Propofol-based Anesthesia Group Research Articles

Survival benefits of propofol-based versus inhalational anesthesia in non-metastatic breast cancer patients: a comprehensive meta-analysis

Whether the anesthesia technique, inhalational general anesthesia (IGA) or propofol-based anesthesia (PBA), influences the long-term survival of non-metastatic breast cancer (eBC) remain unclear and controversial. We carried out a literature search on 16thJuly, 2022 for studies comparing IGA and PBA in eBC undergoing standard surgery, according to PRISMA 2020. The major endpoint in our study was overall survival (OS). Seventeen studies including four randomized clinical trials and thirteen retrospective cohort studies were included in the meta-analysis. Ten studies provided data for crude OS in unweighted eBC patients (imbalance in baseline characteristics). The summarized estimate HRs of the PBA group versus the IGA group (ten studies, N = 127,774, IGA group: 92,592, PBA group: 35,182.) was 0.83 (95%CI: 0.78–0.89). Compared with IGA, PBA was associated with both better 1-year OS (two studies, N = 104,083, IGA group: 84,074, PBA group: 20,009. Pooled HR = 0.80, 0.73–0.89) and 5-year OS (six studies, N = 121,580, IGA group: 89,472, PBA group: 32,108. HR = 0.80, 0.74–0.87). Ten studies applied PSM method to balance the baseline characteristics. In these weighted patients, PBA still showed a better OS (ten studies, N = 105,459, IGA group: 79,095, PBA group: 26,364. HR = 0.93, 0.87–1.00), a better 1-year OS (two studies, N = 83,007, IGA group: 67,609, PBA group: 15,398. HR = 0.88, 0.78–0.98) and a trend towards a better 5-year OS (nine studies, N = 121,580, IGA group: 76,797, PBA group: 24,066. HR = 0.95, 0.88–1.03). Loco-regional recurrence-free survival (LRRFS) was also better in PBA group (HR = 0.73, 0.61–0.86). The present study is the first comprehensive meta-analysis to demonstrate that propofol-based anesthesia could significantly improve OS and LRRFS in non-metastatic breast cancer patients, compared with inhalational anesthesia.

Effects of different anesthetic methods on postoperative acute pain in patients with myasthenia gravis undergoing video-assisted thoracoscopic thymectomy

Objective To evaluate the effects of different anesthetic methods on postoperative acute pain in patients with myasthenia gravis undergoing video-assisted thoracoscopic thymectomy. Methods Fifty-four patients of both sexes, aged 18-64 yr, with body mass index of 20-28 kg/m2, of American Society of Anesthesiologists physical statusⅠor Ⅱ, scheduled for elective video-assisted thoracoscopic thymectomy, were allocated into 2 groups (n=27 each) using a random number table method: sevoflurane-based anesthesia group (group S) and propofol-based anesthesia group (group P). After routine anesthesia induction in two groups, anesthesia was maintained by inhaling sevoflurane and target-controlled infusion of remifentanil in group S and by target-controlled infusion of propofol and remifentanil in group P. Heart rate and mean arterial pressure were recorded before operation and at 5 and 10 min after extubation (T1, 2). The intensity of pain at T2 and visual analog scale (VAS) score and consumption of morphine at 1, 2, 4, 24 and 48 h after operation (T3-7) were recorded.The pressing times of analgesia pump, requirement for rescue analgesia and development of nausea and vomiting were recorded at T7. Results There were no significant differences in heart rate or mean arterial pressure at each time point between two groups (P>0.05). Compared with group S, the intensity of pain was significantly alleviated at T2, and VAS scores and morphine consumption were decreased at T3, 4 in group P (P 0.05). Conclusion Propofol-based anesthesia provides better efficacy in alleviating postoperative acute pain in patients with myasthenia gravis undergoing video-assisted thoracoscopic thymectomy. Key words: Propofol; Anesthetics, inhalation; Pain postoperative; Myasthenia gravis; Thoracoscopy; Thymectomy

Comparison of myocardial injury in pediatric patients undergoing living-donor liver transplantation performed under propofol- versus sevoflurane-based anesthesia

Objective To compare the severity of myocardial injury in pediatric patients undergoing living-donor liver transplantation (LDLT) performed under propofol- versus sevoflurane-based anesthesia. Methods Forty American Society of Anesthesiologists physical status Ⅲ or Ⅳ pediatric patients of both sexes, aged 5-13 months, weighing 5-12 kg, scheduled for elective LDLT under general anesthesia, were divided into 2 groups (n=20 each) using a random number table: propofol-based anesthesia group (group P) and sevoflurane-based anesthesia group (group S). Anesthesia was induced with intravenously injected midazolam 0.15 mg/kg, fentanyl 2-5 μg/kg and cisatracurium 0.15 mg/kg.Anesthesia was maintained by IV infusion of propofol 9-15 mg·kg-1·h-1 (in group P), continuous inhalation of 2.6%-4.0% sevoflurane (in group S), intermittent IV boluses of fentanyl 1-3 μg/kg and IV infusion of cisatracurium 1-2 μg·kg-1·min-1.At 5 min of anesthesia induction, 30 min of anhepatic phase, 3 h of neohepatic stage and the end of surgery, blood samples were taken from the central vein for determination of concentrations of cardiac troponin I and creatine kinase-MB in serum and concentrations of tumor necrosis factor-alpha, interleukin-6 and high-mobility group box 1 protein in serum (by enzyme-linked immunosorbent assay). The occurrence of adverse cardiovascular events (hypertension or hypotention, myocardial ischemia and ventricular premature beat) was recorded during surgery. Results There was no significant difference in concentrations of tumor necrosis factor-alpha, interleukin-6, high-mobility group box 1 protein, cardiac troponin I and creatine kinase-MB in serum at each time point or incidence of adverse cardiovascular events between the two groups (P>0.05). Conclusion The severity of myocardial injury is comparable in pediatric patients undergoing LDLT performed under propofol- versus sevoflurane-based anesthesia. Key words: Anesthetics, inhalation; Propofol; Liver transplantation; Myocardial reperfusion injury; Child

Relationship between anesthetic factor and intestinal injury in patients undergoing cardiac surgery with cardiopulmonary bypass: a comparison of propofol- versus sevoflurane-based anesthesia

Objective To investigate the relationship between anesthetic factors and intestinal injury in the patients undergoing elective cardiac surgery with cardiopulmonary bypass (CPB). Methods Ninety American Society of Anesthesiologists physical status Ⅱ or Ⅲ patients of both sexes, aged 18-64 yr, with New York Heart Association grade Ⅱ or Ⅲ, undergoing elective cardiac surgery with CPB, were divided into 2 groups(n=45 each) using a random number table: propofol-based anesthesia group (group P) and sevoflurane-based anesthesia group (group S). CPB was established routinely after anesthesia induction.Before induction (T0), immediately after aortic unclamping (T1), at 30 min after aortic unclamping (T2) and at 2 h after discontinuation of CPB (T3), blood samples were collected from the radial artery for determination of the plasma endotoxin, D-lactic acid, diamine oxidase (DAO) and intestinal fatty acid-binding protein (I-FABP) concentrations (by enzyme-linked immunosorbent assay) and plasma interleukin-6 (IL-6), IL-8 and tumor necrosis factor-alpha (TNF-α) concentrations (using radio-immunity method). Results Compared with the baseline at T0, the concentrations of plasma endotoxin, D-lactic acid, DAO, TNF-α, IL-6, IL-8 and I-FABP were significantly increased at T1-T3 in both groups (P<0.05). Compared with group P, the concentrations of plasma endotoxin, D-lactic acid, DAO, TNF-α, IL-6, IL-8 and I-FABP were significantly decreased at T1-T3 in group S(P<0.05). Conclusion Anesthetic factors are related to intestinal injury in patients undergoing cardiac surgery with CPB.Compared with propofol-based anesthesia, sevoflurane-based anesthesia is helpful in reducing the inflammatory response and in decreasing the degree of intestinal injury and is more suitable for the cardiac surgery with CPB. Key words: Anesthesia, general; Propofol; Cardiopulmonary bypass; Intestinal mucosa; Wounds and injuries; Sevoflurane

Comparison of development of postoperative cognitive dysfunction using different methods of anesthesia in elderly patients

Objective To compare the development of postoperative cognitive dysfunction (POCD) under total inhalation anesthesia with sevoflurane versus total intravenous anesthesia with propofol in elderly patients. Methods Sixty American Society of Anesthesiologists physical status Ⅱ or Ⅲ patients, aged 65-77 yr, weighing 43-78 kg, with preoperative Mini-Mental State Examination (MMSE) score≥25, scheduled for elective surgery for oral and maxillofacial carcinoma, were divided into 2 groups (n=30 each) using a random number table: total inhalation anesthesia with sevoflurane group (group S) and total intravenous anesthesia with propofol-based anesthesia group (group P). The patients were tracheally intubated under local infiltration anesthesia.In group S, anesthesia was induced with inhalation of 8% sevoflurane (oxygen flow rate 8 L/min), rocuronium 0.9 mg/kg was injected intravenously when the bispectral index (BIS) value reached 45, and the patients were mechanically ventilated; anesthesia was maintained with inhalation of sevoflurane with the end-tidal concentration of 2%-3%.In group P, anesthesia was induced with iv propofol 2 mg/kg and sufentanil 0.3 μg/kg, rocuronium 0.9 mg/kg was injected intravenously when the BIS value reached 45, and the patients were mechanically ventilated; anesthesia was maintained with target-controlled infusion of propofol (target plasma concentration 3-5 μg/ml) and remifentanil (target plasma concentration 3-5 ng/ml). In both groups, intermittent iv boluses of cisatracurium 0.04 mg/kg were given to maintain muscle relaxation during operation, and BIS value was maintained at 40-60 during operation.Before intubation (T1), immediately after onset of intubation (T2), at 10 min of intubation (T3), immediately after begninning of skin incision (T4), while operating on the base of tongue or sawing the lower jaw (T5), at the end of operation (T6) and on the morning of the postoperative day 1 (T7), blood samples from the elbow vein were collected for determination of plasma norepinephrine and epinephrine concentrations by high-performance liquid chromatography and electrochemistry.At T1-7 and on the morning of the postoperative day 3 (T8), blood samples from the elbow vein were collected for measurement of plasma cortisol concentrations by radioimmunoassay.MMSE was used to assess the cognitive function on the postoperative day 7.MMSE score < 24 was defined as POCD, and the occurrence of POCD was recorded. Results Compared with group S, the plasma concentrations of norepinephrine and epinephrine were significantly decreased at T4 and T5, the plasma cortisol concentration was significantly decreased at T4-7 (P 0.05). Conclusion Although the probability of the development of POCD is low when the two anesthetic methods are used, total intravenous anesthesia with propofol-based anesthesia induces a marked decrease in perioperative stress responses when compared with total inhalation anesthesia with sevoflurane. Key words: Anesthesia, intravenous; Anesthesia, inhalation; Propofol; Anesthetics, inhalations; Aged; Cognition disorders; Stress

Comparison of effects of propofol- and sevoflurane-based anesthesia on postoperative cognitive dysfunction in elderly patients undergoing cardiac valve operation under cardiopulmonary bypass

Objective To compare the effects of propofol- and sevoflurane-based anesthesia on postoperative cognitive dysfunction in elderly patients undergoing cardiac valve operation under cardiopulmonary bypass(CPB). Methods Eighty patients of both sexes, of American Society of Anesthesiologists physical status Ⅱ or Ⅲ, aged 65-72 yr, weighing 60-80 kg, scheduled for elective cardiac valve operation under CPB, were randomly divided into 2 groups(n=40 each)using a random number table: propofol-based anesthesia group(group P)and sevoflurane-based anesthesia group(group S). In group P, propofol was given by target-controlled infusion with the target plasma concentration of 0.5-2.0 μg/ml to maintain anesthesia.In group S, 0.5%-2.5% sevoflurane was inhaled for maintenance of anesthesia.Immediately after induction of anesthesia, at the end of operation, and at 6, 12 and 24 h after operation, blood samples were taken from the superior vena cava for determination of plasma matrix metalloproteinase-9, S100β protein and neuron-specific enolase concentrations.Cognitive function was assessed at 1 day before operation, and at 3, 7 and 30 days after operation. Results Compared with group P, the plasma matrix metalloproteinase-9, S100β protein and neuron-specific enolase concentrations at the end of operation and at 6 h after operation and incidence of postoperative cognitive dysfunction were significantly increased in group S(P<0.05). Conclusion Propofol-based anesthesia provides better cerebral protection than sevoflurane-based anesthesia, and the development of postoperative cognitive dysfunction is decreased in elderly patients undergoing cardiac valve operation under CPB. Key words: Propofol; Anesthetics, inhalation; Cardiopulmonary bypass; Heart valve prosthesis; Cognition disorders; Aged

Cerebral protective effect of propofol versus sevoflurane combined with sufentanil anesthesia in patients undergoing valvular surgery under cardiopulmonary bypass

Objective To compare the cerebral protective effect of propofol and sevoflurane combined with sufentanil anesthesia in the patients undergoing valvular surgery under cardiopulmonary bypass(CPB). Methods Sixty American Society of Anesthesiologists physical status Ⅱ or Ⅲ patients, aged 60-70 yr, scheduled for elective valvular surgery under CPB, were randomly divided into either propofol-based anesthesia group(group PA)or sevoflurane-based anesthesia group(group SA), with 30 patients in each group.From induction of anesthesia to the end of surgery, group P received target-controlled infusion of propofol 0.5-2.0 μg/ml, and group S continuously inhaled 0.5%-2.5% sevoflurane.Bispectral index value was maintained at 45-55.Immediately after induction(T0), at the end of surgery(T1), and at 6, 12 and 24 h after surgery(T2-4), the superior vena cava was retrogradely cannulated for blood sampling, and the concentrations of plasma S-100β protein and neuron-specific enzyme were determined using enzyme-linked immunosorbent assay. Results Compared with group SA, the plasma S-100β concentrations at T1, 2 and neuron-specific enzyme concentrations at T1-3 were significantly decreased in group PA. Conclusion The cerebral protective effect of propofol combined with sufentanil anesthesia is superior to that of sevoflurane combined with sufentanil anesthesia in the patients undergoing valvular surgery under CPB. Key words: Propofol; Sufentanil; Anesthetics, inhalation; Cardiopulmonary bypass; Brain injuries

Comparison of postoperative cognitive function in elderly patients undergoing sevoflurane-based anesthesia versus propofol-based anesthesia

Objective To compare the postoperative cognitive function in elderly patients undergoing sevoflurane-based anesthesia versus propofol-based anesthesia. Methods Sixty-two patients of both sexes, aged 65-80 yr, weighing 48-90 kg, of ASA physical statusⅠ or Ⅱ, were randomly allocated to either sevoflurane-based anesthesia group(group S, n=31)or propofol-based anesthesia group(group P, n=31). At 1 day before operation and 7 days after operation, cognitive function was assessed by Mini-Mental State Examination, Digit Span Test(forward test and backward test), Digit-Symbol Substitution Test, Trail Making Test A and Word Recognition Test, and the scores were recorded. Results There were no significant differences between the two groups in the scores of each test used for assessment of cognitive function.Compared to group P, Mini-Mental State Examination scores, forward test scores and backward test scores obtained from Digit Span Test, Digit-Symbol Substitution Test scores, and Word Recognition Test scores were significantly decreased at 7 days after operation, and no significant change was found in Trail Making Test A scores in group S. Conclusion Postoperative cognitive function is decreased under sevoflurane-based anesthesia when compared with that under propofol-based anesthesia in the elderly patients. Key words: Anesthetics, inhalation; Propofol; Anesthesia, general; Aged; Cognition disorders