Sevoflurane-fentanyl Anesthesia Research Articles

Effect of Intraoperative Dexmedetomidine on Post-Craniotomy Pain

PurposePain management for patients who have undergone a craniotomy remains challenging. This study aimed to determine whether intraoperative dexmedetomidine could reduce postoperative pain, analgesic consumption, and possible adverse events in patients after craniotomy. MethodsEighty patients scheduled for elective supratentorial craniotomy under sevoflurane-fentanyl anesthesia were randomly allocated into two equal groups, to receive a continuous dexmedetomidine infusion of 0.5 µg/kg/h or placebo, beginning after induction and continuing until the start of skin closure. Intravenous tramadol (0.5 mg/kg) was administered to achieve an 11-point verbal rating scale (a discrete 0–10 scale) score of 4 or less in the postanesthesia care unit and, thereafter, on the ward. Pain scores, tramadol consumption, sedation scores, postoperative nausea and vomiting (PONV) scores, and other adverse events were recorded in the first 24 hours postoperatively. FindingsSeventy-six patients were included in the analyses. Demographic data, surgical characteristics, and sedation levels were similar between the groups. Dexmedetomidine reduced pain scores (30 minutes, P = 0.041; 2 hours, P = 0.021) and tramadol consumption (0–2 hours, P = 0.043; 0–6 hours, P = 0.006; 0–12 hours, P = 0.023; 0–24 hours, P = 0.040) postoperatively. Dexmedetomidine also reduced PONV scores at 20, 60, 90, 120, and 240 minutes (P = 0.038, 0.022, 0.018, 0.037, 0.016, respectively). The dexmedetomidine group exhibited fewer PONV events that required treatment (P = 0.005). ImplicationsIntraoperative dexmedetomidine infusion was effective for reducing pain and analgesic consumption after craniotomy. In addition, dexmedetomidine may help to reduce PONV in patients after craniotomy treated with tramadol postoperatively. Chinese Clinical Trial Register identifier: ChiCTR-TRC-13003598.

Anesthetic Management of a Child with Simpson-Golabi-Behmel Syndrome—A Case Report

Simpson-Golabi-Behmel syndrome (SGBS) is an X-linked recessive condition associated with pre-natal and postnatal overgrowth with visceral and skeletal anomalies. Abnormal airway anatomy may complicate the perioperative management of SGBS. However, there have been few reports regarding the anesthetic management of children with SGBS. We present the preoperative evalua-tion and intraoperative management of a 1.5-year-old child with SGBS undergoing plastic surgery for cleft palate. Sevoflurane-fentanyl anesthesia without a neuromuscular blocker was planned, due to the preoperative evaluation that airway management would be complicated by the macroglossia and short neck characteristic of SGBS. Fortunately, there was no difficulty in endotracheal intubation in the present patient due to careful planning of general anesthesia and meticulous airway management. Appropriate preoperative preparation for a difficult airway by the anesthe-siologist can ameliorate the difficulties inherent to the anesthetic management of patients with SGBS.

Influence of increased intracranial pressure on sevoflurane-fentanyl anesthesia in major abdominal surgery

Increased intracranial pressure (ICP) may adversely affect sevoflurane anesthesia and the recovery period due to a disturbed cerebral blood flow. Effect of sevoflurane on cerebral hemodynamics remains controversial and depends on the extent of the initial value of ICP [1]. This study was designed to evaluate the safety of sevoflurane- fentanyl anesthesia during major abdominal surgery in patients with increased ICP.

Is I-gel airway a better option to endotracheal tube airway for sevoflurane-fentanyl anesthesia during cardiac surgery?

Background:Anesthetists used lower doses of fentanyl, successfully with hemodynamic control by titrating volatile anesthetic agents or vasodilators for fast-tracking in cardiac surgery.Hypothesis:Lower total doses of anesthetics and fentanyl could be required with hemodynamic control by use of supraglottic devices than endotracheal tube (ETT) and helps in fast-tracking.Design:A prospective randomized observational clinical trial study.Aims:The authors compared the utility of I-gel airway with a conventional ETT during the induction and maintenance of anesthesia with sevoflurane and fentanyl in adults undergoing cardiac surgery.Patients and Methods:A total of 49 adult patients underwent cardiac surgery were randomized into two groups according to the airway management: I-gel group (n = 23) and ETT group (n = 26). Doses of fentanyl and hemodynamic parameters (heart rate [HR], mean arterial pressure [MAP] central venous pressure [CVP], pulmonary artery pressure [PAP], and pulmonary capillary wedge pressure [PCWP]) were recorded preoperative, 5 min following tracheal intubation or I-gel airway insertion, after skin incision, after stenotomy, and after weaning off bypass.Results:None of the patients in the I-gel group required additional doses of fentanyl during the I-gel insertion, compared with 74% of the patients during laryngoscopy and endotracheal insertion in the ETT group, for an average total dose of 22.6 ± 0.6 μg/kg. The MAP and HR did not significantly differ from the baseline values at any point of measurement in either group. Furthermore, CVP, PAP, and PCWP measured during the procedure were significantly lower in I-gel group than ETT group. Extubation required more amount of time in ETT than I- gel group.Conclusion:The I-gel airway is well-tolerated by adult patients undergoing cardiac surgery, and requires lower total doses of anesthetics than endotracheal intubation with hemodynamic control and helps in fast-tracking.

Comparison of sevoflurane-fentanyl anesthesia and propofolfentanyl total intravenous anesthesia during major abdominal surgery in patients with increased intracranial pressure

Comparison of sevoflurane-fentanyl anesthesia and propofolfentanyl total intravenous anesthesia during major abdominal surgery in patients with increased intracranial pressure

The combined effects of midazolam and propofol sedation on muscle power

We performed a randomised, crossover study to investigate the effects of intravenous sedation on grip strength and bite force. Twenty male volunteers received a bolus intravenous injection of midazolam (0.02 mg.kg(-1)) together with a 30-min propofol infusion designed to achieve an effect-site concentration of 1.0 μg.ml(-1). Observed variables included bispectral index, observer's assessment of alertness/sedation, correct answer rate of Stroop colour-word test, grip strength and bite force. Grip strength decreased from a median (IQR [range]) of 483 (443-517 [380-586]) N to 358 (280-405 [108-580]) N (p < 0.001) during sedation and recovered following flumazenil administration, while bite force increased from 818 (593-1026 [405-1406]) N to 1377 (1243-1585 [836-2357]) N (p < 0.001) during sedation. Although bite force gradually returned to baseline following flumazenil administration, it remained increased throughout the experimental period. We conclude that bite force increased during intravenous sedation and that this may have clinical implications.

Effects of aminophylline on cognitive recovery after sevoflurane anesthesia

Aminophylline accelerates the recovery from sevoflurane anesthesia. We studied the effects of escalating doses of aminophylline on cognitive and clinical recovery after sevoflurane anesthesia. After ethical approval and informed consent, 150 patients scheduled for elective surgery under sevoflurane-fentanyl anesthesia were randomly allocated to receive saline or 2, 3, 4 or 5mg/kg of aminophylline (n=30 for each) at the end of anesthesia (T (0)). Short Orientation Memory Concentration Test (SOMCT) scores, entropy values, end-tidal sevoflurane concentrations (EtSevo), times to eyes opening and extubation, respiratory rate (RR) and tidal volume (TV) were recorded. Compared to placebo, patients receiving 2, 3, 4 and 5mg/kg of aminophylline had higher SOMCT scores [median (25th percentile/75th percentile) 20.6 (19/23), 21.5 (21/22), 24.5 (24-25), 25.5 (25/26), respectively, vs. 13.5 (13/14) at 30min after extubation, and 24 (22/26), 25 (24/26), 27.5 (27-28), 27.5 (27/28), respectively, vs. 18.5 (18/19) at 45min after extubation], higher entropy values for the first 10min after T (0), lower EtSevo for the first 4min after T (0), shorter times to eyes opening [5 (4.0/6.0), 5 (4.0/6.0), 4 (2.0/5.5), and 4 (2.0/6.0), respectively, vs. 9.8 (8.0/11.0)min], shorter times to extubation, shorter times to home discharge (P<0.001), and higher RR and larger TV values. Patients who received 4 and 5mg/kg of aminophylline showed higher SOMCT scores, 6min shorter times to eyes opening and to extubation, and 58min shorter times to home discharge. The administration of escalating doses of aminophylline accelerates postoperative cognitive recovery from sevoflurane anesthesia, as measured by the SOMCT, due to increased ventilatory elimination of sevoflurane.

Plasma orexin A increases at emergence from sevoflurane-fentanyl anesthesia in patients undergoing ophthalmologic surgery

Central orexinergic and noradrenergic neurons are involved in the control of sleep and wakefulness. In addition, previous reports suggest that both neurons may have an important role to play in general anesthesia. In the present study, we have determined whether general anesthesia would affect plasma orexin A (OXA) and norepinephrine concentrations. Twelve patients scheduled for elective ophthalmic surgery under general anesthesia with sevoflurane, fentanyl and vecuronium were studied. Arterial blood was collected before and 1 and 2 h after induction of anesthesia and at emergence to measure plasma OXA, cortisol, norepinephrine and epinephrine concentrations. During anesthesia the inhalational concentration of sevoflurane was changed to maintain the bispectral index between 40 and 50. Plasma OXA, cortisol, norepinephrine and epinephrine did not change during anesthesia but significantly increased after emergence compared to pre-anesthesia (from 14.8 ± 1.7 to 21.4 ± 1.7 pM, p < 0.01, from 26.5 ± 5.2 to 52.8 ± 6.0 pM, p < 0.01, from 263 ± 46 to 513 ± 89 pM, p < 0.01, and from 1239 ± 120 to 1631 ± 203 pM, p < 0.01, respectively). There were significant correlations of plasma OXA with cortisol ( r = 0.334, p < 0.05) and epinephrine ( r = 0.292, p < 0.05) but not with norepinephrine. In conclusion we found that plasma OXA significantly increased at emergence from sevoflurane-fentanyl anesthesia and this was probably via activation of the hypothalamic-pituitary-adrenal axis.

Complications of sevoflurane–fentanyl versus midazolam–fentanyl anesthesia in pediatric cleft lip and palate surgery: a randomized comparison study

Careful choice of anesthetic agents in pediatric patients reduces the frequency of anesthesia-related complications. The frequency and type of intraoperative and postoperative complications of sevoflurane-fentanyl versus midazolam-fentanyl anesthesia were compared in 140 consecutive children (aged 3 months to 10 years) undergoing cleft lip and palate repair. Midazolam-fentanyl anesthesia was induced with midazolam (0.05 mg/kg), fentanyl (0.005 mg/kg) and vecuronium (0.1mg/kg), and maintained with the same agents according to the defined parametars. Sevoflurane-fentanyl anesthesia was induced and maintained with sevoflurane (5-8 vol% and 0.8-1 vol%, respectively) in an oxygen/air mixture and supplemented with fentanyl (0.005 mg/kg). Both groups were comparable in basic demographic data, hemodynamic and respiratory parameters. Difficult intubation occurred in 6 of 76 children (midazolam-fentanyl group) and 4 of 64 children (sevoflurane-fentanyl group) (P=0.754). Ventricular extrasystole and bronchospasm occurred in one patient each in the sevoflurane-fentanyl group. Postoperatively, emergence agitation was observed in the sevoflurane-fentanyl group (17 cases; P<0.001); postoperative nausea and vomiting occurred in 2 children (midazolam-fentanyl group) and 3 children (sevoflurane-fentanyl group) (P=0.660). Midazolam-based anesthesia in children is safer than sevoflurane-based anesthesia regarding occurrence of emergence agitation.

Omission of fentanyl during sevoflurane anesthesia decreases the incidences of postoperative nausea and vomiting and accelerates postanesthesia recovery in major breast cancer surgery

Our purpose was to investigate the effect of omission of fentanyl during sevoflurane anesthesia on the incidences of postoperative nausea and vomiting and on postanesthesia recovery in female patients undergoing major breast cancer surgery. Female patients (American Society of Anesthesiologists [ASA] physical status [PS] class I-II; age, 28-84 years) undergoing major breast cancer surgery were randomized to one of two anesthesia maintenance groups: sevoflurane-fentanyl anesthesia (SF; n = 25) or fentanyl-free sevoflurane anesthesia (S; n = 26). All patients were administered with propofol 2 mg x kg(-1) intravenously for anesthesia induction, a laryngeal mask airway was placed, and they received rectal diclofenac and local infiltration anesthesia. Anesthesia was maintained with sevoflurane in oxygen-air and they breathed spontaneously. The patients in group SF received fentanyl 0.1 mg intravenously and those in group S received normal saline during anesthesia. Group SF revealed higher incidences of postoperative nausea (68% vs 27%) and vomiting (32% vs 8%) in the first 24 postoperative hours than group S. The median (25th-75th percentile) length of time from postanesthesia care unit (PACU) admission to ambulation was significantly longer in group SF (n = 23) at 195 min (158-219 min), than in group S, at 141 min (101-175 min). Two patients in group SF could not walk during the PACU stay. Omission of fentanyl during sevoflurane anesthesia, combined with diclofenac and local infiltration anesthesia, decreases the incidences of postoperative nausea and vomiting and accelerates postanesthesia recovery in patients undergoing major breast cancer surgery.

Hemodynamic differences between propofol–remifentanil and sevoflurane anesthesia for repair of cleft lip and palate in infants

Propofol-remifentanil anesthesia is widely used in adults but few studies are available in infants. We aimed at comparing the hemodynamic effects of propofol-remifentanil vs sevoflurane-fentanyl anesthesia. In addition, we sought to investigate recovery and whether remifentanil induced acute opioid tolerance. In total, 39 infants 4-6 months old were prospectively enrolled and randomized to receive either a combination of remifentanil and propofol (n = 17) or a sevoflurane-fentanyl anesthesia (n = 22) for surgical repair of cleft lip and palate. In both groups, sevoflurane was used for induction of anesthesia and fentanyl was administered before tracheal extubation. Mean arterial blood pressure and heart rate were recorded every 5 min after induction. We also recorded time from termination of surgery to tracheal extubation, postoperative behavior and the need for analgesia for the first 24 h after surgery. Postoperative observations were blinded. In the remifentanil-propofol group, the mean arterial blood pressure was higher [58 (51-65) vs 51 (45-55), P = 0.02] and the mean heart rate was lower [111 (108-113) vs 128 (122-143), P < 0.0001]. There were no differences in recovery time or behavior after surgery. In the remifentanil group, a median fentanyl dose of 4 microg x kg(-1) was required to insure a smooth recovery, but there was no difference in morphine consumption during the first 24 h after surgery. A high-dose remifentanil-propofol infusion was associated with a higher blood pressure and lower heart rate than sevoflurane-fentanyl anesthesia in infants. Postoperative morphine consumption, recovery time and quality were similar.

Early increases in cardiac troponin levels after major vascular surgery is associated with an increased frequency of delayed cardiac complications

Objective To evaluate changes in cardiac troponin–I levels after major vascular surgery and their association with early and late postoperative cardiac complications. Design Prospective, observational investigation. Setting University teaching hospital. Patients 75 consecutive patients undergoing major vascular surgery. Interventions All patients received a standard sevoflurane-fentanyl anesthesia during the procedure. Blood levels of creatine kinase with MB subtype and cardiac troponin–I were assessed before surgery and then everyday for the first 3 days after surgery. At the same time, 12-lead electrocardiography was also performed, and occurrence of any cardiac adverse event was recorded. Patients were then followed up for 1 month after surgery. Measurement and Main Results Troponin-I levels increased in 25 patients (33%) during the first 3 days after surgery; 9 of these patients (12%) had myocardial infarction. At univariate analysis, uncontrolled hypertension was the only risk factor for perioperative infarction (odds ratio, 16; (95% confidence interval, 3-74); however, multivariate logistic regression analysis failed to show statistically significant associations. Increases in troponin-I had a 100% sensitivity and 75% specificity in detecting myocardial ischemia with a 36% positive and 100% negative predictive values. Severe cardiac complication 1 month after surgery was reported in 5 patients (6.6%). The increase of cardiac troponin-I levels during the first 3 postoperative days was associated with an increased frequency of major cardiac complication at 1-month follow-up ( P = 0.003), with a 100% sensitivity, 71% specificity, and 100% negative predictive value. Conclusions Myocardial infarction after major noncardiac vascular surgery occurs in up to 12% of cases. Perioperative monitoring of troponin-I plasma levels may help to identify patients at increased risk for cardiac morbidity not only early after surgery but also during the first postoperative month.

Changes of EEG in pediatric patients with cerebral palsy during sevoflurane-fentanyl anesthesia

Changes of EEG in pediatric patients with cerebral palsy during sevoflurane-fentanyl anesthesia

Magnesium and cardiovascular disease.

Magnesium and cardiovascular disease.