Intravenous Induction Of Anesthesia Research Articles

Intravenous sufentanil-midazolam versus sevoflurane anaesthesia in medetomidine pre-medicated Himalayan rabbits undergoing ovariohysterectomy

ObjectiveTo compare physiological effects of sufentanil-midazolam with sevoflurane for surgical anaesthesia in medetomidine premedicated rabbits. Study designProspective, randomized controlled experimental study. AnimalsEighteen female Himalayan rabbits, weight 2.1 ± 0.1 kg. MethodsPremedication with 0.1 mg kg−1 medetomidine and 5 mg kg−1 carprofen subcutaneously, was followed by intravenous anaesthetic induction with sufentanil (2.3 μg mL−1) and midazolam (0.45 mg mL−1). After endotracheal intubation, anaesthesia was maintained with sufentanil-midazolam (n = 9) or sevoflurane (n = 9). Ovariohysterectomy was performed. Intermittent positive pressure ventilation was performed as required. Physiological variables were studied perioperatively. Group means of physiologic data were generated for different anaesthetic periods. Data were compared for changes from sedation, and between groups by anova. Post-operatively, 0.05 mg kg−1 buprenorphine was administered once and 5 mg kg−1 carprofen once daily for 2–3 days. Rabbits were examined and weighed daily until one week after surgery. ResultsSmooth induction of anaesthesia was achieved within 5 minutes. Sufentanil and midazolam doses were 0.5 μg kg−1 and 0.1 mg kg−1, during induction and 3.9 μg kg−1 hour−1 and 0.8 mg kg−1 hour−1 during surgery, respectively. End-tidal sevoflurane concentration was 2.1% during surgery. Assisted ventilation was required in nine rabbits receiving sufentanil-midazolam and four receiving sevoflurane. There were no differences between groups in physiologic data other than arterial carbon dioxide. In rabbits receiving sevoflurane, mean arterial pressure decreased pre-surgical intervention, heart rate increased 25% during and after surgery and body weight decreased 4% post-operatively. Post-operative problems sometimes resulted from catheterization of the ear artery. ConclusionSevoflurane and sufentanil-midazolam provided surgical anaesthesia of similar quality. Arterial blood pressure was sustained during sufentanil-midazolam anaesthesia and rabbits receiving sevoflurane lost body weight following ovariohysterectomy. Mechanical ventilation was required with both anaesthetic regimens. Clinical relevanceAnaesthesia with sufentanil-midazolam in medetomidine premedicated healthy rabbits is useful in the clinical and the research setting, as an alternative to sevoflurane.

Implicaciones anestésicas del Síndrome de cimitarra para cirugía no cardiaca

We present a clinical case report of a child with scimitar syndrome and a review of the literature in order to describe the main surgical and anesthetic implications of these patients. Child, 4months old, weight 4700g, diagnosed with pneumonia and left lobar emphysema requiring mechanical intubation and ICU care. The associated diagnoses are failed extubation, severe pulmonary hypertension and scimitar syndrome confirmed with echocardiography. He was scheduled for pulmonary lobectomy. His mother signed an informed consent authorization for anesthesia and surgery. The child entered surgery, intravenous anesthetic induction was performed and a central venous catheter, an arterial line, urinary catheter and pre-and post-ductal pulse oximeters were inserted. He required vasopressor support with dopamine and transfusion of red blood cells. No adverse events during surgery. At the end of the surgery he was carried back to pediatric ICU and intubated with a chest tube. Extubation was successfully performed two days later with favorable progress. Scimitar syndrome is characterized by an anomalous right pulmonary venous return associated with congenital heart disease and pulmonary malformations. It has a low prevalence in the population but a very high perioperative morbidity and mortality, especially in children. With this report we present the main standards and practices for anesthetic management, monitoring and hemodynamic goals with these patients.

Scimitar syndrome and anesthetic implications

We present a clinical case report of a child with scimitar syndrome and a review of the literature in order to describe the main surgical and anesthetic implications of these patients. Child, 4 months old, weight 4700g, diagnosed with pneumonia and left lobar emphysema requires mechanical intubation and ICU care. The associated diagnoses are failed extubation, severe pulmonary hypertension and scimitar syndrome confirmed with echocardiography. He was scheduled for pulmonary lobectomy. His mother signed an informed consent authorization for anesthesia and surgery. The child entered surgery, intravenous anesthetic induction was performed and a central venous catheter, an arterial line, urinary catheter and pre-and post-ductal pulse oximeters were inserted. He required vasopressor support with dopamine and transfusion of red blood cells. No adverse events during surgery. At the end of the surgery he was carried back to pediatric ICU and intubated with a chest tube. Extubation was successfully performed 2 days later with favorable progress. Scimitar syndrome is characterized by an anomalous right pulmonary venous return associated with congenital heart disease and pulmonary malformations. It has a low prevalence in the population but a very high perioperative morbidity and mortality, especially in children. With this report we present the main standards and practices for anesthetic management, monitoring and hemodynamic goals with these patients.

Sevoflurane, Laryngeal Mask Airway and Single-Dose Dexmedetomidine: A Better Choice for Patients Undergoing Endovascular Coil Embolization

Background: Patients diagnosed with intracranial aneurysms who undergo endovascular coil embolization (ECE), require sufficient dose of anesthesia to prevent rupture of the aneurysms. However, surgeons often prefer fast-channel anesthesia techniques in order to evaluate the effects of the treatment. We designed a double-blind, randomized placebo-controlled study to determine the effects of dexmedetomidine (DEX) on the recovery characteristics of patients who were scheduled to undergo ECE. Methods: After intravenous anesthesia induction with propofol, fentanyl and cisatracurium, and laryngeal mask airway insertion, patients were randomly assigned to receive saline (Group C, N=33), 0.5 μg/kg DEX (Group DEX1, N=34), or 1 μg/kg DEX (Group DEX2, N=34). Maintenance of anesthesia was performed using 2 minimum alveolar concentration (MAC) of end-tidal sevoflurane. The length of time for the eyes to open and characteristics of emergence in patients were recorded after the anesthesia was discontinued. Results: The incidence of intraoperative bradycardia in Group DEX2 (26.4%) was significantly higher than that in the other groups (15.1% in Group C and 11.8% in Group DEX1). Four patients (12.1%) in Group C exhibited emergence agitation, but it was not observed in any of the patients in the other groups. The length of time for the eyes to open in Group DEX2 was nearly 10 minutes longer than that in the other two groups. Conclusions: We concluded that a single-dose of 0.5 μg/kg DEX administered after induction of anesthesia reduced post-sevoflurane agitation in patients undergoing ECE with no adverse effects. Citation: Wen-Fei Tan, Yan-Hua Jiang, Hong Ma, Jun-Ke Wang. Sevoflurane, laryngeal mask airway and single-dose dexmedetomidine: a better choice for patients undergoing endovascular coil embolization. J Anesth Perioper Med 2015; 2: 153-7. doi: 10.24015/JAPM.2015.0021This is an open-access article, published by Evidence Based Communications (EBC). This work is licensed under the Creative Commons Attribution 4.0 International License, which permits unrestricted use, distribution, and reproduction in any medium or format for any lawful purpose. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/.

A comparison of postoperative emergence agitation between sevoflurane and thiopental anesthesia induction in pediatric patients.

BackgroundThis study was performed to compare the incidence of emergence agitation (EA) between inhalation and intravenous anesthesia induction in children after sevoflurane anesthesia.MethodsIn this prospective and double-blind study, 100 children aged 3 to 7 years were enrolled. Subjects were randomly assigned to the sevoflurane (Group S) or thiopental (Group T) anesthesia induction groups. Anesthesia was induced using 8% sevoflurane and 4-6 mg/kg thiopental in Groups S and T, respectively. Anesthesia was maintained with nitrous oxide and sevoflurane. The children were evaluated at 5 and 20 min after arrival in the postanesthesia care unit (PACU) with a four-point agitation scale and the Pediatric Anesthesia Emergence Delirium scale. The incidence of EA and administration of the rescue agent were recorded.ResultsThe incidence of EA was significantly lower in Group T compared to Group S at 5 min after PACU arrival (3/49 patients, 6% vs. 12/47 patients, 26%, P = 0.019). However, there was no difference between the two groups at 20 min after PACU arrival (23/49 vs. 19/47 patients in Group T vs. Group S, P = 0.425). The overall incidence of EA was 60% (28/47 patients) in Group S and 41% (20/49 patients) in Group T (P = 0.102). The number of children who received propofol as a rescue agent was significantly lower in Group T (Group S: 14/47 vs. Group T: 5/49, P = 0.031).ConclusionsIntravenous anesthesia induction with thiopental reduced the incidence of EA in the early PACU period compared to inhalation induction with sevoflurane in 3- to 7-year-old children undergoing sevoflurane anesthesia.

Prospective, Randomized Comparisons of Induction of Anesthesia with Ketamine, Propofol and Sevoflurane for Quality of Recovery from Short Sevoflurane Anesthesia in Pediatric Patients

Background: Emergence agitation (EA) after sevoflurane anesthesia is common in children. When rapid intravenous induction of general anesthesia is indicated in a brief procedure, the induction agent can reduce the incidence of EA after sevoflurane anesthesia. The aim of this study was to compare the efficacy of intravenous induction with ketamine and propofol for reducing EA in children after short sevoflurane anesthesia. Methods: Children aged 2 to 6 years who were scheduled to undergo inguinal hernia repair were randomly divided into 3 groups to receive 2 mg/kg ketamine iv, 3 mg/kg propofol iv, or inspired concentration of 8% sevoflurane for induction of anesthesia. After a laryngeal mask airway (LMA) insertion, a caudal block was performed in all children. Anesthesia was maintained with 1.5% sevoflurane and 65% nitrous oxide in oxygen with spontaneous ventilation. The recovery characteristics were recorded and EA were evaluated by using the Pediatric Anesthesia Emergence Delirium (PAED) scale. Results: One hundred and twenty children were enrolled and randomized to treatment. Children who received ketamine induction had higher incidence of EA than those who received propofol (42% vs 16%, P < 0.05) and showed delayed recovery (32 ± 9 min) as compared with those who received propofol or sevoflurane (22 ± 8 min and 20 ± 7 min, respectively, P < 0.05). The mean peak PAED score was significantly lower in children who received propofol induction (6.8 ± 4.0, P < 0.05) than ketamine (11.8 ± 4.1) or sevoflurane (11.6 ± 3.8). Conclusions: Intravenous induction with ketamine does not prevent the incidence of EA and delays recovery. Induction with propofol improves the quality of recovery by reducing the incidence of EA and provides a safe and early recovery.

Is Two Better Than One? Anticipation of a Favorable Hemodynamic Profile by Combining the Hypnotic Drugs for Induction of Anesthesia.

Is Two Better Than One? Anticipation of a Favorable Hemodynamic Profile by Combining the Hypnotic Drugs for Induction of Anesthesia.

Effectiveness of Midazolam in the Prevention of Etomidate Induced Myoclonus

Introduction: Etomidate, the imidazole derivative, is an intravenous anaesthetic induction agent, having stable hemodynamic profile, minimal respiratory side effects and histamine release. It is extremely useful in hemodynamically compromised patients. But the most common problem associated with its induction is myoclonus. Objective: To determine the effect of pretreatment with midazolam on the frequency of myoclonus after etomidate induction. Methods: Two hundred and fifty patients fulfilling the inclusion and exclusion criteria, scheduled for elective surgical procedures, were included. After all monitoring and intravenous access, the patients were given intravenous midazolam 0.05 mg/kg and after ninety seconds anesthesia induction was done with etomidate, and the myoclonic movements were noted for a minute after etomidate injection. The movement were recorded and graded on a scale of 0 to 3. Results: Myoclonus was developed in 15.45% (38/246) cases while in 84.55% (208/246) patients abnormal muscle movements was not observed after etomidate injection. Mild myoclonus (grade 1) was observed in 23 (9.3%) cases, moderate myoclonus (grade 2) in 11 (4.5%) and severe (grade 3) in 4 (1.6%) cases. Summary: The incidence of myoclonus was lowered significantly (15.45%) after 0.05mg/kg midazolam pretreatment.

Transnasal Humidified Rapid-Insufflation Ventilatory Exchange (THRIVE): a physiological method of increasing apnoea time in patients with difficult airways.

Emergency and difficult tracheal intubations are hazardous undertakings where successive laryngoscopy–hypoxaemia–re-oxygenation cycles can escalate to airway loss and the ‘can't intubate, can't ventilate’ scenario. Between 2013 and 2014, we extended the apnoea times of 25 patients with difficult airways who were undergoing general anaesthesia for hypopharyngeal or laryngotracheal surgery. This was achieved through continuous delivery of transnasal high-flow humidified oxygen, initially to provide pre-oxygenation, and continuing as post-oxygenation during intravenous induction of anaesthesia and neuromuscular blockade until a definitive airway was secured. Apnoea time commenced at administration of neuromuscular blockade and ended with commencement of jet ventilation, positive-pressure ventilation or recommencement of spontaneous ventilation. During this time, upper airway patency was maintained with jaw-thrust. Transnasal Humidified Rapid-Insufflation Ventilatory Exchange (THRIVE) was used in 15 males and 10 females. Mean (SD [range]) age at treatment was 49 (15 [25–81]) years. The median (IQR [range]) Mallampati grade was 3 (2–3 [2–4]) and direct laryngoscopy grade was 3 (3–3 [2–4]). There were 12 obese patients and nine patients were stridulous. The median (IQR [range]) apnoea time was 14 (9–19 [5–65]) min. No patient experienced arterial desaturation < 90%. Mean (SD [range]) post-apnoea end-tidal (and in four patients, arterial) carbon dioxide level was 7.8 (2.4 [4.9–15.3]) kPa. The rate of increase in end-tidal carbon dioxide was 0.15 kPa.min−1. We conclude that THRIVE combines the benefits of ‘classical’ apnoeic oxygenation with continuous positive airway pressure and gaseous exchange through flow-dependent deadspace flushing. It has the potential to transform the practice of anaesthesia by changing the nature of securing a definitive airway in emergency and difficult intubations from a pressured stop–start process to a smooth and unhurried undertaking.

The effects of midazolam and butorphanol, administered alone or combined, on the dose and quality of anaesthetic induction with alfaxalone in goats.

Goats are rarely anaesthetised; consequently, scant information is available on the efficacy of anaesthetic drugs in this species. Alfaxalone is a relatively new anaesthetic agent, of which the efficacy in goats has not yet been studied. In this study, the sedative and alfaxalone sparing effects of midazolam and butorphanol, administered alone or concomitantly, in goats were assessed. Eight clinically healthy goats, four does and four wethers, were enlisted in a randomised crossover manner to receive intramuscular sedative treatments consisting of saline 0.05 mL/kg, or midazolam 0.30 mg/kg, or butorphanol 0.10 mg/kg, or a combination of midazolam 0.30 mg/kg with butorphanol 0.10 mg/kg before intravenous induction of general anaesthesia with alfaxalone. Following induction, the goats were immediately intubated and the quality of anaesthesia and basic physiological cardiorespiratory and blood-gas parameters were assessed until the goats had recovered from anaesthesia. The degree of sedation, quality of induction and recovery were scored. When compared with saline (3.00 mg/kg), midazolam,administered alone or with butorphanol, caused a statistically significant increased level of sedation and a reduction in the amount of alfaxalone required for induction (2.00 mg/kg and 1.70 mg/kg, respectively). Butorphanol alone (2.30 mg/kg) did not cause significant changes in level of sedation or alfaxalone-induction dose. During induction and recovery, the goats were calm following all treatments, including the control group. Cardiorespiratory and blood-gas parameters were maintained within clinically acceptable limits. The present study showed that midazolam, administered alone or combined with butorphanol, produces a degree of sedation that significantly reduces the dose of alfaxalone required for induction of general anaesthesia in goats, without causing any major adverse cardiorespiratory effects.

Comparative evaluation of fentanyl and midazolam with propofol induction on laryngeal mask airway insertion conditions: A study

Background: Propofol alone for laryngeal mask airway (LMA) insertion is unsatisfactory. To overcome the problems associated with it, a number of co-induction drugs have been introduced. The present study was conducted to compare the insertion conditions using midazolam and fentanyl co administered with propofol during intravenous induction of anesthesia. Materials and Methods: This prospective, double-blinded, randomized study was conducted at a tertiary healthcare teaching hospital at Imphal. Ninety American Society of Anesthesiologists (ASA) I and II patients aged 18-60 years were randomly divided into three equal groups and received intravenous (IV) fentanyl 2 μg/kg (Group I), IV midazolam 0.05 mg/kg (Group II), and control (saline) group (Group III) followed by induction with propofol 2.5 mg/kg. LMA was inserted after 90 s. The insertion conditions and hemodynamic changes were noted. Data were collected and analyzed with Statistical Package for Social Sciences (SPSS) v.20. Results: There were no statistical differences in the demographic profile (P > 0.05). Adequate jaw relaxation was present in 21 (70%) patients in Group II and 14 (46.6%) patients in Group I (P > 0.05). Excellent insertion conditions were present in 80% of the patients in both fentanyl and midazolam groups, respectively. Conclusion: Midazolam and fentanyl provides adequate conditions for LMA insertion, although midazolam provides better jaw relaxation.

Priming with atracurium efficiently suppresses etomidate-induced myoclonus

IntroductionEtomidate is a hypnotic drug widely used as an intravenous anesthetic induction agent. The incidence of etomidate-induced myoclonus has been reported as much as 50–80% after induction making it an undesirable drug for induction. ObjectiveOur aim is to use a priming dose of atracurium to suppress etomidate-induced myoclonus during induction of anesthesia. MethodsIn a double-blinded clinical trial 80 patients were randomly given either atracurium (20% of ED95 × kg) or saline as a priming agent. Then, induction of anesthesia was performed using 0.4 mg/kg etomidate. Age, weight, body mass index, bispectral index (BIS) monitor, and duration and grade of myoclonus were recorded. ResultsThe demographic characteristics, age, body mass index, BIS score, and weight were not significantly different between the atracurium (ATRA) priming group and control groups. The binomial regression model showed that BMI was an independent predictor variable for myoclonus (OR: 2.1, CI 95%: 1.7–7.5, p = 0.032). In this model, adjusted odds ratios (OR) of myoclonus (multivariate logistic regression analysis) in the control group was 6.6 (95% CI: 1.5–9.7, p = 0.013). ConclusionLow-dose atracurium priming could effectively suppress etomidate-induced myoclonus.

A Comparison between Total Intravenous Anaesthesia using Propofol plus Remifentanil and Volatile Induction/Maintenance of Anaesthesia using Sevoflurane in Children Undergoing Flexible Fibreoptic Bronchoscopy

Flexible fibreoptic bronchoscopy is an important tool in the evaluation and management of paediatric respiratory disease. Total intravenous anaesthesia (TIVA) and volatile agent induction and maintenance of anaesthesia (VIMA) are commonly used for these procedures. The aim of this study was to determine which is superior for children undergoing flexible fibreoptic bronchoscopy.The study included two phases. In Phase 1, ED99 of propofol in TIVA and ED99 of sevoflurane in VIMA were first determined. In Phase 2, 50 children aged from one to three years were recruited and randomly assigned to either a TIVA or a VIMA group. An ED99 dose of propofol with remifentanil was administered to the TIVA group and sevoflurane to the VIMA group. Haemodynamic variables, stress hormone responses, anaesthesia profiles, adverse reactions and physicians' levels of satisfaction were compared between the two groups. The ED99 values of propofol in the TIVA group and sevoflurane in the VIMA group were 8.9 µg/ml and 6.8% respectively. Haemodynamic variables and stress hormone levels were higher in the VIMA group than in the TIVA group. Agitation and coughing also occurred less frequently in the TIVA group. In addition, physicians' levels of satisfaction were greater in the TIVA group. Our results suggest that TIVA with propofol plus remifentanil is superior to VIMA using sevoflurane alone for children undergoing flexible fibreoptic bronchoscopy.

English

OBJECTIVES: To study the effect of oral clonidine premedication on the induction doses of intravenous thiopentone sodium and propofol. METHODS: After ethical committee approval and informed consent, 120 ASA grade I and II patients were randomly allocated to four groups of 30 each. Group A received a placebo orally, 90 minutes before induction with thiopentone. Group B received clonidine 4μg/kg orally, 90 minutes before induction with thiopentone. Group C received a placebo orally, 90 minutes before induction with propofol. Group D received clonidine 4μg/kg orally, 90 minutes before induction with propofol. The patients were premedicated with Tab Diazepam 5 mg orally on the night before surgery. Inj. Glycopyrrolate 0.004 mg/kg IV was administered before starting anaesthesia. The patients were pre-oxygenated with 100% oxygen for 3 minutes and anaesthesia was induced with either thiopentone sodium 2.5% or propofol, slowly till loss of eyelash reflex was achieved. The dose of either thiopentone sodium or propofol required for induction of anaesthesia was noted. Inj. Succinylcholine 1.5 mg/kg was injected intravenously to facilitate tracheal intubation and after intubation anaesthesia was continued in the conventional manner. The heart rate and blood pressure were recorded throughout the procedure. RESULTS: The dose of thiopentone sodium required for induction was significantly lower by 21.3% in the group B (3.65±0.3 mg/kg) as compared with the control group A (4.64±0.35 mg/kg), effect size, d=2.02, p<0.001. The dose of propofol required for induction was significantly lower by 16.01% in the group D (1.73±0.08 mg/kg) as compared with the control group C (2.06±0.06 mg/kg), effect size, d=0.92, p=0.001. CONCLUSION: Oral clonidine premedication decreases the induction doses of both thiopentone sodium and propofol. INTRODUCTION: Clonidine, a centrally acting alpha-2 receptor agonist, has attracted increasing interest as an adjunct to anaesthesia. A variety of beneficial effects before, during and after anaesthesia, such as sedation, suppression of intubation response, analgesia, decreased anaesthetic requirements, increased cardiovascular stability and improved outcome, have been attributed to clonidine.1 The introduction of thiopentone sodium into clinical practice in 1934, marked the advent of intravenous anaesthesia, its property of producing peaceful sleep easily led to its rapid acceptance as one of the most commonly used intravenous induction agent. Propofol has several advantages like provision of rapid, smooth induction of anaesthesia and rapid recovery. However, an ideal intravenous induction agent is still eluding the anesthesiologists in spite of constant research. Many new adjuncts to intravenous induction of anaesthesia have been tried to improve the induction characteristics and to prevent the unwanted side effects of these agents.2The most widely used intravenous induction anaesthetics agents are thiopentone sodium and propofol. They have been reported to have a variety of effects on the central nervous system. This has led to a growing interest in studies investigating the interactions between them and other centrally acting drugs.

Doppler evaluation of the effects of propofol, etomidate and alphaxalone on fetoplacental circulation hemodynamics in the pregnant ewe

IntroductionUmbilical artery (UA) hemodynamics reflect blood flow and vascular resistance in the placental circulation. We examined non-invasively the hemodynamic effects of propofol, etomidate, and alphaxalone on the placental circulation of a sheep model by means of UA Doppler ultrasonography. MethodsEleven sheep fetuses were examined at 90–109 days of gestation. UA Doppler ultrasound was performed before and after administration of a single intravenous bolus of propofol, etomidate, or alphaxalone. UA Doppler velocities (peak systolic velocity, end diastolic velocity, and mean velocity), vascular indices (pulsatility index, resistance index, and S/D ratio), blood flow, and fetal heart rate were recorded during the experimental period and UA Doppler waveforms were characterized. ResultsA laminar, parabolic, low resistance flow was observed in the UA of the sheep fetuses. No statistically significant changes were observed in the UA Doppler waveforms or in the UA Doppler hemodynamics after anesthesia induction. DiscussionChanges in placental vascular resistance may alter the corresponding UA Doppler waveforms. When resistance in the fetal placenta increases, blood flow in the UA becomes more pulsatile. In the present study, umbilical arteries showed a parabolic flow with low resistance in all cases, as it occurs in normal human pregnancy. The administration of these anesthetics did not cause abnormalities in the normal UA Doppler pattern, inducing no changes in the resistance of the placenta in any case. ConclusionThese results suggest that intravenous anesthetic induction with propofol, etomidate, or alphaxalone does not cause significant detrimental effects on the placental circulation of the pregnant ewe.

Inhalational Induction and Maintenance of Sevoflurane-Based Anesthesia or Total Intravenous Anesthesia Using Propofol and Fentanyl in Patients with Concomitant Dyscirculatory Encephalopathy

Objective: to improve the results of treatment in patients with concomitant cerebrovascular diseases, by reducing the incidence of postoperative delirium due to neuroprotective properties of sevoflurane. Subjects and methods. Eighty2two patients with concomitant dyscirculatory encephalopathy were examined. The goals of the study included evaluating (a) efficiency and safety of total intravenous anesthesia (TIVA) using propofol versus inhalational induction and (b) maintenance of anesthesia (IIMA) using sevoflurane in patients with atherosclerotic and hypertensive encephalopathy undergoing noncardiac surgery. Results. The patients from both groups were susceptible to episodes of unintentional cerebral desaturation (rSO2); however, only the TIVA group showed a high correlation between a decrease in rSO2 and increases in the blood levels of S100beta protein, a marker of neuronal damage, and in the incidence of postoperative delirium (r=0.7321; p=0.0000001) diagnosed in accordance to comprehensive clinical examination and MMSE scores. The IIMA group lacked a relationship of MMSE scores to the episodes of cerebral desaturation (r=0.1609; p=0.4860), which is regarded as a manifestation of the neuroprotective effect resulted from anesthetic preconditioning. Conclusion. sevafluran2based inhalational induction and maintenance of anesthesia in patients with atherosclerotic and hypertensive encephalopathy is preferable over intravenous anesthesia with propofol and fentanyl in patients with concomitatnt disregulatory enc encephalopathy. Key words: cerebral desaturation, postoperative delirium, anesthetic preconditioning, europrotection, sevoflurane.

Different dosing regimens for propofol induction in obese patients

ObjectivesThe aim of the study is to investigate the efficacy of different dosages of single bolus propofol administered on the basis of total body weight or corrected body weight for the intravenous induction of anesthesia in obese patients undergoing bariatric surgery. Materials and methodsThirty-eight obese patients with a body mass index (BMI) of 30 kg/m2 or greater were randomly divided into two groups. They received single-bolus propofol (2 mg/kg) for intravenous induction of anesthesia based on either total body weight (TBW; 20 patients) or corrected body weight 60% (CBW60; 18 patients). Patients’ characteristics, biochemical data, monitored bispectral index (BIS) values, and hemodynamic parameters were compared between the two groups. ResultsThe propofol dose was significantly lower in the CBW60 group than in the TBW group (189.5 ± 36.3 mg vs. 217.3 ± 39.1 mg, respectively; p = 0.03). The highest BIS value, representing potential awareness after intubation, was relatively higher in the CBW60 group, but this difference was not statistically significant (CBW60 group, 53.6 ± 11.1; TBW group, 48.6 ± 8.1; p = 0.22). Eighty-three percent of patients experienced hypotension during induction and at least 44% patients showed marked hypotension. There was no significant difference between the TBW and CBW60 groups in blood pressure after intubation. ConclusionWhen using single bolus propofol, the CBW60 group showed similar BIS values and hemodynamic effects as the TBW group during the intravenous induction of general anesthesia for obese patients.

Roles of Cookgas and Fastrach intubating laryngeal mask airway for anticipated difficult tracheal intubation

To compare the clinical effectiveness of blind intubation through the Cookgas intubating laryngeal airway(CILA) or Fastrach intubating laryngeal mask airway(FT-LMA) for anticipated difficult tracheal intubation. Eighty-six patients with anticipated difficult tracheal intubation who were undergoing elective plastic surgery under general anesthesia were randomly allocated into CILA group(n=43) and FT-LMA group(n=43) . After general anesthesia being induced and CILA or FT-LMA being inserted, the patients were treated with blind intubation through CILA or FT-LMA. In each case, the number and the time of intubating laryngeal airway(ILA) insertion and blind intubation attempts and ILA removal were recorded. The view of glottis under fiberoptic bronchoscope(FOB) via CILA or FT-LMA was recorded. In addition, noninvasive blood pressure and heart rate were recorded before and after intravenous anesthetic induction, at ILA insertion, at intubation, at ILA removal and every minute thereafter for 5 minutes. CILA or FT-LMA was inserted successfully in all 86 patients. The rate of the first successful insertion was not significantly different between two groups(P>0.05) . In CILA group, the first intubation attempt succeeded in 35 patients;5 and 2 cases were intubated blindly at the second and the third attempt, one patient failed who was intubated successfully by FOB via CILA. In FT-LMA group, 32 patients were intubated successfully at the first attempt, 4 at the second attempt, 3 at the third attempt, and 4 cases failed, three of them were intubated smoothly with FOB through FT-LMA, one failed patient was intubated by FOB. The time of FT-LMA insertion(34.2∓13.9) s was significantly longer when compared with CILA(22.4∓18.9) s (P<0.05) . However, the time of blind intubation through CILA and FT-LMA [(46.0∓26.7) s vs.(51.8∓41.1) s]and the time of ILA removal[(39.3∓11.9) s vs.(35.3∓10.4) s] were not significantly different between groups(P>0.05) . Hemodynamic changes during blind intubation in the two groups showed no significant differences(P>0.05) . Blind intubation via CILA or FT-LMA is safe and effective for anticipated difficult tracheal intubation. Nevertheless, CILA is easier to be inserted, with relatively higher success rate of blind intubation.

Emergence delirium in children: a randomized trial to compare total intravenous anesthesia with propofol and remifentanil to inhalational sevoflurane anesthesia

Emergence delirium (ED) refers to a variety of behavioral disturbances commonly seen in children following emergence from anesthesia. Vapor-based anesthesia with sevoflurane, the most common pediatric anesthetic technique, is associated with the highest incidence of ED. Propofol has been shown to reduce ED, but these studies have been methodologically limited. To conduct a randomized-controlled trial comparing the incidence of ED in children following sevoflurane (SEVO) anesthesia and propofol-remifentanil total intravenous anesthesia (TIVA). One hundred and twelve children, ASA I-II, aged ≥ 2 and ≤ 6 years, undergoing strabismus repair, were assigned to receive TIVA (intravenous induction and maintenance of anesthesia with propofol and remifentanil) or SEVO (inhalational induction and maintenance of anesthesia with sevoflurane). Parent-child induction behavior was scored using the Perioperative Adult Child Behavior Interaction Scale (PACBIS). Postoperatively, ED was assessed by a masked investigator using the Pediatric Anesthesia Emergence Delirium (PAED) Scale and pain using the Face, Legs, Activity, Cry, Consolability (FLACC) Scale every 5 min. Data are reported for 94 subjects. Incidence of ED was higher with SEVO (38.3% vs 14.9%, P = 0.018). There was no difference in the median PACBIS score. A higher FLACC score was seen with SEVO (median 3 vs 1, P = 0.033). Subjects experiencing ED had higher FLACC scores vs those unaffected by ED (median 7 vs 1, P < 0.0001). There was a lower incidence of ED after TIVA. Both intravenous and inhalational inductions were similarly well-tolerated. The use of TIVA was associated with reduced postoperative pain as measured using FLACC scores.

Inspiratory Stridor after Tracheal Intubation with a MicroCuff® Tracheal Tube in Three Young Infants

ncuffed tracheal tubes (TTs) have been the stan-dard for tracheal intubation in infants and children for decades until the recent introduction of the Microc uff (Kim-berley-clark, Roswell, GA) cuffed TT. e vidence suggests that the incidence of perioperative airway events after use of these new TTs is small,