Inhalation Anesthesia Research Articles

Atypical posterior reversible encephalopathy syndrome following craniotomy for a metastatic lesion: illustrative case.

An 80-year-old male was found to have a metastatic lesion in his cerebrum. He underwent uncomplicated resection with prolonged inhalational anesthesia due to issues with intravenous access prior to surgery. Postoperatively, the patient had persistent altered mental status. Immediate postoperative head computed tomography and continuous electroencephalography were negative for possible causes. Standard brain magnetic resonance imaging (MRI) after metastatic resection demonstrated the development of edema in his pons and thalami, concerning for posterior reversible encephalopathy syndrome (PRES). Tight blood pressure control was initiated. His neurological examination returned to baseline. Follow-up MRI showed the resolution of edema. This is a report of PRES hypothesized to be attributable to prolonged inhalational anesthetic. PRES is a disorder in which patients present with altered mentation, seizures, visual impairment, or headache. PRES often occurs due to acute uncontrolled hypertension; however, other conditions, including autoimmune disease and cancer chemotherapy, have been linked. In severe cases, permanent brain damage and death have been reported. The authors present a case of PRES as the cause of severe neurological decline following craniotomy without severe or sustained hypertension. The authors hypothesize that PRES could be caused by blood pressure variability in the perioperative period and prolonged anesthesia. https://thejns.org/doi/10.3171/CASE24245.

Incidence of Concurrent Cerebral Desaturation and Electroencephalographic Burst Suppression in Cardiac Surgery Patients.

Increased intraoperative electroencephalographic (EEG) burst suppression is associated with postoperative delirium. Cerebral desaturation is considered as one of the factors associated with burst suppression. Our study investigates the association between cerebral desaturation and burst suppression by analyzing their concurrence. Additionally, we aim to examine their association with cardiac surgical phases to identify potential for targeted interventions. We retrospectively analyzed intraoperative 1-minute interval observations in 51 patients undergoing cardiac surgery. Processed EEG and cerebral oximetry were collected, with the anesthesiologists blinded to the information. The associations between cerebral desaturation (defined as a 10% decrease from baseline) and burst suppression, as well as with phase of cardiac surgery, were analyzed using the Generalized Logistic Mixed Effect Model. The results were presented as odds ratio and 95% confidence intervals (CIs). A value of P < .05 was considered statistically significant. The odds of burst suppression increased 1.5 times with cerebral desaturation (odds ratio [OR], 1.52, 95% CI, 1.11-2.07; P = .009). Compared to precardiopulmonary bypass (pre-CPB), the odds of cerebral desaturation were notably higher during CPB (OR, 22.1, 95% CI, 12.4-39.2; P < .001) and post-CPB (OR, 18.2, 95% CI, 12.2-27.3; P < .001). However, the odds of burst suppression were lower during post-CPB (OR, 0.69, 95% CI, 0.59-0.81; P < .001) compared to pre-CPB. Compared to pre-CPB, the odds of concurrent cerebral desaturation and burst suppression were notably higher during CPB (OR, 52.3, 95% CI, 19.5-140; P < .001) and post-CPB (OR, 12.7, 95% CI, 6.39-25.2; P < .001). During CPB, the odds of cerebral desaturation (OR, 6.59, 95% CI, 3.62-12; P < .001) and concurrent cerebral desaturation and burst suppression (OR, 10, 95% CI, 4.01-25.1; P < .001) were higher in the period between removal of aortic cross-clamp and end of CPB. During the entire surgery, the odds of burst suppression increased 8 times with higher inhalational anesthesia concentration (OR, 7.81, 95% CI, 6.26-9.74; P < .001 per 0.1% increase). Cerebral desaturation is associated with intraoperative burst suppression during cardiac surgery, most significantly during CPB, especially during the period between the removal of the aortic cross-clamp and end of CPB. Further exploration with simultaneous cerebral oximetry and EEG monitoring is required to determine the causes of burst suppression. Targeted interventions to address cerebral desaturation may assist in mitigating burst suppression and consequently enhance postoperative cognitive function.

The effects of anaesthesia on the cardiovascular, respiratory and nervous systems during inhalational anaesthesia: A case report.

Our understanding of the effects of anaesthesia is incomplete. Anaesthesia works primarily by causing widespread depression of the central nervous system. This article will consider the anaesthesia provided for a patient undergoing a hysteroscopy, endometrial ablation and biopsy for abnormal uterine bleeding. The relationship between physiology and the effects of anaesthesia is discussed. Several effects of anaesthesia are observed during the case. Relating to the respiratory system, preoxygenation increased end tidal oxygen by 39%, delaying desaturation during apnoea. Propofol had a profound effect on the patient's respiratory rate by inhibiting the ventilatory drive, resulting in apnoea. The cardiovascular system was affected by tracheal intubation. Stimulation of the sympathetic nervous system caused a 96% increase in heart rate. Induction of anaesthesia resulted in hypotension, treated with the administration of ephedrine, causing vasoconstriction. Modified rapid sequence induction required an increased dose of rocuronium, resulting in an increased duration of action at the neuromuscular junction. The prolonging muscle paralysis required sugammadex as a reversal agent. This case demonstrated the effects of anaesthesia on the respiratory, cardiovascular and nervous systems.

Trends in changing the structure of anesthesia at the advanced stages of medical care in modern armed conflict

The objective was to analyze the structure of anesthesia provided to the wounded at the advanced stages of medical care in the active phase of hostilities.Materials and methods. A retrospective analysis of the medical data of anesthesia was performed. The data on the structure of anesthesia in military medical organizations of 1–3 levels in the zone of a special military operation for the period from 01.2023 to 07.2024 were analyzed.Results. In the structure of combat trauma, with the need for surgical intervention, gunshot wounds amounted to 85.2%, there was a predominance of combined (71.5%) and multiple (19.8%) wounds.The low proportion of combined general anesthesia and the lack of use of inhalation anesthesia at some stages is explained by the special conditions of care. Regional anesthesia (RA), including as part of combined anesthesia, in the structure of anesthesia at the stages of emergency specialized surgical care amounted to 34.5%, and at the stages of qualified surgical care – 25.4%. The lowest rates of RA use were at the stages of level 1, as well as at the stages of level 2 with a 100% flow of primary wounded.Conclusion. RA occupies a significant share in the structure of anesthesia at the military stages of medical evacuation; an increase in the frequency of its use is possible due to the introduction of ultrasonic navigation.

Startle sign events induced by mechanical manipulation during surgery for neuroma localization: a retrospective cohort study

BackgroundChronic pain from peripheral neuromas is difficult to manage and often requires surgical excision, though intraoperative identification of neuromas can be challenging due to anatomical ambiguity. Mechanical manipulation of the neuroma during surgery can elicit a characteristic “startle sign”, which can help guide surgical management. However, it is unknown how anesthetic management affects detection of the startle sign.MethodsWe performed a retrospective cohort study of 73 neuroma excision surgeries performed recently at Massachusetts General Hospital. Physiological changes in the anesthetic record were analyzed to identify associations with a startle sign event. Anesthesia type and doses of pharmacological agents were analyzed between startle sign and no-startle sign groups.ResultsOf the 64 neuroma resection surgeries included, 13 had a startle sign. Combined intravenous and inhalation anesthesia (CIVIA) was more frequently used in the startle sign group vs. no-startle sign group (54% vs. 8%), while regional blockade with monitored anesthetic care was not associated with the startle sign group (12% vs. 0%), p = 0.001 for anesthesia type. Other factors, such as neuromuscular blocking agents, ketamine infusion, remifentanil infusion, and intravenous morphine equivalents showed no differences between groups.ConclusionsHere, we identified hypothesis-generating descriptive differences in anesthetic management associated with the detection of the neuroma startle sign during neuroma excision surgery, suggesting ways to deliver anesthesia facilitating detection of this phenomenon. Prospective trials are needed to further validate the hypotheses generated.

Postoperative analgesia in patients undergoing thoracotomy: A comparison between total intravenous anesthesia and inhalation anesthesia

Objective: Propofol is more effective than inhalational anesthesia; however, the results for the management of acute pain remain controversial. Therefore, this study aimed to determine the incidence of acute pain after inhalation anesthesia and total intravenous anesthesia among patients who underwent thoracotomy at our hospital. Methods: We conducted a single center retrospective observational study using data from electronic medical records. Sixty patients aged ≥20 years with American Society of Anesthesiologists physical status class I or II who underwent regular and emergency thoracotomy between January 1, 2016, and January 1, 2020, at Chungbuk National University Hospital were included in this study. The anesthesia and postoperative pain records of those who received total intravenous anesthesia (n=30) and inhalation anesthesia (n=30) were retrospectively reviewed. The pain score on the numeric rating scale (NRS) was evaluated at 2, 8, 24, and 30 hours postoperatively. Results: The average NRS score of patients who received total intravenous anesthesia was lesser than that of those who received inhalational anesthesia. Moreover, the difference in the NRS scores at eight hours postoperatively was statistically significant (P &lt;0.05). Patients who received inhalational anesthesia had a higher pain score and experienced more severe pain than those who received intravenous anesthesia. Conclusions: Total intravenous anesthesia with propofol-remifentanil provided better analgesia for acute postoperative pain in patients who underwent thoracotomy than inhalational anesthesia, suggesting it may be considered the combination of choice for thoracic surgery.Abbreviations: ASA: American Society of Anesthesiologists, CRTS: Chronic post-thoracotomy pain syndrome, GABA: Gamma-aminobutyric acid, IL: Interleukin, NRS: numeric rating scale.doi: https://doi.org/10.12669/pjms.40.10.9907How to cite this: Lee JY, Jeong ST, Hwang JH, Park SH. Postoperative analgesia in patients undergoing thoracotomy: A comparison between total intravenous anesthesia and inhalation anesthesia. Pak J Med Sci. 2024;40(10):2219-2222. doi: https://doi.org/10.12669/pjms.40.10.9907This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Creation and Preclinical Testing of a Spirometer with Extended Functionality

RELEVANCE. We present the results of preclinical testing of an upgraded portable AR­1 gas flow analyzer produced by JSC Krasnogvardeets (Saint Petersburg) in order to create import-substituting technologies and develop practical and scientific spheres of healthcare.THE AIM OF THE STUDY. was to substantiate the possibility of clinical use of the upgraded device, originally intended for testing ventilators and inhalation anesthesia devices, as a monitor of the external respiration apparatus function.MATERIAL AND METHODS. The preclinical study of the upgraded gas flow analyzer was conducted at the V.A. Almazov National Medical Research Center in comparison with devices for conventional (Bellavista 950, Berner Ross Medical, Russia) and high-frequency (IPV-2C, Intrapulmonary Percussive Ventilation, Percussionaire Corporation, USA) mechanical ventilation in volume- and pressure-controlled modes using an artificial lung. The following reflected spirometry parameters were compared: tidal and minute volume under inhalation and exhalation, respiratory rate, maximum and minimum flows, peak and positive end expiratory pressure, fraction of inspired oxygen.RESULTS. A high accuracy of parameter matching shown by the gas flow analyzer and ventilators was demonstrated.CONCLUSION. The upgraded model of the gas flow analyzer can be used clinically as a portable spirometer at the prehospital and hospital stages.

Comparison of postoperative outcomes after cranial neurosurgery using propofol-based total intravenous anesthesia versus inhalation anesthesia: a nationwide cohort study in South Korea.

We aimed to determine whether propofol-based total intravenous anesthesia (TIVA) is associated with mortality and morbidity following cranial neurosurgery compared with inhalation anesthesia. This nationwide, retrospective, population-based cohort study included patients who underwent cranial neurosurgery under general anesthesia between January 1, 2016, and December 31, 2021. The two study endpoints were 90-day mortality and postoperative complications. In total, 144,506 adult patients were included: 65,442 patients (45.3%) who received TIVA (TIVA group) and 79,064 (54.7%) who received inhalation anesthesia (inhalation anesthesia group). After propensity score (PS) matching, 97,156 patients (48,578 in each group) were included. The 90-day mortality rates after cranial neurosurgery were 14.0% (6,660 / 48,578) in the TIVA group and 14.2% (6,779 / 48,578) in the inhalation anesthesia group. Moreover, the postoperative complication rates following cranial neurosurgery were 47.1% (22,411 / 48,578) and 50.3% (23,912 / 48,578) in the TIVA and inhalation anesthesia groups, respectively. Based on the logistic regression analysis, TIVA was not associated with 90-day mortality compared with inhalation anesthesia (odds ratio [OR]: 0.97, 95% CI: 0.94, 1.01; P = 0.188) in the PS-matched cohort. Logistic regression analysis revealed that the TIVA group had a 12% (OR: 0.88, 95% CI: 0.86, 0.90; P < 0.0.001) lower postoperative complication rate than the inhalation anesthesia group. There was no significant association between the type of anesthesia and postoperative 90-day mortality in patients who underwent cranial neurosurgery in South Korea. However, propofol-based TIVA was associated with a lower incidence of postoperative complications than inhalation anesthesia.

Lung ultrasound assessment of atelectasis following different anesthesia induction techniques in pediatric patients: a propensity score-matched, observational study

IntroductionAtelectasis is a well-documented complication in pediatric patients undergoing general anesthesia. Its incidence varies significantly based on surgical procedures and anesthesia techniques. Inhalation induction, commonly used to avoid the discomfort of venipuncture, is suspected to cause higher rates of respiratory complications, including atelectasis, compared to intravenous induction. This study aimed to evaluate the impact of inhalation versus intravenous anesthesia induction on atelectasis formation in pediatric patients, as assessed by lung ultrasound (LUS).MethodsThis propensity score-matched observational study was conducted at a tertiary pediatric hospital in Milan, Italy. Inclusion criteria were children ≤ 18 years undergoing elective surgery with general anesthesia. Patients were divided into inhalation and intravenous induction groups. LUS was performed before and after anesthesia induction to assess lung aeration. The primary endpoint was the global LUS score post-induction, with secondary endpoints including the incidence and distribution of atelectasis.ResultsOf the 326 patients included, 65% underwent inhalation induction and 35% intravenous induction. The global LUS score was significantly higher in the inhalation group (12.0 vs. 4.0, p < 0.001). After propensity score matching (for age, presence of upper respiratory tract infection, duration of induction, and PEEP levels at induction), average treatment effect (ATE) of mask induction was 5.89 (95% CI, 3.21–8.58; p < 0.001) point on LUS global score and a coefficient of 0.35 (OR 1.41) for atelectasis.DiscussionInhalation induction is associated with a higher incidence of atelectasis in pediatric patients also when we adjusted for clinically relevant covariates.Trial registrationClinicalTrials.gov identifier: NCT06069414.

Comparison of Total Intravenous Anesthesia with Inhaler Anesthesia in Children Intubated with Remifentanil without Muscle Relaxant

Objective: The effects of remifentanil and muscle relaxant-free intubation as well as total intravenous anesthesia and inhaled anesthesia for tonsillectomy and/or adenoidectomy in children were compared. Materials and Methods: The study was conducted on 80 patients who were to undergo tonsillectomy and/or adenoidectomy between December 2014 and June 2015. Patients were randomized and divided into two groups. In the total intravenous anaesthesia group, 2.5 mg/kg propofol and 2 mcg/kg remifentanil were administered as induction within 90 seconds. In this group, 3 mg/kg/h propofol and 0.5 mcg/kg/min remifentanil were used for maintenance of anesthesia. In the sevoflurane group, 8% sevoflurane and 2 mcg/kg remifentanil were administered as induction within 90 seconds. In this group, 2.5% sevoflurane, 50% nitrogen protoxide and 50% oxygen were used at 6 l/min for maintenance of anesthesia. Results: Peak heart rate and systolic arterial pressure were significantly higher in Group I. Diastolic arterial pressure was significantly higher in Group T at 1 and 2 minutes after intubation and in Group 2 at 10 minutes postoperatively. Mean arterial pressure was higher in Group T at 2 minutes after intubation. In addition, Wong-Baker pain scale and agitation score were significantly higher in Group I. Spontaneous respiration and extubation time were significantly shorter in Group I. There was no difference between the groups in terms of side effects. Conclusion: Group total intravenous anaesthesia was thought to be a better choice in children because it had less impact on postoperative pain, agitation and recovery.

Efficacy of ultrasound guided sphenopalatine ganglion block in management of emergence agitation after sinoscopic nasal surgery: a randomized double-blind controlled study

BackgroundNasal surgery has a reported high incidence of agitation during emergence from general anesthesia. Emergence Agitation (EA) increases the risk of surgical site bleeding, falling off the operating table, removal of catheters and intravenous lines, and self-extubation. This study investigated the role of nerve block in EA. ObjectivesThis study evaluated the effect of ultrasound-guided sphenopalatine ganglion block (SPGB) on EA after sinoscopic nasal surgery. The primary outcome was the incidence of EA. Secondary outcomes included the quality of the surgical field, bleeding volume, inhalational anesthesia, MAC, VAS in the PACU, postoperative analgesia duration, and total 24 -h opioid consumption. Patients and methodsThis double-blind, randomized controlled study enrolled 120 patients, of whom 110 completed the study. They were randomly allocated into two equal groups: G1, which received general anesthesia and a bilateral sphenopalatine ganglion block (SPBG) with 5 mL lidocaine 2% on each side, and G2 (control), which received general anesthesia and a bilateral sphenopalatine saline injection of 5 mL on each side. ResultsA significant decrease in the incidence of EA was found in G1 compared to G2 (20% vs. 64%). Intraoperative bleeding volume was significantly lower, and surgical field quality was significantly higher in G1 compared to G2. Pain severity was significantly lower in G1 in the PACU, and 24 h postoperative opioid consumption was significantly reduced compared to G2. Additionally, postoperative analgesia duration was significantly longer in G1 than in G2 (9 h vs. 3 h). ConclusionSPGB effectively reduced EA incidence, severity, and duration after sinoscopic nasal surgery. Furthermore, SPGB reduced intraoperative bleeding, improved surgical field quality, prolonged postoperative analgesia, and reduced 24 -h opioid consumption after sinoscopic nasal surgery. RegistrationNational Clinical Trial Registry, NCT04168879

Comparison of inhalational and intravenous anesthesia induction on electroencephalogram and cerebral perfusion in children with congenital heart disease: A secondary analysis of a randomized controlled trial

ObjectiveThe effects of anesthetics on electroencephalograms and cerebral perfusion remain understudied in children with congenital heart disease. With regard to this, we compared inhalational anesthesia induction and intravenous anesthesia induction. DesignA randomized controlled trial. SettingOperation room in two tertiary hospitals. ParticipantsA cohort of 116 pediatrics patients undergoing cardiac surgery. Measurements and main resultsThe patients were randomly assigned to either the intravenous group (n=58) or the inhalational group (n=58). The inhalational group received anesthesia induction with 4-6% sevoflurane and a bolus of pipecuronium 0.2 mg/kg, while the intravenous group received anesthesia induction with intravenous midazolam 0.2 mg/kg, pipecuronium 0.2 mg/kg, and sufentanil 1 μg/kg. Ten minutes after tracheal intubation, the following parameters were measured: spectral edge frequency, burst suppression event, patient state index, middle cerebral artery blood flow velocity, cerebral oxygen saturation, and hemodynamic parameters. In comparison to the intravenous group, the inhalational group exhibited significant increases in 95% spectral edge frequency, ratio of burst suppression event, blood flow velocity in the middle cerebral artery, and cerebral oxygen saturation (P<0.05 for all), as well as decreases in systolic pressure, diastolic pressure, cardiac index, and the maximal slope of systolic upstroke (P<0.05 for all). ConclusionThe administration of sevoflurane for anesthesia induction results in more burst suppression, while also demonstrating superior cerebral perfusion when compared to the use of intravenous medications for anesthesia induction.

Anesthetic protocol for exploratory laparotomy in giant anteater (myrmecophaga tridactyla): case report

The movement of the giant anteater (Myrmecophaga tridactyla) in search of water and food causes a large number of accidents. The objective of this study is to describe the anesthetic protocol used in an exploratory laparotomy to control internal bleeding in a giant anteater. The animal was treated at the “Luiz Quintiliano de Oliveira” Veterinary Hospital of the Araçatuba School of Veterinary Medicine (UNESP) with a history of being run over. Midazolam was administered to restrain and position the animal during the physical and ultrasound examination, tramadol hydrochloride as premedication, and ketamine and midazolam for induction. Finally, anesthesia was maintained under inhalation anesthesia with isoflurane. Bradycardia during the transoperative period was corrected with a bolus of hypertonic solution (7.5% NaCl) and hydroxyethyl starch (Voluven®). The animal showed a satisfactory anesthetic recovery. Therefore, it is concluded that the anesthetic protocol is declared adequate for this procedure in giant anteaters.

Inhalation Anesthetics Play a Janus-Faced Role in Self-Renewal and Differentiation of Stem Cells.

Inhalation anesthesia stands as a pivotal modality within clinical anesthesia practices. Beyond its primary anesthetic effects, inhaled anesthetics have non-anesthetic effects, exerting bidirectional influences on the physiological state of the body and disease progression. These effects encompass impaired cognitive function, inhibition of embryonic development, influence on tumor progression, and so forth. For many years, inhaled anesthetics were viewed as inhibitors of stem cell fate regulation. However, there is now a growing appreciation that inhaled anesthetics promote stem cell biological functions and thus are now regarded as a double-edged sword affecting stem cell fate. In this review, the effects of inhaled anesthetics on self-renewal and differentiation of neural stem cells (NSCs), embryonic stem cells (ESCs), and cancer stem cells (CSCs) were summarized. The mechanisms of inhaled anesthetics involving cell cycle, metabolism, stemness, and niche of stem cells were also discussed. A comprehensive understanding of these effects will enhance our comprehension of how inhaled anesthetics impact the human body, thus promising breakthroughs in the development of novel strategies for innovative stem cell therapy approaches.

Impact of propofol versus desflurane anesthesia on postoperative hepatic and renal functions in infants with living-related liver transplantation: a randomized controlled trial

BackgroundThe effects of anesthetics on liver and kidney functions after infantile living-related liver transplantation (LRLT) are unclear. This study aimed to investigate the effects of propofol-based total intravenous anesthesia (TIVA) or desflurane-based inhalation anesthesia on postoperative liver and kidney functions in infant recipients after LRLT and to evaluate hepatic ischemia–reperfusion injury (HIRI).MethodsSeventy-six infants with congenital biliary atresia scheduled for LRLT were randomly divided into two anesthesia maintenance groups: group D with continuous inhalation of desflurane and group P with an infusion of propofol. The primary focus was to assess alterations of liver transaminase and serum creatinine (Scr) levels within the first 7 days after surgery. And the peak aminotransferase level within 72 h post-surgery was used as a surrogate marker for HIRI.ResultsThere were no differences in preoperative hepatic and renal functions between the two groups. Upon the intensive care unit (ICU) arrival, the levels of aspartate aminotransferase (AST, P = 0.001) and alanine aminotransferase (ALT, P = 0.005) in group P were significantly lower than those in group D. These changes persisted until the fourth and sixth days after surgery. The peak AST and ALT levels within 72 h after surgery were also lower in group P than in group D (856 (552, 1221) vs. 1468 (732, 1969) U/L, P = 0.001 (95% CI: 161–777) and 517 (428, 704) vs. 730 (541, 1100) U/L, P = 0.006, (95% CI: 58–366), respectively). Patients in group P had lower levels of Scr upon the ICU arrival and on the first day after surgery, compared to group D (17.8 (15.2, 22.0) vs. 23.0 (20.8, 30.8) μmol/L, P < 0.001 (95% CI: 3.0–8.7) and 17.1 (14.9, 21.0) vs. 20.5 (16.5, 25.3) μmol/L, P = 0.02 (95% CI: 0.0–5.0) respectively). Moreover, the incidence of severe acute kidney injury was significantly lower in group P compared to that in group D (15.8% vs. 39.5%, P = 0.038).ConclusionsPropofol-based TIVA might improve liver and kidney functions after LRLT in infants and reduce the incidence of serious complications, which may be related to the reduction of HIRI. However, further biomarkers will be necessary to prove these associations.

Incidences of Rocuronium Use during Anesthetic Induction in Adult Patients Undergoing Orthopedic Surgery Using Supraglottic Airway Devices: A Retrospective Analysis.

Background/Objectives: Neuromuscular blocking agents (NMBAs) are not usually necessary during the induction of general anesthesia in patients using supraglottic airway (SGA) devices. In this study, we assessed the incidences of rocuronium use in adult patients undergoing general anesthesia using SGA devices. Methods: From September 2022 to August 2023, the medical records of adult patients (≥19 years) who underwent orthopedic surgery using SGA devices were retrospectively investigated. The incidences of rocuronium use during anesthetic induction were analyzed according to the anesthetic induction drug. The association of rocuronium use during anesthesia was analyzed in terms of demographic (age, sex, height, and weight), surgical (surgical time), and anesthetic factors (premedication, anesthetic agent, anesthetic time). Results: In total, 321 patients were enrolled. The incidence rate of rocuronium use during anesthetic induction was 28.3%. In the subgroup analysis, patients receiving total intravenous anesthesia (TIVA) with propofol (PPF) and remifentanil showed a markedly lower incidence (14.4%) than the other anesthetic groups. Premedication or short anesthetic duration was associated with lower incidences of rocuronium use. Demographic and other anesthetic factors did not seem to affect the incidences of rocuronium use during anesthesia. Conclusions: The incidence of rocuronium use during anesthetic induction with SGA devices was significantly lower with the PPF-TIVA compared to that using remimazolam-TIVA or inhalational anesthesia. Premedication with midazolam and shorter operation times were associated with a significantly lower incidence of rocuronium use.

Intraoperative monitoring of visual evoked potentials: experience of 240 operations

Background. Intraoperative monitoring (IOM) of visual evoked potentials (VEPs) is used to inform surgeons about impacts on the visual system in order to prevent iatrogenic visual impairment. The VEP monitoring use become widespread only in the last decade; nowadays, there is no generally accepted methodology for its implementation, and the effectiveness of VEP monitoring and the factors determining it have not been sufficiently studied.Aim. The aim of the study was to investigate the factors influencing the VEP monitoring feasibility and effectiveness.Materials and methods. Data from 240 consecutive neurosurgical operations performed using VEP monitoring were retrospectively reviewed. IOM data (registration parameters, presence and type of VEP changes), patient characteristics (gender and age, tumor type and location, presence of preoperative visual dysfunctions), anesthesia parameters and postoperative changes in vision were studied. Statistical analysis was performed using χ2 and Mann–Whitney tests.Results. VEPs were obtained in 91.3 % of eyes with completely or partially preserved vision. The main factors reducing the chances to record VEPs successfully are preoperative visual disorders and the use of inhalation anesthesia. A personalized approach to the selection of reference electrodes and frequency filtering parameters makes it possible to reduce the number of averagings required for VEP recording and accelerate informing surgeons. With successful monitoring 59.1 % of eyes had no noticeable VEP changes; 5.8 % of eyes had signs of intraoperative improvement; 35.1 % had signs of deterioration. Among the last category, 60.7 % of eyes had full VEPs recovery afterwards. After surgery, new visual disorders were detected in 2.6 % of eyes without signs of intraoperative deterioration, in 6.7 % – with temporary deterioration, and in 19.3 % – with signs of deterioration persisted until IOM is finished. Assessing the sensitivity and specificity of VEP monitoring is hampered by the possibility of complications in the early postoperative period and IOM influence on the course and results of the operation. The proportion of total resections was maximal when VEP monitoring was successful. In the subgroup without preoperative visual impairments, the alarms during monitoring were associated with decrease in proportion of total resections proportion due to increase in proportion of subtotal resections.Conclusion. VEP monitoring with a personalized approach allows effective monitoring of visual functions preservation during neurosurgical operations.

320.6: Effect of target-controlled infusion versus general inhalational anesthesia on hemodynamic parameters and post-operative outcomes among renal transplant patients: a single-center, open-label, randomized controlled trial.

320.6: Effect of target-controlled infusion versus general inhalational anesthesia on hemodynamic parameters and post-operative outcomes among renal transplant patients: a single-center, open-label, randomized controlled trial.

Activation of ACE2/Ang-(1–7)/Mas axis improves cognitive dysfunction induced by isoflurane in mice via inhibiting oxidative stress

BackgroundLong-term inhalation anesthesia is known to be associated with postoperative cognitive dysfunction. Our previous studies have confirmed that oxidative stress damage contributes to its mechanistic connection. Angiotensin-converting enzyme 2 (ACE2)/Angiotensin-(1–7)/Mas axis plays a crucial role in balancing the classic Renin-Angiotensin System (RAS) and regulating oxidative stress. This research aims to investigate the involvement of the ACE2/Angiotensin-(1–7)/Mas axis in the development of cognitive impairment induced by long-term isoflurane anesthesia. Methods3-month-old male C57BL/6 mice were randomly assigned to four groups: Control + Vehicle (C + Veh), Anesthesia + Vehicle (A + Veh), Control + Diminazene aceturate (C + DIZE), and Anesthesia + Diminazene aceturate (A + DIZE). Long-term isoflurane exposure was utilized to induce cognitive impairment. DIZE was administered intraperitoneally to mice 10 days prior to anesthesia to intervene ACE2. Cognitive function was administered using Y-maze and fear conditioning test. Flow Cytometry was used to measure the levels of ROS. Western blot was used to determine the expression levels of ACE2 and Mas, as well as the cognitive proteins such as phosphorylated N-methyl-D-aspartate receptor subtype 2B (p-NR2B) and Brain-Derived Neurotrophic Factor (BDNF). ResultsWe successfully constructed a long-term isoflurane anesthesia-mediated cognitive dysfunction model. Following long-term isoflurane anesthesia, there was a decrease in the levels of ACE2 and Mas in the hippocampus, accompanied by increased oxidative stress and significant cognitive impairment. Treatment with the ACE2 activator DIZE effectively restored the levels of ACE2 and Mas and decreased the content of ROS. Notably, DIZE treatment ameliorated cognitive dysfunction induced by long-term isoflurane exposure. ConclusionsThe findings suggest that the activation of the ACE2/Ang-(1–7)/Mas axis could reduce oxidative stress and improve cognitive impairment. ACE2/Ang-(1–7)/Mas axis may play a prophylactic role in mitigating isoflurane-induced cognitive decline and other cognitive impairments related to oxidative stress.

Recommendation for the practice of total intravenous anesthesia.

This Recommendation was developed by the Japanese Society of Intravenous Anesthesia Recommendation Making Working Group (JSIVA-WG) to promote the safe and effective practice of total intravenous anesthesia (TIVA), tailored to the current situation in Japan. It presents a policy validated by the members of JSIVA-WG and a review committee for practical anesthesia management. Anesthesiologists should acquire and maintain the necessary knowledge and skills to be able to administer TIVA properly. A secure venous access is critically important for TIVA. To visualize and understand the pharmacokinetics of intravenous anesthetics, use of real-time pharmacokinetic simulations is strongly recommended. Syringe pumps are essential for the infusion of intravenous anesthetics, which should be prepared according to the rules of each individual anesthesia department, particularly with regard to dilution. Syringes should be clearly labeled with content and drug concentration. Whenmanaging TIVA, particularly with the use of muscle relaxants, monitoring processed electroencephalogram (EEG) is advisable. However, the depth of sedation/anesthesia must be assessed comprehensively using various parameters, rather than simply relying on a single EEG index. TIVA should be swiftly changed to an alternative method that includes inhalation anesthesia if necessary. Use of antagonists at emergence may be associated with re-sedation risk. Casual administration of antagonists and sending patients back to surgical wards without careful observation are not acceptable.