Ca2+ oscillations in the soma of astrocytes in the delta (0.5-4 Hz) and theta (4-8 Hz) frequency bands in vivo in the rat cortex under ketamine-xylazine anaesthesia, which is known to induce permanent slow-wave sleep. The high-frequency astrocytic Ca2+ signals were not observed under fentanyl anaesthesia, excluding the possibility that the signals were introduced by motion artefacts. We also demonstrate that these fast astrocytic Ca2+ signals, previously considered to be exclusive to neurons, are present in a large number of astrocytes and are phase synchronised at the astrocytic network level. We foresee that the disclosure of these high-frequency astrocytic signals may help with understanding the appearance of synchronised oscillatory signals and may open up new avenues of treatment for neurological conditions characterised by altered neuronal oscillations.

Understanding the Ocular Hypertension Model in Mice Induced by Dexamethasone-21-Acetate – Implications for Glaucoma Research

Purpose This study aimed to assess the effectiveness of monocular and bilateral injections of Dexamethasone-21-acetate (Dex-21-Ac) into the murine fornix twice a week as a glucocorticoid-induced ocular hypertension model and investigated potential systemic side effects. Methods Dex-21-Ac was administered twice weekly in three groups: bilateral injections, monocular injections, and a control group receiving the vehicle solution bilateral. After 21 days, enucleated eyes were examined using immunocytochemistry (ICC), and organ histology was performed. Results All groups receiving Dex-21-Ac injections had a significant increase in intraocular pressure (IOP). Monocular injections also resulted in a significant increase in IOP in the fellow eye. The Dex-21-Ac-treated groups showed a bilateral increase in IOP of approximately 8 mmHg, accompanied by elevated expression of alpha smooth muscle actin and fibronectin in the anterior chamber angle. There were no significant changes in weight progression. Hepatic steatosis was observed in all Dex-21-Ac-treated animals, and some suffered from residual neuromuscular blockade under fentanyl anesthesia. Conclusion Bilateral injections of Dex-21-Ac twice a week lead to a significant increase in daytime IOP and fibrotic changes in the trabecular meshwork. Unilateral application has a significant impact on the fellow eye. Local dexamethasone leads to notable systemic effects independent of changes in animal weight. Considering liver damage and associated influence on metabolization, hepatically eliminated injection anesthetics may lead to overdosing and are not recommended. They should be replaced by inhalation anesthesia.

Comparison of Fentanyl, Ketamine, and Lidocaine Combined with Propofol Anesthesia in Patients with Crohn Disease Undergoing Colonoscopy.

BACKGROUND Colonoscopy is the predominant invasive procedure for Crohn disease (CD) patients. Opioids and propofol carry risks of respiratory and cardiovascular complications. This study aimed to evaluate whether substituting fentanyl with ketamine or lidocaine could diminish propofol usage and minimize adverse events. MATERIAL AND METHODS In total, 146 patients with CD scheduled for elective colonoscopy were assigned to anesthesia with fentanyl (n=47), ketamine (n=47), or lidocaine (n=55). Propofol was administered to achieve sufficient anesthesia. Measured outcomes in each group included propofol consumption, hypotension and desaturation incidents, adverse event types, consciousness recovery time, abdominal pain intensity, Aldrete scale, and Post Anaesthetic Discharge Scoring System (PADSS). RESULTS Patients administered fentanyl needed significantly more propofol (P=0.017) than those on ketamine, with lidocaine showing no notable difference (P=0.28). Desaturation was significantly less common in the ketamine and lidocaine groups than fentanyl group (P<0.001). The ketamine group experienced milder reductions in mean arterial (P=0.018) and systolic blood pressure (P<0.001). Recovery metrics (Aldrete and PADSS scores) were lower for fentanyl (P<0.001), although satisfaction and pain levels were consistent across all groups (P=0.797). Dizziness occurred less frequently with lidocaine than fentanyl (17.2%, P=0.018) and ketamine (15.1%, P=0.019), while metallic taste incidents were more prevalent in the lidocaine group (13.5%, P=0.04) than fentanyl group. CONCLUSIONS Using ketamine or lidocaine instead of fentanyl in anesthesia for colonoscopy in patients with CD significantly lowers propofol use, reduces desaturation events, maintains blood pressure more effectively, without increasing hypotension risk, and accelerates recovery, without negatively impacting adverse events or patient satisfaction.

Is OPRM1 genotype a valuable predictor of VAS in patients undergoing laparoscopic radical resection of colorectal cancer with fentanyl?

ObjectiveThis study was conducted to examine the association between the A118G polymorphism of the OPRM1 gene and the risk of increased VAS scores in patients with colorectal cancer who underwent laparoscopic radical resection for which fentanyl was used.MethodsThe OPRM1 A118G genotype in subjects were detected. The relationship between the A118G polymorphism of the OPRM1 gene and increased Visual Analogue Scale (VAS) scores throughout the perioperative period was explored. A total of 101 patients receiving fentanyl anesthesia undergoing laparoscopic radical resection of colon tumors at Zhongshan Hospital, Fudan University between July 2018 and December 2020 were investigated in the present study. The relative risk between the A118G polymorphism of the OPRM1 gene and VAS ≥ 4 in the PACU was estimated using the adjusted effect relationship diagram, baseline characteristic analysis, and multiple logistic regression analysis. The relationship between the A118G polymorphism of the OPRM1 gene and VAS in the PACU, as well as perioperative fentanyl usage, was examined after confounders were adjusted.ResultsSubjects with OPRM1 A118G wild gene A were less sensitive to fentanyl, which was a risk factor for PACU VAS ≥ 4. Before the model was adjusted, the odds ratio (OR) was 14.73 (P = 0.001). After adjusting for age, sex, weight, height, and the duration of surgery, the OR increased to 16.55 (P = 0.001). When adjusting for age, sex, weight, height, surgery duration, COMT Val158Met gene polymorphism, CYP3A4 *1G gene polymorphism, and CYP3A5 *3gene polymorphism, the OR was 19.94 (P = 0.002). Moreover, OPRM1 A118G wild type gene A was found to be a risk factor for increased dosage of fentanyl in the PACU. Before the model was adjusted, the OR reached 16.90 (P = 0.0132). After adjusting for age, sex, body weight, intraoperative fentanyl dosage, surgery duration, and height, the OR was 13.81, (P = 0.0438). When adjusting for age, sex, weight, height, intraoperative fentanyl dosage, surgery duration, COMT Val158Met gene polymorphism, CYP3A4 *1G gene polymorphism, and CYP3A5 *3 gene polymorphism, the OR reached 15.23, (P = 0.0205).ConclusionThe A118G polymorphism of the OPRM1 gene carrying wild gene A was a risk factor for VAS ≥ 4 in the PACU. Moreover, it is a risk factor for increased dosage of fentanyl in the PACU.

Using the blockade of interfascial space of the &lt;i&gt;erector spinae&lt;/i&gt; muscle (&lt;i&gt;erector spinae&lt;/i&gt; plane block) in minimally invasive coronary bypass surgery: prospective randomized study

BACKGROUND: Despite the successful development of cardio-anesthesiology, no consensus exists on the preferred anesthesia method for coronary artery bypass grafting.&#x0D; OBJECTIVE: To evaluate the effectiveness of perioperative analgesia in minimally invasive coronary artery bypass surgery (MIDCAB) using ultrasound-assisted blockade in erector spinae plane (ESP).&#x0D; MATERIALS AND METHODS: A prospective, two-center, randomized study included 37 patients who underwent MIDCAB surgery. In group 1, before the induction of general anesthesia, an ESP block was performed; in group 2, the operation was performed only under general anesthesia.&#x0D; RESULTS: The consumption of fentanyl for anesthesia differed in groups 1 (ESP block) and 2 (general anesthesia): 0.9 (0.8; 1.0) mg vs 3.0 (2.6; 3.2) mg (p 0.01). The norepinephrine dosage was higher in group 2 than in group 1: 0.18 (0.16; 0.22) mcg/kg/min vs 0.05 (0.04; 0.06) mcg/kg/min (p 0.01). Postoperatively, the pain score was lower in group 1 than in group 2, and no additional opioids were required during the first 34 h after extubation. Thereafter, no differences in pain scores were observed between the groups.&#x0D; CONCLUSION: The use of an ESP block with a single injection of a local anesthetic is effective in reducing the total dosage of fentanyl used during surgery, dosage of norepinephrine, and mechanical ventilation and improve the quality of postoperative analgesia during MIDCAB.

Chronic post-thoracotomic pain syndrome in cardiothoracic surgery after minimally invasive coronary bypass surgery: prospective cohort study

BACKGROUND: No consensus has been established on the role of epidural anesthesia in relation to the prevention of chronic post-thoracotomic pain during minimally invasive coronary bypass surgery.&#x0D; OBJECTIVE: This study aimed to evaluate the effect of epidural anesthesia on the incidence of chronic post-thoracotomic pain syndrome after minimally invasive direct coronary artery bypass (MIDCAB) surgery.&#x0D; MATERIALS AND METHODS: The study included 87 patients who underwent MIDCAB surgery. In group 1, epidural anesthesia was performed before the induction of general anesthesia; in group 2, the operation was performed only under general anesthesia.&#x0D; RESULTS: The use of fentanyl for anesthesia varied: 0.5 (0.5; 0.6) mg in group 1 versus 3.5 (3.3; 3.6) mg in group 2 (p 0.01). The incidence of chronic post-thoracotomic pain in patients 3 months after surgery was higher in group 2 than in group 1 (39.1% vs 17.2%, p=0.005). The severity of pain at rest was 3 points (2; 3) in group 1 and 3 points (3; 3.5) in group 2 (p=0.018); however, during a deep breath, these differences became insignificant: 4 points (4; 4) in group 1 and 4 (4; 5) points in group 2 (p=0.453). At 6 months after surgery, chronic post-thoracotomic pain was present in 15.6% of the patients in group 1 and 34.8% in group 2 (p=0.011). After 6 months, the severity of pain at rest was 2.5 (2; 3) in group 1 and 3 (3; 3.75) in group 2 (p=0.01). No differences in cough were found: 4 (3.75; 4) points in group 1 and 4 (4; 4.5) points in group 2 (p 0.05).&#x0D; CONCLUSION: The use of epidural anesthesia led to a decrease in the incidence of chronic post-thoracotomic pain in patients undergoing MIDCAB surgery.

Opioid-free Anesthesia for Laparoscopic Gastroplasty. A Prospective and Randomized Trial

Background: Opioid-free anesthesia (OFA) has gained popularity in recent years due to concerns about the abusive use of this drug but also due to the potential benefits of OFA for pain control and decreased side effects. Objectives: This trial aimed to study whether opioid-free anesthesia (OFA) benefits patients submitted to laparoscopic gastroplasty compared to anesthesia with fentanyl. The primary objective was to measure pain score and morphine use for rescue analgesia. The secondary objective was to evaluate the incidence of postoperative nausea and vomiting (PONV) and oxygen desaturation. Methods: Patients undergoing gastroplasty were randomized to receive general anesthesia with fentanyl (n = 30) or OFA (n = 30) according to a predefined protocol. They were assessed for pain using a verbal numerical scale (VNS), morphine consumption and PONV in the post-anesthesia care unit and on the first day after surgery. Besides, oxygen desaturation during the immediate postoperative period was also recorded. The study was blinded to the surgeon and postoperative evaluators. Results: The groups were comparable for all demographic data analyzed. A significance level of 5% was used, and no differences were found in the variables studied. Conclusion: The specific OFA protocol presented in this trial was safe and effective. However, this study did not find any benefit in using it compared with fentanyl anesthesia in videolaparoscopic gastroplasties.

Influence of St. John's Wort on Intravenous Fentanyl Pharmacokinetics, Pharmacodynamics, and Clinical Effects: A Randomized Clinical Trial.

Patients often use complementary and alternative herbal medicines, hence, potential exists for adverse herb-drug interactions. Fentanyl is metabolized by hepatic CYP3A4 and considered transported by blood-brain barrier P-glycoprotein. Both disposition processes could be upregulated by the herbal St. John's wort. This investigation evaluated effects of St. John's wort on fixed-dose and apparent steady-state IV fentanyl pharmacokinetics, pharmacodynamics, and clinical effects. Healthy volunteers received a fentanyl fixed-dose infusion and an individually tailored target controlled infusion on separate days, before and after 30-day St. John's wort (300 mg thrice daily; n = 8) or placebo control (n = 8) in a randomized parallel-group design. Fentanyl plasma concentrations, pupil diameter, analgesic response to experimental pain (cold pressor), subjective side effects, and cognitive effects were measured. Plasma fentanyl concentrations and changes in pupil diameter were subjected to pharmacokinetic-pharmacodynamic modeling. St. John's wort did not alter fentanyl pharmacokinetics. Clearance (l/min) before and after St. John's wort (1.13 ± 0.29 and 1.24 ± 0.26, respectively) or placebo (0.96 ± 0.28 and 1.12 ± 0.27, respectively) were not different. St. John's wort also did not affect fentanyl pharmacodynamics as measured by pupil constriction after fixed-dose and tailored fentanyl infusions. EC50 (ng/ml) was 1.1 ± 0.7 and 1.4 ± 0.9 before and after St. John's wort versus 1.2 ± 0.8 and 1.4 ± 1.7 before and after placebo. Effect site equilibration time, T½,ke0 (min), was 12.8 ± 5.3 and 11.3 ± 6.4 before and after St. John's wort versus 11.4 ± 6.4 and 11.1 ± 5.6 before and after placebo. St. John's wort had no influence on analgesia, cognitive performance, or somatic cognitive-affective effects of fentanyl. St. John's wort did not alter fentanyl pharmacokinetics, pharmacodynamics or clinical effects, suggesting no effect on hepatic clearance or blood-brain barrier efflux. Patients taking St. John's wort will likely not respond differently to IV fentanyl for anesthesia or analgesia.

Second-hand exposure to aerosolized intravenous anesthetics (fentanyl) among anesthesiologists in Jordan

ABSTRACT Objectives: Fentanyl is a potent opioid that is used as intravenous infusion in anesthesia, and it is considered the most abused opioid among anesthesiologists. This is a qualitative study conducted to provide background regarding the liability of drug abuse among anesthesia personnel. Method: The main aim of this study was to investigate the presence of fentanyl droplets in the ambient of operating rooms where it is used. In this study, tandem mass spectrometry analysis (MS/MS) was conducted on samples collected from the air of a cardiovascular operating room to detect the presence of fentanyl droplets. Results: Analysis of samples collected from the areas surrounding the sharp box and the expiratory end of the patient’s respiratory circuit confirmed the presence of fentanyl in the ambient air. Samples taken from outside the cardiovascular suite showed no presence of fentanyl. Conclusion: The study highlights the importance of raising the safety bar in the operating room to protect anesthesia personnel from the risk of long-term exposure to fentanyl and other anesthesia drugs.

Perseus A500 enables faster recovery from desflurane general anesthesia.

The Dräger Perseus A500 (Perseus) anesthetic workstation has been designed with a lower internal volume. We evaluated the recovery time following general anesthesia using the Perseus workstation compared with that using the conventional Dräger Fabius Plus workstation. Following approval by our institutional research ethics committee, 50 patients receiving elective surgery under general anesthesia were enrolled in the study. Written informed consent was obtained from each patient. The patients were divided into the Perseus group and a control group. The Perseus anesthesia workstation was used for the Perseus group, and the Fabius Plus was used for the control group. General anesthesia was maintained with a 4.2% end-tidal concentration of desflurane, remifentanil, fentanyl, and regional anesthesia. After the surgical procedure, the administration of desflurane was discontinued. The inspiratory and expiratory desflurane concentration, time taken for patients to open their eyes, and the time taken to extubate the trachea after discontinuation of anesthetics were recorded. The inspiratory and expiratory desflurane concentration after the administration of desflurane was discontinued was lower in the Perseus group. Moreover, the time taken for patients to open their eyes was statistically significantly quicker in the Perseus group when compared with the control group: 284 ± 60 vs 325 ± 43s, respectively. The time taken for extubation was also statistically significantly quicker in the Perseus group when compared with the control group: 350 ± 67 vs 388 ± 62s, respectively. We demonstrate in this study that Perseus enables the faster wash-out of anesthetics and faster recovery of patients after general anesthesia.

Analysis of the Effect of Anesthetics Comprising of Remifentanil Combined with Propofol During Thyroidectomy

Objective: To analyze the anesthetic effect of remifentanil combined with propofol during thyroidectomy. Methods: A total of 70 patients who underwent thyroidectomy during November 2018 to November 2019 in Chongqing Eleventh People's Hospital were selected and recruited. These patients were divided into control group and observation group by random number table method. Each group consisted of 35 patients. The patients in the control group was given intravenous anesthesia comprising of propofol combined with intermittent fentanyl anesthesia, whereas the patients in the observation group was given intravenous anesthesia comprising of remifentanil combined with propofol. Results: The heart rate and mean arterial pressure of the observation group after anesthesia for 30 minutes were lower than those of the control group, and the differences were statistically significant (P &lt; 0.05). The total incidence of adverse reactions in the observation group was lower than that of the control group, and the differences were statistically significant (P &lt; 0.05). Conclusion: Remifentanil combined with propofol is effective in thyroidectomy. This combination can reduce the risk of adverse reactions and maintain stable hemodynamic parameters.

Discovering Pain in Newborn Infants.

Randomised Trial of Fentanyl Anesthesia in Preterm Babies Undergoing Surgery: Effects on the Stress Response. By Anand KJ, Sippell WG, and Aynsley-Green A. Lancet 1987; 1:243-8. Reprinted with permission.In a randomised controlled trial, preterm babies undergoing ligation of a patent ductus arteriosus were given nitrous oxide and D-tubocurarine, with (n = 8) or without (n = 8) the addition of fentanyl (10 μg/kg intravenously) to the anesthetic regimen. Major hormonal responses to surgery, as indicated by changes in plasma adrenaline, noradrenaline, glucagon, aldosterone, corticosterone, 11-deoxycorticosterone, and 11-deoxycortisol levels, in the insulin/glucagon molar ratio, and in blood glucose, lactate, and pyruvate concentrations were significantly greater in the nonfentanyl than in the fentanyl group. The urinary 3-methylhistidine/creatinine ratios were significantly greater in the nonfentanyl group on the second and third postoperative days. Compared with the fentanyl group, the nonfentanyl group had circulatory and metabolic complications postoperatively. The findings indicate that preterm babies mount a substantial stress response to surgery under anesthesia with nitrous oxide and curare and that prevention of this response by fentanyl anesthesia may be associated with an improved postoperative outcome.

Ultrasonographic Assessment of Bladder Volumes in Children Undergoing Penile Surgery: Does the Type of Anesthesia Matter?

There are scant data reporting postoperative ultrasonographically measured bladder volumes in children undergoing penile surgery. We studied the effect of various anesthesia techniques on return of micturition after penile surgery in children, using ultrasonographically measured bladder volumes. Ultrasonographically measured postvoiding residual bladder volumes indexed to age-appropriate capacity, and time elapsed between the end of surgery and spontaneous voiding after pediatric circumcision, distal hypospadias repair, or repair of urethrocutaneous fistula, were studied. Children between 4 months and 12 years were randomized to caudal block, intravenous (IV) fentanyl or penile block, in association with inhaled general anesthesia. Bladder volumes were measured before surgery and immediately after voiding for the first time. Time to first postsurgery void was also recorded. Thirty-one children completed all assessments; 12 underwent caudal block, 9 IV fentanyl anesthesia, and 7 were given penile block. The mean first postvoid bladder residual volumes were highest in the caudal and lowest in the penile block children (27.5 vs. 17.3 mL, P = 0.003). The time elapsing between the end of surgery and first voiding was the longest in the fentanyl group compared with caudal and penile blocks (232, 178, 150 minutes, respectively, P = 0.02). None of the anesthetic techniques provoked postoperative urinary retention after minor penile surgery in children. The penile block appears superior to caudal block or to IV fentanyl-based anesthesia with regard to postoperative recovery of normal micturition.

Comparative analysis of the effectiveness of Remifentanil versus Fentanyl anesthesia applied in urological laparoscopic surgery

Objective To compare the effectiveness of Remifentanil versus Fentanyl anesthesia applied in urological laparoscopic surgery. Methods A total of 78 patients undergoing urologic endoscopy in our hospital from July 2016 to December 2017 were recruited, and randomly divided into the Remifentanil group(n=39)with Remifentanil anesthesia and the Fentanyl group(n=39)with Fentanyl anesthesia.The changes in mean arterial pressure and heart rate, anesthetic effects and adverse reaction rates during anesthesia were compared between the two groups. Results The reduction of mean arterial pressure of premedication/induction of anesthesia(T0)was more pronounced in the Fentanyl group than in the Remifentanil group(t=2.855, P=0.003), but the heart rate was lower in the Remifentanil group than in the Fentanyl group(t=4.405, P=0.000). The changes of heart rate and mean arterial pressure were more significant in the Fentanyl group than in Remifentanil group immediately after tracheal intubation(T1), during incision of skin(T2), immediately after suture of the abdomen(T3)and immediately after removal of the tracheal tube(T4)(P<0.05). The spontaneous respiration recovery time, blinking time, extubation time, force recovery time and recovery time were shorter in the Remifentanil group than in the Fentanyl group(P<0.05). The incidence of anesthetic adverse reactions was lower in the Remifentanil group than in the Fentanyl group(10.3%, 4/39 vs.28.2%, 11/39, χ2=4.044, P=0.044). Conclusions Both Remifentanil and Fentanyl groups have good anesthetic effects in urological anesthesia, but Remifentanil has less fluctuations of perioperative blood pressure and heart rate, has higher recovery quality and less anesthetic adverse reactions.Therefore, Remifentanil anesthesia is worthy of promotion. Key words: Analyesics, opioid; Endoscopic surgery

Effect of low dose ropivacaine combined with fentanyl on anesthesia in elderly patients with lower limb fracture

Objective To investigate the effect of small dose of ropivacaine combined with fentanyl on anesthesia in elderly patients with lower limb fracture. Methods A total of 300 elderly patients with lower limb fractures in Yingxin Street Branch of Shanxi Taisteel General Hospital were selected in the research.The patients were randomly divided into control group and observation group according to the digital table, with 150 cases in each group.The control group received routine dose of ropivacaine combined with fentanyl anesthesia, the observation group was given small doses of ropivacaine combined with fentanyl anesthesia.The anesthesia effect, anesthesia block, changes of vital signs during the surgery, the incidence of intraoperative hypotension, and incidence rate of complications were compared between the two groups. Results The excellent rate of anesthesia in the two groups was 100.0%, the difference was not statistically significant(P>0.05). The block onset time, block fading time, motor block score in the control group were (6.35±1.87)min, (73.25±17.89)min, (2.69±0.30)points, respectively, which in the observation group were (6.42±1.61)min, (74.56±19.24)min, (2.63±0.32)points, respectively, the differences between the two groups were not statistically significant(all P>0.05). During operation, the blood pressure, heart rate, body temperature in the two groups were decreased slightly compared with before anesthesia, but the differences were not statistically significant(all P>0.05). The incidence rate of intraoperative hypotension of the observation group was 2.7%, which was significantly lower than 8.7% of the control group (χ2=5.051, P 0.05). Conclusion For elderly patients with lower extremity fractures, small dose of ropivacaine combined with fentanyl has obvious anesthesia effect, the anesthetic effect is similar with routine dose of ropivacaine combined with fentanyl, and can maintain stable vital signs of patients, but also can reduce the intraoperative hypotension, it can be used as an ideal anesthesia method for elderly patients with lower limb fracture. Key words: Fractures, bone; Anesthesia; Ropivacaine; Fentanyl; Aged

Non-invasive real-time autonomic function characterization during surgery via continuous Poincar\xe9 quantification of heart rate variability

Heart rate variability (HRV) provides an excellent proxy for monitoring of autonomic function, but the clinical utility of such characterization has not been investigated. In a clinical setting, the baseline autonomic function can reflect ability to adapt to stressors such as anesthesia. No monitoring tool has yet been developed that is able to track changes in HRV in real time. This study is a proof-of-concept for a non-invasive, real-time monitoring model for autonomic function via continuous Poincaré quantification of HRV dynamics. Anonymized heart rate data of 18 healthy individuals (18–45 years) undergoing minor procedures and 18 healthy controls (21–35 years) were analyzed. Patients underwent propofol and fentanyl anesthesia, and controls were at rest. Continuous heart rate monitoring was carried out from before aesthetic induction to the end of the surgical procedure. HRV components (sympathetic and parasympathetic) were extracted and analyzed using Poincaré quantification, and a real-time assessment tool was developed. In the patient group, a significant decrease in the sympathetic and parasympathetic components of HRV was observed following anesthesia (SD1: p = 0.019; SD2: p = 0.00027). No corresponding change in HRV was observed in controls. HRV parameters were modelled into a real-time graph. Using the monitoring technique developed, autonomic changes could be successfully visualized in real-time. This could provide the basis for a novel, fast and non-invasive method of autonomic assessment that can be delivered at the point of care.

Sevoflurane is an effective adjuvant to propofol-based total intravenous anesthesia for attenuating cough reflex in nonintubated video-assisted thoracoscopic surgery.

Background:Nonintubated video-assisted thoracic surgery (VATS) has been widely developed during the recent years. Cough reflex is an inevitably encountered problem while approaching lung lesions, and it may induce major bleeding. Sevoflurane anesthesia may attenuate cough reflex by inhibiting the pulmonary irritant receptors. However, the incidence of postoperative nausea and vomiting (PONV) in inhalational anesthesia is higher than in the propofol-based total intravenous anesthesia (TIVA). We investigated the effect of sevoflurane combination with propofol-based TIVA on cough reflex and PONV in nonintubated VATS.Methods:Ninety patients undergoing nonintubated VATS with laryngeal mask airway (LMA) and spontaneous breathing were randomly assigned for TIVA or propofol/sevoflurane anesthesia. In the TIVA group (n = 45), anesthesia was induced and maintained with propofol and fentanyl; in the propofol/sevoflurane (P/S) group (n = 45), 1% sevoflurane anesthesia was added to propofol and fentanyl anesthesia. The primary outcome measurements were cough reflex. In addition, the incidence of PONV and extubation time were investigated.Results:Patients with cough reflex were significantly fewer in the P/S group than in the TIVA group (10/45 vs 34/45; P < .001). The cough severity (35/5/5/0 vs 11/17/17/0; P < .001) and limb movement (40/5/0/0 vs 28/17/0/0; P < .001) were lower in the P/S group than in the TIVA group. Besides, incremental fentanyl bolus for cough reflex was 5 (0 [0–1]) in the P/S group and 17 (0 [0–3]) in the TIVA group (P < .05). And there was no conversion to general anesthesia, postoperative hemorrhage, aspiration pneumonia, or PONV in the 2 groups. Besides, there was no significant difference in extubation time (TIVA: 5.04 ± 2.88 vs P/S: 4.44 ± 2.98 minutes; P = .33).Conclusion:Sevoflurane attenuated cough reflex under propofol-based TIVA and did not increase the incidence of PONV and extubation time in nonintubated VATS.

Effects of intravenous anesthesia with sufentanil combined with propofol on hemodynamics and oxygen metabolism in patients with esophageal cancer under high altitude

Objective To investigate the effect of intravenous anesthesia with sufentanil combined with propofol on hemodynamics and oxygen metabolism in patients with esophageal cancer under high altitude. Methods 60 patients with esophageal cancer radical surgery was selected from March 2015 to March 2017 in our hospital and were divided into two groups according to the random number table, 30 patients in each group. Patients in the control group were given with fentanyl and propofol intravenous anesthesia, and patients in the observation group were given sufentanil combined with propofol anesthesia. The occurrence of restlessness during the recovery of anesthesia in the two groups were observed, the spontaneous breathing recovery time, extubation time and postoperative Mini-mental State Examination (MMSE) score were recorded, and the indexes of hemodynamics and oxygen metabolism were measured at the time of before induction of anesthesia (T0), tracheal intubation (T1), skin incision (T2), thoracotomy (T3), free esophagus (T4), esophageal catheter removal time (T5). Results The spontaneous respiration recovery time and extubation time of the observation group were significantly shorter than those of the control group (P<0.05). The degree of restlessness in the observation group was weaker than that in the control group (P<0.05). Mean arterial pressure (MAP) in the control group at T2-T4 were significantly higher than those in T0 (P<0.05), but MAP and heart rate (HR) in the observation group at T1-T5 were significantly lower than those of T0 (P<0.05). Compared with T0 group, oxygen saturation (SpO2), oxygen saturation of mixed venose blood (SvO2) and oxygen delivery (DO2) at T1-T5 were significantly decreased (P<0.05), oxygen consumption (VO2) at T2-T4 was significantly increased (P<0.05), especially in the control group (P<0.05). The MMSE scores of the two groups were significantly lower than those before the operation (P<0.05), and the scores in observation group was significantly higher than the control group (P<0.05). Conclusions The intravenous anesthesia with sufentanil combined with propofol is more helpful in maintaining hemodynamic stability and oxygen metabolism balance than intravenous anesthesia with fentanyl combined with propofol and has little effect on postoperative anesthesia recovery and cognitive function. Key words: Sufentanil/AD; Propofol/AD; Anesthesia, intravenous/MT/AE; Esophageal neoplasms/SU; Hemodynamics

Single-shot spinal anesthesia with heavy bupivacaine in two regimens versus continuous spinal anesthesia in elderly patients undergoing hip surgery: a prospective randomized controlled study

Background Elderly patients with hip fracture are a medical challenge. Spinal anesthesia (SA) is effective, rapid, has minimal effect on mental status, reduces blood loss, and thromboembolic complications. The continuous spinal anesthesia (CSA) produces more sensory–motor blockade with fewer hemodynamic effects. Intrathecal opioids can achieve successful SA using decreased doses of local anesthetics. Aim The aim of this study is to compare the safety and the efficacy of single-shot SA with heavy bupivacaine in two regimens versus continuous SA in elderly patients undergoing hip surgery. Patients and methods This study was carried out on 60 patients aged 65 years or older patents scheduled for hip surgery. Patients were randomized into three groups (n=20): group A SA with hyperbaric bupivacaine 7.5 mg, group B spinal fentanyl anesthesia (SFA) SA with hyperbaric bupivacaine 5 mg+25 μg fentanyl, and group C (CSA) with continuous SA. Heart rate (HR), mean arterial pressure (MAP), onset, duration, and the level of sensory block and onset, duration and score of motor block were recorded. Complications, amounts of fluids, and/or blood products and the use of vasopressors, total doses of bupivacaine, need for sedation, supplementation, and anesthetic failure were recorded. Assessment of pain was done using by visual analog score for 6 h postoperatively. Results MAP showed significant decrease in group A. The onset of sensory block and time to reach T10 showed significant increase in group C. Time of regression of sensory block T12 showed significant decrease in group C. The onset of motor block showed significant increase in group C. The duration of the motor block showed significant decrease in group C. Scores of motor block in the three groups show insignificant difference. Conclusion CSA had the advantage of being significantly hemodynamically stable and lower dose of local anesthetics and ephedrine than SA. Besides, intrathecal opioids improve the quality of spinal block.

Effect of isoflurane + N2O inhalation and propofol + fentanyl anesthesia on myocardial function as assessed by cardiac troponin, caspase-3, cyclooxygenase-2 and inducible nitric oxide synthase expression.

The aim of this study was to evaluate the effect of isoflurane + N2O inhalation and propofol + fentanyl anesthesia on myocardial function as assessed by cardiac troponin T (cTnT). A total of 60 patients were randomized into two groups: isoflurane + N2O inhalation (n=30) and propofol + fentanyl anesthesia (n=30). The findings demonstrated that there was no significant difference between the two experimental groups in terms of cTnT levels, demographic properties or hemodynamic parameters. Isoflurane + N2O inhalation and propofol + fentanyl anesthesia, respectively, were also investigated in a rat model of myocardial infarction. Myocardial cell damage, inflammation and oxidative stress levels, caspase-3/9 activities and cyclooxygenase-2 protein expression were markedly decreased, although there was no statistical significance difference between the two experimental groups. Notably, inducible nitric oxide synthase protein expression in the isoflurane + N2O inhalation group was significantly higher than that of the propofol + fentanyl anesthesia group (P<0.01). In conclusion, isoflurane + N2O inhalation and propofol + fentanyl anesthesia are not associated with risks for myocardial function.