Period Of Anesthesia Research Articles

Impact of dexmedetomidine on the incidence of delirium in elderly patients after cardiac surgery: A randomized controlled trial

BackgroundDelirium is a frequent complication after cardiac surgery and its occurrence is associated with poor outcomes. The purpose of this study was to investigate the impact of perioperative dexmedetomidine administration on the incidence of delirium in elderly patients after cardiac surgery.MethodsThis randomized, double-blinded, and placebo-controlled trial was conducted in two tertiary hospitals in Beijing between December 1, 2014 and July 19, 2015. Eligible patients were randomized into two groups. Dexmedetomidine (DEX) was administered during anesthesia and early postoperative period for patients in the DEX group, whereas normal saline was administered in the same rate for the same duration for patients in the control (CTRL) group. The primary endpoint was the incidence of delirium during the first five days after surgery. Secondary endpoints included the cognitive function assessed on postoperative days 6 and 30, the overall incidence of non-delirium complications within 30 days after surgery, and the all-cause 30-day mortality.ResultsTwo hundred eighty-five patients were enrolled and randomized. Dexmedetomidine did not decrease the incidence of delirium (4.9% [7/142] in the DEX group vs 7.7% [11/143] in the CTRL group; OR 0.62, 95% CI 0.23 to 1.65, p = 0.341). Secondary endpoints were similar between the two groups; however, the incidence of pulmonary complications was slightly decreased (OR 0.51, 95% CI 0.26 to 1.00, p = 0.050) and the percentage of early extubation was significantly increased (OR 3.32, 95% CI 1.36 to 8.08, p = 0.008) in the DEX group. Dexmedetomidine decreased the required treatment for intraoperative tachycardia (21.1% [30/142] in the DEX group vs 33.6% [48/143] in the CTRL group, p = 0.019), but increased the required treatment for postoperative hypotension (84.5% [120/142] in the DEX group vs 69.9% [100/143] in the CTRL group, p = 0.003).ConclusionsDexmedetomidine administered during anesthesia and early postoperative period did not decrease the incidence of postoperative delirium in elderly patients undergoing elective cardiac surgery. However, considering the low delirium incidence, the trial might have been underpowered.Trial RegistrationClinicalTrials.gov NCT02267538

Factors Causing Post-Anesthetic High Respiratory Resistance in Patients Undergoing Transurethral Resection of Bladder Tumors.

BackgroundIn this study, we investigated the causes of high respiratory resistance that is observed after general anesthesia. We focused on respiratory resistance at 5 Hz (R5), which were measured preoperatively and postoperatively.MethodsOur prospective observational study enrolled 68 patients who underwent transurethral resection of bladder tumors from April to October 2015. Respiratory impedance was measured the day before surgery and immediately after general anesthesia. Participants were divided into 2 groups: Group L (postoperative R5 values < 4.0 cmH2O/L/sec; n = 33) and Group H (postoperative R5 values ≥ 4.0 cmH2O/L/sec; n = 35). Patient background, preoperative R5 values, endotracheal tube or subglottic devices, anaesthetic period, desflurane or sevoflurane, and endotracheal suctioning were compared.ResultsSignificant parameters were height, inhalation of desflurane, endotracheal suctioning, and preoperative R5 value. Logistic regression showed that endotracheal suctioning and a higher preoperative R5 level increased postoperative respiratory resistance (> 4 cmH2O/L/sec).ConclusionsThe endotracheal suctioning at the end of anesthesia influenced respiratory resistance more than use of the endotracheal tube and desflurane.

Development of a DIPG Orthotopic Model in Mice Using an Implantable Guide-Screw System.

ObjectiveIn this work we set to develop and to validate a new in vivo frameless orthotopic Diffuse Intrinsic Pontine Glioma (DIPG) model based in the implantation of a guide-screw system.MethodsIt consisted of a guide-screw also called bolt, a Hamilton syringe with a 26-gauge needle and an insulin-like 15-gauge needle. The guide screw is 2.6 mm in length and harbors a 0.5 mm central hole which accepts the needle of the Hamilton syringe avoiding a theoretical displacement during insertion. The guide-screw is fixed on the mouse skull according to the coordinates: 1mm right to and 0.8 mm posterior to lambda. To reach the pons the Hamilton syringe is adjusted to a 6.5 mm depth using a cuff that serves as a stopper. This system allows delivering not only cells but also any kind of intratumoral chemotherapy, antibodies or gene/viral therapies.ResultsThe guide-screw was successfully implanted in 10 immunodeficient mice and the animals were inoculated with DIPG human cell lines during the same anesthetic period. All the mice developed severe neurologic symptoms and had a median overall survival of 95 days ranging the time of death from 81 to 116 days. Histopathological analysis confirmed tumor into the pons in all animals confirming the validity of this model.ConclusionHere we presented a reproducible and frameless DIPG model that allows for rapid evaluation of tumorigenicity and efficacy of chemotherapeutic or gene therapy products delivered intratumorally to the pons.

Hyaluronidase administered with xylazine–tiletamine–zolazepam into adipose tissue shortens recovery from anesthesia in pigs

ObjectiveTo evaluate the effect of hyaluronidase on uptake, duration and speed of elimination of xylazine–tiletamine–zolazepam administered in the subcutaneous fat over the dorsal lumbar region of swine. Study designBlinded, randomized, crossover study. AnimalsSix healthy Landrace/Large White pigs weighing 132±24 kg (mean±standard deviation). MethodsAnimals were administered xylazine (1 mg kg−1) and tiletamine–zolazepam (8 mg kg−1) (control treatment, CON), or xylazine–tiletamine–zolazepam at the same doses with hyaluronidase (400 IU) (treatment HYA). The treatments were administered into the dorsal lumbar adipose tissue, 2.5–3.0 cm laterally from the spinous process of the second lumbar vertebra. The latency, anesthesia and recovery periods were measured. Heart rate, noninvasive systolic, diastolic, and mean arterial pressures, respiratory rate, hemoglobin oxygen saturation and rectal temperature were recorded every 10 minutes for up to 50 minutes. ResultsOne animal in CON and one animal in HYA were responsive to stimulation and did not allow safe handling. No significant difference was found between treatments for latency (CON 11.3±5.9 minutes, HYA 7.4±5.1 minutes) and anesthesia (CON 53±53 minutes, HYA 49±38 minutes) periods. Recovery period was shorter in HYA (9±6 minutes) than in CON (32±16 minutes) (p < 0.05). Physiological variables were not significantly changed over time and were within accepted normal clinical limits for the species in both treatments. Conclusion and clinical relevanceHyaluronidase (400 IU) administered into adipose tissue in pigs did not reduce the latency and duration of dissociative anesthesia, but was associated with faster recovery.

Wipeout period of spinal anesthesia in hemorrhoidectomy in relation to Prakriti: An observational study.

Background:A maximum number of hemorrhoidectomies are performed under spinal anesthesia. However, the effect of spinal anesthesia varies from person to person due to difference in their physical and psychological properties, which is well explained in Ayurveda as Prakriti (physiology of an individual). In this study, we have tried to establish a relation between wipeout period of spinal anesthesia and different Prakriti.Objectives:To observe wipeout period of spinal anesthesia in hemorrhoidectomy in relation to different Prakriti.Materials and Methods:A total of 30 individuals who underwent hemorrhoidectomy under spinal anesthesia were selected for the study and their Prakriti was assessed as per the standard Prakriti assessment chart before surgery. Apart from demographic data, pain assessment was also recorded by following visual analog scale. Postoperative follow-up was done until the wipeout effect of spinal anesthesia was observed. GraphPad Prism software was used to analyze the data; P < 0.05 was considered statistically significant.Results:Male predominance was observed in hemorrhoidectomy cases. Majority of the patients were 20–25 years of age with body weight between 61 and 70 kg. Distribution of Prakriti was observed to be highest in Vata-Pitta Prakriti (36.6%). A significant difference was observed in the wipeout period among Prakriti where the duration of wipeout period was more in the Kapha Prakriti individuals (P < 0.0001).Conclusion:Kapha involvement increases the wipeout period in posthemorrhoidectomy; however, in Pitta and Vata Prakriti individuals, the wipeout period is less. Future studies could include a larger sample size and various other factors to analyze the involvement of Kapha.

A Comparative Study between Protective Lung Ventilation versus Conventional Ventilation in Obese Patients Undergoing Abdominal Laparoscopic Surgery

Background: Obesity is a serious problem worldwide. During general anesthesia and post-operative period, obese patients more likely to develop post-operative pulmonary complications as atelectasis and impaired pulmonary function compared to non-obese. Intraoperative protective ventilation consisting of low tidal volume, high PEEP and recruitment maneuvers resulted in alveolar recruitment and optimization of intraoperative respiratory mechanics. Objective: This study tested two strategies of mechanical ventilation in obese patients to find out which is best regarding gas exchange optimization, airway mechanics and atelectasis score. Methods: Study was a randomized prospective comparative control study was carried out on 50 obese patients with BMI 30-50 kg/m2. Patients were prepared for laparoscopic cholecystectomy. Patient’s selection according to attendees at time of operation as a single numbers were protective ventilation (group A) and a double numbers were conventional ventilation (group B). Results: Study showed significance between preoperative and postoperative pulmonary function tests and revealed better POST FVC in group A mean 86.04 (± 10.35) L, while in group B was 74.96 (± 14.73) L, p value (0.021). Better POST FEV1 in group A mean 73.56 (± 16.49) L, while in group B was 56.92 (± 8.340) L, p value (0.046). Better post-operative oxygenation in protective ventilation (group A). Mean Post P (A-a) O2 in group A was 27.93 (±7.76) mmHg, while in group B was 35.82 (±11.98) mmHg, p value (0.022). Study found peak and plateau airway pressures were higher in protective group with no change in airway resistance. Pulmonary compliance was improved but, in this study revealed more alterations of the hemodynamics in the patients who were subjected to protective ventilation despite adequate preoperative fluid preload. Hemodynamic instability observed in 24% in group A, but only occurred in 8% in group B. Study found that protective ventilation was superior to standard ventilation in prevention of atelectasis development 64%of the cases in group A revealed normal postoperative CT Chest and 36% showed lamellar atelectasis. In group B, 48% of the cases showed normal postoperative CT Chest, 40% revealed lamellar atelectasis and 12% showed plate atelectasis. Conclusions: Study found protective ventilation was superior to conventional ventilation in prevention of lung atelectasis and associated with better oxygenation and pulmonary function tests in the post-operative in obese laparoscopic cholecystectomy. In spite of it was very effective in optimizing gas exchange, but associated with more hemodynamic affection.

Comparative study between magnesium sulphate and L-hyoscyamine on duodenal motility during ERCP under general anaesthesia: A prospective randomized study

ObjectiveEndoscopic retrograde cholangiopancreatography (ERCP) is a relatively complex procedure as compared with other endoscopy which needs longer duration, duodenal relaxation and good sedation. The aim of this study was to evaluate the efficacy and safety of magnesium sulphate as spasmolytic agent during ERCP under general anaesthesia.DesignA prospective randomized study.SettingDelivery room, operating room and postoperative recovery area.Patients and methodPatients, who were treated for calcular obstructive jaundice by ERCP were randomized into two groups. The patients were randomized into two groups: G I, patients received 500 mg magnesium sulphate in 100 ml saline 15 min before induction and G II, patients received 0.5 mg L-hyoscyamine sulphate before induction of anaesthesia.MeasurementThe primary outcome was duodenal relaxation during ERCP under general anaesthesia. Secondary outcomes include changes of heart rate, changes in oxygen saturation, time needed for cannulation, procedure difficulty, duration of the procedure, post-procedure complications, and the need of post-procedure analgesia.ResultsDuodenal motility score was found to be 0.85 ± 1.47 in GI and 2.2 ± 3.08 in GII (P = 0.0001). The number of patients who had no duodenal contraction was significantly more in GI. The success rate of biliary cannulation is significantly higher in GI than in GII (58 (100%) vs 54 (93.1%), P = 0.04). The duration of cannulation was significantly shorter in GI. The number of patients who developed pancreatitis, nausea and vomiting was significantly less in GI. The pulse rate was found to be statistically less in GI at different time follow-ups.ConclusionMagnesium sulphate is a safe spasmolytic agent during general anaesthesia that improves the success rate of ERCP and it allows easy completion of the procedure by decreasing the duodenal motility. It decreases the duration of the procedure, subsequently shortens the period of anaesthesia and improves post procedure recovery. It reduces post ERCP pancreatitis, nausea and vomiting.

Effect of Atipamzole on Fos Protein Expression Induced by Telazol/Xylazine in Rat Cerebral Cortex and Thalamencephal

The aim of the study was to assess effect of the atipamezole on talezol/xylazine induced expression of c-fos in rat brain. Rats were injected with the mixture of 13.81 mg · kg−1 telazol and 5.21 mg · kg−1 xylazine, following 10 min later 0.522 mg · kg−1 atipamezole injected, and then the cerebral cortex and thalamencephal were removed at 1 h after injected. Level of Fos protein was measured in the brain tissue by western-blot. The results revealed that telazol/xylazine induction Fos protein expression in the thalamencephal and cerebral cortex during the period of anesthesia, atipamezole attenuated telazol/xylazine induction Fos protein expression in the thalamencephal and cerebral cortex. The results indicated that atipamezole could inhibite telazol/xylazine-induced c-fos expression in the rat brain, and played a protective role of neuronal injury.

Review of preclinical studies on pediatric general anesthesia-induced developmental neurotoxicity

Thousands of infants and children undergo complicated surgical procedures that require prolonged periods of anesthesia and/or sedation each year. A growing body of preclinical research suggests pediatric anesthetics are harmful to the developing brain; yet, the extent to which these effects generalize to the clinical setting remains unclear. As there will be a continuing need for surgical and other interventions requiring sedation and/or anesthesia during the neonatal period, it seems clear that research efforts should focus on determining the extent to which general anesthetics can affect the developing brain as well as determining strategies for preventing or ameliorating the adverse effects associated with exposure to such agents. The purpose of this paper is to provide a review of the preclinical literature examining the effects of general anesthesia on brain and behavioral development. This paper will detail the effects of different anesthetic agents on various indices of neurotoxicity and functional outcomes as well as provide a review of potential protective compounds and suggestions for areas of future research.

Continuous positive airway pressure (CPAP) decreases pulmonary shunt in anaesthetized horses

ObjectiveTo evaluate the effects of continuous positive airway pressure (CPAP) on intrapulmonary shunt, cardiac output and oxygen delivery in horses subjected to a 6 hour period of general anaesthesia. Study designRandomized, experimental, crossover study. AnimalsTen healthy adult horses. MethodsFollowing medetomidine, diazepam and ketamine administration, orotracheal intubation was performed and horses positioned in dorsal recumbency. Anaesthesia was maintained with isoflurane carried in an oxygen and air mix (FiO2 0.5) combined with a medetomidine infusion. Horses were anaesthetized twice and either CPAP (8 cmH2O) or physiologic airway pressure (NO CPAP) was applied to the lungs for 6 hours; the order of treatments was randomly assigned. Following induction of anaesthesia, cardiovascular and respiratory variables (including arterial blood gas analysis) were recorded every 30 minutes, cardiac output was measured every 60 minutes using the lithium dilution technique and oxygen delivery calculated. If PaCO2 exceeded 100 mmHg (13.3 kPa), controlled ventilation was initiated and horses excluded from further data collection. Groups were compared using a general linear model. ResultsData from eight horses were analysed. PaO2 was 15–56 mmHg (2.00–7.45 kPa) higher (p < 0.001) and shunt fraction 6–14% lower (p < 0.001) in the CPAP group. No differences were seen for cardiac output and oxygen delivery. The lack of difference in oxygen delivery was attributed to lower haemoglobin levels in the CPAP group than in the NO CPAP group. Conclusions and clinical relevanceCPAP of 8 cmH2O can be used in dorsally recumbent horses to decrease pulmonary shunt fraction without causing a decrease in cardiac output during longterm anaesthesia.

Transcutaneous assessment of glomerular filtration rate in unanesthetized rats using a small animal imager: impact on arterial pressure, heart rate, and activity

Transcutaneous assessment of fluorescein isothiocyanate (FITC)‐sinistrin clearance using a small animal imager has recently been validated as an accurate method for the measurement of glomerular filtration rate (GFR) in freely moving rats. This technique involves a brief, light period of anesthesia during which the imager is adhered to the rat and FITC‐sinistrin is administered. The rat is then moved to an experimental chamber where it is housed unrestrained for a 2‐h data collection period. This study assessed the impact of the experimental protocol on mean arterial pressure (MAP), heart rate, and locomotor activity in adult Sprague Dawley rats using radiotelemetry given that anesthesia and stress are known to affect arterial pressure and kidney function. These data were compared with time‐equivalent measurements made in the same rats at rest. MAP was low following anesthesia, but increased within 15 min and remained stable thereafter. Heart rate was not affected by the GFR protocol. Locomotor activity increased following anesthesia before decreasing to relatively low levels during the final 75‐min, the approximate period from which GFR is calculated. Moreover, MAP, heart rate, and locomotor activity during the final 75‐min of the data collection period were not different to that observed during an equivalent time period at baseline. Taken together, our findings suggest that this recently developed minimally invasive procedure for the measurement of GFR in unanesthetized rats does not negatively impact arterial pressure, heart rate, or locomotor activity. Thus, it is likely to be a valuable implement for acquiring serial measurements of GFR in unanesthetized rats.

Inhalation anesthesia induced by isoflurane alters penicillin disposition in swine tissues.

Twelve healthy swine were dosed with penicillin G intramuscularly. Fluids and tissues samples were collected at the end of two periods of general anesthesia, performed 24h apart. Tissue samples were collected by minimally invasive laparoscopy under general anesthesia at 8 and 28h postdose. Four nonanesthetized, penicillin-treated pigs were euthanized at 8h postdose, and a second set of four similarly treated control pigs were sacrificed 28h postdose. Liver penicillin tissue concentrations from animals that underwent anesthesia and laparoscopic tissue collection had tissue concentrations that were higher than nonanesthetized pigs at both time points. Urine, plasma, kidney, skeletal, and cardiac muscle showed no differences between the two groups. Laparoscopic tissue collection under general anesthesia in swine induces physiological changes that cause alterations in tissue pharmacokinetics not seen in conscious animals.

The Subtleties of Success in Simultaneous Augmentation-Mastopexy.

Many have challenged the safety of performing breast augmentation and mastopexy simultaneously. However, staging these procedures incurs the increased risk and inconvenience of two periods of anesthesia and recuperation. The authors set out to evaluate the occurrence of complications across the populations of patients undergoing (1) combined augmentation-mastopexy, (2) isolated augmentation, and (3) isolated mastopexy. A retrospective analysis of one surgeon's consecutive series of each of these procedures from 2000 to 2009 was conducted. Preoperative risk factors were characterized. Sixteen different complications were examined, and those necessitating operative revision were tracked. Statistical analysis was performed looking for significant differences between the surgical groups. No instances of infection, tissue loss, or implant exposure occurred among the 297 patients over an average follow-up period of 15.5 months. The isolated mastopexy group did not provide sufficient data for statistical comparison. Tissue-related complications were most common in the combined procedure group. The operative revision rate for isolated augmentation was 7.97 percent compared with a combined procedure revision rate of 12.4 percent (p = 0.28). The majority of complications in this series comparing simultaneous augmentation-mastopexy to isolated augmentation were minor. Complications requiring operative revision were not found to be significantly different between the two groups. There was a much lower reoperation rate (12.4 percent) with the combined procedure compared with a 100 percent reoperation rate when the procedure is staged. Thus, the authors feel the combined procedure can safely be part of every plastic surgeon's practice. Therapeutic, III.

Comparison of required induction dose, induction and recovery characteristics, and cardiorespiratory effects of co-administration of ketofol with diazepam and midazolam in healthy dogs

Background: Co-administration of anesthetics has been employed to decrease potential unpleasant effects associated with single drug. OBJECTIVES: This study was designed to evaluate the effects of co-administration of ketofol with diazepam or midazolam in healthy dogs. METHODS: Six adult mix-breed male dogs were used. After sedation with acepromazine (0.1 mg/kg), anesthesia was induced with keteofol (KF; 1 ml contained 5 mg ketamine and 5 mg propofol), ketofol-diazepam (KFD), or ketofol-midazolam (KFM) (1 ml contained 5 mg KF and 2.5 mg diazepam or midazolam) randomly. All the dogs received the three treatments with at least one week interval. RESULTS: The total dose of ketofol used for induction of anesthesia in KF (4.2±0.44 mg/kg) was significantly higher than KFD (2.27±0.6 mg/kg) and KFM (1.68±0.25 mg/kg). The total dose of diazepam and midazolam used in KFD and KFM was 1.00±0.25 and 0.73±0.10 mg/kg, respectively (p>0.05). The time needed for sternal recumbency, standing position and normal walking was longer in KFD and KFM compared to KF (p<0.05). Heart rate (HR) showed significant increase in KF at several time points (p<0.05). Respiratory rate (fr) in KF showed a significant decrease during the anesthesia period compared to the base (p<0.05). HR and fr were more stable in KFD and KFM. Induction and recovery quality in the three treatments were acceptable. CONCLUSIONS: Co-administration of ketofol with diazepam and midazolam reduced the required induction dose and prolonged recovery in dogs. Diazepam and midazolam could attenuate the unfavorable effects of ketofol in some cardiorespiratory variables.

Early childhood exposure to short periods of sevoflurane is not associated with later, lasting cognitive deficits.

A detrimental effect of commonly used anesthetics on the neurodevelopmental and behavioral parameters has long been shown in young animals subjected to early childhood anesthesia. Epidemiologic studies suggest the possibility of a modestly elevated risk of adverse neurodevelopmental outcomes in children exposed to anesthesia during early childhood. However, these results are still preliminary and inconclusive. To further elucidate the probability of occurrence of such adverse outcomes, we evaluated cognitive performance of children who underwent general anesthesia early in their childhood. One hundred and fifteen children aged 5-16 years with established glaucoma were included in the study. Of these, 68 children had a history of at least one general anesthesia with sevoflurane before age 3. Phonemic and semantic verbal fluency, and forward and backward digit span tests were performed to evaluate cognitive function in the study subjects. The two-way anova revealed that all these variables showed significant changes in various age groups, but they were comparable among subjects with no, single, or multiple childhood anesthesia. It can be concluded that brief periods of anesthesia with single anesthetic sevoflurane may be safe for children under age 3.

Postoperative pain control in cats: clinical trials with pre-emptive lidocaine epidural co-administered with morphine or methadone.

Objectives The aim of the study was to evaluate the effectiveness of epidural lidocaine in combination with either methadone or morphine for postoperative analgesia in cats undergoing ovariohysterectomy. Methods Under general anesthesia, 24 cats that underwent ovariohysterectomy were randomly allocated into three treatment groups of eight each. Treatment 1 included 2% lidocaine (4.0 mg/kg); treatment 2 included lidocaine and methadone (4.0 mg/kg and 0.3 mg/kg, respectively); and treatment 3 included lidocaine and morphine (4.0 mg/kg and 0.1 mg/kg, respectively). All drugs were injected in a total volume of 0.25 ml/kg via the lumbosacral route in all cats. During the anesthetic and surgical periods, the physiologic variables (respiratory and heart rate, arterial blood pressure and rectal temperature) were measured at intervals of time zero, 10 mins, 20 mins, 30 mins, 60 mins and 120 mins. After cats had recovered from anesthesia, a multidimensional composite pain scale was used to assess postoperative analgesia 2, 4, 8, 12, 18 and 24 h after epidural. Results The time to first rescue analgesic was significantly ( P <0.05) prolonged in cats that received both lidocaine and methadone or lidocaine and morphine treatments compared with those that received lidocaine treatment alone. All cats that received lidocaine treatment alone required rescue analgesic within 2 h of epidural injections. All treatments produced significant cardiovascular and respiratory changes but they were within an acceptable range for healthy animals during the surgical period. Conclusions and relevance The two combinations administered via epidural allowed ovariohysterectomy with sufficient analgesia in cats, and both induced prolonged postoperative analgesia.

Cross-Leg Flap-Sharing Technique Using an Anterolateral Thigh Perforator Flap.

Cross-Leg Flap-Sharing Technique Using an Anterolateral Thigh Perforator Flap.

Effect of preoperative sleep disturbance on the consumption of propofol during general anesthesia and postoperative sleep quality

Objective To evaluate the effects of preoperative sleep disturbance on the consumption of propofol during the period of general anesthesia and postoperative sleep quality. Methods Sixty-five patients scheduled for elective thyroidectomy surgery under general anesthesia were enrolled in the study. According to the preoperative Pittsburgh Sleep Quality Index (PSQI) score, the patients were divided into sleep normal group (n=33) and sleep disorder group (n=32). Anesthesia was induced and maintained with propofol given by closed-loop target-controlled infusion (CLTCI). The consumption of propofol during the period of general anesthesia, postoperative sleep quality in the evening of surgery and at 24 h after operation, and the painful levels of the patients at 1 d and 2 d after operation were compared between two groups. Results The total consumption of propofol in sleep disorder group [(1 024.33±213.02)mg] was more than that in sleep normal group [(892.25±242.30)mg] (P<0.05), and the dosage of unit surface area per minute of propofol in sleep disorder group [(4.94±0.80)mg/(min·m2)] was also more than that in sleep normal group [(4.45±0.96)mg/(min· m2)] (P<0.05). Each group suffered from bad sleep quality in the evening of operation, and got improvement one day later (P<0.05). The sleep quality in sleep disorder group was improved after general anesthesia (P<0.05). Conclusions Preoperative sleep disturbance increased the consumption of propofol in the general anesthesia. General anesthesia can improve the sleep quality of the patients who suffered from sleep disorder. Key words: Sleep disorders; Anesthesia, general; Propofol/AD; Sleep

Long-Term Evaluation of Continuous Epidural Anesthesia in an Improved Canine Model.

BackgroundContinuous epidural analgesia with catheterization is a useful technique, because it has a wide adaptation range and provides prolonged analgesia. Problems that may arise from long-term epidural analgesia are changes in the analgesic area, duration of analgesia and catheter-related problems. Few articles have evaluated gradual changes of long-term epidural analgesia. In the animal models used in those studies, the catheter was inserted by an invasive surgical procedure. In the present study, we evaluated changes in a canine model in which the catheter was inserted by a minimally invasive procedure.ObjectivesTo evaluate long-term changes in the efficacy of epidural analgesia in an improved canine model in which the epidural catheter was inserted and fixed for 5 weeks using a minimally invasive procedure.Materials and MethodsSix beagles underwent epidural catheterization under general anaesthesia. The catheter tip was located in the sixth lumbar region; the catheter peripheral end was passed subcutaneously through the neck. Physiological saline was continuously infused (1.0 mL/h) via the catheter throughout the study. The efficacy of epidural analgesia was assessed weekly with 2% lidocaine once a week in 5 weeks. Peripheral blood analysis including interleukin-6 (IL-6) level in the cerebrospinal fluid (CSF), histological evaluations and epidurography were performed to evaluate the mechanisms underlying the changes.ResultsNo dog died and the catheters were kept in place. The efficacy of analgesia was well maintained until 4 weeks; at 5th week, the efficacy decreased by half. The spread of injected medium was not observed in the cranial direction at 5th week and the tip of catheter was capped with granulation tissue. Throughout the study period, white blood cell counts and C-reactive protein levels were slightly high for catheterization and the IL-6 level in CSF was below detectable limits.ConclusionsThis was the longest study period with continuous epidural analgesia administered in canines. The effective period of epidural anesthesia was 4 weeks in this study. We speculate that time-dependent decrease in the anaesthetic efficacy was attributed to formation of granulation tissue surrounding the catheter tip.

Effects of indexes of consciousness (IoC1 and IoC2) monitoring on remifentanil dosage in modified radical mastectomy: a randomized trial.

BackgroundThis study investigated the effects of indexes of consciousness (IoC1 and IoC2) monitoring on remifentanil dosage.MethodsIn this randomized, single-blinded, prospective study, 120 patients undergoing unilateral modified radical mastectomy were randomly assigned to the treatment group (T group, n = 60) or control group (C group, n = 60). In the T group, patients received both IoC1 (sedation) and IoC2 (analgesia) monitoring, and remifentanil dosages were adjusted by anesthetists according to IoC2. In the C group, remifentanil dosages were adjusted based on the anesthetists’ judgment according to the patients’ vital signs. Remifentanil dose, adjustment frequency, infusion duration, intraoperative adverse events, and quality of anesthetic recovery were compared between the two groups. The primary outcome was the dose of remifentanil.ResultsCompared with the C group, mean remifentanil dosage was significantly higher in the T group (3.8 ± 1.9 versus 3.2 ± 1.2 μg kg-1 h-1, P < 0.05) during the anesthetic period, as was the adjustment frequency of target-controlled infusion (2.9 ± 1.9 versus 2.0 ± 1.2 times/surgery, P < 0.05), but there was no difference in infusion duration. Voluntary eye opening, extubation time, and recovery score were not significantly different between the two groups (P > 0.05). Total adverse events were significantly reduced in the T group (P < 0.05).ConclusionsIoC1-targeted propofol dosing does not seem to be significantly different to hemodynamic-based monitoring, whereas IoC2 monitoring can increase remifentanil dosage during modified radical mastectomy, but the anesthetic process is more controllable and total adverse events are reduced, which improves the controllability of anesthesia.Trial registrationTrial registration number: ChiCTR-TRC-13004101, registered on 27 November 2013.