Inhalation Anesthesia Group Research Articles

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.

Propofol total intravenous anesthesia vs. sevoflurane inhalation anesthesia: Effects on post‑operative cognitive dysfunction and inflammation in geriatric patients undergoing laparoscopic surgery.

Propofol total intravenous anesthesia (TIVA) or sevoflurane inhalation anesthesia (IA) affects post-operative cognitive dysfunction in geriatric patients undergoing laparoscopic surgery; however, relevant real-world clinical evidence on the matter is limited. The present study aimed to compare the effects of propofol TIVA and sevoflurane IA on post-operative cognitive dysfunction in the aforementioned type of patients. The present prospective study enrolled 197 geriatric patients undergoing laparoscopic surgery. Patients were assigned to the propofol TIVA group (n=97) and sevoflurane IA group (n=100) according to the actual anesthesia regimens. The mini-mental state examination (MMSE) score was assessed before surgery and on day (D)1, D3 and D7 following surgery in both groups. The MMSE score on D1 was higher in the TIVA group compared with the IA group (P=0.006). The change in the MMSE scores from before surgery to D1 (P<0.001), D3 (P=0.011) and D7 (P=0.003) was smaller in the TIVA group vs. the IA group. Multivariate linear regression analyses suggested that the anesthesia method of TIVA (vs. IA) was independently related to the increased MMSE score on D1 (b=0.803; P=0.001) and D7 (b=0.472; P=0.025). The levels of interleukin (IL)-17A, IL-6 and tumor necrosis factor-α on D1, D3 and D7 exhibited a slightly decreasing trend in the TIVA group vs. the IA group, although the difference was not statistically significant (all P>0.05). Notably, the levels of IL-17A before surgery (P=0.015), on D3 (P=0.016) and D7 (P=0.002), as well as those of IL-6 on D1 (P=0.027), were negatively associated with the MMSE score at the corresponding time points. Overall, the present study demonstrates that propofol TIVA ameliorates post-operative cognitive dysfunction on D1 compared with sevoflurane IA and exerts a potentially suppressive effect on inflammation in geriatric patients undergoing laparoscopic surgery.

Impact of prognostic nutritional index change on prognosis after colorectal cancer surgery under propofol or sevoflurane anesthesia

BackgroundThe alteration of the prognostic nutritional index (PNI) or the utilization of distinct anesthesia strategies has been linked to the prognosis of various cancer types, but the existing evidence is limited and inconclusive, particularly for colorectal cancer (CRC). Our objective was to evaluate the association between PNI change and progression free survival (PFS) and overall survival (OS) in patients treated with CRC surgery after propofol-based or sevoflurane-based anesthesia.MethodsWe conducted a retrospective analysis of 414 patients with CRC who underwent surgical resection. Among them, 165 patients received propofol-based total intravenous anesthesia (TIVA-P), while 249 patients received sevoflurane-based inhalation anesthesia (IA-S). The PNI change (ΔPNI) was calculated by subtracting the pre-surgery PNI from the post-surgery PNI, and patients were categorized into high (≥ -2.25) and low (< -2.25) ΔPNI groups. Univariate and multivariate analyses were employed to evaluate the effects of the two anesthesia methods, ΔPNI, and their potential interaction on PFS and OS.ResultsThe median duration of follow-up was 35.9 months (interquartile range: 18–60 months). The five-year OS rates were 63.0% in the TIVA-P group and 59.8% in the IA-S group (hazard ratio [HR]: 0.96; 95% confidence interval [CI]: 0.70–1.35; p = 0.864), while the five-year PFS rates were 55.8% and 51.0% (HR: 0.92; 95% CI: 0.68–1.26; p = 0.614), respectively. In comparison to patients in the low ΔPNI group, those in the high ΔPNI group exhibited a favorable association with both OS (HR: 0.57; 95% CI: 0.40–0.76; p < 0.001) and PFS (HR: 0.58; 95% CI: 0.43–0.79; p < 0.001). Stratified analysis based on ΔPNI revealed significant protective effects in the propofol-treated participants within the high ΔPNI group, whereas such effects were not observed in the low ΔPNI group, for both OS (p for interaction = 0.004) and PFS (p for interaction = 0.024).ConclusionsOur data revealed that among patients who underwent CRC surgery, those treated with TIVA-P exhibited superior survival outcomes compared to those who received IA-S, particularly among individuals with a high degree of PNI change.

Effect of Dexmedetomidine on Intraoperative Hemodynamics and Blood Loss in Patients Undergoing Spine Surgery: A Systematic Review and Meta-Analysis

Objective Dexmedetomidine (Dex) is a highly selective α2 adrenoceptor agonist that reduces blood pressure and heart rate. However, its ability to provide stable hemodynamics and a clinically significant reduction in blood loss in spine surgery is still a matter of debate. This study aimed to investigate the effects of Dex on intraoperative hemodynamics and blood loss in patients undergoing spine surgery.Methods The Web of Science, MEDLINE, EMBASE, and the Cochrane Library were searched up to February 2023 for randomized controlled trials (RCTs) including patients undergoing spine surgeries under general anaesthesia and comparing Dex and saline. A fixed- or random-effect model was used depending on heterogeneity.Results Twenty-one RCTs, including 1388 patients, were identified. Dex added the overall risk of intraoperative hypotension (odds ratio [OR]: 2.11; 95% confidence interval [CI]: 1.24 - 3.58; P=0.006) and bradycardia (OR: 2.48; 95%CI: 1.57 - 3.93; P=0.0001). The use of a loading dose of Dex led to significantly increased risks of intraoperative hypotension (OR: 2.00; 95%CI: 1.06 - 3.79; P=0.03) and bradycardia (OR: 2.28; 95%CI: 1.42 - 3.66; P=0.0007). For patients receiving total intravenous anesthesia, there was an increased risk of hypotension (OR: 2.90; 95%CI: 1.24 - 6.82; P=0.01) and bradycardia (OR: 2.66; 95%CI: 1.53 - 4.61; P=0. 0005). For patients in the inhalation anesthesia group, only an increased risk of bradycardia (OR: 4.95; 95%CI: 1.41 - 17.37; P=0.01) was observed. No significant increase in the risk of hypotension and bradycardia was found in the combined intravenous-inhalation anesthesia group. The incidence of severe hypotension (OR: 2.57; 95%CI: 1.05 - 6.32; P=0.04), but not mild hypotension, was increased. Both mild (OR: 2.55; 95%CI: 1.06 - 6.15; P=0.04) and severe (OR: 2.45; 95%CI: 1.43 - 4.20; P=0.001) bradycardia were associated with a higher risk. The overall analyses did not reveal significant reduction in intraoperative blood loss. However, a significant decrease in blood loss was observed in total inhalation anesthesia subgroup (mean difference [MD]: -82.97; 95%CI: -109.04 - -56.90; P<0.001).Conclusions Dex increases the risks of intraoperative hypotension and bradycardia in major spine surgery. The administration of a loading dose of Dex and the utilization of various anesthesia maintenance methods may potentially impact hemodynamic stability and intraoperative blood loss.

Comparison of effects of different anesthesia methods on immune function and liver function of liver cancer patients after operation

ABSTRACT Liver cancer, one of the most common malignant tumors, has seriously threatened people’s physical and mental health. The paper was conducted to investigate the functions of two different anesthesia methods on Tumor necrosis factor-α (TNF-α), C-reactive protein (CRP) and T lymphocyte subsets in patients undergoing liver cancer resection, and to explore the liver function impact of patients undergoing liver cancer surgery. 80 liver cancer patients were split into propofol intravenous anesthesia group and sevoflurane inhalation anesthesia group. The patient’s operation-related indicators and changes in TNF-α, CRP and T lymphocyte subsets before anesthesia, after anesthesia, 1 day after anesthesia, and 3 days after anesthesia were calculated. The levels of TNF-α and CRP in the two groups after operation were clearly higher than those before anesthesia, but there was no obvious difference between the two groups. After operation, the TNF-α of the propofol intravenous anesthesia group was lower than the sevoflurane inhalation anesthesia group. The CD3+, CD4+ and CD4+/CD8+ levels in both groups recovered to the pre-anaesthesia level 3 days after the operation. The levels of ALT, AST, ALB and TBIL returned to normal at d4 in both propofol intravenous anesthesia and sevoflurane inhalation anesthesia groups. Compared with evoflurane inhalation anesthesia for patients with liver cancer, intravenous anesthesia with propofol can reduce the body’s inflammatory response to a certain extent, has weak inhibitory effect on T lymphocyte immune function, and a smaller effect on liver function.

Effects of propofol and inhaled anesthetics on postoperative complications for the patients undergoing one lung ventilation: A meta-analysis.

IntroductionWith the widespread use of one-lung ventilation (OLV) in thoracic surgery, it is unclear whether maintenance anesthetics such as propofol and inhaled anesthetics are associated with postoperative complications. The purpose of this study was to compare the effects of propofol and inhaled anesthetics on postoperative complications in OLV patients.MethodsPubMed, EMBASE, Medline, and Cochrane Library were searched for relevant randomized controlled trials until 09/2021. All randomized controlled trials comparing the effect of propofol versus inhaled anesthetics on postoperative complications in OLV patients were included. All randomized controlled trials comparing:(a) major complications (b) postoperative pulmonary complications (c) postoperative cognitive function (MMSE score) (d) length of hospital stay (e) 30-day mortality, were included.ResultsThirteen randomized controlled trials involving 2522 patients were included in the analysis. Overall, there was no significant difference in major postoperative complications between the inhaled anesthetic and propofol groups (OR 0.78, 95%CI 0.54 to 1.13, p = 0.19; I2 = 0%). However, more PPCs were detected in the propofol group compared to the inhalation anesthesia group (OR 0.62, 95%CI 0.44 to 0.87, p = 0.005; I2 = 37%). Both postoperative MMSE score (SMD -1.94, 95%CI -4.87 to 0.99, p = 0.19; I2 = 100%) and hospital stay (SMD 0.05, 95%CI -0.29 to 0.39, p = 0.76; I2 = 73%) were similar between the two groups. The 30-day mortality rate was also not significantly different between groups (OR 0.79, 95%CI 0.03 to 18, p = 0.88; I2 = 63%).ConclusionsIn patients undergoing OLV, general anesthesia with inhaled anesthetics reduced PPC compared to propofol, but did not provide clear benefits on other major complications, cognitive function, length of hospital stay, or mortality.

Postoperative Long-Term Outcomes and Independent Risk Factors of Non-Small-Cell Lung Cancer Patients With Propofol versus Sevoflurane Anesthesia: A Retrospective Cohort Study.

Background: Existing studies have shown that the relationship between anesthetic agents and non-small-cell lung cancer (NSCLC) prognosis remains controversial. Therefore, this retrospective cohort study was designed to investigate the effects of propofol or sevoflurane anesthesia on the long-term oncologic outcomes of NSCLC patients. Methods: We identified 1,778 eligible patients (propofol-based total intravenous anesthesia (TIVA) group, n = 686; sevoflurane-based inhalation anesthesia (INHA) group, n = 1,092) out of 2,388 patients undergoing elective NSCLC surgery from June 2013 to June 2016 in the Harbin Medical University Cancer Hospital. The primary endpoints were five-year overall survival and recurrence-free survival. The secondary endpoints were independent risk factors of cancer recurrence or all-cause mortality. The data were analyzed with propensity score matching, Kaplan–Meier survival, and Cox multivariate analyses as appropriate. Results: After propensity score matching, there were 672 patients in each group. The median follow-up period was 69 months (interquartile range: 68–70 months) for all patients. Five-year overall survival was 75.7% (95% confidence interval (CI) 72.4–79.1) in the TIVA group and 71.8% (68.4–75.4) in the INHA group (p = 0.160) (hazard ratio (HR), 0.86; 95% CI, 0.70–1.06; p = 0.158), and five-year recurrence-free survival was 68.5% (65.0–72.2) and 62.7% (59.1–66.5 (p = 0.108) (HR, 0.90; 95% CI, 0.75–1.08; p = 0.253), respectively. Subgroup analyses showed there were no significant difference in the overall survival or recurrence-free survival between the two groups in each TNM stage of NSCLC. The independent risk factors included age ≥60 years, male, blood transfusion, segmental/wedge resection and pneumonectomy, thoracotomy, postoperative complications, lung adenocarcinoma, TNM stages, high CEA and CYFRA211 levels, and postoperative radiotherapy. Conclusions: Our data indicated no difference between the propofol-based TIVA and sevoflurane-based INHA in terms of five-year overall survival and recurrence-free survival after NSCLC surgery.

Sevoflurane anesthesia rather than propofol anesthesia is associated with 3-month postoperative hypocortisolism in patients undergoing endoscopic transsphenoidal surgery for non-functional pituitary adenoma with preoperative normal hypothalamic-pituitary-adrenal axis.

The effects of anesthetic technique on intermediate-term postoperative adrenocorticotropic hormone (ACTH) functional outcomes have not been fully determined in non-functioning pituitary adenoma (NFPA) patients. Postoperative hypocortisolism is potentially life-threatening and requires steroid replacement after pituitary surgery. The present study determined whether sevoflurane anesthesia was predictive of 3-month postoperative hypocortisolism in NFPA patients with preoperative normal hypothalamic-pituitary-adrenal (HPA) axis. Demographics, preoperative pituitary hormone status, intraoperative data, and tumor characteristics were retrospectively collected from 429 NFPA patients, who had preoperative normal HPA axis and underwent endoscopic transsphenoidal surgery. Patients were divided into two groups based on intraoperative anesthetic technique: sevoflurane-based inhalation anesthesia group (n = 74) and propofol-based intravenous anesthesia group (n = 355). After propensity score matching, 73 patients were selected in each group and the incidence of 3-month postoperative hypocortisolism (primary outcome measure) was compared between the two groups. The incidence of 3-month postoperative hypocortisolism was higher in the sevoflurane anesthesia group than the propofol anesthesia group before (n = 20[27.0%] vs. n = 49[13.8%], P = 0.008) and after (n = 20 [27.4%] vs. n = 5 [6.8%], P = 0.002) propensity score matching, respectively. Sevoflurane anesthetic use (odds ratio [95% CI] 5.37[1.80-15.98], P = 0.003) and postoperative steroid administration (2.89 [1.06-7.92], P = 0.039) were predictors of 3-month postoperative hypocortisolism. In patients with preoperative normal HPA axis undergoing endoscopic transsphenoidal surgery for NFPA, sevoflurane anesthesia and postoperative steroid administration were associated with the development of 3-month postoperative hypocortisolism. A large-scale prospective study is needed to confirm the negative association between sevoflurane anesthesia and postoperative ACTH functional outcome.

Retrospective assessment of the association between inhalation anesthesia and post-operative complications in morbidly obese patients undergoing bariatric surgery

Background/Aim: Today, obesity is a rapidly growing health problem. Healthcare professionals have been encountering both obese adult and adolescent patients in the operating room more and more frequently. Morbid obesity affects all body systems, thus necessitating greater care in anesthesia management. Studies conducted in recent years have failed to find clear evidence for the most appropriate anesthesia technique with minimal effect on post-operative complications. Therefore, this study was designed to compare the effects of inhalation anesthesia and total intravenous anesthesia (TIVA) on post-operative complications in morbidly obese patients who underwent bariatric surgery. Methods: After receiving approval from the University Ethics Committee, the files of 304 patients who underwent laparoscopic gastric bypass and sleeve gastrectomy between January 2018 and December 2021 were screened. Patients with unexpectedly difficult airways, who underwent open surgery, in whom the anesthesia technique had to be changed intra-operatively for any reason, those scheduled for intensive care as decided during surgical planning, and those with liver or kidney failure were excluded from the study. A total of 278 patients were included in the study. Patients were divided into two groups according to the method of anesthesia used: (1) TIVA (Group T) and (2) inhalation anesthesia (Group I). Results: The study was performed with 278 patients of whom 213 were women, and 65 were men. Patient demographics were similar between the two groups. Comparison of the clinical characteristics of the study groups showed that the rate of admission to the intensive care unit (P=0.032), average duration of surgery (P

Evaluation of the effects of total intravenous anesthesia and inhalation anesthesia on postoperative cognitive recovery.

To compare the effects of total intravenous anesthesia (TIVA) and inhalation anesthesia (IA) used in lumbar disc herniectomy on postoperative cognitive recovery based on the mini-mental state examination (MMSE) score and neuron-specific enolase (NSE) levels. The study sample consisted of 80patients aged 18-65years who were scheduled for elective lumbar disc herniectomy. The patients were divided into two groups according to the anesthesia technique applied, such as TIVA or IA. The patients in the TIVA group were administered remifentanil and propofol and those in the IA group were administered sevoflurane for maintenance. The MMSE was applied to the patients before the operation and 1h and 24 h postoperatively. Venous blood samples were obtained for the measurement of NSE before the operation and on the 24 h postoperatively. The mean preoperative MMSE scores were similar in the two groups. In the TIVA group, the preoperative and postoperative MMSE scores at 1 h were similar but were higher at 24 h postoperatively compared to the previous two scores (p = 0.001 and p < 0.001, respectively). In the IA group, the preoperative and postoperative 24 h MMSE scores were similar but lower at 1h postoperatively than the other two scores (p = 0.006 and p < 0.001, respectively). In the TIVA group, there was asignificant decrease in the postoperative serum NSE levels than the preoperative values (p = 0.038). The use of IA may result in higher cognitive dysfunction 1h after the operation compared to TIVA. The effects of both methods on cognitive functions were similar at 24 h postoperatively.

The long-term survival outcomes of gastric cancer patients with total intravenous anesthesia or inhalation anesthesia: a single-center retrospective cohort study

BackgroundThe relationship between the type of anesthesia and the survival outcomes of gastric cancer patients is uncertain. This study compared the overall outcome of gastric cancer patients after surgery with total intravenous anesthesia (TIVA) or inhalation anesthesia (IHA).MethodsClinicopathological variables of gastric cancer patients were retrieved from the database of the Surgical Gastric Cancer Patient Registry in West China Hospital, Sichuan University. Patients were grouped according to whether they received TIVA or IHA during the operation. Propensity score (PS) matching was used to balance the baseline variables, and survival outcomes were compared between these two groups. In addition, studies comparing survival outcomes between TIVA and IHA used for gastric cancer surgery and published before April 20th, 2020, were identified, and their data were pooled.ResultsA total of 2827 patients who underwent surgical treatment from Jan 2009 to Dec 2016 were included. There were 323 patients in the TIVA group and 645 patients in the IHA group, with 1:2 PS matching. There was no significant difference in overall survival outcomes between the TIVA and IHA groups before matching the cohort (p = 0.566) or after matching the cohort (p = 0.679) by log-rank tests. In the Cox hazard regression model, there was no significant difference between the TIVA and IHA groups before (HR: 1.054, 95% CI: 0.881–1.262, p = 0.566) or after (HR: 0.957, 95% CI: 0.779–1.177, p = 0.679) PS matching. The meta-analysis of survival outcomes between the TIVA and IHA groups found critical statistical value in the before PS matching cohort (HR 0.74, 95% CI: 0.57–0.96 p < 0.01) and after PS matching cohort (HR: 0.65, 95% CI: 0.46–0.94, p < 0.01).ConclusionsCombined with the results of previous studies, total intravenous anesthesia has been shown to be superior to inhalation anesthesia in terms of overall survival for gastric cancer patients undergoing surgical treatment. The selection of intravenous or inhalation anesthesia for gastric cancer surgery should take into account the long-term prognosis of the patient.

Koroner Arter Cerrahisi Geçiren Hastalarda İntravenöz Anestezi ve İnhalasyon Anestezisinin Kırmızı Hücre Dağılım Genişliği ve Ortalama Platelet Volümü Üzerine Etkileri

INTRODUCTION: The effects of midazolam-based intravenous anesthesia (TIVA) and sevoflurane-based inhalation anesthesia (SEVO) maintenance on postoperative hematological parameters were compared in patients undergoing coronary artery surgery. METHODS: The 100 patients included in the study were divided into two groups according to the anesthesia management: All patients' anesthesia inductions were performed with 10 μgkg-1 fentanyl, 0.15 mgkg-1 midazolam, and 0.8 mgkg-1 rocuronium. Anesthesia was maintained with total intravenous anesthesia in the TIVA group patients, while sevoflurane was used in the SEVO group patients. Demographic, clinical, operative data, red cell distribution width (RDW), and mean platelet volume (MPV) values were recorded. RESULTS: Except that the extubation time was shorter in the SEVO group, no difference was observed between the groups in terms of all these variables. There was a significant increase in postoperative RDW and MPV measurements in both groups. Postoperative RDW value was lower in the inhalation anesthesia group compared to the TIVA group (p=0.013). DISCUSSION AND CONCLUSION: In our study, RDW was found to be lower in the inhalation anesthesia group, indicating less inflammation. There was no difference in terms of postoperative complications and mortality.

Efficiency and safety of an anesthetic technique in surgical correction of congenital malformations of the lower parts of the urogenital system in children

Objective: to assess the efficiency and safety of an anesthetic technique in surgical correction of congenital malformations of the lower parts of the urogenital system in children by means of the performance of the comparative analysis of perioperative adverse events and complications, consumption of the inhalation anesthetic sevoflurane and the cost of anesthesia, and also the course of the early postoperative period. Material and methods. Depending on the type of anesthesia, all patients (127 boys) were divided into 3 clinical groups: those operated under multicomponent balanced inhalation anesthesia (group 1, n = 37), under general laryngeal mask anesthesia in combination with caudal blockade with 0.25% bupivacaine solution (group 2, n = 45), under general laryngeal mask anesthesia with caudal blockade with the combination of 0.25% bupivacaine solution and adjuvant (group 3, n = 45). Results. The performed analysis has not revealed any statistically significant distinctions in the assessment of anesthesia complications but it has found some significant distinctions in the consumption of sevoflurane, depth of anesthesia and its cost, as well as the necessity for postoperative anesthesia and introduction of analgesics, which testifies to the efficiency and safety of combined anesthesia and its economic benefit. Conclusion. The most effective, safe, and economically reasonable is the technique of combined anesthesia with the application of caudal blockade with local anesthetic solution and 0.1% adjuvant of morphine solution during surgical correction of congenital malformations of the lower parts of the urogenital system in children.

Comparison of the Postoperative Liver Function Between Total Intravenous Anesthesia and Inhalation Anesthesia in Patients with Preoperatively Elevated Liver Transaminase Levels: A Retrospective Cohort Study.

BackgroundAnesthesia and surgery may deteriorate liver function in patients with elevated liver enzyme levels; therefore, in these patients, choosing anesthetics with less hepatotoxicity is important.MethodsThis retrospective study investigated the effect of total intravenous anesthesia (TIVA) versus inhalation anesthesia (INHA) on the postoperative liver function in patients with preoperatively elevated liver enzyme levels (aspartate transaminase [AST] or alanine transaminase [ALT] >40 U/L) who underwent non-hepatic surgery under general anesthesia. We compared the changes in enzyme levels within 24 hrs before and after surgery.ResultsIn 730 patients (TIVA: n=138; INHA: n=592), the baseline characteristics were comparable, except for higher comorbidity rates in the TIVA group. The median anesthesia and operation times were significantly longer in the TIVA group because approximately 50% of the TIVA group (vs 19.7% of the INHA group) underwent neurosurgery, which had a relatively longer operation time than other surgeries. Intraoperative hypotensive events and vasopressor use were more frequent in the TIVA group. After 1:4 propensity score matching (TIVA: n=94; INHA: n=376), the baseline characteristics and surgical variables were comparable, except for longer anesthesia time. Before matching, postoperative AST and ALT changes were significantly lower in the TIVA group than in the INHA group. After matching, only the ALT change was significantly lower after TIVA than after INHA [median (interquartile range), −16.7 (−32 to −4) % vs −12.0 (−28.6–6.5) %, P=0.025].ConclusionTIVA may be safer for patients with preoperatively elevated liver transaminase levels.

Quality of recovery after anesthesia for patients undergoing laparoscopic surgery: a prospective, controlled, double-blind randomized study comparing total intravenous anesthesia versus desflurane anesthesia

Background: Fast-track surgery is a multimodal approach to reduce postsurgical organ dysfunction and complications in order to improve patient’s postoperative recovery. The study aimed to compare inhaled anesthesia (IA) and total intravenous anesthesia (TIVA) with regard to quality of recovery, cost-effectiveness, and which anesthetic technique is more suitable for fast-track programs concerning laparoscopic cholecystectomy or pelvic surgery. Methodology: This study was conducted at King Fahd Hospital of the University from December 2019 to March 2020. A total of 50 patients were randomly allocated into two groups; one received IA (desflurane group) and the other TIVA (propofol group). Preoperative and postoperative assessments were carried out using various tools to compare both techniques. Results: The recovery and emergence from anesthesia was more rapid in patients who received IA. The time until patients could answer simple questions was shorter in the IA group. On the contrary, quality of recovery- 15 at 6 hours after surgery was significantly higher in the TIVA group. Similarly, the ability to concentrate and coordinate measured by the Bourdon-Wiersma test was also significantly better in the TIVA group. The ability to retain new facts (anterograde amnesia) as assessed by the picture card test was significantly higher in the TIVA group. Also, postoperative nausea and vomiting were more common with IA. Conclusion: Both IA and TIVA are suitable for fast-track anesthesia. While desflurane group had a rapid emergence and recovery time, the quality of recovery and the ability to concentrate and anterograde amnesia were better in the TIVA group.

Effects of different anesthesia methods on cognitive function and inflammatory factors in elderly patients with lung cancer during perioperative period

Objective To explore the effects of different anesthesia methods on cognitive function and serum interleukin-6(IL-6), interleukin-8(IL-8) levels in elderly patients with lung cancer during perioperative period. Methods From March 2015 to March 2017, ninety elderly patients undergoing radical resection of lung cancer treated in Heji Hospital Affiliated to Changzhi Medical College were selected in the research.According to the different anesthesia methods, they were divided into inhalation anesthesia group(A group), general intravenous anesthesia group(B group) and epidural block anesthesia group(C group), with 30 cases in each group.The minimum mental state examination(MMSE) scores, cognitive dysfunction rate, serum IL-6 and IL-8 levels of the three groups before operation, one day after operation and three days after operation were compared. Results One day and three days after operation, the MMSE scores of C group were (25.62±2.11)points, (27.12±2.04)points, respectively, which were higher than those of group A[(22.61±2.75)points, (25.78±2.68)points] and B group[(22.34±2.01)points, (25.81±2.42)points], the differences were statistically significant(tA group=4.756, 2.179, tB group=6.165, 2.267, all P<0.05). One day and three days after operation, the cognitive dysfunction rates of C group were 26.67%(8/30), 6.67%(2/30), respectively, which were lower than those of A group[50.00%(15/30), 26.67%(8/30)] and B group[66.67%(20/30), 30.00%(9/30)], the differences were statistically significant(χA group2=3.455, 4.320, χB group2=9.643, 5.455, all P<0.05). One day and three days after operation, the serum IL-6 and IL-8 levels of C group[IL-6: (99.53±16.82)ng/mL, (83.24±8.34)ng/mL, IL-8: (50.43±7.84)ng/mL, (42.15±5.25)ng/mL] were lower than those of A group[IL-6: (122.43±18.41)ng/mL, (88.51±10.42)ng/mL, IL-8: (64.53±8.94)ng/mL, (55.62±6.78)ng/mL]and B group[IL-6: (124.52±20.10)ng/mL, (87.95±9.34)ng/mL, IL-8: (63.27±9.03)ng/mL, (54.62±6.30)ng/mL], the differences were statistically significant(IL-6: tA group=5.030, 2.163, tB group=5.222, 2.060, all P<0.05; IL-8: tA group=6.495, 8.604, tB group=5.881, 8.329, all P<0.05). Conclusion The influence of epidural block anesthesia on postoperative cognitive dysfunction in elderly patients with radical resection of lung cancer is minimal, which can inhibit the expression of inflammatory factors.It is better than the other two anesthesia methods, and it is worthy of radical operation for elderly patients with lung cancer. Key words: Lung neoplasms; Aged; Anesthesia, Inhalation; Anesthesia, General; Anesthesia, Epidural; Cognitive function; Inflammatory factors

Comparison of the hemodynamic effects of a loading dose of dexmedetomidine combined with total intravenous anesthesia or inhalation anesthesia on children with obstructive sleep apnea-hypopnea syndrome

Objective To investigate the effects of a loading dose of dexmedetomidine(Dex) on the hemodynamics of children with obstructive sleep apnea-hypopnea syndrome(OSAHS) during total intravenous anesthesia and total inhalation anesthesia. Methods A total of 50 patients scheduled for adenotonsillectomy were enrolled in the study, and randomly divided into a total intravenous anesthesia group (group A) and an inhaled anesthesia group (group B) (n=25). After anesthesia induction, both groups were given a loading dose of Dex (1 μg/kg over 10 min). The systolic blood pressure(SBP), diastolic blood pressure(DBP), mean arterial pressure(MAP) and heart rate were recorded before infusion(T0), 5 min(T5) and 10 min(T10) after administration of Dex. Results Compared with baseline values, group A presented remarkable increases in SBP, DBP and MAP at T5 and T10(P<0.05). Group B demonstrated decreased SBP, DBP and MAP 10 min after infusion(P<0.05). The heart rate in the both groups were significantly decreased after Dex infusion(P<0.05). Conclusions During anesthesia maintenance, a loading dose of Dex can significantly increase arterial blood pressure in OSAHS patients when combined with total intravenous anesthesia, and significantly decrease arterial blood pressure when combined with inhaled anesthesia. Key words: Dexmedetomidine; Hemodynamics; Pediatric; Maintenance of anesthesia; Obstructive sleep hypopnea syndrome

ВЛИЯНИЕ ТИПА АНЕСТЕЗИИ НА ЦЕРЕБРАЛЬНУЮ ОКСИГЕНАЦИЮ И КОГНИТИВНЫЕ ФУНКЦИИ ПРИ КАРОТИДНОЙ ЭНДАРТЕРЭКТОМИИ

Carotid endarterectomy (CEA) can be followed by postoperative cognitive dysfunction (POCD). Goal of the study: to investigate the effect of total intravenous anesthesia (TIVA) with propofol and inhalation anesthesia (IA) with sevoflurane on cerebral oxygenation and POCD. Materials and methods. 40 patients were enrolled into the study and divided into the groups of TIVA and IA. The cerebral tissue oxygen saturation with oxygen (SctO2) was recorded during CEA and in 24 hours after it. Cognitive functions were assessed with Montreal Cognitive Assessment (MoCA) before the CEA, in 1 and 5 days after. Results. Reduction of SctO 2 was observed on the operated side after carotid clamping. SctO 2 transitory reduced on the contralateral side in the TIVA group and was significantly higher in the IA group. MoCA changes in 24 hours after the surgery correlated with SctO 2 reduction on the ipsilateral side in TIVA group (rho = 0.54; p = 0.015). In 5 days after CEA, the cognitive functions were higher in the IA group (p = 0.028). Conclusion. Anesthesia with sevoflurane used for CEA may mitigate an asymmetry of cerebral perfusion, improves oxygenation of contralateral hemisphere and reduces the risk of POCD.

Influence of two anesthetic methods on postoperative cardiac function in elderly patients with coronary artery disease

Objective To explore the influence of inhalation anesthesia versus intravenous anesthesia on postoperative cardiac function in elderly patients with coronary artery disease, and to assess the effect of the two anesthesia schemes on controlling the incidence rate of postoperative adverse cardiovascular events in patients with versus without heart surgery. Methods 224 elderly patients with coronary artery disease admitted to our hospital were chosen from Jan. 2013 to Sep. 2015. Patients were randomly divided into the inhalation anesthesia group and the intravenous anesthesia group (n=112, each). The perioperative adverse cardiovascular events were considered as a primary endpoint, and the postoperative adverse cardiovascular events within 3 days after operation as a secondary endpoint in all patients. The univariate analysis and multivariate Logistic regression analysis were used to evaluate the risk factors for the adverse cardiovascular events after surgery. The influence of the two anesthesia methods on the incidence rate of postoperative adverse cardiovascular events was compared. Results Among 224 patients, 31 cases (13.8%) showed the perioperative adverse cardiovascular events, including 4 cases (1.8%) during surgery, 27 cases (12.1%) after surgery; 16 cases (14.3%) in inhalation group and 15 cases (13.4%) in intravenous group (16, 14.3% vs. 15, 13.4%, P>0.05). The independent risk factors for myocardial ischemia shown at the day of surgery were New York Heart Association (NYHA) class Ⅲ and intraoperative hypotension, those shown at second day after surgery were intraoperative hypotension, intravenous anesthesia, NYHA class Ⅲ, and those shown at third day after surgery were intraoperative hypertension and intravenous anesthesia (all P<0.05). Among 224 cases, 7 patients (3.1%) died after surgery, of which 2 cases had cardiac death and 5 cases had non-cardiac death. Conclusions The inhalation anesthesia effectively reduces the incidence of myocardial ischemic events in elderly patients within 3 days after surgery, but it does not improve the incidence of perioperative cardiac events and mortality. The inhalation anesthesia has a certain protective effect on myocardium, which is worthy of promotion. Key words: Anesthetic, inhalation; Anesthesia, intravenous; Coronary artery disease

Effects of Different Anesthetic Methods on Cellular Immune and Neuroendocrine Functions in Patients With Hepatocellular Carcinoma Before and After Surgery.

Many anesthesia methods have been studies in hepatocellular carcinoma (HCC). We aimed to explore the effects of combined intravenous and inhalation anesthesia and combined general and epidural anesthesia on cellular immune function and neuroendocrine function in patients with HCC before and after surgery. Between September 2012 and April 2014, 72 patients who underwent a hepatectomy in our hospital were enrolled. Compared with the combined intravenous and inhalation anesthesia group, the combined general and epidural anesthesia group demonstrated increased CD4+ /CD8+ T cells 0 hr after surgery, increased CD3+ , CD4+ , CD4+ /CD8+ cells, and IFN-γ levels 12 hr after surgery, and increased CD3+ , CD4+ , and CD4+ /CD8+ cells 24 hr after surgery (all P < 0.05). At 72 hr after surgery, the levels of ACTH and Cor in the combined general and epidural anesthesia group, and the levels of CD3+ , CD4+ , CD4+ /CD8+ cells, and IFN-γ in both the combined intravenous and inhalation anesthesia and the combined general and epidural anesthesia groups decreased to pre-surgery levels. Significant differences were observed in the comparisons of CD3+ , IL-6, and IL-10 between the combined intravenous and inhalation anesthesia and the combined general and epidural anesthesia groups 72 hr after surgery (all P < 0.05). Our results revealed that combined general and epidural anesthesia plays a crucial role in hepatectomy via the mitigation of the inhibition of immunologic function in HCC patients during the perioperative period. Combined general and epidural anesthesia also hastens the recovery of immunologic suppression after surgery, which can provide a certain reference for the selection of clinical anesthesia in the treatment of HCC.