Sevoflurane For Maintenance Of Anesthesia Research Articles

Estimation of carbon emissions associated with tibial plateau levelling osteotomies in 10 dogs

ObjectiveTo describe a method of estimating the carbon emissions resulting from 10 clinical canine surgical procedures. Study designProspective observational cohort study. AnimalsA total of 10 adult client-owned dogs presenting to two private referral centres in the UK for tibial plateau levelling osteotomy (TPLO) using either isoflurane or sevoflurane for maintenance of anaesthesia. MethodsSingle-use consumables, pharmaceuticals and waste streams were recorded. Volatile anaesthetic use was calculated based on fresh gas flow (FGF) and vaporizer setting. Travel of owners and staff involved in the procedure was recorded (the latter adjusted by procedure length relative to working day). Energy use was calculated based on the clinic’s monthly usage adjusted for floor area of rooms used. Overnight hospitalisation, kennelling consumables and a revisit for postoperative radiography were excluded. Carbon accounting was performed using published carbon conversion factors (‘bottom-up analysis’) if available, or conversion factors based on cost (‘top-down’). Data are presented as median (range) and totals per emission category. ResultsCarbon emissions from all cases amounted to 667.2 kgCO2e. In these two clinics, median carbon emissions from a canine TPLO were 63.5 (47.6–93) kgCO2e, which is equivalent to driving 372 km (231 miles) in an average UK passenger car. Travel accounted for 30.1% of carbon emissions. Volatile anaesthetics accounted for 21.4% of carbon emissions, with other pharmaceuticals accounting for 24.0%. Consumables, building energy and waste disposal accounted for 19.7%, 3.9% and 0.9% of carbon emissions, respectively. Conclusionsand clinical relevanceand clinical relevance Likely carbon hotspots for canine orthopaedic procedures include travel and pharmaceuticals, particularly volatile anaesthetic agents. Carbon reductions should focus on reducing travel emissions, streamlining pharmaceutical use and lower-carbon anaesthetic techniques. Future research should focus on improving carbon accounting methodology and widening the range of cases assessed.

Anaesthetic Management during Balloon Atrial Septostomy in Transposition of Great Arteries

<strong>Background: </strong>Transposition of the great arteries (TGA) is a congenital heart defect that can cause death in 30% of the first week of birth, 50% in the first month, 70% in 6 months, and 90% in the first year, thus requiring immediate corrective action in neonates with rapid early detection. The purpose of this case study is to highlight management considerations in TGA cases in the Balloon Atrial septostomy (BAS) procedure.<p><strong>Discussion:</strong> A 1-day-old newborn girl was brought to Dr. Moewardi General Hospital in February 2022. The patient had a history of cyanosis when she cried and was born with an APGAR score of 6.7.8. The lips were cyanotic on physical examination, with a SpO2 of 77% with a nasal O2 of 2 lpm. The echocardiography results obtained TGA, ASD II, PFO, and PDA. The patient then underwent a BAS procedure. Anesthesia management was performed using ketamine for induction, air bar, O2, and sevoflurane for maintenance of anesthesia. The operation was successful, and postoperative care was carried out. Anesthesia management aims to keep SVR and PVR to a minimum, with a PVR lower than SVR, to prevent desaturation in the patient. A decrease in PVR also can increase pulmonary blood flow, allowing more blood to be mixed and higher oxygen saturation in the blood for the patient.</p><p><strong>Conclusion:</strong> The principle of anesthesia management in TGA cases is to avoid a reduction in cardiac output and SVR and keep the PVR lower than the SVR.</p>

Comparison of the median effective concentration (EC50) and effect of sevoflurane with or without remifentanil in cesarean section with supreme laryngeal mask under narcotrend monitoring: a randomized trial.

Remifentanil combined with sevoflurane is a standard protocol for obstetric general anesthesia (GA). In this study, we performed a randomized clinical trial to evaluate whether remifentanil has an effect on the median effective concentration (EC50) of sevoflurane and compare anesthetic outcomes of them in cesarean section with Supreme™ laryngeal mask airway (SLMA) under narcotrend monitoring. Ninety parturients with singleton births undergoing elective cesarean delivery (CD) with initial inhaled 1.0 minimum alveolar concentration (MAC) sevoflurane for anesthesia maintenance were assigned to three groups randomly and evenly: Group A (0.05 µg·kg-1·min-1 remifentanil combined with sevoflurane), Group B (0.1 µg·kg-1·min-1 remifentanil combined with sevoflurane), and Group C (normal saline combined with sevoflurane). Narcotrend was used to monitor the depth of anesthesia during the operation, with the level of anesthesia depth controlled within the D-E stage. The EC50 of sevoflurane was determined by Dixon's sequential method. The Narcotrend index, amount of bleeding, neonatal Apgar score, and corresponding treatment measures in the three groups were recorded. The results showed that the estimated EC50 of sevoflurane for obstetric GA was 0.80 MAC (95% CI: 0.63-0.95 MAC) in group A, 0.82 MAC (95% CI: 0.63-0.96 MAC) in group B, and 0.80 MAC (95% CI: 0.63-0.95 MAC) in group C. There was no statistically significant difference in the estimated EC50 of sevoflurane, time to wakefulness, Apgar score, amount of intraoperative bleeding, and postoperative bleeding within 24 hours between the three groups (all P>0.05). The addition of remifentanil at 0.05-0.1 µg·kg-1·min-1 did not change the EC50 of sevoflurane and anesthetic quality. The concentration of inhaled anesthetics can be minimized with Narcotrend monitoring. Chinese Clinical Trial Registry ChiCTR2000034512.

Comparison of recovery profiles of propofol and sevoflurane anesthesia with bispectral Index monitoring In general anesthesia: Running title: Recovery profiles: Propofol vs sevoflurane

Introduction: Introduction of more rapid and short-acting volatile anesthetics and intravenous anesthetics has allowed anesthesiologists to achieve a recovery profile that facilitates rapid emergence after general anesthesia. Both propofol and sevoflurane provide rapid induction and faster recovery by titrating the depth of anesthesia based on the BIS Index during maintenance. The objectives of the study were analysis of hemodynamic parameters, changes in the BIS Index, recovery characteristics, postoperative complications. Methods: Following IRB approval, an observational study was conducted in 60 patients of ASA grade I-II, aged 18-60 years undergoing surgical procedures under general anesthesia. Patients were randomly divided into two groups, with 30 patients each receiving propofol infusion (Group P) or sevoflurane (Group S) to maintain anesthesia. The requirement of anesthetic agents was titrated by BIS monitoring. BIS score was held between 40 to 60. Results: Hemodynamic parameters like heart rate and mean arterial pressure (MAP) were comparable in both groups. During recovery, the meantime to spontaneous ventilation, eye-opening, hand squeezing, following verbal command, extubation, stating the name, and mean time to achieve modified Aldrete's score of ≥ 9 from the cessation of the anesthetic drug was significantly shorter in Group S as compared to Group P. PONV was noted as a postoperative complication in the sevoflurane group. Conclusion: In our study, sevoflurane provided rapid emergence and faster recovery with stable hemodynamic. However, propofol appears to be an excellent alternative to sevoflurane for maintenance of anesthesia as it also provides fast recovery with a lower incidence of PONV

Atelectasis prevention during anaesthesia using high-flow nasal cannula therapy: A paediatric randomised trial using MRI images

BackgroundAtelectasis frequently occurs early on during anaesthesia in children. We hypothesised that positive expiratory pressure (PEP) generated via high-flow nasal cannula (HFNC) could prevent atelectasis in non-intubated children under general anaesthesia. The objective was to compare the volume of atelectasis present in patients treated via HFNC to that of patients treated via a face bag-mask without PEP. The outcome used for this comparison was the ratio of the atelectasis volume to the total pulmonary volume. MethodsA prospective single-centre, single-blind, randomised trial was conducted in a tertiary hospital from November 2018 through May 2019. The trial subjects were infants and children between six months and six years of age who required anaesthesia for an MRI. The children were randomised to receive sevoflurane for maintenance of anaesthesia either via a classic face bag-mask or by HFNC. The atelectasis volume was measured from thoracic MRI images. The judgement criterion was the ratio of the atelectasis volume to the lung volume. ResultsOf a trial group of 42 patients, 21 received anaesthesia via a face bag-mask and 21 via HFNC. After three patients were excluded for technical issues, the data for 39 patients were analysed. The atelectasis volume to the lung volume ratio in the HFNC group was significantly smaller than the ratio for the face bag-mask group (1.6% vs 6.8%, respectively; p=0.002). ConclusionHFNC was associated with a lower atelectasis lung ratio compared to using a face bag-mask during anaesthesia for children maintained with spontaneous ventilation. Registered on Clinicaltrials.gov: NCT 03592589

Comparison of propofol and sevoflurane on cerebral oxygenation using juglar venous oximetery (SjVo2) in patients undergoing surgery for traumatic brain injury

Background:Traumatic brain injury (TBI) induces major insult to the normal cerebral physiology. The anesthetic agents may infrequently produce deleterious effects and further aggravate damage to the injured brain. This study was conducted to evaluate the effects of propofol and sevoflurane on cerebral oxygenation, brain relaxation, systemic hemodynamic parameters and levels of interleukin-6 (IL-6) in patients with severe TBI undergoing decompressive craniectomy.Methods:A prospective randomized comparative study was conducted on 42 patients undergoing surgery for severe TBI. Patients were randomized into two groups, Group P received propofol and Group S received sevoflurane for maintenance of anesthesia. All patients were induced with fentanyl, propofol, and vecuronium. The effect of these agents on cerebral oxygenation was assessed by jugular venous oxygen saturation (SjVO2). Hemodynamic changes and quality of intraoperative brain relaxation were also assessed. The serum levels of IL-6 were quantitated using enzyme-linked immunosorbent assay technique.Results:SjVO2 values were comparable and mean arterial pressure (MAP) was found to be significantly lower in Group P as compared to those in Group S (P < 0.05). Brain relaxation scores were comparable between the groups. The level of IL-6 decreased significantly at the end of surgery compared to baseline in patients receiving sevoflurane (P = 0.040).Conclusions:Cerebral oxygenation measured by SjVO2 was comparable when anesthesia was maintained with propofol or sevoflurane. However, significant reduction in MAP by propofol needs attention in patients with severe TBI. The decrease in IL-6 level reflects anti-inflammatory effect and probable neuroprotective potential of propofol and sevoflurane.

Desflurane is not inferior to sevoflurane in the occurrence of adverse respiratory events during laryngeal mask airway anesthesia: a non-inferiority randomized double-blinded controlled study.

Compared to sevoflurane, desflurane is less favorable to most anesthesiologists for laryngeal mask airway (LMA) anesthesia because desflurane has a pungent odor. This non-inferiority study aimed to determine whether desflurane is not worse than sevoflurane in triggering airway irritations during general anesthesia using LMA. Patients scheduled for elective surgery under LMA anesthesia were randomly allocated to receive either desflurane or sevoflurane for maintenance of anesthesia. After intravenous fentanyl, lidocaine and propofol administration followed by LMA insertion, 0.5-1.0 MAC of the volatile anesthetic in 50% N2O was maintained throughout the surgery. The primary outcome was the occurrence of perioperative adverse respiratory events. Other outcomes included recovery profiles, hemodynamic changes and postoperative complications. One-hundred and ten patients per group completed the study without any serious complications, lost to follow-up, or protocol deviation. During awake LMA removal, patients in the desflurane group experienced lesser episodes of laryngospasm (risk difference, -7.3%; 95% CI, -12.7% to -1.9%; P=0.009) than those in the sevoflurane group. The emergence time and time to LMA removal were significantly shorter in the desflurane group. The quality of recovery indicated by an ability to self-transfer from bed to bed was significantly better after desflurane anesthesia. No difference between groups was found in a return of orientation and a readiness for post-anesthesia care unit discharge. Desflurane is non-inferior to sevoflurane in the occurrence of laryngospasm at emergence after LMA anesthesia. The superiority of desflurane compared to sevoflurane with regards to respiratory complications requires further investigation.

Anaesthesia maintenance with propofol versus sevoflurane to reduce postoperative pain: Still too early for recommendations?

Anaesthesia maintenance with propofol versus sevoflurane to reduce postoperative pain: Still too early for recommendations?

Impact of Anesthesia on Long-term Outcomes in Patients With Supratentorial High-grade Glioma Undergoing Tumor Resection: A Retrospective Cohort Study.

Intravenous and inhalational anesthesia might have different associations with long-term outcome in cancer patients, with reports of adverse effects of inhalation anesthesia. However, the effects of anesthesia in patients with high-grade glioma (HGG) are not known. This study investigated 154 patients who received propofol and 140 patients who received sevoflurane for maintenance of anesthesia during HGG tumor resection. The primary outcomes were progression-free survival and overall survival. Median progression-free survival was 10 months (interquartile range [IQR], 6 to 18) versus 11 months (IQR 6 to 20; P=0.674), and median overall survival was 18 months (IQR, 11 to 39) versus 18 months (IQR, 10 to 44; P=0.759) in patients maintained with propofol and sevoflurane, respectively. Higher preoperative Karnofsky performance status and postoperative chemotherapy were associated with a reduced hazard of tumor progression or death, whereas higher age-adjusted Charlson comorbidity index and longer duration of anesthesia were associated with an increased hazard of progression or death. World Health Organization tumor classification IV and incomplete tumor resection were associated with an increased hazard of tumor progression but not death. Anesthesia maintenance with sevoflurane increased the risk of death in patients with Karnofsky performance status <80 compared with propofol (hazard ratio, 1.66; 95% confidence interval, 1.08-2.57; P=0.022). Compared with maintenance of anesthesia with propofol, sevoflurane did not worsen progression-free or overall survival in patients with HGG undergoing tumor resection. However, propofol might be beneficial in patients with poor preoperative Karnofsky performance status.

To Compare Propofol and Sevoflurane for Maintenance of Anaesthesia on Recovery Characteristics and Cognitive Functions: A Randomised Control Trial

To Compare Propofol and Sevoflurane for Maintenance of Anaesthesia on Recovery Characteristics and Cognitive Functions: A Randomised Control Trial

Comparison of Recovery Profile of Propofol, Sevoflurane, and Desflurane Anesthesia in Transnasal Trans-sphenoidal Surgery for Pituitary Tumors: A Prospective Randomized Trial

Abstract Background Smooth and early emergence is always a concern in neurosurgical patients as it prevents complication and facilitates neurological examination and immediate postoperative intervention, if necessary. Methods A prospective randomized trial was conducted to evaluate the effects of propofol, sevoflurane, and desflurane used for maintenance of anesthesia at the time of emergence and recovery from anesthesia in 75 patients undergoing elective trans-sphenoidal surgery for pituitary tumors. We evaluated time for emergence and extubation, modified Short Orientation Memory Concentration Test (SOMCT) score, Aldrete's scores, pain score, and postoperative nausea and vomiting (PONV) score. Results Emergence and extubation times were significantly shorter in patients receiving desflurane as compared with those receiving propofol or sevoflurane (p &lt; 0.001). Modified SOMCT and Aldrete's scores were comparable in all the three groups with better cognitive scores in patients who received desflurane. Heart rate and mean arterial pressure were comparable at emergence and extubation in all the three groups except mean airway pressure (MAP) at extubation that was higher in the desflurane group compared with propofol and sevoflurane groups (p = 0.02), which was clinically comparable. Pain and PONV scores were also comparable between the groups. Conclusions Desflurane had shorter time to emergence and time to extubation in comparison to propofol and sevoflurane. Thus, desflurane can be used as an alternative to propofol and sevoflurane for maintenance of anesthesia in patients undergoing transnasal trans-sphenoidal pituitary surgery for its excellent recovery profile after anesthesia.

A randomised trial to compare the increase in intracranial pressure as correlated with the optic nerve sheath diameter during propofol versus sevoflurane-maintained anesthesia in robot-assisted laparoscopic pelvic surgery.

Robot-assisted surgery can cause raised intracranial pressures (ICP) due to steep trendelenburg position and pneumoperitoneum. The choice of anesthetic agents can influence the ICP, which can be measured indirectly by correlating it with the sonographically measured optic nerve sheath diameter (ONSD). In this study, our primary aim was to compare the change from baseline of the ONSD during propofol versus sevoflurane-maintained anesthesia in patients undergoing robotic pelvic surgery. In this prospective, interventional, double-blinded study, we randomised 50 patients into two groups P and S. Subjects in group P received intravenous propofol infusion while those in group S received inhalation sevoflurane for maintenance of anesthesia. The ONSD at fixed intervals was noted as the mean of four values measured using ultrasound in both eyes by two independent anesthesiologists who were blinded to the group allocation. The patient demographics and baseline parameters were similar. The mean maximum rise in ONSD from baseline was 0.01 ± 0.01cm in group P while it was 0.03 ± 0.01cm in group S (p = 0.001). Percentage change from baseline in group P was 3.41 ± 1.81% and 8.00 ± 2.95% in group S (p = 0.001). We found a positive correlation between the duration of surgery and the maximum rise in ONSD in group S (p = 0.003), but not in group P. Propofol-based total intravenous anesthesia is more effective than inhalation sevoflurane in attenuating the increase in ICP as correlated with the ONSD during robotic pelvic surgery.Clinical trial registration: Yes; Principal investigator: Nambiath Sujata; Trial number: REF/2016/11/012713 (registered); Trial registry: CTRI- http://ctri.nic.in .

Comparative evaluation of isoflurane and sevoflurane for maintenance of anaesthesia in buffaloes undergoing diaphragmatic herniorrhaphy

The study was conducted in 12 adult female buffaloes suffering from diaphragmatic hernia (DH). The animals were randomly divided in 2 groups of 6 each. DH was repaired under general anaesthesia using glycopyrrholatexylazine-butorphanol-thiopentone maintained with isoflurane and sevoflurane in group TI and TS, respectively. Clinical and behavioural parameters were observed during herniorrhaphy while physiological, haematological and biochemical parameters were recorded at different intervals (before rumenotomy, before premedication, 5 min after thiopentone injection, at 15 min and 30 min of inhalant anaesthesia, at recovery and at 24 h of recovery). No significant difference was seen in sedation, muscle relaxation and analgesia scores between the groups. The respiratory rate was less depressed and corneal reflex was mostly intact during maintenance in TS group. Recovery and standing with ataxia in TS group was significantly earlier than TI group. There was no significant difference in haematological and blood biochemical parameters between the groups. The results indicated that sevoflurane is a better maintenance agent than isoflurane for maintenance of general anaesthesia in buffaloes undergoing DH.

Effect of sevoflurane versus isoflurane on middle ear pressure during tonsillectomy operation

Background Increase in middle ear pressure (MEP) (mmH 2 O) is an undesirable condition because of its potential complications. The aim of this randomized study was to compare the effects of isoflurane and sevoflurane on MEP. Patients and methods Patients in American Society of Anesthesiologists (ASA) group I-II between 6 and 14 years of age undergoing tonsillectomy operation were randomized into two groups. Group 1 received isoflurane and group 2 received sevoflurane for maintenance of anesthesia after induction with thiopental and suxamethonium in both groups. MEPs were measured and recorded 1 day before the operation (T0), with the patient lying supine on the operating table (T1), after the induction of anesthesia and endotracheal intubation (T2), and soon after withdrawal of anesthesia (T3). Finally, MEP values were compared intragroup with the baseline value (T0) and between groups. Results In comparison with the baseline value in T0, MEP was significantly increased in T1, T2, and T3 in the two groups. There were no differences between groups at all times, but at the end of anesthesia at T3, the increase in MEP was significantly lower in group 1 (isoflurane group) than in group 2 (sevoflurane groups) (103 ± 68 vs. 138 ± 99, P P Conclusion There was an increase in MEP after anesthesia with both the inhalational anesthetics, but the increase in MEP was significantly lower during isoflurane anesthesia, which makes it more suitable during middle ear surgery.

Survey on the adequacy of depth of anaesthesia with bispectral index and isolated forearm technique in elective Caesarean section under general anaesthesia with sevoflurane

Awareness during general anaesthesia for Caesarean section (C/S), although uncommon, remains a concern for anaesthesiologists. We examined the relationship between the bispectral index (BIS) and responses to the isolated forearm technique (IFT) to evaluate the adequacy of general anaesthesia in C/S and determine a suitable cut-off point for BIS values based on IFT results. In 61 parturients, a standardized anaesthetic technique was applied. It included sodium thiopental and succinylcholine for induction, and O2, N2O, and sevoflurane for maintenance of anaesthesia. BIS values and IFT response were recorded at 16 predetermined events during anaesthesia. Positive IFT responses were seen in 41%, 46%, and 23% of the parturients at laryngoscopy, intubation, and skin incision, respectively. BIS could not reliably differentiate between IFT responders and non-responders during these three stages. The receiver operating characteristic curve cut-off points for BIS to predict IFT responders with 100% sensitivity were 34, 37, and 27, respectively, for these stages. In all stages of the operation after skin incision, more than 90% of parturients had no IFT test response, and BIS values between 40 and 63 were associated with negative IFT results. During a structured interview within 12-24 h after the operation, no patient had evidence of explicit recall of intraoperative events. The BIS is not reliable for monitoring anaesthesia depth in C/S. Lower than previously recommended values are needed to avoid IFT test responses during laryngoscopy, intubation, and skin incision.

Comparison of recovery profiles of propofol and sevoflurane anesthesia with bispectral index monitoring in percutaneous nephrolithotomy

BackgroundThe aim of the study was to evaluate the comparative effects of propofol infusion versus sevoflurane for maintenance of anesthesia with respect to hemodynamics, recovery characteristics, nausea and vomiting in patients undergoing percutaneous nephrolithotomy.MethodsForty American Society of Anesthesiologists physical status I-II patients, aged between 22 and 65 years were randomly divided to receive either intravenous anesthesia with propofol (group P) or sevoflurane (group S). Cardiovascular variables, peripheral oxygen saturation (SpO2), end-tidal carbon dioxide (ETCO2), bispectral index (BIS) and train-of-four (TOF) values were recorded at intervals throughout the procedure. Time to spontaneous respiration, eye opening, extubation, obey commands, hand squeezing, Aldrete Score > 9 and the incidence of postoperative nausea and vomiting were recorded.ResultsEarly recovery times [spontaneous respiration (P = 0.002), eye opening (P = 0.006), extubation (P = 0.013), obey commands (P < 0.05), hand squeezing (P = 0.005)] were significantly longer in group P. The incidence of vomiting was significantly higher in group S (P < 0.05). Hemodynamic parameters, levels of SpO2, ETCO2, and BIS and TOF values were not significantly different between the groups (P > 0.05).ConclusionsThe present study which adjusted sevoflurane concentration and propofol infusion rate according to BIS values revealed that maintenance of anesthesia with sevoflurane is associated with faster recovery than anesthesia with propofol. Propofol resulted in a significantly lower incidence of postoperative nausea and vomiting. Hemodynamic parameters and levels of SpO2 and ETCO2 were comparable between the groups during percutaneous nephrolithotomy.

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

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

In vivo effects of different anesthetic agents on apoptosis

BackgroundThis study was designed to measure in vivo effects of propofol, isoflurane and sevoflurane on apoptosis by measuring caspase-3 and tumor necrosis factor (TNF)-related apoptosis inducing ligand (TRAIL) blood level as apoptotic markers.MethodsAfter obtaining ethical committee approval and informed written consents, sixty adult patients ASA I scheduled for open cholecystectomy participated in this study. They were randomally allocated into one of three equal groups to receive propofol infusion, low-flow isoflurane or sevoflurane for maintenance of anesthesia. Venous blood samples were collected preoperatively, immediately postoperative and after 24 hours to measure hemoglobin, hematocrit, creatinine, liver enzymes, serum TRAIL and caspase-3 levels.ResultsThere was no significant difference in hematological markers and serum creatinine. Liver enzymes showed significant postoperative rise (P < 0.05). In Propofol group, TRAIL and caspase-3 levels were significantly elevated immediately postoperative then decreased significantly after 24-hours (P < 0.05). In Isoflurane group, immediate postoperative level of TRAIL was significantly higher than 24 hours reading and significantly lower than its level in Propofol group at the same timing meanwhile caspase-3 levels were comparable at different timings. In Sevoflurane group, TRAIL and caspase-3 levels increased significantly in both postoperative samples than preoperative level and than those of Isoflurane and Propofol groups after 24 hours concerning TRAIL (P & 0.05).ConclusionsThis study concluded that isoflurane is superior and sevoflurane is the least effective among the three anesthetics in protection against apoptosis. This study neither proved nor excluded propofol-induced apoptosis. Further studies are required during lengthy procedure and in compromised patients.

Bispectral Index-guided Administration of Anesthesia for Transsphenoidal Resection of Pituitary Tumors

The main aims of anesthesia for pituitary surgery include maintenance of hemodynamic stability, provision of conditions that facilitate surgical exposure, and a smooth emergence to facilitate a prompt neurologic assessment. The primary aim of our study was to compare the effects of 3 anesthetic regimens on hemodynamics and recovery characteristics of the patients. Ninety patients undergoing transsphenoidal surgery were enrolled in the study. Standard anesthesia technique was followed for induction. Patients were randomly divided to receive propofol, isoflurane, or sevoflurane for maintenance of anesthesia. The bispectral index target range during maintenance was 40 to 60. The hemodynamic variables (heart rate and mean arterial pressure) and bispectral index were noted during the various stages of the surgery. The time to emergence and extubation was noted. We evaluated cognitive function at 5 and 10 minutes posttracheal extubation. The 3 study groups were comparable with respect to age, sex, weight, and duration of surgery. We observed an increase in heart rate and blood pressure during intubation, nasal packing, and insertion of self-retaining nasal speculum. After tracheal intubation, the rise in blood pressure was more in sevoflurane group than propofol. During emergence, hypertensive response was seen in all patients. Emergence and extubation times were significantly shorter with propofol and sevoflurane. Patients who received propofol had better cognition scores. Aldrete scores were better with propofol and sevoflurane than isoflurane. The pressor response after intubation and emergence hypertension was significantly less with propofol. Better recovery profile was seen in sevoflurane and propofol groups and a better cognition in patients receiving propofol. Propofol plus nitrous oxide anesthesia could be the technique of choice in patients undergoing transnasal transsphenoidal pituitary surgery.

Recovery characteristics following maintenance of anaesthesia with sevoflurane or isoflurane in dogs premedicated with acepromazine

A standard anaesthetic protocol was used to anaesthetise 40 dogs for intravenous urography and a retrograde urethrogram or vaginourethrogram. The dogs were allocated by blocked randomisation to receive either isoflurane or sevoflurane for maintenance of anaesthesia after they had been premedicated with acepromazine and pethidine, and anaesthesia induced with propofol. An observer who was unaware of which agent had been used assessed ataxia 30 and 60 minutes after discontinuation of administration of the anaesthetic and assigned an overall recovery score. No complications occurred during anaesthesia of either group of dogs. The scores for ataxia were significantly lower after 60 minutes than after 30 minutes, but there was no significant difference between the groups. The quality of recovery was significantly better in the dogs that received sevoflurane than in those that received isoflurane, but the recovery times were similar.