Continuous Infusion Of Propofol Research Articles

Initial loading of dexmedetomidine and continuous propofol sedation for prevention of delayed recovery: A randomized controlled trial

BackgroundSedation with continuous dexmedetomidine and bolus midazolam administration provides a lower incidence of unacceptable patient movement during procedures but requires a longer recovery time. The authors aimed to compare recovery time and unacceptable patient movement during sedation with initial loading of dexmedetomidine followed by continuous propofol infusion with those during sedation with continuous dexmedetomidine and bolus midazolam administration. MethodsIn this prospective randomized controlled trial, 54 patients undergoing dental surgery and requiring intravenous sedation were assigned to either the dexmedetomidine and propofol group (n = 27, dexmedetomidine administered at 6 μg/kg/h for 5 minutes, followed by continuous propofol infusion using a target-controlled infusion) or the dexmedetomidine and midazolam group (n = 27, dexmedetomidine administered at 0.2-0.7 μg/kg/h continuously after the same initial loading dose with bolus midazolam). A bispectral index of 70 through 80 was maintained during the procedure. Patient movement that interfered with the procedure and time from the end of sedation to achieving a negative Romberg sign were assessed. ResultsTimes from the end of sedation to achieving a negative Romberg sign in the dexmedetomidine and propofol group (median, 14 minutes [interquartile range, 12-15 minutes]) were significantly shorter (P < .001) than in the dexmedetomidine and midazolam group (median, 22 minutes [interquartile range, 17.5-30.5 minutes]). The incidence of unacceptable patient movement was comparable between groups (n = 3 in the dexmedetomidine and propofol group, n = 4 in the dexmedetomidine and midazolam group; P = .999). ConclusionsSedation with a single loading dose of dexmedetomidine followed by continuous propofol infusion can prevent delayed recovery without increasing unacceptable patient movement. Practical ImplicationsThe combination of dexmedetomidine and propofol may provide high-quality sedation for ambulatory dental practice. This clinical trial was registered in the University Hospital Medical Information Network Clinical Trials Registry. The registration number is UMIN000039668.

Effectiveness and safety of an atropine/midazolam and target controlled infusion propofol-based moderate sedation protocol during percutaneous endoscopic transgastric jejunostomy procedures in Parkinson's disease: a real-life retrospective observational study.

Patients with Parkinson's disease (PD), often elderly with various comorbidities, may require a continuous intestinal infusion of carbidopa/levodopa gel by the placement of a percutaneous endoscopic gastrostomy (PEG) with a jejunal tube (PEG-J) to improve their motor outcome and quality of life. However, it is unclear what is the best procedural sedation protocol for PEG-J procedures. Fifty patients with PD and indication for PEG-J procedure (implantation, replacement, removal) underwent, from 2017 to 2022, a sedation protocol characterized by premedication with atropine (0.01 mg/Kg i.v.), midazolam (0.015-0.03 mg/Kg i.v.) and induction with bolus propofol (0.5-1 mg/Kg i.v.) as well as, finally, sedation with continuous infusion propofol (2-5 mg/Kg/h i.v.) by Target Controlled Infusion (TCI) technique. Ninety-eight per cent of patients experienced no intraprocedural or peri-procedural adverse events. All the procedures were technically successful. A good discharge time was recorded. The vital parameters recorded during the procedure did not vary significantly. A PEG-J procedure conducted within 30 min showed a significant advantage over end-tidal carbon dioxide (EtCO2). Indeed, the latter showed some predictive behavior (OR: 1.318, 95% CI 1.075-1.615, p = 0.008). In the real world, this sedation protocol showed a good safety and effectiveness profile, even with reduced doses of midazolam and a TCI propofol technique in moderate sedation.

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.

Comparison of hemodynamic changes with general or local anesthesia during dental treatment in pediatric patients: A prospective clinical study.

Severe hemodynamic fluctuations during dental treatment can trigger highly undesirable physical reactions. A study was made to determine whether the administration of propofol and sevoflurane contributes to the stabilization of hemodynamic parameters during dental treatment in pediatric patients versus the use of local anesthesia alone. Forty pediatric patients needing dental treatment were assigned to either general anesthesia with local anesthesia (study group [SG]) or local anesthesia alone (control group [CG]). Two percent sevoflurane in oxygen (100% oxygen, 5 L/min) and continuous propofol infusion (target-controlled infusion [TCI], 2 μg/mL) were used as general anesthesia agents in SG; and 2% lidocaine with 1:80,000 adrenaline was used as local anesthesia in both groups. Heart rate, blood pressure and oxygen saturation were measured before starting dental treatment (baseline) and every 10 min during dental treatment. Blood pressure (p<.001), heart rate (p=.021) and oxygen saturation (p=.007) decreased substantially after the administration of general anesthesia. The levels of these parameters subsequently remained low and then recovered at the end of the procedure. On the other hand, the oxygen saturation values remained closer to baseline in SG versus CG. In contrast, the hemodynamic parameters experienced lesser fluctuations in CG than in SG. General anesthesia affords more favorable cardiovascular parameters during the entire dental treatment in comparison to local anesthesia alone (blood pressure and heart rate decrease significantly and oxygen saturation proves more stable and with values closer to baseline), and allows dental treatment to be performed on healthy, lacking cooperative ability children who otherwise could not be treated with local anesthesia alone. No side effects were observed in either group.

The system of anesthesiological support for coloproctological operations

Introduction. The prevalence of hemorrhoidal disease is 200 people per 1000 adult population, of which 75% are professionally active people. The choice of anesthetic support affects not only the effectiveness of the operation, but also the course of the early postoperative period. At the same time, regardless of the use of various variants of neuroaxial blockades, most authors indicate the development of complications such as acute urinary retention and severe postoperative pain syndrome in the postoperative period.Aim. To substantiate and evaluate the effectiveness of the proposed system of anesthesiological support for proctological operations.Material and methods. The study was conducted in 100 patients who were divided into two groups of 50 people. The operations were performed under conditions of combined anesthesia (spinal anesthesia + medical sedation). Spinal anesthesia was achieved with 0.5% isobaric bupivacaine solution, the average dose was 8.5 ± 0.12 mg. For drug sedation, a continuous infusion of propofol was used at a target concentration of 5–4–3 mg/kg per hour. The criterion for including patients in the main group was the appointment in the early postoperative period of the alpha 1 adrenoblocker tamsulosin hydrochloride at a dose of 0.4 mg/day.Results and discussion. The system of anesthetic support, including a combination of spinal anesthesia using an isobaric solution of bupivacaine at a dose of 7.5 to 10.0 mg and intravenous sedation with propofol at a target concentration of 5–4–3 mg/kg per hour, program of postoperative anesthesia based on a combination of multidirectional drug action and the appointment of alpha 1 adrenoblocker tamsulosin hydrochloride at a dose of 0.4 mg/day allows for high-quality and safe surgical treatment.Conclusion. The administration oftamsulosin hydrochloride at a dose of 0.4 mg prevented the development of acute urinary retention of patients.

Comparison of recovery profiles in target-controlled infusions (TCI) versus manually controlled infusions for total intravenous anesthesia (TIVA) in laparoscopic surgeries. A randomized controlled trial.

Considerable importance has been attached to early recovery and discharge readiness after surgeries. Many centers use total intravenous anesthesia (TIVA) as their anesthesia technique of choice. Target-controlled infusions (TCI) have been proposed as a method to precisely deliver continuous infusions of propofol and opioids as compared to the traditionally used manual-controlled infusion (MCI) methods. However, TCI has also been shown to result in the administration of larger doses of propofol which could cause delayed emergence and recovery from anesthesia. Studies involving TCI have focused mainly on its effects on anesthesia induction but not much literature is available on recovery profiles of patients on TCI. This study was designed to compare the effect of conventionally used MCI methods versus the target-controlled infusion (TCI) method of administering TIVA on recovery characteristics in patients undergoing laparoscopic surgery. This was a prospective randomized interventional study on 54 patients. Our primary objective was to compare the rates of recovery from anesthesia as judged by four parameters. Time to return of spontaneous ventilation, time to respond to verbal commands, time to extubation, and time to shift patient out of the operating room after stoppage of propofol infusion. As secondary objectives, intraoperative average bispectral index (BIS) values and total anesthetic drugs (propofol and fentanyl) consumption were also compared. We noted that for laparoscopic surgeries lasting less than 4 hours, both MCI and TCI techniques of TIVA have comparable rates of recovery after the stoppage of propofol infusion. Total consumption of propofol and fentanyl was also similar; however, with the use of the TCI method of TIVA, better depth of anesthesia as evidenced by lower average BIS levels was noted. Recovery rates after TIVA using a target-controlled infusion (TCI) system are similar to BIS-guided MCIs in patients undergoing laparoscopic surgery lasting less than 4 hours. TCI resulted in better depths of anesthesia though per kg/min consumption of propofol was found to be more.

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.

Paraventricular thalamus controls consciousness transitions during propofol anaesthesia in mice

BackgroundThe neuronal mechanisms underlying propofol-induced modulation of consciousness are poorly understood. Neuroimaging studies suggest a potential role for non-specific thalamic nuclei in propofol-induced loss of consciousness. We investigated the contribution of the paraventricular thalamus (PVT), a midline thalamic nucleus that has been implicated in arousal control and general anaesthesia with inhaled anaesthetics, to loss and recovery of consciousness during propofol anaesthesia. MethodsPolysomnographic recordings and righting reflex test were used to determine the transitions of loss and recovery of righting reflex, used as a measure of consciousness in mice, during propofol anaesthesia in mice under conditions mimicking clinical propofol administration. PVT neuronal activities were monitored using fibre photometry and regulated using optogenetic and chemogenetic methods. ResultsPopulation activities of PVT glutamatergic neurones began to decrease before propofol-induced loss of consciousness and rapidly increased to a peak at the onset of recovery of consciousness. Chemogenetic inhibition of PVT calretinin-expressing (PVTCR) neurones shortened onset (from 176 [35] to 127 [26] s; P=0.001) and prolonged return (from 1568 [611] to 3126 [1616] s; P=0.002) of righting reflex. Conversely, chemogenetic activation of PVTCR neurones exerted opposite effects. Furthermore, optogenetic silencing of PVTCR neurones accelerated transitions to loss of consciousness (from 205 [35] to 158 [44] s; P=0.027) and slowed transitions to recovery of consciousness (from 230 [78] to 370 [99] s; P=0.041). During a steady period of unconsciousness maintained with continuous propofol infusion, brief optical activation of PVTCR neurones restored cortical activity and arousal with a latency of about 5 s. ConclusionsThe paraventricular thalamus contributes to the control of consciousness transitions in propofol anaesthesia in mice. This provides a potential neuroanatomical target for controlling consciousness to reduce anaesthetic dose requirements and side effects.

Updates in Prevention of Surgical Site Infection: Comment.

Long et al.1 provided a well-written and accessible review of new ideas in the field of surgical site infection prevention. Within their discussion of the patient’s microbiome, the authors touch on the potential for interactions between the patient microbiome and anesthetic agents administered perioperatively. Although they accurately identify the immunosuppressive potential of volatile anesthetics and intravenous opioids, we think that it is important to note that there exist other agents capable of producing and maintaining general anesthesia. Medications like ketamine and propofol are immunomodulatory in different ways, and thus their use may also impact the development of surgical site infections.Long et al.1 cite two mouse model articles where exposure to volatile anesthetics was associated with a decrease in intestinal microbiome diversity.2,3 In contrast, Guo et al.,4 using a rat model, looked at the effect of a continuous infusion of propofol during a 3-h period on the intestinal microbiome and found little change in the diversity of the intestinal microbiome after exposure to propofol. Similarly, Gerb et al.5 looked at the effects on the intestinal microbiome of mice after 10 daily exposures to a bolus dose of ketamine that rendered the mice unconscious for approximately 15 to 30 min per ketamine exposure and also found little change in the diversity of the intestinal microbiome.No definitive evidence exists to recommend one type of anesthetic over another. Given the minimal impact on the intestinal microbiome, it might be tempting to conclude that replacing volatile anesthetics with agents such as propofol and ketamine might decrease the incidence of surgical site infection. But there is also evidence to the contrary. For example, Visvabharathy et al.6 looked at susceptibility to infection due to exogenous bacteremia using Listeria and Staphylococcus aureus in mice receiving intravenous propofol compared to mice receiving intravenous ketamine with xylazine and found that propofol increased susceptibility to infection. In a research letter, Liu et al.7 looked at the intestinal microbiome in 21 patients undergoing nephrectomy with propofol alone compared to sevoflurane alone compared to propofol and sevoflurane combined and found that the mixed anesthetic7 was associated with the fewest perturbations.Clearly it remains premature to advocate for a total intravenous technique in the absence of more clinically robust data. Further research in animal models and in humans is needed to try and elucidate not only if there is an optimal anesthetic agent for prevention of surgical site infection, but also what the combined effects of multiple anesthetics, as routinely administered when patients present for surgery, have on the patient’s susceptibility to infection after surgery.Surgical site infections are a multidisciplinary problem. Once more data are available, it may turn out that the effects of anesthetic agents are small and of minor importance in patients with normal immune systems. But the selection of anesthetic agents is one aspect we have almost complete control over; we should be making every effort to maximize the ability of the patient’s immune system to combat infection.The authors declare no competing interests.

Uso concomitante de ketamina y propofol en perfusión continua en cuidados intensivos: eficacia y seguridad para analgesia y sedación prolongada

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 1.5mg/kg/h (interquartile range [IQR], 1–2mg/kg/h) and the infusion duration was 5 days (IQR, 3–5 days). The maximum dose of propofol was 3.2mg/kg/h (IQR, 2.5–3.6mg/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 64mmHg to 60mmHg; P=.006) and the diastolic blood pressure (from 50.5 to 48mmHg; P=.023) 1h after the initiation of the ketamine and propofol infusion, but this difference was not observed 12h 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.

Evaluation of Continuous Infusions of Dexmedetomidine versus Propofol as an Adjuvant to Ketamine in Patients Undergoing Elective Upper Limb Surgery under Brachial Plexus Block – A Randomized Control Trial

Abstract Background: The use of anesthetic ketamine at usual doses has been limited by side effects such as sympathetic stimulation, treatment-emergent delirium, and prolonged recovery time. Recently, there has been a growing interest in combining subanesthetic doses of ketamine with subanesthetic doses of drugs such as propofol and dexmedetomidine to mitigate the unwanted effects of ketamine. Hence, we aimed to compare the effectiveness, in terms of postoperative Aldrete scores, intraoperative pain, sedation scores, hemodynamic changes, respiratory effects, surgeon satisfaction, and postoperative delirium, of continuous infusions of ketamine with adjuvant dexmedetomidine versus continuous infusions of ketamine with adjuvant propofol among patients undergoing elective upper limb surgery under brachial plexus block. Methods: We performed a double-blind, randomized, controlled trial among 60 participants randomly allocated into two groups. Group A patients (n = 30) received ketamine 0.5 mg/kg mixed with dexmedetomidine 0.5 μg/kg in 100 mL/h lipid emulsion as an infusion, whereas Group B patients received ketamine 0.5 mg/kg mixed with propofol 1 mg/kg in 100 mL/h normal saline as an infusion. Results: The mean Aldrete score at 0 min, 30 min, and 1 h was significantly higher among Group B patients (P = 0.001, P = 0.001, and P = 0.043, respectively). The mean diastolic blood pressure at 2 h was significantly higher in Group A compared to Group B (87.8 vs. 77.8, P = 0.001). Similarly, the mean arterial pressure at 45 min and 90 min was significantly higher in Group A compared to Group B (97.1 ± 6.7 vs. 92.2 ± 6.0, P = 0.004; 95.5 ± 5.5 vs. 90.8 ± 6.3, P = 0.005, respectively). The mean sedation score was not significantly different between groups. Conclusion: Propofol, when used as an adjuvant to ketamine, provides better hemodynamic stability and better Aldrete score in patients who receive brachial plexus block for elective upper limb surgeries compared to adjuvant dexmedetomidine.

916: BENZODIAZEPINE BOLUSES VERSUS PROPOFOL OR DEXMEDETOMIDINE INFUSIONS IN CRITICALLY ILL ADULT PATIENTS

Introduction: Critically ill patients who require mechanical ventilation (MV) are administered sedative medications to promote compliance with the ventilator and reduce anxiety and agitation. Previous studies have shown worse outcomes with benzodiazepine infusions compared to infusions of propofol or dexmedetomidine. There are limited studies evaluating boluses of benzodiazepines titrated to lighter depths of sedation in this population. The purpose of this study is to compare MV days in patients who received PRN benzodiazepine doses vs. continuous infusion of propofol or dexmedetomidine. Methods: This was a single center, retrospective study of patients admitted to the medical intensive care unit (ICU) at Denver Health Medical Center from 2016 to 2020 requiring MV and sedated with either continuous infusion of propofol or dexmedetomidine (Infusion) vs. boluses of midazolam or lorazepam (Bolus). The primary outcome for this study is duration of MV. Secondary outcomes include average RASS score while on MV, ICU length of stay (LOS), 90-day mortality, delirium incidence, and hypotension requiring vasopressors. Results: 101 patients were included in the analysis;(50 in the Bolus group and 51 in the Infusion group). There were no significant differences between baseline characteristics in the two groups. For the primary outcome, the duration of MV in the Bolus group was 1 day [IQR 1-3] vs. 2 days [IQR 1-3.5] (P=.297) in the Infusion group. In the Bolus group, ICU LOS was 4 [IQR 2-6] vs. 3 days [IQR 1-4], (P=.009). The average RASS score was -0.85 in the Bolus group vs. -0.99 in the Infusion group, (P=1.6). 90-day mortality was 24% in the Bolus group vs. 2%, (P=.001). The incidence of ICU delirium was 70% vs. 65%, (P=.57). 70% of patients in the Bolus group compared to 49% in the Infusion group required vasopressors, (P=.03). Conclusions: There was no difference in the duration of MV between patients who received continuous infusions of propofol or dexmedetomidine vs benzodiazepine bolus sedation strategy. However, use of PRN boluses was associated with an increase in ICU LOS, 90-day mortality, and vasopressor use. Limitations include a retrospective study design and confounding factors such as acuity of illness as well as hemodynamic instability at baseline. Further study is warranted to confirm findings.

Developments in buffalo anaesthesia with special reference to diaphragmatic herniorrhaphy

Ruminants are poor subject for general anaesthesia. Diaphragmatic hernia (DH) is a common digestive disorder in buffaloes requiring balanced general anaesthesia for surgical repair. For premedication, initially, a combination of phenothiazine/chloralhydrate was used which was later replaced by alpha2 agonist like xylazine. Anticholinergics like atropine or glycopyrrolate were included in balanced anaesthetic protocols to reduce cardiac depression by alpha2 agonists. Thiobarbiturates historically were used for induction and maintenance but late recovery and cardiorepiratory depression lead to switch over to propofol. Maintenance of anaesthesia by top-up or continuous rate infusion (CRI) of propofol was not economical. The inclusion of opioids like butorphanol improved the analgesia as well as has dose sparing effect on induction and maintenance agent. The introduction of inhalants for maintenance significantly improved outcomes with the ease of change of depth of anaesthesia. It has also been observed that adrenocortical suppression by etomidate and mechanical intermittent positive pressure ventilation (IPPV) resulted in poor outcomes whereas maintaining the homeostasis and functional adreno-cortical axis of buffaloes under anaesthesia improves the success rate of DH surgeries. The balanced anaesthetic combination of Atropine/xylazine/ butorphanol/propofol/isoflurane has been found to be most satisfactory till date in buffaloes undergoing DH surgery. The studies on muscle relaxants, blood gas analysis and end tidal carbon dioxide (EtCO2) in buffaloes are scarce. Moreover, many drugs have been used in combinations in clinical cases on the basis of extrapolation from other species; but in buffaloes the effect of individual drug (like dose sparing effect of analgesics, minimum alveolar concentration (MAC) of inhalants) has to be still studied.

830: INCIDENCE OF HYPERTRIGLYCERIDEMIA IN PATIENTS ON PROPOFOL, CLEVIDIPINE, OR BOTH

Introduction: Drugs that are formulated in lipid emulsions can cause hypertriglyceridemia. However, the incidence rates of hypertriglyceridemia due to lipid emulsions are not well defined. Furthermore, there has not been an investigation of this issue in patients receiving both propofol and clevidipine concurrently. The purpose of this study is to evaluate the incidence of hypertriglyceridemia in patients who were exposed to propofol, clevidipine, or concurrent propofol and clevidipine. Methods: Adult patients who received at least 24 hours of continuous infusion of propofol and/or clevidipine were included. Patients were excluded if they did not have a triglyceride level drawn after at least 24 hours of infusion, had hypertriglyceridemia at baseline, were diagnosed with acute pancreatitis on admission, or received total parental nutrition with lipids. The main outcomes are the incidence of hypertriglyceridemia (defined by a triglyceride level greater than or equal to 400 mg/dL) and the median and peak triglyceride levels in the 3 groups. Secondary outcomes include hospital length of stay, ICU length of stay, total lipid infused, and time to peak triglyceride level. Results: A total of 190 patients were included in the study with 109 patients in the propofol group, 50 patients in the clevidipine group, and 31 patients in the concurrent infusion group. There was no statistical difference in the incidence of hypertriglyceridemia between propofol vs. clevidipine vs. both drugs concurrently [19 (17.4%) vs. 6 (12%) vs. 4 (12.9%) patients, p=0.6246]. Additionally, there was no difference found in the peak or median triglyceride levels between the three groups with peak levels of 216 mg/dL vs. 189.5 mg/dL vs. 205 mg/dL, (p=0.7069) and median levels of 177 mg/dL vs. 185.5 mg/dL vs. 177 mg/dL, (p=0.6791) for propofol, clevidipine, and both drugs concurrently, respectively. Conclusions: In our analysis, the incidence of hypertriglyceridemia ranged from 12% to 17.4% and was similar in patients on propofol, clevidipine, and both drugs concurrently. In addition, the three groups had similar peak and median triglyceride levels, and none of the patients included in the study developed pancreatitis. The results of this study suggest that frequent routine monitoring of triglyceride levels may not be necessary.

Agreement of high-definition oscillometry at two cuff locations with invasively measured arterial blood pressures in anaesthetised cheetahs

ObjectivesTo evaluate the agreement between high-definition oscillometry (HDO) used on the metatarsus or tail base with invasive arterial blood pressures measured in the dorsal pedal artery in anaesthetised cheetahs. Study DesignProspective clinical study. AnimalsA group of 13 captive adult cheetahs. MethodsCheetahs were immobilised with medetomidine (32–45 μg kg–1) and tiletamine/zolazepam (0.93–1.39 mg kg–1) administered intramuscularly, and anaesthesia was maintained with either isoflurane in oxygen or continuous propofol infusion. Invasive blood pressure was measured via a 20 gauge intra-arterial catheter in the dorsal pedal artery in the metatarsus and used as a reference method for pressures simultaneously estimated using HDO on the contralateral metatarsus and tail base. Bland–Altman plots (for repeated measurements) and criteria defined by the American College of Veterinary Internal Medicine (ACVIM) were used to compare agreement according to the anatomical location of the cuff, the anaesthetic maintenance agent and magnitude of the blood pressure. ResultsA total of 147 paired measurements were obtained with HDO on the metatarsus and 135 on the tail. Agreement with invasive pressures was better when HDO was used on the tail (rather than on the metatarsus) with all ACVIM criteria being met. Mean bias (a positive bias meaning that HDO overestimated the invasively measured pressures) ± standard deviation of differences for systolic, diastolic and mean arterial pressures were –7.0 ± 13.9, 4.2 ±12.1 and 4.6 ±11.2 mmHg, respectively, for HDO on the tail, and –11.9 ±15.1, 2.8 ±16.5 and 2.1 ±13.2 mmHg, respectively, for HDO on the metatarsus. Agreement was better during isoflurane anaesthesia than propofol, and at lower blood pressures than at higher. Conclusions and clinical relevanceWhen used on the tail base of anaesthetised cheetahs, HDO met the ACVIM validation criteria for a noninvasive device, as compared to invasively measured pressures in the dorsal pedal artery.

Effect of Propofol versus Sevoflurane Anesthesia on Acute Kidney Injury after Lung Transplantation Surgery: A Prospective Randomized Controlled Trial.

This prospective randomized controlled trial aimed to compare the effects of sevoflurane and propofol anesthesia on the occurrence of acute kidney injury (AKI) following lung transplantation (LTx) surgery. Sixty adult patients undergoing bilateral LTx were randomized to receive either inhalation of sevoflurane or continuous infusion of propofol for general anesthesia. The primary outcomes were AKI incidence according to the Acute Kidney Injury Network (AKIN) criteria and blood biomarker of kidney injury, including neutrophil gelatinase-associated lipocalin (NGAL) and cystatin C levels within 48 h of surgery. Serum interleukin (IL)-1β, IL-6, tumor necrosis factor-α, and superoxide dismutase were measured before and after surgery. The post-operative 30-day morbidity and long-term mortality were also assessed. Significantly fewer patients in the propofol group developed AKI compared with the sevoflurane group (13% vs. 38%, p = 0.030). NGAL levels were significantly lower in the propofol group at immediately after, 24 h, and 48 h post-operation. IL-6 levels were significantly lower in the propofol group immediately after surgery. AKI occurrence was significantly associated with a lower 5-year survival rate. Total intravenous anesthesia with propofol reduced the AKI incidence in LTx compared with sevoflurane, which is understood to be mediated by the attenuation of inflammatory responses.

USE OF BISPECTRAL INDEX (BIS) FOR MONITORING OF SEDATION AND TOTAL INTRAVENOUS ANESTHESIA (TIVA) IN PEDIATRIC PATIENTS UNDERGOING COLONOSCOPY

The objectives of this study were to determine whether there was a correlation between bispectral index (BIS) and Ramsey Sedation Scale (RSS) in regard to the type of sedation and total intravenous anesthesia (TIVA) during colonoscopy procedures in children, and to assess the utility of ketamine and propofol combination (ketofol) for this kind of procedures at children’s age. In our prospective study, 40 ASA I-II patients, 3 to 17 years of age, were randomly divided into two groups of 20 patients each. After premedication with atropine and midazolam, sedation was induced with propofol and fentanyl in Group PF, whereas in Group PK propofol and ketamine were used for induction. Both groups were further divided into two subgroups depending on whether anesthesia was maintained with intermittent doses or continuous infusion of propofol. Ketamine and/or fentanyl were administered as bolus doses. Heart rate (HR), peripheral oxygen saturation (SpO2), RSS and BIS values of all patients were recorded every 5 minutes throughout the colonoscopy procedures. The strongest degree of correlation between RSS and BIS existed when sedation or TIVA was maintained by the boluses of propofol and fentanyl. The use of ketamine significantly reduced the doses of propofol and fentanyl. BIS can be monitored in all pediatric patients in whom sedation and TIVA are administered during colonoscopy, but the effect of different anesthetics on the EEG signal should be considered in order to adequately assess the depth of sedation and anesthesia.Key words: awareness, monitoring, child, anesthetics, endoscopy

The incidence of propofol infusion syndrome in critically-ill patients.

PRIS is a potentially fatal syndrome characterized by various clinical symptoms and abnormalities. Experts suggest that propofol treatment duration ≥48 h or dose ≥83 μg/kg/min is associated with developing PRIS. We hypothesized PRIS might be underdiagnosed due to the overlap of PRIS clinical manifestations with critical illnesses. Multihospital, retrospective study of adult patients who received continuous propofol infusion ≥48 h or dose ≥60μg/kg/min for >24 h since admission were assessed for the development of PRIS. The incidence of PRIS was 2.9% with a PRIS-associated mortality rate of 36.8%. In PRIS patients, propofol was administered at a median dose of 36.4 μg/kg/min and over a median duration of 147.0 h. The development of PRIS was observed at a median of 125.0 h post-propofol initiation and a cumulative dose of 276.5 mg/kg. The development of metabolic acidosis (78.9%), cardiac dysfunction (52.6%), hypertriglyceridemia (100%), and rhabdomyolysis (26.3%) were observed in our PRIS patients. PRIS can often be overlooked and underdiagnosed. It is important to monitor for early signs of PRIS in patients who are on prolonged propofol infusion. Prompt recognition and interventions can minimize the dangers resulting from PRIS.

Anestesia total intravenosa en Tortuga (Chelonoidis carbonaria) sometido a plastrotomía para enterotomía: Reporte de caso

Chelonians are gradually more present in the routine of non-conventional animals in veterinary clinics, centers and hospitals, demanding vast knowledge of capable professionals to provide specialized care. In this way, the anesthesia of reptiles becomes even more challenging, since their anatomical and physiological characteristics are different when compared to other animal groups. The present study aimed to report the anesthetic techniques and procedures used in a specimen of a 10-year-old Red-footed tortoise (Chelonoidis carbonaria), weighing 1.54 kg. The chelonian was submitted to plastrotomy and enterotomy to remove foreign bodies. In his anamnesis, it was found that the animal had penile prolapse, constipation and severe tenesmus for four days. The radiographic evaluation revealed five radiopaque, amorphous and irregular structures in the colic region, which ranged from 2.04 cm to 0.50 cm, and after an unsuccessful attempt at conservative treatment, surgical treatment was chosen. As pre-anesthetic medication, dexmedetomidine (30 ug/kg), methadone (1 mg/kg), dextroketamine (10 mg/kg) and midazolam (1 mg/kg) were used. Subsequently, induction was performed with propofol (2.5 mg/kg) in the subcarapacial venous sinus, followed by venous access in the jugular vein with a 24G catheter and administration of an intravenous bolus of propofol (5 mg/kg). After muscle relaxation, the animal was intubated using a number 2.0 endotracheal tube (uncuffed) and continuous infusion of propofol at a rate of 100 ug/kg/min for anesthetic maintenance. Intraoperative analgesia was performed by coccygeal epidural block with lidocaine without vasoconstrictor (0.2 mL/5 cm of carapace). Among the physiological parameters monitored, heart and respiratory rate, capnography and cloacal temperature stand out, which remained stable throughout the anesthetic period. At the end of the procedure, dexmedetomidine and midazolam were reversed with atipamezole (0.03 mg/kg) and flumazenil (0.01 mg/kg), respectively. His extubation occurred 20 minutes after the end of the surgical procedure, and his post-anesthetic recovery was uneventful.

Effect of Different Doses of Propofol on Pulmonary Function and Inflammatory Response in Patients with Lung Ischemia Reperfusion Injury Induced by One-Lung Ventilation Based on Big Data Analysis.

Objective To analyze the effect of different doses of propofol on pulmonary function and inflammatory response in patients with lung ischemia reperfusion injury (LIRI) induced by one-lung ventilation (OLV) based on big data analysis. Methods A retrospective study was performed on 105 patients who underwent lobectomy in our hospital (January 2018 to January 2022). According to the doses of propofol, they were split into low-dose group (LDG), middle-dose group (MDG), and high-dose group (HDG), which received the continuous micropump infusion of propofol at the doses of 2 mg/(kg·h), 5 mg/(kg·h), and 10 mg/(kg·h) after induction, respectively, with 35 cases in each group. The indexes, such as the pulmonary function and inflammatory factors of patients, at different times were compared. The logistic regression analysis was performed according to the occurrence of LIRI. Results With no notable difference at T0 among the three groups (P > 0.05), the Cdyn levels significantly decreased at T1 (P < 0.05) and gradually increased at T2. The Cdyn levels at T1 and T2 were remarkably higher in HDG and MDG than in LDG (P < 0.05). With no notable differences at T0 and T1 among the three groups (P > 0.05), the PA-aO2 levels and RI values at T2 in MDG and HDG were lower compared with LDG (P < 0.05). The RI values at T1 and T2 in HDG were higher compared with MDG, with no obvious difference (P > 0.05). The OI levels at T1 and T2 in HDG were lower compared with the other two groups (P < 0.05), and the OI levels at T1, T2, and T3 in LDG were higher compared with MDG, with no obvious difference (P > 0.05). The TNF-α and ICAM-1 levels at T1 and T2 in MDG and HDG were lower compared with LDG, with no obvious difference between MDG and HDG (P > 0.05). Compared with LDG, the MDG and HDG at T1 and T2 had lower MDA levels (P < 0.05) and higher SOD levels (P < 0.05). Logistic regression analysis showed that Cdyn, PA-aO2, and OLV time were independent risk factors for LIRI in patients undergoing lobectomy. Conclusion Propofol has a good protective effect on lung function in patients with OLV-induced LIRI. Appropriately increasing the dose of propofol can effectively improve the local cerebral hypoxia and lung compliance of patients and reduce the inflammatory response and oxidative stress response, with 5 mg/(kg·h) as the clinical reference. Preoperative assessment and preparation should be made for patients, close attention should be paid to risk factors, such as Cdyn and PA-aO2, and OLV time should be controlled.