Sevoflurane Anesthesia Research Articles

Sevoflurane Alters Serum Metabolites in Elders and Aging Mice and Increases Inflammation in Hippocampus.

Postoperative cognitive dysfunction (POCD) is a central nervous system complication that occurs after anesthesia, particularly among the elderly. However, the neurological pathogenesis of postoperative cognitive dysfunction remains unclear. The aim of this study was to evaluate the effects of sevoflurane exposure on serum metabolites and hippocampal gene expression in elderly patients and aging mice by metabolomics and transcriptomic analysis and to explore the pathogenesis of sevoflurane induced POCD. Human serum samples from five patients over 60 years old were collected before sevoflurane anesthesia and 1 hour after anesthesia. Besides, mice aged at 12 months (n=6 per group) were anesthetized with sevoflurane for 2 hours or with sham procedure. Subsequently, serum and hippocampal tissues were harvested for analysis. Further investigation into the relationship between isatin and neuroinflammation was conducted using BV2 microglial cells. Sevoflurane anesthesia led to the activation of inflammatory pathways, an increased presence of hippocampal astrocytes and microglia, and elevated expression of neuroinflammatory cytokines. Comparative analysis identified 12 differential metabolites that exhibited changes in both human and mouse serum post-sevoflurane anesthesia. Notably, isatin levels were significantly decreased after anesthesia. Notably, isatin levels significantly decreased after anesthesia, a factor known to stimulate proliferation and proinflammatory gene expression in microglia-the pivotal cell type in inflammatory responses. Sevoflurane-induced alterations in serum metabolites in both elderly patients and aging mice, subsequently contributing to increased inflammation in the hippocampus.

Post-operative vomiting after pediatric strabismus surgery: A comparison of propofol versus sevoflurane anaesthesia.

Squint surgery is a risk factor for postoperative vomiting (POV) in children. This study was designed to compare the incidence of POV in children undergoing strabismus surgery under balanced anesthesia with sevoflurane versus intravenous anesthesia with propofol. In this prospective randomized controlled study conducted in a tertiary care ophthalmology hospital, 70 ASA I-II children aged 1-12 years undergoing strabismus surgery were randomized to two groups -Group S (sevoflurane-based anesthesia) and Group P (propofol-based anesthesia) for maintenance. The surgical details, intraoperative hemodynamic parameters, recovery characteristics, and emergence delirium were recorded. Any episode of postoperative vomiting in the 0-2 hours, 2-6 hours, and 6-24 hours period was noted. Rescue antiemetic was administered if there was more than one episode of vomiting. Both the groups were similar with respect to demographic and surgical details. The average duration of surgery was 118.2 ± 41.88 min in group S and 137.32 ± 39.09 min in group P (P = .05). Four children in group S (11.4%) and one child in group P (2.9%) had POV in the first 24 hours but this was not statistically significant (P = .36). The median time to discharge from post anesthesia care unit was significantly less (P = .02) in the P group (50 min) than in the S group (60 min). Propofol-based anesthesia does not offer advantage over sevoflurane, in reducing POV after squint surgery, when dual prophylaxis with dexamethasone and ondansetron is administered. It, however, reduces the duration of stay in the post anesthesia care unit.

Opioid-free anaesthesia reduces postoperative nausea and vomiting after thoracoscopic lung resection: a randomised controlled trial

BackgroundIntraoperative opioid use has a positive relationship with postoperative nausea and vomiting (PONV), and opioid-free anaesthesia (OFA) may reduce PONV. We investigated whether OFA compared with opioid-based anaesthesia would reduce PONV during the first 2 postoperative days among patients undergoing thoracoscopic lung resection. MethodsIn this randomised controlled trial, 120 adult patients were randomly assigned (1:1, stratified by sex) to receive either OFA with esketamine, dexmedetomidine, and sevoflurane, or opioid-based anaesthesia with sufentanil and sevoflurane. A surgical pleth index (SPI) of 20–50 was applied for intraoperative analgesia provision. All patients received PONV prophylaxis (dexamethasone and ondansetron) and multimodal analgesia (flurbiprofen axetil, ropivacaine wound infiltration, and patient-controlled sufentanil). The primary outcome was the occurrence of PONV during the first 48 h after surgery. ResultsThe median age was 53 yr old and 66.7% were female. Compared with opioid-based anaesthesia, OFA significantly reduced the incidence of PONV (15% vs 31.7%; odds ratio [OR]=0.38, 95% confidence interval [CI], 0.16–0.91; number needed to treat, 6; P=0.031). Secondary and safety outcomes were comparable between groups, except that OFA led to a lower rate of vomiting (OR=0.23, 95% CI, 0.08–0.77) and a longer length of PACU stay (median difference=15.5 min, 95% CI, 10–20 min). The effects of OFA on PONV did not differ in the prespecified subgroups of sex, smoking status, and PONV risk scores. ConclusionsIn the context of PONV prophylaxis and multimodal analgesia, SPI-guided OFA administration halved the incidence of PONV after thoracoscopic lung resection, although it was associated with a longer stay in the PACU. Clinical trial registrationChinese Clinical Trial Registry (ChiCTR2200059710).

Retracted: MFG-E8 Exerts Neuroprotection in Neural Stem Cells Induced by Anesthetic Sevoflurane via Regulating the PI3K/AKT Pathways.

[This retracts the article DOI: 10.1155/2022/5609501.].

Astrocyte-derived exosomes-transported miRNA-26a-5p ameliorates sevoflurane-induced cognitive dysfunction in aged mice

Prolonged sevoflurane anesthesia is the primary factor contributing to the development of perioperative neurocognitive disorders (PND). Recent studies have highlighted neuronal apoptosis and abnormal dendritic structures as crucial features of PND. Astrocytes-derived exosomes (ADEs) have been identified as carriers of microRNAs (miRNAs), playing a vital role in cell-to-cell communication through transmitting genetic material. Nevertheless, the specific mechanisms by which miRNAs in ADEs contribute to sevoflurane-induced cognitive deficit are currently unknown. Through a series of in vivo and in vitro experiments, we demonstrated that ADEs contributed to improved neurocognitive outcomes by reducing neuronal apoptosis and promoting dendritic development. Our miRNA microarray analysis revealed a significant increase in the expression level of miR-26a-5p within ADEs. Furthermore, we identified NCAM as the downstream target gene of miR-26a-5p. Subsequent gain- and loss-of-function experiments were conducted to validate the role of the miR-26a-5p/NCAM axis. Finally, we found that the AKT/GSK3-β/CRMP2 signaling pathway was involved in regulating neurons through exosomal miR-26a-5p. Taken together, our findings suggest that the treatment with miR-26a-5p in ADEs can improve neurocognitive outcomes induced by long-term sevoflurane anesthesia, suggesting a promising approach for retarding the progress of PND.

Higher Brain Uptake of Gentamicin and Ceftazidime under Isoflurane Anesthesia Compared to Ketamine/Xylazine.

We have recently shown that the volatile anesthetics isoflurane and sevoflurane acutely enhance the brain uptake of the hydrophilic markers sucrose and mannitol about two-fold from an awake condition, while the combined injection of the anesthetic agents ketamine and xylazine has no effect. The present study investigated two small-molecule hydrophilic drugs with potential neurotoxicity, the antibiotic agents ceftazidime and gentamicin. Transport studies using an in vitro blood-brain barrier (BBB) model, a monolayer of induced pluripotent stem cell-derived human brain microvascular endothelial cells seeded on Transwells, and LC-MS/MS analysis demonstrated the low permeability of both drugs in the range of sucrose, with permeability coefficients of 6.62 × 10-7 ± 2.34 × 10-7 cm/s for ceftazidime and 7.38 × 10-7 ± 2.29 × 10-7 cm/s for gentamicin. In vivo brain uptake studies of ceftazidime or gentamicin after IV doses of 25 mg/kg were performed in groups of 5-6 mice anesthetized at typical doses for surgical procedures with either isoflurane (1.5-2% v/v) or ketamine/xylazine (100:10 mg/kg I.P.). The brain uptake clearance, Kin, for ceftazidime increased from 0.033 ± 0.003 μL min-1 g-1 in the ketamine/xylazine group to 0.057 ± 0.006 μL min-1 g-1 in the isoflurane group (p = 0.0001), and from 0.052 ± 0.016 μL min-1 g-1 to 0.101 ± 0.034 μL min-1 g-1 (p = 0.0005) for gentamicin. We did not test the dose dependency of the uptake, because neither ceftazidime nor gentamicin are known substrates of any active uptake or efflux transporters at the BBB. In conclusion, the present study extends our previous findings with permeability markers and suggests that inhalational anesthetic isoflurane increases the BBB permeability of hydrophilic small-molecule endobiotics or xenobiotics when compared to the injection of ketamine/xylazine. This may be of clinical relevance in the case of potential neurotoxic substances.

Impact of propofol and sevoflurane anesthesia on cognition and emotion in gastric cancer patients undergoing radical resection.

Propofol and sevoflurane are commonly used anesthetic agents for maintenance anesthesia during radical resection of gastric cancer. However, there is a debate concerning their differential effects on cognitive function, anxiety, and depression in patients undergoing this procedure. To compare the effects of propofol and sevoflurane anesthesia on postoperative cognitive function, anxiety, depression, and organ function in patients undergoing radical resection of gastric cancer. A total of 80 patients were involved in this research. The subjects were divided into two groups: Propofol group and sevoflurane group. The evaluation scale for cognitive function was the Loewenstein occupational therapy cognitive assessment (LOTCA), and anxiety and depression were assessed with the aid of the self-rating anxiety scale (SAS) and self-rating depression scale (SDS). Hemodynamic indicators, oxidative stress levels, and pulmonary function were also measured. The LOTCA score at 1 d after surgery was significantly lower in the propofol group than in the sevoflurane group. Additionally, the SAS and SDS scores of the sevoflurane group were significantly lower than those of the propofol group. The sevoflurane group showed greater stability in heart rate as well as the mean arterial pressure compared to the propofol group. Moreover, the sevoflurane group displayed better pulmonary function and less lung injury than the propofol group. Both propofol and sevoflurane could be utilized as maintenance anesthesia during radical resection of gastric cancer. Propofol anesthesia has a minimal effect on patients' pulmonary function, consequently enhancing their postoperative recovery. Sevoflurane anesthesia causes less impairment on patients' cognitive function and mitigates negative emotions, leading to an improved postoperative mental state. Therefore, the selection of anesthetic agents should be based on the individual patient's specific circumstances.

Exploring effects of anesthesia on complexity, differentiation, and integrated information in rat EEG.

To investigate mechanisms underlying loss of consciousness, it is important to extend methods established in humans to rodents as well. Perturbational complexity index (PCI) is a promising metric of "capacity for consciousness" and is based on a perturbational approach that allows inferring a system's capacity for causal integration and differentiation of information. These properties have been proposed as necessary for conscious systems. Measures based on spontaneous electroencephalography recordings, however, may be more practical for certain clinical purposes and may better reflect ongoing dynamics. Here, we compare PCI (using electrical stimulation for perturbing cortical activity) to several spontaneous electroencephalography-based measures of signal diversity and integrated information in rats undergoing propofol, sevoflurane, and ketamine anesthesia. We find that, along with PCI, the spontaneous electroencephalography-based measures, Lempel-Ziv complexity (LZ) and geometric integrated information (ΦG), were best able to distinguish between awake and propofol and sevoflurane anesthesia. However, PCI was anti-correlated with spontaneous measures of integrated information, which generally increased during propofol and sevoflurane anesthesia, contrary to expectations. Together with an observed divergence in network properties estimated from directed functional connectivity (current results) and effective connectivity (earlier results), the perturbation-based results seem to suggest that anesthesia disrupts global cortico-cortical information transfer, whereas spontaneous activity suggests the opposite. We speculate that these seemingly diverging results may be because of suppressed encoding specificity of information or driving subcortical projections from, e.g., the thalamus. We conclude that certain perturbation-based measures (PCI) and spontaneous measures (LZ and ΦG) may be complementary and mutually informative when studying altered states of consciousness.

Effect of Dexmedetomidine versus Propofol on Sevoflurane related Emergence Agitation in Paediatric Patients: A Randomised Clinical Study

Introduction: Postoperative Emergence Agitation (EA) is a troublesome side-effect of sevoflurane anaesthesia. Drugs like dexmedetomidine and propofol offer significant benefits in reducing the incidence and severity of sevoflurane-related postoperative EA in paediatric patients. Aim: To compare the efficacy of intravenous dexmedetomidine and propofol in reducing the incidence and severity of EA associated with sevoflurane anaesthesia in paediatric patients. Materials and Methods: A randomised clinical study was conducted on 140 patients, belonging to American Society of Anaesthesiologists Physical Status (ASA PS) classes I and II, aged between 2-6 years, undergoing infraumbilical surgery lasting more than one hour. The patients were divided into two equal groups receiving dexmedetomidine 0.3 μg/kg (Group SD) and propofol 1 mg/kg (Group SP) at the start of skin closure, administered over 10 minutes. The incidence of EA in the Post Anaesthesia Care Unit (PACU) was evaluated using the Watcha scale, and the severity of EA was assessed using the Paediatric Anaesthesia Emergence Delirium (PAED) scale. A Watcha score of 3 or 4 indicated the presence of EA, while a PAED score of ≥12 was deemed significant. Statistical analysis of the data was performed using International Business Machines (IBM) Statistical Package for Social Sciences (SPSS) version 22.0, with an Independent sample t-test for comparing normally distributed quantitative parameters, and the Chi-square test for comparing categorical outcomes between the study groups. Results: The mean age of the patients in group SD was 4.19±0.78 years, and in group SP was 4.03±0.71 years. Both study groups were found to be comparable in terms of patient characteristics such as age, sex, weight, and duration of surgery (p-value >0.05). The incidence of postoperative EA, as measured by the Watcha scale, was higher in group SP compared to group SD upon arrival and up to 30 minutes in the PACU (p-value <0.001). The severity of EA, assessed using the PAED score, was greater in group SP compared to group SD at 0, 5, 10,15 and 20 minutes in the PACU (p-value <0.001). Conclusion: Dexmedetomidine 0.3 μg/kg was more effective than propofol 1 mg/kg in reducing the incidence and severity of EA associated with sevoflurane anaesthesia, with minimal haemodynamic effects and no clinically relevant severe adverse effects in both the groups. The significantly prolonged extubation times observed in the propofol group did not result in significantly longer stays in the PACU.

Effect of Propofol in Conjunction with Sevoflurane in Anesthesia of Individuals Undergoing Laparoscopic Cholecystectomy

Effect of Propofol in Conjunction with Sevoflurane in Anesthesia of Individuals Undergoing Laparoscopic Cholecystectomy

The clinical effect of sevoflurane anesthesia with laryngeal mask airway in the extraction of teeth in children.

To evaluate the effect of sevoflurane general anesthesia with laryngeal mask airway in the extraction of teeth. A retrospective analysis was performed on 88 children who underwent extraction of teeth in the Department of Anesthesiology of our hospital from June 2022 to April 2023, including 44 patients who received traditional anesthesia as the control group and 44 patients who received laryngeal mask airway sevoflurane general anesthesia as the observation group. Anesthesia and operation records of patients in the two groups were analyzed, including intraoperative vital signs, anesthesia induction time, recovery time of spontaneous breathing, first feeding time within 24 h after surgery, postoperative pain score, incidence of adverse reactions, Ramsay score and wake agitation, and other indicators were collected, and statistical analysis was conducted. The recovery time of the observation group was 7.88 ± 4.95 min, and the recovery time of spontaneous respiration was 10.58 ± 3.64 min, which were significantly shorter than 15.23 ± 5.12 min and 14.41 ± 3.56 min of the control group (P < 0.001). There were no significant differences between the two groups in anesthesia induction, operation duration and first feeding time within 24 h after operation (P > 0.05). There was no significant difference in postoperative pain scores between the two groups (P > 0.05). The overall incidence of adverse reactions was 6.82% in the observation group compared with 22.73% in the control group (χ² = 4.423, P = 0.035). In addition, the Ramsay score of the observation group was significantly improved compared with the control group (P < 0.05), and the incidence of agitation during the recovery period was also significantly decreased (P < 0.05). Laryngeal mask airway sevoflurane anesthesia can significantly accelerate the recovery process of children after extraction of teeth, and reduce the occurrence of adverse reactions, providing a safer and more efficient choice than traditional anesthesia.

Liproxstatin-1 alleviates ferroptosis in sevoflurane anesthesia-induced cognitive deficits of aged mice: The role oxidative stress.

In this study, we aimed to validate the hypothesis that the interplay between sevoflurane, oxidative stress and ferroptosis is crucial for the pathogenesis of sevoflurane-induced cognitive impairment in aged individuals. The mice with sevoflurane-induced cognitive impairment were used to explore the effects of sevoflurane on oxidative stress, iron homeostasis, and cognitive function in aged mice. Iron content and oxidative stress markers were analyzed in hippocampal tissue homogenates using specific assays. Additionally, the levels of iron death-related markers (Fth1 and Gpx4) were assessed by real-time PCR and Western blotting. Morris Water Maze and novel object recognition (NOR) tests were conducted to evaluate cognitive function. Sevoflurane exposure in aged mice resulted in a significant increase in iron overloading in the hippocampus, followed by a subsequent stabilization. Oxidative stress levels were elevated in the hippocampal tissue of sevoflurane-exposed mice, and a significant correlation was observed between iron death and oxidative stress. Liproxstatin-1, a ferroptosis inhibitor, effectively ameliorated the decline in memory and learning abilities induced by sevoflurane anesthesia. Liproxstatin-1 treatment reduced iron overload and oxidative stress in the hippocampal tissue of aged mice. The expression of Fth1 and Gpx4, iron death-related markers, was downregulated following Liproxstatin-1 intervention. Our findings suggest that sevoflurane anesthesia disrupts iron homeostasis, leading to increased oxidative stress and cognitive impairment in aged mice. These results highlight the potential of targeting iron-mediated processes to mitigate sevoflurane-induced cognitive impairment in the aging population.

In vivo imaging reveals a synchronized correlation among neurotransmitter dynamics during propofol and sevoflurane anesthesia.

General anesthesia is widely applied in clinical practice. However, the precise mechanism of loss of consciousness induced by general anesthetics remains unknown. Here, we measured the dynamics of five neurotransmitters, including γ-aminobutyric acid, glutamate, norepinephrine, acetylcholine, and dopamine, in the medial prefrontal cortex and primary visual cortex of C57BL/6 mice through in vivo fiber photometry and genetically encoded neurotransmitter sensors under anesthesia to reveal the mechanism of general anesthesia from a neurotransmitter perspective. Results revealed that the concentrations of γ-aminobutyric acid, glutamate, norepinephrine, and acetylcholine increased in the cortex during propofol-induced loss of consciousness. Dopamine levels did not change following the hypnotic dose of propofol but increased significantly following surgical doses of propofol anesthesia. Notably, the concentrations of the five neurotransmitters generally decreased during sevoflurane-induced loss of consciousness. Furthermore, the neurotransmitter dynamic networks were not synchronized in the non-anesthesia groups but were highly synchronized in the anesthetic groups. These findings suggest that neurotransmitter dynamic network synchronization may cause anesthetic-induced loss of consciousness.

Comparison of Propofol and Fentanyl for Preventing Emergence Agitation Following Sevoflurane Anesthesia in Pediatric Patients: A Single-Center Study in Bangladesh

Comparison of Propofol and Fentanyl for Preventing Emergence Agitation Following Sevoflurane Anesthesia in Pediatric Patients: A Single-Center Study in Bangladesh

An enriched environment promotes cognitive recovery and cerebral blood flow in aged mice under sevoflurane anaesthesia.

Sevoflurane is an inhalation anaesthetic agent widely used in clinical settings. Despite good surgical outcomes using sevoflurane, patients frequently develop postoperative cognitive dysfunction (POCD). An enriched environment (EE), as a rehabilitation technique, could provide objects and tools to facilitate neuromotor and visual stimuli and brain activity, and is reported to improve cognitive functions. We aim to investigate the impairments of sevoflurane inhalation on cognitive function in mice and determine the benefits of EE in ameliorating POCD. Eighteen-month-old mice were exposed to sevoflurane inhalation for 2 h and then placed in standard environment (SE) or EE cages. The mice without sevoflurane exposure in standard or EE cages were used as controls. The behavioural tests include Morris water maze, Y maze and novel object recognition. Magnetic resonance imaging (MRI) was used to determine the blood circulation in the brains. The proangiogenic factors (CD31, angiopoietin-1, vascular endothelial growth factor, and N-cadherin) and neurotrophic (brain-derived neurotrophic factor, post-synaptic density protein 95) expression in hippocampus of aged mice were evaluated by Western blotting and RT-PCR analysis. Sevoflurane-exposed mice demonstrated reduced performance in learning, memory and spatial memory tests. Enriched environment improved the behavioural performance of sevoflurane-exposed animals. Sevoflurane exposure reduced the blood flow in the brains, and these effects were ameliorated by EE habitation. The EE also promoted the expression of angiogenic and neurotropic factors in sevoflurane-exposed animals. In summary, EE is effective in ameliorating the side-effects of sevoflurane exposure in aged mice.

Investigating the Effect of Dexmedetomidine in Controlling Postoperative Emergence Agitation in Children under Sevoflurane Anesthesia.

Emergence agitation (EA) is one of the common problems during recovery from general anesthesia, especially in children. In this study, we investigated the effect of dexmedetomidine on the control of agitation after anesthesia with sevoflurane in children. This randomized control-placebo, double-blind prospective clinical trial was conducted on seventy-six children between 2 and 7 years with ASA (American Society of Anesthesiologists) class I who were candidates for elective adenoidectomy surgery and tonsillectomy. Participants were selected by an available sampling method. Patients were randomly placed in one of the two groups D (dexmedetomidine 0.5 μg/kg infusion within ten minutes) or P (placebo: normal saline infusion within ten minutes). A four-point scale evaluated agitation. Pain evaluation was done by FLACC (faces, legs, activity, cry, and consolability). The statistical software was SPSS version 23. P < 0.05 was considered statistically significant. The level of agitation was significantly lower in the intervention group (P < 0.05), except after 40 minutes in the PACU (Post Anesthesia Care Unit) (P=1.00). Patients in the control group experienced high pain scores when admitted at PACU, 10, 20, and 30 minutes after admission at PACU (P < 0.05). Pethidine and metoclopramide prescriptions in the intervention group were lower than in the control group (P < 0.05). Shivering occurred in five patients in the intervention group and nine in the control groups (P=0.032). Hypotension that required intervention occurred in 3 patients in the intervention group and one in the control group (P=0.024). Our trial demonstrated that the prescription of 0.5 μg/kg of dexmedetomidine within ten minutes after intubation significantly reduced the EA frequency, pain severity, analgesic consumption, and PONV (postoperative nausea and vomiting). However, it caused delays in the emergence from anesthesia. This trial is registered with IRCT20160430027677N14.

Do volatile anaesthetics depress urine output?

Urine output is markedly reduced by isoflurane, but it is unclear whether the decrease is a specific effect of volatile anaesthetics. Therefore, this study compared the diuretic response to crystalloid volume loading during surgical procedures performed with volatile anaesthetics or intravenous anaesthesia. Data from two clinical trials in which patients were randomized between isoflurane and propofol anaesthesia (open thyroid surgery, n = 29) and between sevoflurane and propofol anaesthesia (open hysterectomy; n = 25) were analysed. Urine volume was measured and the diuretic response to volume loading with 1.7-1.8 L of Ringer's solution over 30 min was studied by population volume kinetic analysis. The kinetic method used 631 measurements of plasma dilution based on blood haemoglobin and plasma albumin and 138 measurements of urine output to quantify the diuretic response to volume loading in the four study groups. The urine output after 150 min of thyroid surgery was 132 (77-231) mL in the propofol group and 218 (80-394) mL in the isoflurane group ( P = 0.50; median and interquartile range). The corresponding volumes were 50 (45-65) mL for propofol and 60 (34-71) mL for sevoflurane at 90 min in the hysterectomy patients ( P = 0.81). The kinetic analysis, which corrected for differences in infused volume, body weight, and plasma volume expansion, did not reveal any statistically significant differences in diuretic response to volume loading between the two inhaled anaesthetics and intravenous anaesthesia. Isoflurane and sevoflurane did not affect urine output more strongly than propofol.

The Impact of Various Anesthetic Techniques on Cerebral Oxygenation during Spinal Surgery Performed in a Prone Position with Controlled Hypotension

Background: While prone positioning during anesthesia is necessary for certain surgical procedures, it also increases the risk of postoperative neurological complications. This risk is exacerbated by controlled hypotension used to minimize blood loss during spinal surgeries. Monitoring regional cerebral oxygen saturation (rScO2 ) is essential for maintaining cerebral oxygenation and preventing adverse outcomes like cognitive dysfunction and organ failure. This study aimed to evaluate the effect of different anesthetic techniques on cerebral oxygenation in patients undergoing spinal surgery in the prone position with controlled hypotension. Methods: Fifty-four patients scheduled for spinal surgery in a prone position with controlled hypotension were randomly assigned into two equal groups, to receive sevoflurane or propofol anesthesia. Data were collected at various intervals: before and after anesthesia induction, post-induction in the prone position, during surgery, and before awakening in the supine position. Parameters recorded included rScO2 , peripheral oxygen saturation (SpO2), heart rate (HR), patient state index (PSI), end-tidal carbon dioxide tension (ETCO2 ), and mean arterial pressure (MAP). Results: rScO2 levels decreased in both patient groups once positioned in the prone position. However, the rScO2 values were significantly lower in the propofol group compared to the other group (p = 0.025, 0.032 respectively). Conclusion: The study suggests that propofol as the anesthetic agent may have exacerbated the decline in cerebral oxygenation associated with the transition to prone positioning. Sevoflurane might thus be preferable for patients at risk of compromised cerebral oxygenation.

Drug utilization study of pre-anesthetic, intraoperative, and post-operative medications use in various surgeries of orthopedic and surgery department of tertiary care teaching hospital

Background: Every year millions of patients undergo surgery. The prescribing pattern of medications in patients undergoing surgery may differ based on the hospital setup, profile of the patient, and type of surgical procedure. Hence, the present study is undertaken to know the prescribing pattern of pre-anesthetic, intraoperative, and post-operative agents in surgery and orthopedic department. Aims and Objectives: The aim of this study was to analyze the pattern of pre-anesthetic, intraoperative and post-operative medications used in surgery and orthopedic departments at a tertiary care teaching hospital. Materials and Methods: This cross-sectional, observational study was conducted in the departments of surgery and orthopedic in a tertiary care teaching hospital after taking approval from Institutional Ethics Committee. The details of demographic, clinical data and drugs prescribed during the pre-operative, intraoperative, and post-operative period were recorded in a preformed case record form and analyzed using descriptive statistics. Results: A total of 400 patients prescriptions were collected and analyzed which included 244 patients in orthopedic department and 156 patients in the surgery department. The average number of drugs per encounter was 10.01 and 7.25 in the surgery and orthopedic department, respectively. Preoperatively, the majority of patients received ondansetron (99.5%) followed by glycopyrrolate, midazolam, tramadol, and ranitidine. Surgery was done either under general anesthesia (sodium thiopental and sevoflurane) or local anesthesia (Bupivacaine). Skeletal muscle relaxants used along with general anesthetics included succinylcholine, atracurium, and vecuronium. Postoperatively, antimicrobial agents (AMAs) (831) were most commonly used followed by analgesic agents (368). The majority of AMAs were used from “Watch group” (50%) compared to “Access group” (38.88%) (World Health Organization-Access, Watch, Reserve classification). Conclusion: The present study gives an insight into the use of pre-anesthetic, intraoperative, and post-operative medications in our set-up. Generic medicines are used more which is good as it reduces the cost. Post-operative antimicrobial usage was more from the “Watch group” compared to the “Access group,” which is a concern and needs implementation of antibiotic policy.

Influencing Factors of Delirium during Recovery in Urological Postoperative Patients Undergoing Sevoflurane Anaesthesia.

To analyse the incidence and influencing factors of delirium during recovery in urological postoperative patients undergoing sevoflurane anaesthesia. The clinical data of patients undergoing sevoflurane anaesthesia in the urology surgery department in our hospital from January 2022 to December 2022 were retrospectively analysed. The incidence of delirium during the recovery period was recorded by using the Chinese version of the Confusion Assessment Method (CAM) for Severity of Delirium after surgery, and the patients were divided into occurrence and non-occurrence groups. Whether delirium occurred during recovery was determined through univariate analysis. In binary logistic regression analysis, the occurrence of emergence delirium was the dependent variable, and the variables with statistical differences in the univariate analysis were the independent variables. The influencing factors of emergence delirium in post-urological surgery patients who underwent sevoflurane anaesthesia were determined. Delirium during recovery occurred in 10 of 100 patients (10.00%). Odds ratio (OR) of age (OR = 1.445, p = 0.022), history of diabetes (OR = 1.798, p = 0.010), operation time (OR = 1.670, p = 0.008), American Society of Anesthesiologists (ASA) classification (OR = 1.740, p = 0.006) and sevoflurane inhalation concentration (OR = 1.890, p = 0.001) are the influencing factors of postoperative delirium in urologic patients undergoing sevoflurane anaesthesia. Age, history of diabetes, operation time, ASA classification and sevoflurane inhalation concentration are the influencing factors.