Sevoflurane Group Research Articles

COMPARISON OF INDUCTION OF GENERAL ANESTHESIA WITH PROPOFOL AND SEVOFLURANE FOREASE OF I GEL INSERTION: A RANDOMISED CONTROLLED TRIAL

Objectives: The aim of this study is to compare the conditions for supraglottic airway device (I Gel) insertion following induction of anesthesia with inhalation of Sevoflurane or intravenous induction with propofol in patients undergoing short surgery (<3 h) and comparison the loss of eye reflex, Hemodynamic parameters, Jaw opening, Ease of insertion, coughing, gagging, laryngeal spasm are taken into consideration. Methods: It is randomized control trial was conducted in the Department of Anaesthesia at Command Hospital (Air Force) Bengaluru after obtaining permission from the Institutional Ethical Committee. A total of 140 patients included in the study with written consent, during the 18-month period between May 2020 and November 2021. Patients were randomized into one of the two groups as group P: Propofol and group S: Sevoflurane for induction of anesthesia. Both groups receive IV Lignocaine (2 mL of 1%) before induction of anesthesia. The grading condition for insertion between the groups were noted and compared using appropriate statistical tool using SPSS v21 operating on windows 10. Results: There was no significant difference in the mean age of patients between propofol group and sevoflurane group. Overall propofol group had the better performance compared to the sevoflurane group. There was higher incidence of repeat administration in the sevoflurane group (2.9%) compared to propofol group (1.4%), which was statistically insignificant. Conclusion: The present study found comparable results for supraglottic airway device (I Gel) following induction of anesthesia with inhalation of Sevoflurane or intravenous induction with Propofol.

Comparison of the Effects of Desflurane and Sevoflurane on Variations in Salivary Melatonin and Sleep Disturbance After Total Knee Arthroplasty: A Single-center, Prospective, Randomized, Controlled, Open-label Study

PurposeAnesthesia has been shown to disrupt the circadian rhythm. Recovery of the circadian rhythm after general anesthesia might help alleviate symptoms of insomnia and postoperative delirium. We hypothesized that recovery of the circadian rhythm is faster after total knee arthroplasty (TKA) with desflurane than with sevoflurane. This study compared the influence of sevoflurane versus desflurane anesthesia on the postoperative circadian rhythm of melatonin in adults undergoing TKA. DesignSingle-center, prospective, randomized, controlled, open-label study. MethodsThis study involved adult patients undergoing TKA at a university hospital in Japan from May 1, 2018 to December 31, 2019. The primary outcome of the study was the comparison of the effect of sevoflurane and desflurane on the circadian rhythm of salivary melatonin for 3 days postoperatively. The secondary outcomes were postoperative fatigue and sleep quality for 3 days postoperatively. FindingsTwenty-eight patients (American Society of Anesthesiologists physical status of I or II) were scheduled for TKA and randomized to receive sevoflurane (n = 14) or desflurane (n = 14) anesthesia. There was no significant difference in the melatonin concentration between the sevoflurane and desflurane groups. The salivary melatonin concentration after sevoflurane or desflurane anesthesia was significantly higher at 9:00 p.m. on a postoperative day (POD)0 and POD1 than on POD3 (P < .05). Patients in the desflurane group had significantly greater fatigue than those in the sevoflurane group at 7:00 a.m. and 12:00 p.m. on POD3 (P < .05). Patients in the sevoflurane group had a deeper sleep than those in the desflurane group on POD0 (P < .05). In the sevoflurane group, the sleep time during the night of POD2 was longer than that on POD0 (6.1 vs 4.2 hours, P < .05). ConclusionsUnder the current study conditions, desflurane was equivalent to sevoflurane in terms of the postoperative salivary melatonin concentration and sleep disturbance after TKA but not in terms of recovering the postoperative circadian rhythm.

Sevoflurane improves renal ischemia-reperfusion injury in rats through RISK signaling pathway

Purpose: To investigate the effect of sevoflurane on renal ischemia-reperfusion injury (IRI) in rats and its regulatory effect on reperfusion injury salvage kinase (RISK) signaling pathway.Methods: A total of thirty (30) Sprague-Dawley rats were randomly divided into sham, model and sevoflurane groups with 10 animals per group. Renal IRI models were created in model and sevoflurane groups, while sham group had no ligation. Renal injury was determined using hematoxylin and eosin (HE) staining. Blood urea nitrogen (BUN) and serum creatinine (Scr) levels were assayed while apoptosis was determined via terminal deoxynucleotidyl transferase-mediated dUTP nick-end labeling (TUNEL) staining. Enzyme-linked immunosorbent assay (ELISA) was used to assess malonaldehyde (MDA) content and inflammatory factors in kidney tissues and peripheral blood, respectively. Reactive oxygen species (ROS) level was determined using 2,7-dichlorodi-hydro fluorescein diacetate (DCFHDA) while Western blotting was used to determine the expression of apoptosis- and RISK signaling pathway-related proteins in kidney tissues.Results: Compared to model group, renal injury in sevoflurane group rats was significantly alleviated (p &lt; 0.01). The levels of BUN and Scr in peripheral blood, apoptosis level in kidney tissues, MDA content and ROS level in kidney tissues, interleukin-1β (IL-1β), tumor necrosis factor-alpha (TNF-α) and IL-6 content, and content of caspase-3 protein in kidney tissues were significantly reduced (p &lt; 0.01), whereas IL-10 content, Bcl-2/Bax ratio and expression levels of p-ERK1/2, p-Akt and phosphorylated glycogen synthase kinase 3β (p-GSK-3β) were significantly increased (p &lt; 0.01) in the sevoflurane group.Conclusion: Sevoflurane represses the release of inflammatory factors, lowers ROS level and apoptosis of renal cells and improves renal function through activation of RISK signaling pathway in kidney tissues of rats with renal IRI. Thus, sevoflurane is a potential agent for the treatment of IRI.

Comparison of Regional Cerebral Oxygen Saturation Variations Between Sevoflurane and Propofol Anaesthesia in Gynecological Laparoscopic Surgery

Background: Measurement of regional cerebral oxygen saturation (rSO2) is a safe, noninvasive, and portable optical method that can be used to monitor activity within the cortical areas of the human brain. Making use of specific wavelengths of light, near-infrared spectroscopy (NIRS) provides measurements of oxygenated hemoglobin (Hb) and deoxygenated Hb that is in direct relation with hemodynamic changes in the brain. Aim: The aim of this study was to compare the changes in rSO2 at different time points between propofol and sevoflurane anesthesia during gynecological laparoscopic surgery. After approval by the institutional ethics committee, written informed consent was taken from all eligible patients. Methods: This randomized clinical study was conducted in a gynecology operation theater complex. Thirty-four patients aged between 18 and 60 years categorized between the American Society of Anesthesiologists (ASA) class I I and II who are scheduled for gynecological laparoscopic surgery under general anesthesia were randomized into two groups with 17 patients in each group. The Group 1 patients receive sevoflurane anesthesia and Group 2 patients receive total intravenous anesthesia using an infusion of propofol. The rSO2 values were continuously monitored using NIRS. The bispectral index target range during maintenance was 40–50. Results: The sevoflurane group showed significantly higher rSO2 values than the propofol group in gynecological laparoscopic surgery. Conclusion: It can be inferred that the sevoflurane group showed significantly higher rSO2 values than the propofol group in gynecological laparoscopic surgery not only during pneumoperitoneum in the Trendelenburg position but also after desufflation of the abdomen in the neutral position (supine).

Effect of sevoflurane on CD4+CD25+FOXP3+ regulatory T cells in patients with gastric cancer undergoing radical surgery.

In this study, the proportion of CD4+CD25+FOXP3+ regulatory T (Treg) cells in CD4+ T cells in the peripheral blood of gastric cancer patients before anesthesia induction (T1), after surgery (T2) and the first day after surgery (T3) was studied to explore the effect of sevoflurane and propofol anesthesia on the prognosis of gastric cancer patients. Forty patients with advanced gastric cancer were recruited and randomly divided into the sevoflurane group (S group) and the propofol group (T group). Flow cytometry was used to detect the proportion of CD4+CD25+FOXP3+ Treg cells in CD4+ T cells in the peripheral blood of patients with T1, T2 and T3, respectively. Compared with stage ⅡB, the proportion of CD4+CD25+FOXP3+ Treg cells in T1, T2 and T3 of stage ⅢA and stage ⅢB patients was increased. Compared with the T group, the expression of CD4+CD25+FOXP3+ Treg cells in the peripheral blood of T2 and T3 in the S group was decreased. The results showed that the expression of CD4+CD25+FOXP3+ Treg cells might be related to the TNM stage of gastric cancer and sevoflurane could alleviate the inhibition of postoperative immune function more than propofol. Sevoflurane effectively reduced the expression level of CD4+CD25+FOXP3+ Treg cells in peripheral blood of T2 and T3 of patients with gastric cancer, providing the theoretical basis for the selection of surgical anesthetics for patients with gastric cancer.

Effects of coenzyme Q10 in a propofol infusion syndrome model of rabbits.

Coenzyme Q (CoQ) might be the main site of interaction with propofol on the mitochondrial respiratory chain in the propofol infusion syndrome (PRIS) because of the structural similarity between coenzyme Q10 (CoQ10) and propofol. To investigate the effects of CoQ10 on survival and organ injury in a PRIS model in rabbits. Sixteen male New Zealand white rabbits were divided into 4 groups: (1) propofol infusion group, (2) propofol infusion and CoQ10, 100 mg/kg was administered intravenously, (3) sevoflurane inhalation was administered, and (4) sevoflurane inhalation and CoQ10, 100 mg/kg intravenously, was administered. Arterial blood gas and biochemical analyses were repeated every 2 h and every 12 h, respectively. Animals that were alive on the 24th hour after anesthesia induction were euthanized. The organ damages were investigated under light and transmission electron microscopy (TEM). The propofol infusion group had the highest troponin T levels when compared with the other three groups at the 12th hour. The propofol + CoQ10 group had lower troponin T levels when compared with the propofol and sevoflurane groups (P < 0.05). Administration of CoQ10 decreased total liver injury scores and total organ injury scores both in the propofol and sevoflurane groups. The propofol and sevoflurane organ toxicities were attenuated with CoQ10 in liver, gallbladder, urinary bladder, and spleen. The addition of CoQ10 to propofol and sevoflurane anesthesia prevented the propofol-associated increase in troponin T levels at the 12th hour of infusion and decreased anesthetic-induced total liver and organ injury scores.

Renal safety of critical care sedation with sevoflurane: a systematic review and meta-analysis.

Volatile anesthetic agents are increasingly widely used for critical care sedation. There are concerns that sevoflurane presents a risk of renal injury when used in this role. RCTs comparing the use of critical care sevoflurane sedation with any control in humans were systematically identified using MEDLINE, Cochrane CENTRAL, web of Science, and CINAHL (until May 2022), if they presented comparative data on renal function or serum inorganic fluoride levels. Pooled SMDs (95% CI) were calculated where possible after assessment of quality with GRADE and risk of bias with ROB-2. Eight studies analyzing 793 patients were included. The median duration of use of critical care sevoflurane sedation was 4.8 [IQR 3.5-9.2] hours; however, most trials also included a period of prior intraoperative use. No significant difference was found in serum creatinine at 1day (SMD 0.05, 95% CI - 0.12 to 0.21), 48h (SMD = - 0.04; 95% Cl - 0.25 to 0.17), 72h (SMD = - 0.15; 95% CI - 0.45 to 0.15), and at discharge (SMD = - 0.1; 95% CI - 0.3 to 0.13) between the sevoflurane group and the control groups. Creatinine clearance was measured in two studies at 48h with no significant difference (SMD = - 0.13; 95% Cl - 0.38 to 0.11). Levels of serum inorganic fluoride were significantly elevated in patients where sevoflurane was used. Sevoflurane was not associated with renal failure when used for critical care sedation of fewer than 72-h duration, despite the elevation of serum fluoride. Longer-term studies are currently inadequate, including in patients with compromised renal function, to further evaluate the role of sevoflurane in this setting.Trial registration PROSPERO (CRD42022333099).

Plasma cytokine levels in spinal surgery with sevoflurane or total intravenous propofol anesthesia – A post hoc analysis of a randomized controlled trial

Surgical tissue trauma stimulates an inflammatory response resulting in increased levels of cytokines which could contribute to acute kidney injury (AKI). It is not clear if anesthetic modality affects this response. We aimed to investigate the role of anesthesia in a healthy surgical population on the inflammatory response and the correlation to plasma creatinine.This study is a post hoc analysis of a published randomized clinical trial. We analyzed plasma from patients who underwent elective spinal surgery randomized to either total intravenous propofol anesthesia (n = 12) or sevoflurane anesthesia (n = 10). The plasma samples were collected before anesthesia, during anesthesia, and 1 h after surgery. Plasma cytokine levels after surgery were analyzed for correlations with duration of surgical insult and change in plasma creatinine concentration.The cytokine interleukin-6 (IL-6) was increased after surgery compared with preoperatively. IL-6 was higher in the sevoflurane group than the propofol group after surgery. No patient developed AKI, but plasma creatinine was increased postoperatively in the sevoflurane group. There was a significant association between surgical time and plasma IL-6 postoperatively. No significant correlation between change in plasma creatinine and IL-6 was detected. The cytokines IL-4, IL-13, Eotaxin, Interferon γ-Induced Protein 10 (IP-10), Granulocyte Colony-Stimulating Factor (G-CSF), Macrophage Inflammatory Protein-1β (MIP-1β), and Monocyte Chemoattractant Protein 1 (MCP-1) were lower postoperatively than before surgery independent of anesthetic modality.This post hoc analysis revealed that plasma IL-6 was increased after surgery and more so in the sevoflurane group than the propofol group. Postoperative plasma IL-6 concentration was associated with surgical time.

Comparison of the Sevoflurane versus Desflurane Anaesthesia on the Recovery of Airway Reflexes and Cognitive Function: An Original Research.

Sevoflurane and desflurane virtually equally dissolve in blood gases, yet current research suggests that desflurane helps in a quick return of airway reflex than sevoflurane however the return of cognitive activity fluctuates greatly. In order to compare the lengths of time required to recover after sevoflurane and desflurane anesthesia, the current research was conducted. Current study was randomized that included 100 subjects who were posted for cholecystectomy (elective). Only adult and non-obese subjects were included in the study. The intended anesthetic agents sevoflurane and desflurane were utilized in the study and all the protocols were followed for the surgery. After the end of the surgery, tests for regaining cognitive function and airway reflexes were carried out, and different time intervals were recorded. The values were recorded and compared for the variances while considering the P < 0.05 as significant. The mean T1 was 8.19 ± 3.28 min for sevoflurane and was 5.82 ± 4.02 min. There was no significant variance between the two agents for the T1, 2 (P = 0.013 and 0.110 respectively). After the inhalation anesthetics ceased at T1, desflurane patients responded to verbal commands more quickly than sevoflurane patients (5.824.02 vs. 8.193.28 min). The SOMCT and swallowing test were similarly completed more quickly by desflurane-treated patients than by sevoflurane-treated patients (T3VST4) (13.693.37 vs. 10.024.86 min, P = 0.008 and (14.094.30 vs. 9.824.50 min, P 0.001, respectively). For the T3, 4-time intervals, there was a significant difference between the sevoflurane and desflurane groups. Desflurane causes patients to recover more quickly from laparoscopic cholecystectomy under controlled circumstances than sevoflurane does.

Enrichment of Sevoflurane and Propofol After Coronary Artery Bypass Grafting and Hub Genes Analysis: An Integrated Bioinformatics Study

Background: Internationally, coronary artery bypass grafting (CABG) is acknowledged as the most efficient way to treat coronary heart disease. In the CABG, sevoflurane and propofol are both used. For patients scheduled for an off-pump CABG, the differentially expressed genes (DEGs) in the anaesthetic gas sevoflurane and the intravenous anaesthetic propofol groups were investigated and compared in this study. Methods: First, DEGs were discovered using the Gene Expression Omnibus-retrieved gene expression profile (GSE129562) (GEO). Additionally, GO (Gene Ontology) function and KEGG (Kyoto Encyclopedia of Genes and Genomes) pathway enrichment analysis were performed on the DEGs. Thirdly, protein–protein interactions (PPIs) for the DEGs were created. Results: In the anaesthetic gas sevoflurane group, our investigation identified a total of 1710 DEGs, of which 1320 genes were up-regulated and 390 genes were down-regulated. The top three DEGs in the protein–protein network with the highest degrees are JUN, RELA, and HDAC1. In the intravenous anaesthetic propofol group, our investigation identified a total of 195 DEGs, of which 37 genes were up-regulated and 158 genes were down-regulated. The three DEGs with the highest degrees in the protein–protein network are JUN, FOS, and JUND. These DEGs were shown to be enriched in various keywords and pathways in the anaesthetic gas sevoflurane category or in the intravenous anaesthetic propofol group, according to GO enrichment analysis and KEGG enrichment analysis. JUN is the gene that these two groups have in common. However, the DEGs in the most significant module clearly distinguish among these 2 categories. Conclusion: Our findings show that certain DEGs may have an impact on patients scheduled for off-pump CABG in the sevoflurane gas anesthetic group and the propofol intravenous anesthetic group. These findings may aid future research into the molecular processes and biomarkers.

Comparative Study on Postoperative Recovery Profiles of Desflurane and Sevoflurane Using I-GEL in Elective Ambulatory Surgeries

Introduction: In providing general anesthesia for ambulatory surgery, the goal is to achieve optimal surgical conditions while ensuring a rapid early recovery without side effects. Desflurane and sevoflurane are proven as effective ambulatory inhalational anesthetic agents. The aim of this research is to investigate and compared the hemodynamic stability, postoperative outcome and airway responses in elective ambulatory surgeries in patients receiving anesthesia with desflurane or sevoflurane using I-Gel supraglottic airway.Methods: A prospective, observational study was conducted involving 60 patients of age 18 – 50 years undergoing ambulatory surgeries under general anesthesia, randomly allocated into 2 equal groups receiving desflurane (Group D) or sevoflurane (Group S) for maintenance of anesthesia with suitable size I-Gel. Patients were monitored for hemodynamic parameters and postoperative recovery profile using fast track criteria (FTC) score at different time intervals. Pearson’s Chi Square test and Mann- Whitney U test were used for statistical analysis.Results: The mean time taken for postoperative recovery characteristics were significantly lower in Group D than Group S (p&lt;0.001).The FTC score was significantly higher (p&lt;0.001) in Group D than Group S at all-time intervals for 30 minutes. The requirement of additional analgesics was 46.7% in Group D and 60% in Group S (p&gt;0.301) and that of antiemetic was 30% in Group D and 26.67% in Group S (p&gt;0.774).Conclusions: Desflurane showed superior postoperative recovery characteristics and better FTC score without any increase in adverse airway events than sevoflurane.

Comparison of Sevoflurane and Halothane Anesthesia Cognitive Function in Adult

Background: Patients reach their full cognitive and psychomotor potential during the intermediate period of recovery. We still utilize Halothane, which has a delayed recovery profile, despite the fact that rapid clearance drugs like Sevoflurane have a positive impact on early cognitive recovery, which permits early mobility and reduces post-surgical complications. Objective: The study's goal was to promote the use of sevoflurane over halothane by contrasting the two anesthetics' effects on patients' cognitive functioning after surgery. Method: The prospective randomized comparative study was carried out in the Department of Anaesthesia, Analgesia and Intensive Care Medicine, between the period of September 2021 to June 2022. Study population was the patients of either sex, aged between18-50 years, ASA-I and II, patients undergoing elective surgery by general anaesthesia, lasting for 1 hour or more and remaining 24 hours after surgery. A total number of 100 patients were divided into two groups. 50 patients were in Sevoflurane group and 50 in Halothane group. Results: Group- Sevoflurane had a considerably faster emergence time (10.85 min vs. 15.13 min, P0.001) than Group- Halothane. Group- Sevoflurane had a mean BAMSE score of 29 at baseline and showed no change by the conclusion of the observation period, but Group- Halothane saw their scores both drop and then recover. Patients in Group- Sevoflurane finished the (TMT-A) 30 minutes after regaining consciousness in a considerably shorter amount of time (40. 9 seconds vs. 55. 8 seconds, P 0.001). Furthermore, there was no statistically significant difference between the groups after 1.5 hours, 2.5 hours, or 3.5 hours. Conclusion: So the study concludes that adult patient of sevoflurane group experienced an early post-operative cognitive recovery than halothane group. Though sevoflurane is costly, considering the benefits of patients in terms of early cognitive recovery that causes less postoperative complications and shorter hospital stay, sevoflurane should be used instead of halothane.

Effect of propofol versus sevoflurane on auditory and cognitive functions: a randomized controlled trial

BackgroundHearing loss and cognitive impairment are postoperative complications which need more awareness by anaesthesiologists. We set out to investigate whether sevoflurane or propofol would have a negative impact on auditory function, attention, or auditory memory. This is a prospective randomized controlled study which was conducted on patients who were candidates for elective laparoscopic cholecystectomy under general anesthesia with either the sevoflurane or the propofol. All included participants were subjected to cognitive and auditory evaluation preoperative and 1 week after the operation. Cognitive assessment included: Paired Associate Learning test (PALT) and Paced Auditory Serial Addition Test (PASAT). Audiological assessment was done by measuring the auditory brainstem response (ABR).ResultsThere was no statistically significant difference between both groups in either age (p value = 0.537) or sex (p value = 0.175). In the propofol group, the postoperative values of LT ABR-I and III were significantly higher than the preoperative ones (p value < 0.001, 0.003), all the postoperative RT ABR waves were significantly higher than the preoperative ones (P < 0.05). In the sevoflurane group, the postoperative values for LTABR-I, III, III–V were significantly higher than the preoperative ones with p value (0.012, 0.008 and 0.009) and the postoperative values for RTABR-III, V, I–III, and III–V were significantly higher than preoperative values (P = 0.041, 0.029, 0.005 and < 0.001). There were no statistically significant differences between the propofol and sevoflurane groups in all waves of ABR on both sides (P > 0.05). There was a significant worsening between pre- and postoperative PASAT scores in the propofol and sevoflurane groups, respectively, with p value (< 0.001) with no statistically significant difference between both groups (p value = 0.906). In addition, there was a significant worsening between pre- and postoperative PALT scores in the propofol group only (p value = 0.01) with a statistically significant difference between both groups (p value = 0.038).ConclusionsThere was a statistically significant postoperative impairment in auditory function and attention following both the propofol and sevoflurane anesthesia with no significant difference between the two drugs. Whereas, the auditory memory was significantly impaired following the propofol only.

A Prospective, Randomized, Open-Label Study Comparing Recovery Characteristics between Desflurane and Sevoflurane Anesthesia in Elderly Patients Undergoing Elective Supratentorial Craniotomy

Abstract Background Sevoflurane and desflurane are the two commonly used volatile anesthetics and it is mandatory to comprehend their hemodynamic and recovery profiles to ensure safe administration and early recovery in elderly neurosurgical patients. The primary objective of the study was to compare the recovery profiles of sevoflurane and desflurane in elderly patients undergoing supratentorial craniotomy. The secondary outcome measures studied were intraoperative hemodynamic changes, intraoperative brain condition, and early postoperative cognition using short orientation memory concentration test (SOMCT). Methods The prospective, open-labeled study involving 78 elderly patients undergoing elective supratentorial craniotomies randomized the subjects into sevoflurane and desflurane groups in the ratio of 1:1 (39 each). Pre- and early postoperative cognitive function of the patient was assessed using SOMCT. Time for emergence, extubation, and recovery were also compared between the groups. Hemodynamic parameters during surgery and brain relaxation were recorded. Student's t-test was used to find the significance of study parameters on a continuous scale and chi-squared test to find the significance of study parameters on a categorical scale between two groups. Results The mean emergence time (minutes) was found to be significantly longer in sevoflurane group as opposed to desflurane (9.44 ± 2.07 vs. 8.28 ± 2.53, p = 0.02). Similarly, the mean recovery time was significantly longer for sevoflurane group than desflurane (17.33 ± 3.36 vs. 15.64 ± 4.63, p = 0.03). A statistically significant difference in pre- and early postoperative SOMCT was observed between the two groups (5.31 ± 2.89 vs. 4.33 ± 1.74, p = 0.04) with better early postoperative SOMCT (p = 0.05) in desflurane group. However, extubation time, average duration of surgery, brain relaxation, and modified Aldrete score were comparable between the groups. Conclusion Elderly patients who received desflurane had a shorter emergence and recovery time compared with sevoflurane. Improved early postoperative SOMCT scores were noted in desflurane group.

Comparison of hemodynamic alterations and post-operative profile of sevoflurane and propofol during laparoscopic cholecystectomies

Background: Modern laparoscopic surgeries with insufflation of gas into peritoneal cavity are gold standard treatment for cholelithiasis. Propofol, a GABA receptor positive allosteric modulator and Sevoflurane, an inhalational anesthetic are used for maintenance of general anesthesia. In laparoscopy, significant hemodynamic changes occur. Searching in field of anesthesia is going on for anesthetic agent for better recovery. Aims and Objectives: Objective of the study is to compare sevoflurane with propofol for intraoperative hemodynamic changes and post-operative recovery profile of patient’s undergone laparoscopic cholecystectomies under general anesthesia. Secondary objective is to compare post-operative complications. Materials and Methods: A prospective, randomized, single-blinded, and comparative study done after permission from the institutional ethical committee and informed consent from patients. Total 84 patients of 20–50 years age of either sex were scheduled for laparoscopic cholecystectomy, divided in two equal groups – Group P, induced with propofol and anesthesia was maintained with propofol (100–120 μg/kg/min), nitrous oxide and oxygen and Group S induced with propofol and anesthesia was maintained using sevoflurane (1–2%), nitrous oxide, and oxygen. Results: We found that time for eye opening was 9±1.21 min in Group P and 8±1.34 min in Group S. Time for following verbal command was 10±1.20 min in Group P and 9±1.32 min in Group S. Time for speaking name by patient was 11±1.20 min in Group P and 10±1.34 min in Group S. Difference between two groups regarding eye opening, following verbal command, and time to speak own name are highly significant with P&lt;0.001 which proves that eye opening, following verbal command and time for speaking name by patient were significantly shorter in sevoflurane group. Time to achieve modified aldrete score &gt;8 was 14±1.30 min in Group P and 13±1.37 min in Group S. Difference between two groups is also highly significant with P&lt;0.001 which proves that time to achieve modified aldrete score&gt;8 were significantly shorter in sevoflurane group. Conclusion: From our study, maintenance of general anesthesia with sevoflurane is associated with faster recovery from anesthesia.

Impact of general anaesthesia on breast cancer survival: a 5-year follow up of a pragmatic, randomised, controlled trial, the CAN-study, comparing propofol and sevoflurane.

Anaesthesia may impact long-term cancer survival. In the Cancer and Anaesthesia study, we hypothesised that the hypnotic drug propofol will have an advantage of at least five percentage points in five-year survival over the inhalational anaesthetic sevoflurane for breast cancer surgery. From 2118 eligible breast cancer patients scheduled for primary curable, invasive breast cancer surgery, 1764 were recruited after ethical approval and individual informed consent to this open label, single-blind, randomised trial at four county- and three university hospitals in Sweden and one Chinese university hospital. Of surveyed patients, 354 were excluded, mainly due to refusal to participate. Patients were randomised by computer at the monitoring organisation to general anaesthesia maintenance with either intravenous propofol or inhaled sevoflurane in a 1:1 ratio in permuted blocks. Data related to anaesthesia, surgery, oncology, and demographics were registered. The primary endpoint was five-year overall survival. Data are presented as Kaplan-Meier survival curves and Hazard Ratios based on Cox univariable regression analyses by both intention-to-treat and per-protocol. EudraCT, 2013-002380-25 and ClinicalTrials.gov, NCT01975064. Of 1764 patients, included from December 3, 2013, to September 29, 2017, 1670 remained for analysis. The numbers who survived at least five years were 773/841 (91.9% (95% CI 90.1-93.8)) in the propofol group and 764/829 (92.2% (90.3-94.0)) in the sevoflurane group, (HR 1.03 (0.73-1.44); P=0.875); the corresponding results in the per-protocol-analysis were: 733/798 (91.9% (90.0-93.8)) and 653/710 (92.0% (90.0-94.0)) (HR=1.01 (0.71-1.44); P=0.955). Survival after a median follow-up of 76.7 months did not indicate any difference between the groups (HR 0.97, 0.72-1.29; P=0.829, log rank test). No difference in overall survival was found between general anaesthesia with propofol or sevoflurane for breast cancer surgery. Swedish Research Council; Uppsala-Örebro Regional Research Council; Västmanland Regional Research Fund; Västmanland Cancer Foundation; Stig and Ragna Gohrton Foundation; Birgit and Henry Knutsson Foundation.

Subanesthetic-dose propofol infusion for preventing emergence agitation in children: a retrospective observational study.

Anesthesia maintenance using propofol and a propofol bolus dose at the end of surgery have been shown to prevent emergence agitation (EA).However, the preventive effect of subanesthetic propofol infusion during sevoflurane anesthesia on EA remains unknown. We aimed toevaluate the effect of subanesthetic propofol infusion on EA in children. We retrospectively compared the incidences of severe EA requiring pharmacological intervention in children who underwent adenoidectomy, tonsillectomy with or without adenoidectomy, or strabismus surgery between maintenance with sevoflurane alone (sevoflurane group) and maintenance with subanesthetic propofol with sevoflurane (combination group). A multivariable logistic regression model adjusted for confounders was used to assess the association between anesthesia methods and the occurrence of EA. Additionally, we estimated the direct effect of anesthesia methods by a mediation analysis, excluding the indirect effects of intraoperative fentanyl and droperidol administration. Among 244 eligible patients, 132 and 112 were in the sevoflurane and combination groups, respectively. The crude incidence of EA was significantly lower in the combination group (17.0% [n = 19]) than in the sevoflurane group (33.3% [n = 44]) (P = 0.005).After adjusting for confounders, the incidence of EA was still significantly lower in the combination group (adjusted odds ratio [aOR]: 0.48, 95% confidence interval [CI] 0.25-0.91). The mediation analysis revealed a direct association of anesthesia methods with a lower EA incidence in the combination group (aOR: 0.48, 95% CI 0.24-0.93) than in the sevoflurane group. Subanesthetic propofol infusion may effectively prevent severe EA requiring the administration of opioids or sedatives.

Effect of ketamine versus sevoflurane on the right ventricular pressure during balloon dilatation of congenital pulmonary valve stenosis

Background &amp; Objective: Congenital pulmonary stenosis (PS) is a prevalent cardiac anomaly that is commonly treated with balloon dilatation. The procedure can be successfully completed under appropriate anesthetic technique, depending upon the choice of the anesthetist and the patients’ physical status. We compared the effect of IV ketamine with sevoflurane inhalational anesthesia on right ventricular pressure in infants undergoing balloon dilatation for congenital pulmonary valve stenosis.&#x0D; Methodology: This double-blinded, randomized, clinical trial included 40 infants, aged from 1 to 12 months, with congenital PS undergoing balloon dilatation. They were randomly allocated to one of the two groups. In the ketamine group, 20 patients received 2 mg/kg of ketamine intravenously till being unconscious. In the sevoflurane group, 20 patients received 3% sevoflurane and were maintained using the open circuit technique till losing consciousness. The right ventricular pressure was the primary outcome. Secondary outcomes were the hemodynamics and oxygen saturation.&#x0D; Results: Compared to sevoflurane, ketamine showed a non-significant difference in the right ventricular pressure before and after induction of anesthesia and after balloon dilatation. The mean arterial blood pressure significantly dropped immediately after sevoflurane induction and after the initial 10 min (P = 0.031 and 0.041, respectively). The heart rate significantly decreased immediately after sevoflurane induction (P = 0.028). The oxygen saturation remained comparable in both groups at 10 and 20 min after induction, and at postoperative anesthesia care unit.&#x0D; Conclusion: Intravenous ketamine is considered a safe and effective alternative to sevoflurane for infants with congenital pulmonary stenosis undergoing balloon dilatation. It maintains the right ventricular pressure with stable hemodynamic effects, compared to sevoflurane inhalational anesthesia.&#x0D; Abbreviations: PS - Pulmonary Stenosis; TS – Tricuspid Stenosis; PACU – Post Anesthesia Care Unit; TTE - Transthoracic Echocardiography&#x0D; Key words: Balloon Dilatation; Infants; Ketamine; Pulmonary Stenosis; Sevoflurane.&#x0D; Citation: Sayed AG, Abd el Moez WA, Shoukry A, Elshafeey AE. Effect of ketamine versus sevoflurane on the right ventricular pressure during balloon dilatation of congenital pulmonary valve stenosis. Anaesth. pain intensive care 2023;27(5):451−457; DOI: 10.35975/apic.v27i5.2210&#x0D; Received: April 18, 2023; Reviewed: July 18, 2023; Accepted: August 21, 2023

A Perfusion Index-Based Evaluation and Comparison of Peripheral Perfusion in Sevoflurane and Isoflurane Anaesthesia: A Prospective Randomised Controlled Trial.

Perfusion index has shown to be helpful in the operative and critical care settings to monitor peripheral tissue perfusion. Randomised controlled trials quantifying different agents' vasodilatory properties using perfusion index has been limited. Therefore, we undertook this study to compare the vasodilatory effects of isoflurane and sevoflurane using perfusion index. This is a pre-specified sub-analysis of a prospective randomised controlled trial on the effects of inhalational agents at equipotent concentration. We randomly allocated patients scheduled for lumbar spine surgery to either isoflurane or sevoflurane groups. We recorded values of perfusion index at age-corrected 1 Minimum Alveolar Concentration (MAC) concentration at baseline, pre- and post-application of a noxious stimulus. The primary outcome of interest was the measure of vasomotor tone with perfusion index, and the secondary outcomes which were analysed were mean arterial pressure and heart rate. At age-corrected 1.0 MAC, there was no significant difference in the pre-stimulus haemodynamic variables and perfusion index between both groups. During the post-stimulus period, there was a significant increase in heart rate in the isoflurane group compared to the sevoflurane group, with no significant difference in the mean arterial pressure values between both groups. Though the perfusion index decreased during the post-stimulus period in both groups, there was no statistically significant difference between the 2 groups (P = .526, repeated-measures analysis of variance). In a steady state of age-corrected 1.0 MAC, isoflurane and sevoflurane had a similar perfusion index before and after a standardised nociceptive stimulus, which suggests that both of these agents have similar effect on peripheral perfusion and vasomotor tone.

Comparison of the Incidence of Postoperative Acute Kidney Injury Following the Administration of Remimazolam or Sevoflurane in Elderly Patients Undergoing Total Knee Arthroplasty: A Randomized Controlled Trial.

We evaluated the incidence of postoperative acute kidney injury (AKI) and complications when remimazolam (RMMZ) or sevoflurane (SEVO) were used in elderly patients undergoing total knee arthroplasty. Seventy-eight participants aged ≥65 were randomly allocated to either the RMMZ or SEVO group. The primary outcome was the incidence of AKI on postoperative day (POD) 2. The secondary outcomes included intraoperative heart rate (HR), blood pressure (BP), total drug administered, emergence time, postoperative complications on POD 2, and hospital length of stay (HLOS). The incidence of AKI was comparable between the RMMZ and SEVO groups. The doses of intraoperative remifentanil, vasodilators, and additional sedatives were significantly higher in the RMMZ group than in the SEVO group. Overall intraoperative HR and BP tended to remain higher in the RMMZ group. The emergence time in the operating room was significantly faster in the RMMZ group; however, the time required for an Aldrete score ≥ 9 was comparable between the RMMZ and SEVO groups. Postoperative complications and HLOS were comparable between the RMMZ and SEVO groups. RMMZ may be recommended for patients who are expected to decrease in intraoperative vital signs. However, stable hemodynamics with RMMZ were not sufficient to influence the prevention of AKI.