Intravenous Infusion Of Propofol Research Articles

Use of esketamine for tracheoscopic drug injection: a randomized controlled trial.

Sufentanil may induce hypotensive bradycardia and other adverse reactions in elderly patients during anesthesia, while esketamine exhibits sedative and analgesic effects with minimal impact on respiration and circulation. The objective of this study was to investigate the impact of these two anesthetics on vital signs in patients undergoing bronchoscopy and lavage under general anesthesia. This study was a randomized controlled trial with a parallel design. A total of 100 patients aged ≥60 years with ASAI or II who were undergoing bronchoscopy and lavage were randomly assigned to two groups: group A (esketamine, n = 50) and group B (sufentanil, n = 50). During anesthesia induction, both groups received intravenous infusion of propofol at a dose of 1.5 mL/kg and atracurium. In group A, esketamine at a dose of 0.3 mg/kg was injected; in group B, sufentanil at a dose of 0.2 μg/kg was injected intravenously. Subsequently, a laryngeal mask was inserted and connected to an anesthesia machine for mechanical ventilation. Anesthesia maintenance involved continuous intravenous infusion of propofol at a dose of 3 mL/kg. The mean arterial pressure (MAP), heart rate (HR), and blood oxygen saturation (SpO2) were recorded at various time points: before anesthesia injection (T0), after laryngeal mask insertion (T1), 5 min after the operation started (T2), 15 min after the operation started (T3), and before the end of the operation (T4). Additionally, the recovery time was recorded. The blood pressure of patients in the esketamine group exhibited higher levels compared to those in the sufentanil group at multiple time points during the operation, while maintaining a more stable intraoperative blood pressure and shorter postoperative recovery time than that observed in the sufentanil group. The blood pressure and heart rate of patients in the esketamine group exhibited significant fluctuations after laryngeal mask implantation compared to pre-anesthesia induction, with a statistically significant increase observed. Conversely, no significant changes were observed in the sufentanil group. The heart rate and oxygen saturation showed no significant differences between the two groups, nor did the amount of propofol administered during the procedure. The utilization of esketamine during the induction phase of bronchoscopy and lavage under general anesthesia can enhance hemodynamic stability and reduce the occurrence of hypotension, thereby facilitating postoperative anesthetic recovery.

INhaled Sedation versus Propofol in REspiratory failure in the Intensive Care Unit (INSPiRE-ICU1): protocol for a randomised, controlled trial

IntroductionSedation in mechanically ventilated adults in the intensive care unit (ICU) is commonly achieved with intravenous infusions of propofol, dexmedetomidine or benzodiazepines. Significant limitations associated with each can impact their...

How Is the Nociceptive Withdrawal Reflex Influenced by Increasing Doses of Propofol in Pigs?

The nociceptive withdrawal reflex (NWR) is a physiological, polysynaptic spinal reflex occurring in response to noxious stimulations. Continuous NWR threshold (NWRt) tracking has been shown to be possibly useful in the depth of anesthesia assessment. The primary aim of this study was to describe how propofol modulates the NWRt over time in pigs. Five juvenile pigs (anesthetized three times) were included. An intravenous (IV) infusion of propofol (20 mg/kg/h) was started, and boli were administered to effect until intubation. Afterwards, the infusion was increased every ten minutes by 6 mg/kg/h, together with an IV bolus of 0.5 mg/kg, until reaching an electroencephalographic suppression ratio (SR) of between 10% and 30%. The NWRt was continuously monitored. For data analysis, the time span between 15 min following intubation and the end of propofol infusion was considered. Individual durations of propofol administration were divided into five equal time intervals for each pig (TI1-TI5). A linear regression between NWRt and TI was performed for each pig. Moreover, the baseline NWRt and slopes of the linear regression (b1) were compared among days using a Friedman Repeated Measures Analysis of Variance on Ranks. The NWRt always increased with the propofol dose (b1 = 4.71 ± 3.23; mean ± standard deviation). No significant differences were found between the baseline NWRt and the b1 values. Our results suggest that the NWRt may complement the depth of anesthesia assessment in pigs receiving propofol.

Comparison of dexmedetomidine and propofol infusion on intraoperative haemodynamics during functional endoscopic sinus surgery under general anaesthesia- A randomized controlled trial

Functional endoscopic sinus surgery (FESS) is a surgical technique to treat sinonasal diseases. Intraoperative bleeding is one of the major challenges, which hinder the confined area of visibility and prolongs the procedure. Intraoperative induced hypotension can reduce intraoperative bleeding, to provide clear surgical field for dissection and hence decreasing operative time. So, we compared effect of dexmedetomidine and propofol infusion on the intraoperative haemodynamics during functional endoscopic sinus surgery (FESS). To study the effect of intravenous (IV) dexmedetomidine and propofol infusion on intraoperative haemodynamics under general anaesthesia in functional endoscopic sinus surgery(FESS). Secondary aim was to study estimated blood loss if any. To study the effect of I.V. dexmedetomidine and propofol infusion on intraoperative haemodynamics under general anaesthesia in functional endoscopic sinus surgery (FESS). Patients were divided randomly by sealed envelope method into two groups with 30 patients in each group. Group D patients received dexmedetomidine 1ug/kg as a loading dose over 20 minutes followed by 0.3 ug/kg/hr infusion for maintainence. Group P patients received propofol 2mg/kg as a loading dose followed by 100-200 ug/kg/min infusion for maintenance. The findings in our study highlights that dexmedetomidine infusion decreases haemodynamic parameters like arterial blood pressure and heart rate more as compared to propofol infusion during FESS. The effect on hemodynamics sustained and consistent without requirement of additional hypotensive agents. So altogether, this lead to better surgical field. Use of dexmedetomidine is a safe and effective method to control bleeding and improve the quality of surgical field and intraoperative haemodynamics.

The Effect of Premedication with Oral Acetaminophen on the Prevention of Localized Pain Resulting from Intravenous Propofol Injection: A Randomized Double Blind Placebo Clinical Trial

Background: Propofol is one of the most widely used medications in anesthesia and intensive care. Propofol Intravenous injection is painful for patients at the injection site. The aim of this study was to determine the effect of premedication with oral acetaminophen in prevention of local pain caused by intravenous injection of propofol.
 Methods: This study was a double-blind randomized controlled trial. Data were collected from July 2020 to July 2021 in Shariati Hospital. All stages of premedication and induction of anesthesia were the same in all three groups of patients. Pb, P500 and P1000 groups (patients with oral placebo, 500 or 1000 mg of oral paracetamol, respectively) received the medication 1 hour before transfer to the operating room.
 Results: In this study, 150 patients were included. 44.7% were men, 55.3% women, and mean age of patients was 36.82 ± 10.24. The highest severity of reported pain was in the group of patients receiving placebo. Patients receiving 1 gram of acetaminophen had the lowest reported pain. Patients receiving 500 mg of acetaminophen reported significantly less pain than patients receiving placebo and more pain than patients in the group receiving 1 g of acetaminophen. Age, gender and weight did not have any significant effect on the pain severity.
 Conclusion: When compared to placebo, the use of oral acetaminophen as a premedication considerably lowers discomfort induced by intravenous propofol infusion. A dosage of 1 g of oral acetaminophen is more effective than 500 mg in decreasing pain. The level of pain and acetaminophen's pain-relieving effects were not affected by age, gender or weight.

Effects of continuous intravenous infusion with propofol on intestinal metabolites in rats.

Microbial metabolites play an important role in regulating intestinal homeostasis and immune responses. Propofol is a common anesthetic in clinic, but it is not clear whether it affects intestinal metabolites in rats. Tail vein puncture was performed after adaptive feeding for 1 month in eight 2-month-old rats and they were given continuous intravenous infusion of propofol for 3 h. The feces of rats were divided into different groups based on time periods, with before and after anesthesia with propofol on days 1, 3 and 7 labeled as groups P, A1, A3 and A7, respectively. The effect of continuous intravenous infusion with propofol on rat fecal metabolites was determined using the non-targeted metabolomics technique gas chromatography coupled with a time-of-flight mass spectrometer analysis. The types and contents of metabolites in rat feces were changed after continuous intravenous infusion with propofol, but the changes were not statistically significant. The contents of the metabolites 3-hydroxyphenylacetic acid and palmitic acid increased from day 3 to 7, and it was shown that the two metabolites were positively correlated at a statistically significant level. Linoleic acid decreased to its lowest level on day 3, and it returned to pre-anesthesia level on day 7. At the same time, linoleic acid metabolism was a metabolic pathway that was co-enriched 7 days after infusion with propofol. Spearman correlation analysis showed that there was significant correlation between some differential metabolites and differential microorganisms. It was observed that zymosterol 1, cytosin and elaidic acid were negatively correlated with Alloprevotella in the A3 vs. P group. In the A7 vs. P group, cortexolone 3 and coprostan-3-one were positively correlated with Faecalibacterium, whilst aconitic acid was negatively correlated with it. In conclusion, the present study revealed statistically insignificant effects of continuous intravenous propofol on the intestinal metabolites in rats.

Comparison of sedation efficacy of intravenous infusion of dexmedetomidine versus propofol in terms of opioid consumption in patients requiring postoperative mechanical ventilation after head and neck onco-surgeries - A randomized prospective study.

The conventional drug regimen of sedation for patients requiring mechanical ventilation in an intensive care unit (ICU) is propofol or midazolam. Dexmedetomidine is a newer drug for sedation with a better clinical profile. We conducted this study to compare the sedative efficacy of dexmedetomidine versus propofol in patients after head and neck cancer surgeries requiring mechanical ventilation. After ethics committee approval and written informed consent, 80 patients undergoing head and neck onco-surgery were recruited. The patients were randomly allocated to group I [1 mg/kg of bolus propofol over 15 minutes followed by infusion of 1 mg/kg/hour titrated by increasing or decreasing the infusion dose to Ramsay Sedation Score (RSS) 2-4] or group II (a loading dose of dexmedetomidine 1 mcg/kg over 15 minutes followed by a maintenance dose of 0.4 µg/kg/hour titrated to desired sedation level). The RSS, behavioral pain scale (BPS), heart rate, blood pressure, fentanyl consumption, additional sedative agent, extubation time, length of ICU stays, mechanical ventilation duration, side effects, and patient's satisfaction were noted. Total fentanyl required was 0.56 ± 0.13 µg/kg/hour in group II and 0.58 ± 0.18 µg/kg/hour in group I ( P = 0.75). Extubation time, RSS, BPS, patient satisfaction, and ICU duration were similar in both the groups. The incidence of hemodynamic-related adverse effects were 41.67% in group II and 11.11% in group I ( P = 0.006). The fentanyl requirement was comparable in both the groups in the postoperative period. Dexmedetomidine was associated with an increased incidence of bradycardia and hypotension as compared to the propofol group. Propofol should be the preferred sedative for postoperative mechanical ventilation after head and neck onco-surgeries.

General anesthesia alters the diversity and composition of the lung microbiota in rat

BackgroundThe lung microbiome plays a crucial role in human health and disease. Extensive studies have demonstrated that the disturbance of the lung microbiome influences immune response, cognition, and behavior. The goal of this study was to investigate the effect of general anesthetics on lung microbiome. MethodsEight-week-old male SD rats received a continuous intravenous infusion of propofol or inhalation of isoflurane for 4 h. 16S rRNA gene amplification from BALF samples was used to investigate the changes in the lung microbiome after interventions. We further performed neurobehavioral assessments to find the differential strains’ association with behavior disorder after isoflurane anesthesia. ResultsThe absolute and relative quantitation of 16S rRNA sequencing data showed that isoflurane altered the diversity and abundance of the lung microbiome in rats more than propofol. Elusimicrobia increased significantly in the isoflurane group. Both EPM and OFT results showed that rats exhibited depression-like behaviors after inhalation of isoflurane. In addition, significant differences were found in the COG/KO/MetaCyc/KEGG pathway enrichment analyses among the groups. ConclusionContinuous inhalation of isoflurane changed the diversity and composition of the lung microbiota in rats, resulting in post-anesthesia depression.

Septorinoplasti Olgularında Sevofluran İnhalasyon Anestezisi ve Propofol İle Uygulanan Total İntravenöz Anestezinin Postoperatif Boğaz Ağrısı ve Bulantı-Kusma Açısından Karşılaştırılması

Objective: The objective of this prospective observational study was to compare the use of inhalation anesthesia with sevoflurane and total intravenous anesthesia with propofol in terms of sore throat and postoperative nausea/vomiting in elective septorhinoplasty cases under general anesthesia. Methods: This study was conducted using the data of 52 participating patients. Following induction of anesthesia, Group 1 (n=26) received sevoflurane inhalation and remifentanil infusion, while Group 2 (n=26) received intravenous propofol and remifentanil infusion. The presence of nausea/vomiting, the presence and severity of sore throat, extubation times, and the number of patients who were given additional analgesics and antiemetics were recorded at the end of operation. Results: Within post-anesthesia care unit, Group 2 had less sore throat at the postoperative 2nd, 6th, and 12th h (p values, respectively: 0,014; 0,004; 0,015; 0,044. The number of patients receiving additional analgesics in the postoperative period was 19 in Group 1 and 9 in Group 2 (p=0.005). The results of the groups in terms of postoperative nausea/vomiting were similar. Conclusion: In septorhinoplasty operations, total intravenous anesthesia with propofol resulted in less sore throat and reduced postoperative analgesic use compared to inhalation anesthesia with sevoflurane. Keywords: Sore throat, nausea and vomiting, propofol, septorhinoplasty, sevoflurane, TIVA

Effects of smoking on controlled hypotension with nitroglycerin during ear-nose-throat surgery.

In this study, the aim was to research the effects of smoking habits on controlled hypotension administered with nitroglycerin during ear-nose-throat surgery. This study administered controlled hypotension with nitroglycerin and total intravenous anesthesia to a total of 80 patients undergoing septoplasty operations. The patients were divided into two groups of 40 non-smokers (Group 1) and 40 smokers (Group 2). Intravenous propofol infusion was used for anesthesia maintenance. Nitroglycerin with 0.25-1 μg/kg/min dose was titrated to provide controlled hypotension. During this process, the hemodynamic parameters of patients, total propofol and nitroglycerin amounts used, operation duration, and duration of controlled hypotension were recorded at the end of the operation. At the end of the operation, the surgeon assessed the lack of blood in the surgical field with Fromme Scale. Fromme scale values were significantly higher in Group 2 compared to Group 1. The MAP values at 10, 20, 30 min, and end of operation were lower, while 10- and 20-min heart rate values were higher in Group 2 compared to Group 1. Nitroglycerin, chosen for controlled hypotension to reduce hemorrhage in the surgical field during nasal surgery, was shown to cause more pronounced hypotension and reflex tachycardia due to endothelial dysfunction linked to nicotine in patients who smoke. Despite lower pressure values in the smoking group, the negative effects of nicotine on platelet functions combined with similar effects of nitroglycerin to increase bleeding amounts.

Total Intravenous Anaesthesia with Propofol and Dexmedetomidine for Brachial Plexus Repair with Intraoperative Neuromuscular Monitoring: A Case Series

Background: Brachial plexus surgery requires neural repair with the use of intraoperative peripheral nerve stimulation without muscle relaxants.
 Methods: Twelve cases were conducted under total intravenous anaesthesia, receiving intravenous propofol, fentanyl and dexmedetomidine infusion. Intraoperative hemodynamic conditions and postoperative functional recovery were assessed.
 Results: 9 out of 12 cases were stable while one was in a lighter plane requiring 20 mg propofol and increased dexmedetomidine, two had bradycardia requiring reduced dexmedetomidine infusion. At three months, five cases showed improvement.
 Conclusion: Satisfactory conditions were achieved including hemodynamic stability, and muscle-sparing improving prognoses of brachial plexus surgeries.

Prospective observational study on the use of continuous intravenous ketamine and propofol infusion for prolonged sedation in critical care

IntroductionAnalgesia and sedation are a priority in paediatric intensive care. The combination of ketamine and propofol is a possible option in patients requiring prolonged or difficult sedation and to reduce the use of benzodiazepines and opiates. The aim of this study was to assess the efficacy and safety of combination ketamine and propofol in continuous infusion for prolonged analgesia/sedation in the paediatric intensive care setting. Patients and methodsProspective, observational single-group cohort study in patients aged 1 month to 16 years admitted to the paediatric intensive care unit in 2016–2018 that received ketamine and propofol in continuous infusion for analgesia and sedation. We collected data on demographic and clinical characteristics, analgesia and sedation scores (MAPS, COMFORT-B and SOPHIA), haemodynamic parameters and adverse events. ResultsThe study included 32 patients. The maximum dose of ketamine was 1.5 mg/kg/h (interquartile range [IQR], 1−2 mg/kg/h) and the infusion duration was 5 days (IQR, 3–5 days). The maximum dose of propofol was 3.2 mg/kg/h (IQR, 2.5–3.6 mg/kg/h) and the infusion duration, 5 days (IQR, 3–5 days). Thirty (93.7%) patients had previously received midazolam and 29 (90.6%) fentanyl. Analgesia scores did not change after initiation of the ketamine and propofol infusion. There was a statistically significant increase in the COMFORT-B score, but the score remained in the adequate sedation range (12–17). There were small but statistically significant decreases in the mean arterial pressure (from 64 mmHg to 60 mmHg; P = .006) and the diastolic blood pressure (from 50.5 to 48 mmHg; P = .023) 1 h after the initiation of the ketamine and propofol infusion, but this difference was not observed 12 h later and did not require administration of vasoactive drugs. No other major adverse events were detected during the infusion. ConclusionsThe combination of ketamine and propofol in continuous infusion is a safe treatment in critically ill children that makes it possible to achieve an appropriate level of analgesia and sedation without relevant haemodynamic repercussions.

5-Aminolevulinic acid hydrochloride enhances bupivacaine-induced hypotension in spontaneously hypertensive rats

PurposeOral administration of 5-aminolevulinic acid hydrochloride (5-ALA-HCl) has been reported to enhance the hypotensive effects associated with anesthetics, especially in elderly hypertensive patients treated with antihypertensive agents. The present study aimed to clarify the effects of antihypertensive-agent- and anesthesia-induced hypotension by 5-ALA-HCl in spontaneously hypertensive rats (SHRs). MethodsWe measured blood pressure (BP) of SHRs and normotensive Wistar Kyoto (WKY) rats treated with amlodipine or candesartan before and after administration of 5-ALA-HCl. We also investigated the change in BP following intravenous infusion of propofol and intrathecal injection of bupivacaine in relation to 5-ALA-HCl administration. FindingsOral administration of 5-ALA-HCl significantly reduced BP in SHRs and WKY rats with amlodipine and candesartan. Infusion of propofol significantly reduced BP in SHRs treated with 5-ALA-HCl. Intrathecal injection of bupivacaine significantly declined SBP and DBP in both SHRs and WKY rats treated with 5-ALA-HCl. The bupivacaine-induced decline in SBP was significantly larger in SHRs compared with WKY rats. ConclusionThese findings suggest that 5-ALA-HCl does not affect the antihypertensive agents-induced hypotensive effect, but enhances the bupivacaine-induced hypotensive effect, especially in SHRs, indicating that 5-ALA may contribute to anesthesia-induced hypotension via suppression of sympathetic nerve activity in patients with hypertension.

Effects of Isoflurane versus Propofol for Postoperative Neurocognitive Recovery in Patients Undergoing Surgery under General Anaesthesia: A Randomised Clinical Study

Introduction: Propofol and isoflurane are commonly used in general anaesthesia. Both the drugs are neither neuroprotective nor neurotoxic. In clinical settings, inhaled anaesthetics like isoflurane are frequently used. But, it has been claimed that isoflurane anaesthesia would be a factor inducing cognitive impairment. Propofol is metabolised quickly, primarily in the liver, and its by products are inert. After the initial dose, the half-life of propofol is 2 to 8 minutes, and even with prolonged infusions, propofol promotes quick recovery. Aim: To evaluate the effects of propofol and isoflurane on postoperative recovery patterns in patients receiving general anaesthesia and to determine how they affect cognitive function and memory. Materials and Methods: A double-blinded randomised clinical study was conducted at the Department of Anaesthesia, RL Jalappa Hospital and Research Centre, Tamaka, Kolar, Karnataka, India, during the period from January 2022 to March 2022. In the present study, 60 patients of between age 50-90 years were included. Patients were split into two groups: group A received an intravenous infusion of propofol, and group B received isoflurane. Patients in both groups had their cognitive ability and memory tested before surgery. In the present study, baseline Mean Atrial Pressure (MAP), Heart Rate (HR), Pulse Oximetry (SpO2 ) and Ramsay Sedation score were comparable in both groups. The novel variables, such as surgery types, duration, and medications were evaluated in both groups. Mini Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) were assessed one hour before and four hours after surgery. Comparison of a continuous variable across the groups was performed using the Student’s t-test or MannWhitney U test, depending on the normality of the distribution. A comparison of categorical variables across the two study groups was made using the Chi-square test. A p-value of <0.05 was considered statistically significant. Results: Age group of 50-60 years were more in both group A (66.7%), and group B (70%). In Group A, most participants were females (56.7%), and in group B, majority were males (60%). In group A, the postoperative assessment showed a mean MoCA score of 25.6±1.52; in group B postoperative assessment showed a mean MoCA score of 24.17±1.46 with a p-value of 0.001, which was statistically significant. The postoperative assessment showed a mean MMSE score of 26.3±1.58 in group A and in group B, the postoperative assessment showed a mean MMSE score of 24.9±1.4 with a p-value of 0.001, which was statistically significant. Conclusion: The current results imply that postoperative delirium is more frequently present after isoflurane anaesthesia than after propofol anaesthesia.

A Comparative Study Between the Effects of Aprepitant and Ondansetron for the Prevention of Postoperative Nausea and Vomiting after Laparoscopic Cholecystectomy

Background: Postoperative nausea and vomiting is one of the most typical side effects following surgery and anaesthesia (PONV). There has been a significant paradigm shift in the approach taken to prevent PONV. There have also been a few new medical treatments for the prevention and treatment of PONV. Clinical trials and meta-analyses show that aprepitant prevents PONV better than ondansetron. Objective: To compare the frequency of PONV after administration of Aprepitant vs Ondansetron in laparoscopic cholecystectomy Materials and Methods: The Jinnah Hospital in Lahore's Laparoscopic Operation Theater conducted this randomised control trial over the course of six months, from 15 April to 15 October 2019. Two groups of patients were randomly assigned. Ondansetron 8 mg was given orally to Group O two hours before induction with a sip of water. Two hours prior to induction, Group A took 80 mg of aprepitant orally with a sip of water. Every patient was instructed to fast for 6–8 hours. A 20G cannula was used to create an intravenous line after entering the operation room, and Ringer lactate was started. During surgery, the following parameters are all monitored: heart rate, oxygen saturation (SpO2), electrocardiography, noninvasive blood pressure (NIBP), and end-tidal carbon dioxide concentration (EtCO2). Using an intravenous infusion of propofol 2 mg/kg, anaesthesia was induced. Atracurium 0.6 mg/kg intravenous was used to aid in endotracheal intubation. In order to maintain anaesthesia, oxygen and (0.5–1%) isoflurane were used. As an analgesic, nalbuphine 0.1 mg/kg and paracetamol 15 mg/kg were administered. Neostigmine 0.04 mg/kg intravenous and Glycopyrotate 0.008 mg/kg intravenous were administered at the conclusion of operation to reverse the neuromuscular blockade. The last stitch or staple was made at 0 hours. Prior to surgery, the patient or attendant was instructed to contact the on-call doctor about any episodes of PONV. PONV occurrence was observed every 12 hours for 48 hours. Results: In this study we compared Aprepitant and Ondansetron on prophylaxis of PONV in patients undergoing laparoscopic cholecystectomy. Results showed that frequency of PONV was significantly higher with Ondansetron as compared to Aprepitant. i.e. (14.6% vs. 24.2%, p-value=0.032). From 0-12 hours frequency of PONV was higher with Ondansetron while from 12-24 hours PONV was higher in Aprepitant. Practical Implication: Government and hospitals should devise ways and procedures for effective research work for the benefit of patients, so that patient’s post-operative complications and symptoms can be managed efficiently. Conclusion: Aprepitant is more effective than ondansetron at preventing PONV in patients having laparoscopic cholecystectomy, according to the findings of this trial. Keywords: Vomiting, Postoperative nausea, PONV, Aprepitant, Cholecystectomy, Ondansetron, General anesthesia

Abstract 12070: Post-Cardiac Arrest Sedation Modulates Electroencephalographic Slow-Wave Activity and Promotes Neurological Recovery in a Mouse Model of Cardiac Arrest

Introduction: The majority of patients resuscitated from cardiac arrest (CA) present in coma or with an altered level of consciousness. Although CA survivors are routinely sedated during targeted temperature management, the effects of sedation on CA outcomes remain to be determined. Hypothesis: Post-CA sedation would modulate cerebral physiology and improve neurological outcomes in mice. Methods: Adult C57BL/6J mice of both sexes were subjected to potassium chloride-induced CA and thereafter resuscitated with manual chest compression. Starting at return of spontaneous circulation (ROSC) or at 60 minutes after ROSC, mice received intravenous infusion of propofol at 40 mg · kg -1 · h -1 , dexmedetomidine at 1 μg · kg -1 · h -1 , or normal saline for 2 hours. Body temperature was lowered and maintained at 33°C during sedation. Cerebral blood flow was measured for 4 hours after ROSC. Telemetric electroencephalogram (EEG) was recorded in freely moving mice from 3 days before up to 7 days after CA. Results: Sedation with propofol or dexmedetomidine starting at ROSC attenuated brain injury and improved survival in hypothermia-treated post-CA mice (propofol [13/16] vs. no sedation [4/16], P = 0.008; dexmedetomidine [14/16] vs. no sedation [4/16], P = 0.002). Mice that were not sedated after ROSC exhibited cerebral hyperemia immediately after resuscitation and EEG power in all frequency bands remained less than 20% of the baseline in the first 4 hours after ROSC. Administration of propofol or dexmedetomidine starting at ROSC attenuated cerebral hyperemia and induced slow-wave (0.5-4 Hz) EEG activity that reached near baseline levels during and early after sedation. Increased EEG activity within 6 hours after ROSC was associated with improvement in neurological outcomes at 24 hours post-CA. In contrast, delayed sedation starting at 60 minutes after ROSC failed to improve outcomes, without attenuating cerebral hyperemia and inducing slow-wave EEG activity. Conclusions: Post-CA sedation with propofol or dexmedetomidine improved neurological outcomes and survival in mice resuscitated from CA and treated with hypothermia. The beneficial effects of sedation were accompanied by attenuation of the cerebral hyperemic response and induction of EEG slow-wave activity.

Post-cardiac arrest Sedation Promotes Electroencephalographic Slow-wave Activity and Improves Survival in a Mouse Model of Cardiac Arrest.

Patients resuscitated from cardiac arrest are routinely sedated during targeted temperature management, while the effects of sedation on cerebral physiology and outcomes after cardiac arrest remain to be determined. The authors hypothesized that sedation would improve survival and neurologic outcomes in mice after cardiac arrest. Adult C57BL/6J mice of both sexes were subjected to potassium chloride-induced cardiac arrest and cardiopulmonary resuscitation. Starting at the return of spontaneous circulation or at 60 min after return of spontaneous circulation, mice received intravenous infusion of propofol at 40 mg · kg-1 · h-1, dexmedetomidine at 1 µg · kg-1 · h-1, or normal saline for 2 h. Body temperature was lowered and maintained at 33°C during sedation. Cerebral blood flow was measured for 4 h postresuscitation. Telemetric electroencephalogram (EEG) was recorded in freely moving mice from 3 days before up to 7 days after cardiac arrest. Sedation with propofol or dexmedetomidine starting at return of spontaneous circulation improved survival in hypothermia-treated mice (propofol [13 of 16, 81%] vs. no sedation [4 of 16, 25%], P = 0.008; dexmedetomidine [14 of 16, 88%] vs. no sedation [4 of 16, 25%], P = 0.002). Mice receiving no sedation exhibited cerebral hyperemia immediately after resuscitation and EEG power remained less than 30% of the baseline in the first 6 h postresuscitation. Administration of propofol or dexmedetomidine starting at return of spontaneous circulation attenuated cerebral hyperemia and increased EEG slow oscillation power during and early after sedation (40 to 80% of the baseline). In contrast, delayed sedation failed to improve outcomes, without attenuating cerebral hyperemia and inducing slow-wave activity. Early administration of sedation with propofol or dexmedetomidine improved survival and neurologic outcomes in mice resuscitated from cardiac arrest and treated with hypothermia. The beneficial effects of sedation were accompanied by attenuation of the cerebral hyperemic response and enhancement of electroencephalographic slow-wave activity.

Analgesic Efficacy and Safety of Spinal Oxycodone in Total Hip Arthroplasty: A Preliminary Study.

The aim of this study was to assess the analgesic efficacy and safety of 1 mg and 0.5 mg oxycodone administration in a spinal block procedure for a total hip arthroplasty (THA). Forty-two THA patients aged 59-81 with American Society Anesthesiology (ASA) II-III were included. All patients received anesthesia using spinal blockade, with bupivacaine 0.5% spinal heavy 2.5 ml, with 0.5 ml oxycodone hydrochloride 1.0 mg (group A; n = 28) or 0.5 mg (group B; n = 14). During surgery, each patient was sedated with 2-4 mg/kg/h intravenous propofol infusion. They received 100 mg intravenous ketoprofen at the end of the surgery at 8 pm and 8 am, with recommended doses every 12 h thereafter. Subcutaneous morphine 5 mg was used as a rescue analgesic, and the time to morphine use was recorded. After surgery, pain intensity (at the moment of patient report) was assessed using an 11-point numerical rating scale (NRS). The incidence of adverse effects was monitored. Blood samples were taken for assays of serum oxycodone, noroxycodone and bupivacaine levels. The time to rescue analgesia was 9.6 ± 5.6 h in group A and 7.3 ± 1.9 h in group B, and it did not differ between patient groups (P = 0.179). The mean NRS pain score was 4.5 in group A and 4.2 in group B. Three group A patients had detectable oxycodone levels: two < 7.1 ng/ml and in 1 spinal block induced anesthesia was unsuccessful and so he/she underwent general anesthesia (this patient was excluded from the analysis). Four group B patients had single values < 5 ng/ml. Noroxycodone levels were in all patients undetectable, and bupivacaine levels were 70-300 ng/ml. Regarding adverse effects, one patient had hypotension, one had bradycardia, and one had pruritus. Oxycodone in spinal block prolongs analgesia period, does not cause serious adverse effects and seems to be safe and effective opioid for patients undergoing THA.

Inter-hospital transfer of a pregnant prone patient with COVID-19 as a bridge to ECMO.

Sir, Pregnant women are at a higher risk of severe coronavirus disease 2019 (COVID-19) compared to non-pregnant women and are associated with worse outcomes.[1] The management of acute respiratory distress syndrome (ARDS) in a pregnant woman is challenging because of physiological changes of pregnancy and the detrimental effects of hypoxaemia and hypercarbia on the foetus. Prone ventilation and extracorporeal membrane oxygenation (ECMO) are effective rescue strategies in severe ARDS requiring invasive mechanical ventilation. We transferred a pregnant patient with critical COVID-19 on invasive mechanical ventilation (IMV) and prone position as a bridge to ECMO. A 28-year-old primigravida at 24 weeks’ gestation, with laboratory-confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection was admitted for breathing difficulty and cough since 8 days. She was started on oxygen by face mask to target oxygen saturation (Spo2) ≥94%, dexamethasone 6 mg intravenous once daily and enoxaparin 40 mg subcutaneous 12 hourly. Laboratory parameters showed C-reactive protein 140 mg/L, haemoglobin 12.8 gm%, white cell count 4200/mm3, procalcitonin 1.1 ng/ml, lactate dehydrogenase 680 U/L, D-dimer 1011 ng/ml and normal renal and liver function tests. Her oxygenation worsened the next day, and a trial of continuous positive airway pressure (CPAP) was given in the intensive care unit (ICU). However, because of worsening oxygenation and respiratory distress, the patient was tracheal-intubated and started on IMV with lung-protective ventilation strategy. The patient remained hypoxaemic (partial pressure of oxygen to a fraction of inspired oxygen (PaO2/FiO2) ratio of 67 mm Hg) and higher plateau pressure (Pplat) of 32 cm H2O. She was proned with shoulder and thigh support and adequate padding of pressure areas. The abdomen and pelvis were kept in a suspended position. Periodical foetal assessment was performed using cardiotocography and portable Doppler ultrasound, while the suspended abdomen was checked manually for any obstruction or tension. The patient continued to be severely hypoxaemic (PaO2/FiO2 <80 mm Hg) despite two sessions of prone ventilation of 16 h each. The case was discussed with the ECMO team at Central Command Centre as a potential candidate for ECMO. Given the absence of retrieval ECMO and level III neonatal ICU, an inter-hospital transfer was planned. Due to rapid desaturation on supine positioning, a decision to transfer the patient in prone position was taken. A team of two anaesthesiologist-intensivists and three ICU trained nurses accompanied the patient. Heart rate, rhythm, arterial blood pressure, end-tidal continuous waveform capnography, SpO2 and ventilator waveforms were monitored continuously throughout the patient care [Table 1]. The tracheal tube was firmly secured with a tube holder and standard tie. An intravenous infusion of propofol and midazolam was used for sedation, and cisatracurium was used for neuromuscular blockade. The patient was transferred as a single unit with shoulder and pelvic support from the ICU bed to the ambulance stretcher. One staff was solely dedicated for foetal assessment and airway. An intensivist was responsible for IMV, and another supervised the transfer. The transfer was uneventful with continuous monitoring of the patient and foetus. The ECMO facility was approximately 9 km away and took a travel time of 28 min.Table 1: Vitals of the patient during inter-hospital transportProne ventilation is an effective rescue strategy for the management of refractory hypoxaemia in severe ARDS by improving ventilation-perfusion matching and reducing mortality.[2] Pregnancy is traditionally excluded from trials on ARDS. However, protocolised proning with due consideration to physiological changes of pregnancy and adequate monitoring is recommended as a low-cost and effective strategy in ARDS management.[3] The transfer in the prone position can be catastrophic with a risk of the misplaced airway and rapid deoxygenation or inability to perform cardiopulmonary resuscitation during an emergency.[4] The systematic planning of transfer with attention to airway, monitoring and pressure areas was found to have been successful in a smaller case series.[56] The twin issues of second-trimester pregnancy and prone position made this case challenging. However, adequate planning, team briefing and continuous patient and foetal monitoring ensured a safe transfer. In conclusion, safe transfer of a pregnant, prone patient was possible with adequate planning, risk management and an experienced team. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

GABRA1 and GABRB2 Polymorphisms are Associated with Propofol Susceptibility.

PurposeTo explore the effect of gene polymorphisms of propofol GABAA receptor and metabolic enzyme on drug susceptibility during the induction period of general anesthesia.Patients and MethodsA total of 294 female patients aged 18–55 years, ASA I–II, who underwent hysteroscopy with intravenous general anesthesia, were included in the study. Anesthesia was induced by continuous intravenous infusion of propofol at 40 mg·kg−1·h−1. Infusion of propofol was ended when both the Modified Observer’s Assessment of Awareness/Sedation scale (MOAA/S scale) decreased to 1 and the BIS index decreased to 60. The time when the MOAA/S scale decreased to 1 and the time when BIS index decreased to 60 was recorded to assess the susceptibility to the sedation effect. The maximum decreased percentage in mean arterial pressure (MAP) within 5 minutes was recorded to assess the susceptibility of cardiovascular response. Venous blood of each patient was collected to identify the presence of genetic variants in the GABRA1, GABRA2, GABRB2, GABRB3, GABRG2, CYP2B6, and UGT1A9 genes using the Sequenom MassARRAY® platform.ResultsAfter receiving propofol infusion, carriers of polymorphic GABRA1 rs4263535 G allele required significantly less time for BIS decreased to 60, while carriers of polymorphic GABRB2 rs3816596 T allele required significantly more time for BIS decreased to 60, carriers of polymorphic GABRA1 rs1157122 C allele and carriers of polymorphic GABRB2 rs76774144 T allele had a significantly less change in MAP.ConclusionGABRB2 rs3816596 and GABRA1 rs4263535 polymorphisms are associated with susceptibility to the sedation effect of propofol. GABRA1 rs1157122 and GABRB2 rs76774144 polymorphisms are associated with the degree of drop in blood pressure after propofol infusion.