Propofol Anesthesia In Patients Research Articles

Comparison of opioid-free and opioid-inclusive propofol anaesthesia for thyroid and parathyroid surgery: arandomised controlled trial.

Postoperative nausea and vomiting occur frequently following thyroid and parathyroid surgery and are associated with worse patient outcomes. We hypothesised that opioid-free propofol anaesthesia would reduce the incidence of postoperative nausea and vomiting compared with opioid-inclusive propofol anaesthesia in patients undergoing these procedures. We conducted a randomised, double-blinded controlled trial in adult patients scheduled to undergo thyroid and parathyroid surgery at two medical centres in mainland China. Patients were allocated randomly (1:1, stratified by sex and trial site) to an opioid-free anaesthesia group (esketamine, lidocaine, dexmedetomidine and propofol) or an opioid-inclusive group (sufentanil and propofol). Propofol infusions were titrated to bispectral index 45-55. Patients received prophylaxis for nausea and vomiting using dexamethasone and ondansetron and multimodal analgesia with paracetamol and flurbiprofen axetil. The primary outcome was the incidence of postoperative nausea and vomiting in the first 48 h after surgery. We assessed 557 patients for eligibility and 394 completed this trial. The incidence of postoperative nausea and vomiting in the first postoperative 48 h was lower in the opioid-free anaesthesia group (10/197, 5%) compared with opioid-inclusive group (47/197, 24%) (OR (95%CI) 0.17 (0.08-0.35), p < 0.001), yielding a number needed to treat of 5.3. Additionally, opioid-free propofol anaesthesia was associated with a reduced need for rescue anti-emetics, lower rates of hypotension and desaturation after tracheal extubation, and higher patient satisfaction. Time to tracheal extubation was prolonged slightly in the opioid-free group. The two groups had similar postoperative pain scores and 30-day outcomes. Opioid-free propofol anaesthesia reduced postoperative nausea and vomiting in patients undergoing thyroid and parathyroid surgery. An opioid-free anaesthetic regimen can optimise anaesthetic care during thyroid and parathyroid surgery.

Postoperative liver injury after sevoflurane or propofol anesthesia in patients undergoing non-cardiac surgery: a retrospective cohort study

Although sevoflurane is generally considered safe, reports suggest that sevoflurane may cause postoperative liver injury more frequently than previously believed. Therefore, we aimed to compare the incidence of clinically significant postoperative liver injury following non-cardiac surgery between patients who underwent sevoflurane anesthesia and propofol-based total intravenous anesthesia. We retrospectively reviewed adult surgical patients from January 2010 to September 2022 who underwent general anesthesia in our center using sevoflurane or propofol over 3 h. After 1:1 propensity score matching, the incidence of postoperative liver injury was compared between the two groups. Out of 58,300 patients reviewed, 44,345 patients were included in the analysis. After propensity score matching, 7767 patients were included in each group. The incidence of postoperative liver injury was 1.4% in the sevoflurane group, which was similar to that in the propofol group (1.6%; p = 0.432). Comparison of the severity of postoperative alanine aminotransferase elevation showed that the incidence of borderline and mild elevation was higher in the sevoflurane group, but there was no difference in the incidence of moderate and severe elevation. In conclusion, sevoflurane anesthesia over 3 h was not associated with a higher incidence of clinically significant postoperative liver injury compared to propofol anesthesia.

Comparison of Fentanyl, Ketamine, and Lidocaine Combined with Propofol Anesthesia in Patients with Crohn Disease Undergoing Colonoscopy.

BACKGROUND Colonoscopy is the predominant invasive procedure for Crohn disease (CD) patients. Opioids and propofol carry risks of respiratory and cardiovascular complications. This study aimed to evaluate whether substituting fentanyl with ketamine or lidocaine could diminish propofol usage and minimize adverse events. MATERIAL AND METHODS In total, 146 patients with CD scheduled for elective colonoscopy were assigned to anesthesia with fentanyl (n=47), ketamine (n=47), or lidocaine (n=55). Propofol was administered to achieve sufficient anesthesia. Measured outcomes in each group included propofol consumption, hypotension and desaturation incidents, adverse event types, consciousness recovery time, abdominal pain intensity, Aldrete scale, and Post Anaesthetic Discharge Scoring System (PADSS). RESULTS Patients administered fentanyl needed significantly more propofol (P=0.017) than those on ketamine, with lidocaine showing no notable difference (P=0.28). Desaturation was significantly less common in the ketamine and lidocaine groups than fentanyl group (P<0.001). The ketamine group experienced milder reductions in mean arterial (P=0.018) and systolic blood pressure (P<0.001). Recovery metrics (Aldrete and PADSS scores) were lower for fentanyl (P<0.001), although satisfaction and pain levels were consistent across all groups (P=0.797). Dizziness occurred less frequently with lidocaine than fentanyl (17.2%, P=0.018) and ketamine (15.1%, P=0.019), while metallic taste incidents were more prevalent in the lidocaine group (13.5%, P=0.04) than fentanyl group. CONCLUSIONS Using ketamine or lidocaine instead of fentanyl in anesthesia for colonoscopy in patients with CD significantly lowers propofol use, reduces desaturation events, maintains blood pressure more effectively, without increasing hypotension risk, and accelerates recovery, without negatively impacting adverse events or patient satisfaction.

Improved Pittsburgh Sleep Quality Index scores on first postoperative night achieved by propofol anesthesia in patients undergoing ambulatory gynecologic surgery.

BACKGROUNDSleep disturbance on the first postoperative night commonly develops for patients after day surgeries. The choice of either total intravenous anesthesia by propofol or total inhalation anesthesia with sevoflurane has become an issue for preventing sleep disturbance.AIMTo compare sleep quality on the first postoperative night for female patients after total intravenous anesthesia by propofol and total inhalation anesthesia with sevoflurane.METHODSWe enrolled 61 American Society of Anesthesia (ASA) class I-II outpatients who underwent minor gynecologic surgeries by either propofol or sevoflurane anesthesia. Sleep quality of the very night was assessed by the Pittsburgh Sleep Quality Index (PSQI) on the next day, and PSQI scores were compared by the Wilcoxon signed-rank test and paired t-test pre-operatively and postoperatively.RESULTSFor the propofol group, the mean postoperative global PSQI score (3.3 ± 1.3) was lower than the mean preoperative global PSQI score (4.9 ± 2.3) (P < 0.001); for the sevoflurane group, the mean postoperative global PSQI score (6.5 ± 2.8) was higher than the mean preoperative global PSQI score (5.5 ± 3.2) (P = 0.02). Eighty percent of patients receiving propofol anesthesia subjectively reported improved sleep quality, but only 17% of patients receiving sevoflurane anesthesia reported improved sleep quality.CONCLUSIONSleep quality assessed by the PSQI is better improved in ASA class I-II female patients receiving propofol anesthesia other than sevoflurane anesthesia for undergoing minor gynecologic surgeries.

The Effect of Relaxation Therapy on Hypoxia During Intravenous Propofol Anesthesia in Patients With Pre-operative Anxiety: A Prospective Randomized Controlled Trial.

BackgroundThis study aimed to investigate the effect of relaxation therapy on hypoxia during intravenous propofol anesthesia in patients with pre-operative anxiety.MethodsTwo-hundred and eighty patients were randomly categorized in the experimental group (relaxation therapy group) and control group. The Spielberger State-Trait Anxiety Inventory (S-STAI) was administered 30 to 60 min pre-operatively to assess the patient's current anxiety status and select appropriate patients. Patients in the experimental group received pre-surgical relaxation therapy. Decrease in oxygen saturation during the procedure was recorded for each patient group, and the relevant data were compared between the two groups.ResultsThe basic S-STAI scores of the experimental and control groups were 56.88 ± 2.91 and 57.27 ± 3.56, respectively (p = 0.331). The difference was not statistically significant. The incidence of hypoxia in the experimental group during painless artificial abortion [routine blood oxygen saturation (SpO2) <95%, duration >15 s] decreased from 30 to 12.3%.ConclusionRelaxation therapy may effectively reduce the incidence of hypoxia during painless artificial abortion by using less dose of propofol. It may help patients relieve their anxiety and improve perioperative safety.Trial RegistrationChinese Clinical Trial Registry (ChiCTR2000032109).

Imaging Features of Artificial Intelligence Algorithm in the Analysis of Cerebral Protective Effect of Craniotomy Hematoma Removal under Propofol Anesthesia in Patients with Chronic Subdural Hematoma

Objective. The aim of this work was to study the cerebral protective effect of craniotomy hematoma removal under propofol anesthesia based on the artificial intelligence algorithm analysis of the changes in imaging characteristics of chronic subdural hematoma (CSDH) patients. Methods. A total of 60 CSDH patients who were treated in hospital were recruited and were randomly rolled into an experimental group and a control group, with 30 people in each group. Patients in the experimental group were treated with propofol anesthesia + craniotomy hematoma removal, while those in the control group were treated with conventional anesthesia + craniotomy hematoma removal. Head CT examinations were performed on the next day, one week, one month, three months, and six months after the operation. A two-dimensional empirical mode decomposition (BEMD) algorithm was used for edge detection and denoising of brain CT images of CSDH patients. Then, the amount of hematoma was calculated, and the Markwalder grading was performed to evaluate the neurological function. The number of recurrence and reoperation cases within six months of follow-up was collected. Results. 1. The quality of CT images was remarkably improved after processing with artificial intelligence algorithms. 2. The amount of hematoma in the experimental group was remarkably lower than that in the control group at January, March, and June after surgery (12.89 ± 2.12 VS 20.32 ± 16.41; 7.55 ± 4.13 VS 15.88 ± 14.22; 3.39 ± 3.79 VS 6.55 ± 3.69, P &lt; 0.05 ). 3. The experimental group was remarkably better than the control group in Markwalder grading three months and six months after the operation ( P &lt; 0.05 ). Conclusion. Artificial intelligence algorithm had good effect on the brain CT image processing of CSDH patients, and craniotomy hematoma removal under propofol anesthesia had an ideal brain protection effect.

Propofol modulates the proliferation, invasion and migration of bladder cancer cells through the miR‑145‑5p/TOP2A axis.

Propofol-based anesthesia has been reported to reduce the recurrence and metastasis of a number of cancer types following surgical resection. However, the effects of propofol in bladder cancer (BC) are yet to be fully elucidated. The aim of the present study was to investigate the functions of propofol in BC and their underlying mechanisms. In the study, the expression of microRNA (miR)-145-5p in BC tissues and cell lines was evaluated using reverse transcription-quantitative PCR, and the effects of propofol on BC cells were determined using cell viability, wound healing and Transwell cell invasion assays, bioinformatics analysis, western blotting, immunohistochemistry and in vivo tumor xenograft models. It was found that propofol significantly suppressed the proliferation, migration and invasion of BC cells in vitro. In addition, propofol induced miR-145-5p expression in a time-dependent manner, and miR-145-5p knockdown attenuated the inhibitory effects of propofol on the proliferation, migration and invasion of BC cells. Topoisomerase II α (TOP2A) was a direct target of miR-145-5p, and silencing TOP2A reversed the effects of miR-145-5p knockdown in propofol-treated cells. Furthermore, propofol suppressed tumor xenograft growth, which was partially attenuated by miR-145-5p knockdown. The present study provided novel insight into the advantages of surgical intervention with propofol anesthesia in patients with BC.

Effects of anesthetics on post-operative 3-month neuroendocrine function after endoscopic transsphenoidal non-functional pituitary adenoma surgery.

Anesthetic techniques can affect perioperative neuroendocrine function. The objective of this study was to compare 3-month post-operative neuroendocrine functional outcomes between sevoflurane and propofol anesthesia in patients undergoing endoscopic transsphenoidal surgery (ETS) for removal of non-functional pituitary adenomas (NFPAs) retrospectively. Among 356 patients who underwent ETS for removal of NFPAs under sevoflurane-remifentanil anesthesia (sevoflurane group, n=103) or propofol-remifentanil anesthesia (propofol group, n=253), 92 patients in each group were selected and their 3-month post-operative neuroendocrine functional outcomes (primary outcome measure) were compared after propensity score matching. Overall changes in post-operative 3-month neuroendocrine function compared to pre-operative baseline did not differ between the sevoflurane and propofol groups (worsened: 32.6% vs 29.3%, persistently decreased: 9.8% vs 12.0%, improved: 12.0% vs 20.7%, normalized: 9.8% vs 12.0%, persistently normal: 18.5% vs 19.6%; P=.400). The incidence of pituitary hormone deficiency at 3 months post-operatively did not differ between the sevoflurane and propofol groups (adrenocorticotropic hormone deficiency: 18.5% vs 17.4%, P = 1.000; thyroid-stimulating hormone deficiency: 10.9% vs 3.3%, P=.081; gonadotropin deficiency: 54.3% vs 48.9%, P=.555; growth hormone deficiency: 45.7% vs 48.9%, P=.768; panhypopituitarism: 1.1% vs 1.1%, P=1.000). In patients undergoing ETS for removal of NFPAs, the effects of both sevoflurane-remifentanil and propofol-remifentanil anesthetic techniques on post-operative 3-month neuroendocrine functional outcomes were similar, suggesting that propofol and sevoflurane can be freely used in such patients in terms of post-operative intermediate-term neuroendocrine functional outcome.

Application value of sufentanil combined with propofol anesthesia in basal ganglia intracerebral hemorrhage

Objective To investigate the clinical value of sufentanil combined with propofol anesthesia in cerebral hemorrhage in basal ganglia. Methods From November 2015 to June 2018, 100 patients with cerebral hemorrhage in the basal ganglia of the People's Hospital of Shanxi Province were enrolled and randomly divided into two groups according to the digital table, with 50 cases in each group.The control group received fentanyl+ propofol, and the study group received sufentanil + propofol.At T0 (before induction of anesthesia), T1 (after anesthesia induction), T2 (after tracheal intubation), T3 (surgery), the hemodynamic parameters[mean arterial pressure (MAP), heart rate (HR)] level, postoperative recovery time (recovery of spontaneous breathing, recovery time and extubation time), preoperative and postoperative 6 h serum angiotensin Ⅱ (Ang Ⅱ), renin activity (PRA), neuron specific enolase (NSE) ), glial fibrillary acidic protein (GFAP) levels, the incidence of adverse reactions of the two groups were counted. Results (1)Hemodynamics: MAP and HR levels in the two groups were higher in T1, T2 and T3 than those in T0(all P<0.05), and HR and MAP in the study group were lower than those in the control group (all P<0.05). (2)Postoperative recovery: the time of extubation, recovery time and spontaneous breathing time of the study group were (12.42±3.27)min, (9.10±1.95)min, (7.32±2.23)min, respectively, which were shorter than those of the control group[(15.30±3.35)min, (12.67±2.18)min, (8.96±2.48)min] (t=4.350, 8.631, 3.477, all P<0.05). (3)Serum Ang Ⅱ and PRA: the serum Ang Ⅱ and PRA levels in the two groups at 6 h after surgery were higher than those before surgery(all P<0.05), and Ang Ⅱ, PRA levels of the study group were lower than those of the control group (t=4.350, 8.631, 3.477, all P<0.05). (4) Serum NSE and GFAP: the serum NSE and GFAP levels in the two groups at 6 h after surgery were higher than those before surgery(all P<0.05), and NSE, GFAP levels of the study group were lower than those of the control group (all P<0.05). (5) Adverse reactions: the incidence of adverse reactions in the study group [12.0%(6/50)] was lower than that in the control group [28.0%(14/50)] (χ2=4.000, P<0.05). Conclusion Sufentanil combined with propofol anesthesia in patients with cerebral hemorrhage in the basal ganglia can promote hemodynamic fluctuations, inhibit the increase of Ang Ⅱ and PRA, NSE and GFAP, and has less adverse reactions and high security. Key words: Cerebral hemorrhage; Anesthesia; Blood pressure; Heart rate; Hemodynamics; Sufentanil; Propofol

Xenon as an Adjuvant to Propofol Anesthesia in Patients Undergoing Off-Pump Coronary Artery Bypass Graft Surgery: A Pragmatic Randomized Controlled Clinical Trial.

Xenon was shown to cause less hemodynamic instability and reduce vasopressor needs during off-pump coronary artery bypass (OPCAB) surgery when compared with conventionally used anesthetics. As xenon exerts its organ protective properties even in subanesthetic concentrations, we hypothesized that in patients undergoing OPCAB surgery, 30% xenon added to general anesthesia with propofol results in superior hemodynamic stability when compared to anesthesia with propofol alone. Fifty patients undergoing elective OPCAB surgery were randomized to receive general anesthesia with 30% xenon adjuvant to a target-controlled infusion of propofol or with propofol alone. The primary end point was the total intraoperative dose of norepinephrine required to maintain an intraoperative mean arterial pressure >70 mm Hg. Secondary outcomes included the perioperative cardiorespiratory profile and the incidence of adverse and serious adverse events. Adding xenon to propofol anesthesia resulted in a significant reduction of norepinephrine required to attain the predefined hemodynamic goals (cumulative intraoperative dose: median [interquartile range]: 370 [116-570] vs 840 [335-1710] µg, P = .001). In the xenon-propofol group, significantly less propofol was required to obtain a similar depth of anesthesia as judged by clinical signs and the bispectral index (propofol effect site concentration [mean ± SD]: 1.8 ± 0.5 vs 2.8 ± 0.3 mg, P≤ .0001). Moreover, the xenon-propofol group required significantly less norepinephrine during the first 24 hours on the intensive care unit (median [interquartile range]: 1.5 [0.1-7] vs 5 [2-8] mg, P = .048). Other outcomes and safety parameters were similar in both groups. Thirty percent xenon added to propofol anesthesia improves hemodynamic stability by decreasing norepinephrine requirements in patients undergoing OPCAB surgery.

Comparison of the myocardial protective effect of sevoflurane versus propofol in patients undergoing heart valve replacement surgery with cardiopulmonary bypass

BackgroundThis study aimed to compare myocardial protective effects of anaesthesia with intravenous infusion of propofol versus inhalation of sevoflurane in patients undergoing heart valve replacement surgery with cardiopulmonary bypass.MethodsSeventy-six patients undergoing valve replacement with cardiopulmonary bypass were randomly assigned to propofol or sevoflurane anesthesia during the surgery, respectively. For assessing myocardial injury, cardiac troponin I (cTnI) and creatine kinase isozyme (CK-MB) were determined before induction (T0), 0.5 h (T1) and 3 h (T2) after aortic unclamping, and 24 h (T3) and 48 h (T4) after surgery. The concentrations of interleukin (IL)-6 and IL-10 as the systemic inflammatory and anti-inflammatory markers were also measured at above time points.ResultsIn the sevoflurane group, the plasma concentrations of cTnI and CK-MB from Tl to T4 and the levels of IL-6 and IL-10 from T1 to T2 were lower than those in the propofol group. Moreover, a higher ratio of automatic heart beat recovery and a shorter length of intensive care unit or hospital stay were found in the sevoflurane group comparing with the propofol group.ConclusionSevoflurane anaesthesia produced more prominent myocardial protection and attenuated inflammatory response than propofol anaesthesia in patients with valve replacement surgery under cardiopulmonary bypass, resulting in shorter ICU and in-hospital stay.Retrospective clinical trial registrationIdentified as ChiCTR-IOR-16009979 at http://www.chictr.org.cn/.

Effect of propofol anesthesia on resting state brain functional connectivity in Indian population with chronic back pain.

Functional magnetic resonance imaging (fMRI) studies in healthy volunteers have shown alterations in brain connectivity following anesthesia as compared to the awake state. It is not known if the anesthesia-induced changes in brain connectivity are different in a pathological state. This study aims to evaluate changes in the resting state functional connectivity in the brain, after propofol anesthesia, in patients with chronic back pain (CBP). Fourteen adults with CBP were included in this prospective study over 6 months. After excluding structural brain pathology, a resting state fMRI was performed in the awake state, and the sequences were repeated after propofol anesthesia. The primary outcome measure was change in resting state connectivity after propofol. Student's t-test was performed between the pre and post-propofol sedation data of all patients with total brain volume as covariates of interest. A repeated measures analysis of variance was used to compare pre- and post-propofol changes in cardiorespiratory parameters. There were 8 male and 6 female patients in the study, and the mean age of the study population was 46.9 ± 11.3 years. Propofol sedation resulted in an increased strength of functional connectivity between the posterior cingulate cortex (PCC) and thalamus in patients with CBP, whereas there was a generalized decrease in functional integration within the large scale brain networks. The changes in cardiorespiratory parameters before and after propofol administration were not statistically significant. Strengthening of functional connectivity was seen between PCC and thalamus with decrease in large scale brain networks following propofol anesthesia in patients with CBP. These changes are similar to those previously described in normal volunteers.

Meta-analysis of the cardioprotective effect of sevoflurane versus propofol during cardiac surgery.

BackgroundTo evaluate the cardioprotective effects of sevoflurane versus propofol anesthesia in patients undergoing cardiac surgery.MethodsStudies were retrieved through searching several databases. Study quality was evaluated by Jadad scale. Meta-analysis was performed with RevMan5.0 software. Publication bias was tested by funnel plot.ResultsAs a result, 15 studies were included. Compared with propofol, sevoflurane anesthesia significantly improved postoperative (WMD (weighted mean difference) = 0.62, 95% CI: 0.33 to 0.92; P < 0.0001) and postoperative 12 hour cardiac index (WMD = 0.18, 95% CI: 0.03 to 0.33; P = 0.02), postoperative cardiac output (WMD = 1.14, 95% CI: 0.74 to 1.54; P < 0.00001), and reduced postoperative 24 hour cardiac troponin I concentration (WMD = -0.86, 95% CI:-1.49 to -0.22; P = 0.008), postoperative inotropic drug usage (OR (odds ratio) = 0.31, 95% CI: 0.22 to 0.44; P < 0.00001), vasoconstrictor drug usage (OR = 0.30, 95% CI:0.21 to 0.43; P < 0.00001), ICU stay (WMD = -15.53, 95% CI: -24.29 to -6.58; P = 0.0007) and a trial fibrillation incidence (OR = 0.25, 95% CI: 0.07 to 0.85; P = 0.03). However, no significant differences were found in other indexes. Subgroup analysis indicated the similar results.DiscussionThe sevoflurane-induced cTnI reduction is associated with lower incidence of late adverse cardiac events, accounting for its roles in cardiac protection. Several limitations existed such as the small sample size and the lack use of blind design.ConclusionsSevoflurane may exhibit a more favorable cardioprotective effect during cardiac surgery than propofol.

Xenon as adjuvant to propofol anaesthesia in patients undergoing off-pump coronary artery bypass surgery: a randomized prospective controlled trial

in Group N (po0,001). Discussion. Oxidative stress causes renal tubular damage, accordingly causes proteinuria by increasing the glomerular permeability.Therefore, various drugs such as dopamine, mannitol, diuretics, fenoldopam, enalaprilat, dexamethasone and diltiazem are used to preserve the renal function during cardiac surgery. Recently, the protective effects of NAC on organ injuries, and especially renal injury due to the suggested beneficial effects of NAC as an antioxidant on oxidative stress are examined and investigated (3). we have found that i.v. prophylactic use of NAC had a protective effect on renal function.

Determination of EC95 of remifentanil for smooth emergence from propofol anesthesia in patients undergoing transsphenoidal surgery.

In patients undergoing pituitary surgery using a transsphenoidal approach, anesthesia emergence should be smooth with minimal coughing. Recent studies demonstrated that a target-controlled infusion of remifentanil effectively suppresses coughing induced by the endotracheal tube. We investigated the EC95 of remifentanil for smooth emergence without coughing from propofol anesthesia in patients undergoing transsphenoidal hypophysectomy. A total of 41 patients undergoing transsphenoidal hypophysectomy, aged 20 to 65 years, with an ASA physical status of I or II, were enrolled. For all participants, anesthesia was induced and maintained with a target-controlled infusion of remifentanil and propofol using predicted effect-site concentration (Ce). A biased coin design up-and-down sequential allocation and isotonic regression method were used to determine the remifentanil EC95 to prevent emergence coughing. In addition, we observed recovery profiles after anesthesia. According to the study design, 19 patients received remifentanil 2.6 ng/mL Ce and 22 patients received a lower Ce, ranging from 1.0 to 2.2 ng/mL. The EC95 of remifentanil to prevent coughing was estimated as 2.51 ng/mL (95% confidence interval, 2.28-2.57 ng/mL). Despite the exclusion of 1 case because of delayed emergence, 17 of 18 patients receiving 2.6 ng/mL of remifentanil had bradypnea (<10 breaths/min) until 3 minutes after extubation. However, end-tidal carbon dioxide was maintained below 55 mm Hg during anesthetic emergence and respiratory rate recovered within 20 minutes of admission to the postanesthetic care unit. The EC95 of remifentanil for smooth emergence from anesthesia was 2.51 ng/mL after transsphenoidal hypophysectomy.

Sevoflurane versus propofol for interventional neuroradiology: a comparison of the maintenance and recovery profiles at comparable depths of anesthesia.

BackgroundSevoflurane and propofol are used widely for interventional neuroradiology (INR). Using the bispectral index (BIS), we compared the clinical properties of sevoflurane and propofol anesthesia in patients undergoing INR at comparable depths of anesthesia.MethodsThe patients were allocated randomly into two groups. The sevoflurane group received propofol (1.5 mg/kg), alfentanil (5 µg/kg), and rocuronium (0.6 mg/kg) for induction, and the propofol group was induced with a target effect-site concentration of propofol (4 µg/ml), alfentanil (5 µg/kg), and rocuronium (0.6 mg/kg). After intubation, anesthesia was maintained with sevoflurane or propofol with 67% nitrous oxide in 33% oxygen. Sevoflurane and propofol concentrations were titrated to maintain the BIS at 50-60. Phenylephrine or opioid was used to maintain the mean arterial pressure within 20% of the baseline values. The amounts of phenylephrine or alfentanil used, the number of patients showing movement during the procedure, and the recovery times were recorded.Results Compared to the propofol group, the sevoflurane group showed faster recovery in spontaneous ventilation, eye opening, extubation, and orientation (4 vs. 7 min, 7 vs. 9 min, 8 vs. 10 min, 10 vs. 14 min, respectively; P < 0.01). In the propofol group, significantly greater amounts phenylephrine were used (P < 0.05), and more patients moved during the procedure (P < 0.05).ConclusionsThe use of sevoflurane in maintaining anesthesia during INR was associated with faster recovery, less patient movement during the procedure, and a more stable hemodynamic response when compared to propofol.

Model-based causal closed-loop approach to the estimate of baroreflex sensitivity during propofol anesthesia in patients undergoing coronary artery bypass graft

Cardiac baroreflex is a fundamental component of the cardiovascular control. The continuous assessment of baroreflex sensitivity (BRS) from spontaneous heart period (HP) and systolic arterial pressure (SAP) variations during general anesthesia provides relevant information about cardiovascular regulation in physiological conditions. Unfortunately, several difficulties including unknown HP-SAP causal relations, negligible SAP changes, small BRS values, and confounding influences due to mechanical ventilation prevent BRS monitoring from HP and SAP variabilities during general anesthesia. We applied a model-based causal closed-loop approach aiming at BRS assessment during propofol anesthesia in 34 patients undergoing coronary artery bypass graft (CABG) surgery. We found the following: 1) traditional time and frequency domain approaches (i.e., baroreflex sequence, cross-correlation, spectral, and transfer function techniques) exhibited irremediable methodological limitations preventing the assessment of the BRS decrease during propofol anesthesia; 2) Granger causality approach proved that the methodological caveats were linked to the decreased presence of bidirectional closed-loop HP-SAP interactions and to the increased incidence of the HP-SAP uncoupling; 3) our model-based closed-loop approach detected the significant BRS decrease during propofol anesthesia as a likely result of accounting for the influences of mechanical ventilation and causal HP-SAP interactions; and 4) the model-based closed-loop approach found also a diminished gain of the relation from HP to SAP linked to vasodilatation and reduced ventricular contractility during propofol anesthesia. The proposed model-based causal closed-loop approach is more effective than traditional approaches in monitoring cardiovascular control during propofol anesthesia and indicates an overall depression of the HP-SAP closed-loop regulation.

Comparison of inflammatory cytokine profiles in plasma of patients undergoing otorhinological surgery with propofol or isoflurane anesthesia

The effects of anesthetics on cytokine release in patients without comorbidities who undergo minor surgery are not well defined. We compared inflammatory cytokine profiles in adult patients undergoing minimally invasive surgery who received isoflurane or propofol anesthesia. Thirty-four patients without comorbidities undergoing minor surgery were randomly assigned to receive an inhaled anesthetic (isoflurane; n=16) or an intravenous anesthetic (propofol; n=18). Blood samples were drawn before premedication and anesthesia (T1), 120min after anesthesia induction (T2), and on the first post-operative day (T3). Plasma concentrations of interleukins (IL-) 1β, 6, 8, 10 and 12 and tumor necrosis factor (TNF)-α were measured using flow cytometry. The pro-inflammatory cytokine IL-6 was increased in the isoflurane group at T2 and T3 compared to T1 (P<0.01). In the propofol group, IL-6 and IL-8 were significantly increased at T3 compared to T1. However, there were no significant differences in cytokine concentrations between the isoflurane and propofol groups. An inflammatory response occurred earlier in patients who received an inhaled agent compared with an intravenous anesthetic, but no differences in plasma cytokine profiles were evident between isoflurane and propofol anesthesia in patients without comorbidities undergoing minimally invasive surgeries.

Comparison of recovery profile for propofol and sevoflurane anesthesia in cases of open cholecystectomy

Objective:Sevoflurane and propofol are considered to be the agents of choice in surgeries of short duration due to their better recovery profile and few post-operative complications. This study was designed to compare the early recovery profile of sevoflurane and propofol anesthesia in patients undergoing open cholecystectomy.Materials and Methods:A total of 60 patients of either sex with American Society of Anesthesiologists grade 1 and 2 scheduled for elective cholecystectomy were prospectively randomized into two groups. Group S (30 patients) were maintained with sevoflurane anesthesia (1-2%), while in Group P (30 patients) were maintained with propofol infusion (75-125 μg/kg/min) in both the groups the anesthetic concentration/dose was so adjusted to keep hemodynamic parameter (mean arterial pressure and heart rate) within 15% of their respective baselines values.Results:It was observed that there was no significant difference (P > 0.05) between there early recovery profile that includes spontaneous eye opening (7.5 ± 1.6 min for sevoflurane group and 6.9 ± 1.7 min for propofol group), following simple verbal command (9.2 ± 2.2 min for sevoflurane group and 8.9 ± 1.9 min for propofol group) and extubation time (10.7 ± 2.3 min for sevoflurane group and 10.3 ± 2.0 min for propofol group) but there was a significant difference (P < 0.05) in incidence of post-operative nausea and vomiting (PONV) in both groups.Conclusion:Propofol is as good as sevoflurane for maintenance of anesthesia in surgeries like open cholecystectomy with an added advantage of lower incidence of PONV owing to its intrinsic antiemetic properties.

Should We Use Psychostimulant Drugs to Boost the Emergence from General Anesthesia?

Recently, Chemali et al. 1showed that psychostimulants can accelerate the emergence from propofol anesthesia as evidenced by a faster recovery of the righting reflex and by signs of electroencephalogram activation after the injection of methylphenidate during propofol infusion. The authors believe that methylphenidate can be safely used in a clinical setting to facilitate the awakening from prolonged propofol anesthesia or in patients overly sedated by propofol. In our view, the use of psychostimulants such as methylphenidate as emergence drugs may lead to undesirable consequences, especially in the abovementioned subsets of patients.It has been recently suggested that sequential activation of consciousness, connectedness to the environment, and responsiveness may be prerequisites for the smooth and uneventful emergence from anesthesia.2Switching on the connectedness or responsiveness before the consciousness is fully recovered from the effect of GABAergic drugs may be a cause of cognitive dysfunction or even delirium on emergence.2,3Although connectedness to external stimuli is likely to rely on norepinephrinergic signaling,4responsiveness probably requires the engagement of the basal ganglia and is subject to dopaminergic modulation in the striatum.5Methylphenidate can increase extracellular levels of both norepinephrine and dopamine in cortical and subcortical areas.6–9We believe that administering methylphenidate during propofol infusion or immediately after its termination and before the anesthetic is eliminated and consciousness sufficiently restored would interrupt the natural sequential switching-on of consciousness–connectedness–responsiveness and may result in postoperative cognitive dysfunction.We also suspect that accelerated emergence in otherwise uncomplicated anesthesia cases may be unpleasant, similar to sudden and forced awakening from sleep.10The authors themselves noticed that the electroencephalogram pattern after methylphenidate injection during propofol infusion was not exactly a return to a normal awake state: rather, the electroencephalogram showed signs of overactivation.1Administration of methylphenidate at doses comparable to those used in this study causes an increase in locomotion in rats.11,12If the authors had examined the behavior of rats awakened from anesthesia by methylphenidate and compared it with that of animals allowed to naturally awaken from propofol, they would probably have found increased locomotor activity in the former group. The human equivalent of rat hyperlocomotion may be restlessness and agitation, both of which are undesirable and can complicate the postoperative period.Finally, many stimulant drugs with a dopaminergic mechanism of action, including methylphenidate, lead to the so-called rebound hypersomnolence, evidenced by a period of enhanced compensatory sleep after drug-induced waking.13,14For methylphenidate, rebound hypersomnolence occurs at about 3 h after its intraperitoneal administration in rats.14It is unclear whether this phenomenon could be potentiated by residual sedation after propofol anesthesia. However, such potentiation is likely to occur and may have detrimental effects in overly sedated patients and, therefore, should be examined before the drug is used in humans.In conclusion, the results of the study by Chemali et al . certainly enrich our knowledge about the mechanisms of anesthesia and prepare us for possible drug interactions in patients on methylphenidate scheduled for surgery. However, before proceeding to examine the ability of methylphenidate to accelerate the emergence from propofol anesthesia in patients, especially in those with increased drug-induced GABAergic tone, it seems prudent to investigate the effects of methylphenidate on postanesthetic cognitive function in animals. Meanwhile, we can still rely on the natural emergence from anesthesia caused by physiologic elimination of the anesthetic drug. Fortunately, with the ever-improving pharmacokinetic profiles of modern anesthetic drugs, we do not have to wait too long.*Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan. abpetr@med.niigata-u.ac.jp