Sevoflurane Group Research Articles

Comparison of Sevoflurane and Halothane Anesthesia Cognitive Function in Adult

Background: Patients reach their full cognitive and psychomotor potential during the intermediate period of recovery. We still utilize Halothane, which has a delayed recovery profile, despite the fact that rapid clearance drugs like Sevoflurane have a positive impact on early cognitive recovery, which permits early mobility and reduces post-surgical complications. Objective: The study's goal was to promote the use of sevoflurane over halothane by contrasting the two anesthetics' effects on patients' cognitive functioning after surgery. Method: The prospective randomized comparative study was carried out in the Department of Anaesthesia, Analgesia and Intensive Care Medicine, between the period of September 2021 to June 2022. Study population was the patients of either sex, aged between18-50 years, ASA-I and II, patients undergoing elective surgery by general anaesthesia, lasting for 1 hour or more and remaining 24 hours after surgery. A total number of 100 patients were divided into two groups. 50 patients were in Sevoflurane group and 50 in Halothane group. Results: Group- Sevoflurane had a considerably faster emergence time (10.85 min vs. 15.13 min, P0.001) than Group- Halothane. Group- Sevoflurane had a mean BAMSE score of 29 at baseline and showed no change by the conclusion of the observation period, but Group- Halothane saw their scores both drop and then recover. Patients in Group- Sevoflurane finished the (TMT-A) 30 minutes after regaining consciousness in a considerably shorter amount of time (40. 9 seconds vs. 55. 8 seconds, P 0.001). Furthermore, there was no statistically significant difference between the groups after 1.5 hours, 2.5 hours, or 3.5 hours. Conclusion: So the study concludes that adult patient of sevoflurane group experienced an early post-operative cognitive recovery than halothane group. Though sevoflurane is costly, considering the benefits of patients in terms of early cognitive recovery that causes less postoperative complications and shorter hospital stay, sevoflurane should be used instead of halothane.

Effect of propofol versus sevoflurane on auditory and cognitive functions: a randomized controlled trial

BackgroundHearing loss and cognitive impairment are postoperative complications which need more awareness by anaesthesiologists. We set out to investigate whether sevoflurane or propofol would have a negative impact on auditory function, attention, or auditory memory. This is a prospective randomized controlled study which was conducted on patients who were candidates for elective laparoscopic cholecystectomy under general anesthesia with either the sevoflurane or the propofol. All included participants were subjected to cognitive and auditory evaluation preoperative and 1 week after the operation. Cognitive assessment included: Paired Associate Learning test (PALT) and Paced Auditory Serial Addition Test (PASAT). Audiological assessment was done by measuring the auditory brainstem response (ABR).ResultsThere was no statistically significant difference between both groups in either age (p value = 0.537) or sex (p value = 0.175). In the propofol group, the postoperative values of LT ABR-I and III were significantly higher than the preoperative ones (p value < 0.001, 0.003), all the postoperative RT ABR waves were significantly higher than the preoperative ones (P < 0.05). In the sevoflurane group, the postoperative values for LTABR-I, III, III–V were significantly higher than the preoperative ones with p value (0.012, 0.008 and 0.009) and the postoperative values for RTABR-III, V, I–III, and III–V were significantly higher than preoperative values (P = 0.041, 0.029, 0.005 and < 0.001). There were no statistically significant differences between the propofol and sevoflurane groups in all waves of ABR on both sides (P > 0.05). There was a significant worsening between pre- and postoperative PASAT scores in the propofol and sevoflurane groups, respectively, with p value (< 0.001) with no statistically significant difference between both groups (p value = 0.906). In addition, there was a significant worsening between pre- and postoperative PALT scores in the propofol group only (p value = 0.01) with a statistically significant difference between both groups (p value = 0.038).ConclusionsThere was a statistically significant postoperative impairment in auditory function and attention following both the propofol and sevoflurane anesthesia with no significant difference between the two drugs. Whereas, the auditory memory was significantly impaired following the propofol only.

A Prospective, Randomized, Open-Label Study Comparing Recovery Characteristics between Desflurane and Sevoflurane Anesthesia in Elderly Patients Undergoing Elective Supratentorial Craniotomy

Abstract Background Sevoflurane and desflurane are the two commonly used volatile anesthetics and it is mandatory to comprehend their hemodynamic and recovery profiles to ensure safe administration and early recovery in elderly neurosurgical patients. The primary objective of the study was to compare the recovery profiles of sevoflurane and desflurane in elderly patients undergoing supratentorial craniotomy. The secondary outcome measures studied were intraoperative hemodynamic changes, intraoperative brain condition, and early postoperative cognition using short orientation memory concentration test (SOMCT). Methods The prospective, open-labeled study involving 78 elderly patients undergoing elective supratentorial craniotomies randomized the subjects into sevoflurane and desflurane groups in the ratio of 1:1 (39 each). Pre- and early postoperative cognitive function of the patient was assessed using SOMCT. Time for emergence, extubation, and recovery were also compared between the groups. Hemodynamic parameters during surgery and brain relaxation were recorded. Student's t-test was used to find the significance of study parameters on a continuous scale and chi-squared test to find the significance of study parameters on a categorical scale between two groups. Results The mean emergence time (minutes) was found to be significantly longer in sevoflurane group as opposed to desflurane (9.44 ± 2.07 vs. 8.28 ± 2.53, p = 0.02). Similarly, the mean recovery time was significantly longer for sevoflurane group than desflurane (17.33 ± 3.36 vs. 15.64 ± 4.63, p = 0.03). A statistically significant difference in pre- and early postoperative SOMCT was observed between the two groups (5.31 ± 2.89 vs. 4.33 ± 1.74, p = 0.04) with better early postoperative SOMCT (p = 0.05) in desflurane group. However, extubation time, average duration of surgery, brain relaxation, and modified Aldrete score were comparable between the groups. Conclusion Elderly patients who received desflurane had a shorter emergence and recovery time compared with sevoflurane. Improved early postoperative SOMCT scores were noted in desflurane group.

Comparison of hemodynamic alterations and post-operative profile of sevoflurane and propofol during laparoscopic cholecystectomies

Background: Modern laparoscopic surgeries with insufflation of gas into peritoneal cavity are gold standard treatment for cholelithiasis. Propofol, a GABA receptor positive allosteric modulator and Sevoflurane, an inhalational anesthetic are used for maintenance of general anesthesia. In laparoscopy, significant hemodynamic changes occur. Searching in field of anesthesia is going on for anesthetic agent for better recovery. Aims and Objectives: Objective of the study is to compare sevoflurane with propofol for intraoperative hemodynamic changes and post-operative recovery profile of patient’s undergone laparoscopic cholecystectomies under general anesthesia. Secondary objective is to compare post-operative complications. Materials and Methods: A prospective, randomized, single-blinded, and comparative study done after permission from the institutional ethical committee and informed consent from patients. Total 84 patients of 20–50 years age of either sex were scheduled for laparoscopic cholecystectomy, divided in two equal groups – Group P, induced with propofol and anesthesia was maintained with propofol (100–120 μg/kg/min), nitrous oxide and oxygen and Group S induced with propofol and anesthesia was maintained using sevoflurane (1–2%), nitrous oxide, and oxygen. Results: We found that time for eye opening was 9±1.21 min in Group P and 8±1.34 min in Group S. Time for following verbal command was 10±1.20 min in Group P and 9±1.32 min in Group S. Time for speaking name by patient was 11±1.20 min in Group P and 10±1.34 min in Group S. Difference between two groups regarding eye opening, following verbal command, and time to speak own name are highly significant with P&lt;0.001 which proves that eye opening, following verbal command and time for speaking name by patient were significantly shorter in sevoflurane group. Time to achieve modified aldrete score &gt;8 was 14±1.30 min in Group P and 13±1.37 min in Group S. Difference between two groups is also highly significant with P&lt;0.001 which proves that time to achieve modified aldrete score&gt;8 were significantly shorter in sevoflurane group. Conclusion: From our study, maintenance of general anesthesia with sevoflurane is associated with faster recovery from anesthesia.

Impact of general anaesthesia on breast cancer survival: a 5-year follow up of a pragmatic, randomised, controlled trial, the CAN-study, comparing propofol and sevoflurane.

Anaesthesia may impact long-term cancer survival. In the Cancer and Anaesthesia study, we hypothesised that the hypnotic drug propofol will have an advantage of at least five percentage points in five-year survival over the inhalational anaesthetic sevoflurane for breast cancer surgery. From 2118 eligible breast cancer patients scheduled for primary curable, invasive breast cancer surgery, 1764 were recruited after ethical approval and individual informed consent to this open label, single-blind, randomised trial at four county- and three university hospitals in Sweden and one Chinese university hospital. Of surveyed patients, 354 were excluded, mainly due to refusal to participate. Patients were randomised by computer at the monitoring organisation to general anaesthesia maintenance with either intravenous propofol or inhaled sevoflurane in a 1:1 ratio in permuted blocks. Data related to anaesthesia, surgery, oncology, and demographics were registered. The primary endpoint was five-year overall survival. Data are presented as Kaplan-Meier survival curves and Hazard Ratios based on Cox univariable regression analyses by both intention-to-treat and per-protocol. EudraCT, 2013-002380-25 and ClinicalTrials.gov, NCT01975064. Of 1764 patients, included from December 3, 2013, to September 29, 2017, 1670 remained for analysis. The numbers who survived at least five years were 773/841 (91.9% (95% CI 90.1-93.8)) in the propofol group and 764/829 (92.2% (90.3-94.0)) in the sevoflurane group, (HR 1.03 (0.73-1.44); P=0.875); the corresponding results in the per-protocol-analysis were: 733/798 (91.9% (90.0-93.8)) and 653/710 (92.0% (90.0-94.0)) (HR=1.01 (0.71-1.44); P=0.955). Survival after a median follow-up of 76.7 months did not indicate any difference between the groups (HR 0.97, 0.72-1.29; P=0.829, log rank test). No difference in overall survival was found between general anaesthesia with propofol or sevoflurane for breast cancer surgery. Swedish Research Council; Uppsala-Örebro Regional Research Council; Västmanland Regional Research Fund; Västmanland Cancer Foundation; Stig and Ragna Gohrton Foundation; Birgit and Henry Knutsson Foundation.

Subanesthetic-dose propofol infusion for preventing emergence agitation in children: a retrospective observational study.

Anesthesia maintenance using propofol and a propofol bolus dose at the end of surgery have been shown to prevent emergence agitation (EA).However, the preventive effect of subanesthetic propofol infusion during sevoflurane anesthesia on EA remains unknown. We aimed toevaluate the effect of subanesthetic propofol infusion on EA in children. We retrospectively compared the incidences of severe EA requiring pharmacological intervention in children who underwent adenoidectomy, tonsillectomy with or without adenoidectomy, or strabismus surgery between maintenance with sevoflurane alone (sevoflurane group) and maintenance with subanesthetic propofol with sevoflurane (combination group). A multivariable logistic regression model adjusted for confounders was used to assess the association between anesthesia methods and the occurrence of EA. Additionally, we estimated the direct effect of anesthesia methods by a mediation analysis, excluding the indirect effects of intraoperative fentanyl and droperidol administration. Among 244 eligible patients, 132 and 112 were in the sevoflurane and combination groups, respectively. The crude incidence of EA was significantly lower in the combination group (17.0% [n = 19]) than in the sevoflurane group (33.3% [n = 44]) (P = 0.005).After adjusting for confounders, the incidence of EA was still significantly lower in the combination group (adjusted odds ratio [aOR]: 0.48, 95% confidence interval [CI] 0.25-0.91). The mediation analysis revealed a direct association of anesthesia methods with a lower EA incidence in the combination group (aOR: 0.48, 95% CI 0.24-0.93) than in the sevoflurane group. Subanesthetic propofol infusion may effectively prevent severe EA requiring the administration of opioids or sedatives.

Effect of ketamine versus sevoflurane on the right ventricular pressure during balloon dilatation of congenital pulmonary valve stenosis

Background &amp; Objective: Congenital pulmonary stenosis (PS) is a prevalent cardiac anomaly that is commonly treated with balloon dilatation. The procedure can be successfully completed under appropriate anesthetic technique, depending upon the choice of the anesthetist and the patients’ physical status. We compared the effect of IV ketamine with sevoflurane inhalational anesthesia on right ventricular pressure in infants undergoing balloon dilatation for congenital pulmonary valve stenosis.&#x0D; Methodology: This double-blinded, randomized, clinical trial included 40 infants, aged from 1 to 12 months, with congenital PS undergoing balloon dilatation. They were randomly allocated to one of the two groups. In the ketamine group, 20 patients received 2 mg/kg of ketamine intravenously till being unconscious. In the sevoflurane group, 20 patients received 3% sevoflurane and were maintained using the open circuit technique till losing consciousness. The right ventricular pressure was the primary outcome. Secondary outcomes were the hemodynamics and oxygen saturation.&#x0D; Results: Compared to sevoflurane, ketamine showed a non-significant difference in the right ventricular pressure before and after induction of anesthesia and after balloon dilatation. The mean arterial blood pressure significantly dropped immediately after sevoflurane induction and after the initial 10 min (P = 0.031 and 0.041, respectively). The heart rate significantly decreased immediately after sevoflurane induction (P = 0.028). The oxygen saturation remained comparable in both groups at 10 and 20 min after induction, and at postoperative anesthesia care unit.&#x0D; Conclusion: Intravenous ketamine is considered a safe and effective alternative to sevoflurane for infants with congenital pulmonary stenosis undergoing balloon dilatation. It maintains the right ventricular pressure with stable hemodynamic effects, compared to sevoflurane inhalational anesthesia.&#x0D; Abbreviations: PS - Pulmonary Stenosis; TS – Tricuspid Stenosis; PACU – Post Anesthesia Care Unit; TTE - Transthoracic Echocardiography&#x0D; Key words: Balloon Dilatation; Infants; Ketamine; Pulmonary Stenosis; Sevoflurane.&#x0D; Citation: Sayed AG, Abd el Moez WA, Shoukry A, Elshafeey AE. Effect of ketamine versus sevoflurane on the right ventricular pressure during balloon dilatation of congenital pulmonary valve stenosis. Anaesth. pain intensive care 2023;27(5):451−457; DOI: 10.35975/apic.v27i5.2210&#x0D; Received: April 18, 2023; Reviewed: July 18, 2023; Accepted: August 21, 2023

A Perfusion Index-Based Evaluation and Comparison of Peripheral Perfusion in Sevoflurane and Isoflurane Anaesthesia: A Prospective Randomised Controlled Trial.

Perfusion index has shown to be helpful in the operative and critical care settings to monitor peripheral tissue perfusion. Randomised controlled trials quantifying different agents' vasodilatory properties using perfusion index has been limited. Therefore, we undertook this study to compare the vasodilatory effects of isoflurane and sevoflurane using perfusion index. This is a pre-specified sub-analysis of a prospective randomised controlled trial on the effects of inhalational agents at equipotent concentration. We randomly allocated patients scheduled for lumbar spine surgery to either isoflurane or sevoflurane groups. We recorded values of perfusion index at age-corrected 1 Minimum Alveolar Concentration (MAC) concentration at baseline, pre- and post-application of a noxious stimulus. The primary outcome of interest was the measure of vasomotor tone with perfusion index, and the secondary outcomes which were analysed were mean arterial pressure and heart rate. At age-corrected 1.0 MAC, there was no significant difference in the pre-stimulus haemodynamic variables and perfusion index between both groups. During the post-stimulus period, there was a significant increase in heart rate in the isoflurane group compared to the sevoflurane group, with no significant difference in the mean arterial pressure values between both groups. Though the perfusion index decreased during the post-stimulus period in both groups, there was no statistically significant difference between the 2 groups (P = .526, repeated-measures analysis of variance). In a steady state of age-corrected 1.0 MAC, isoflurane and sevoflurane had a similar perfusion index before and after a standardised nociceptive stimulus, which suggests that both of these agents have similar effect on peripheral perfusion and vasomotor tone.

Comparison of the Incidence of Postoperative Acute Kidney Injury Following the Administration of Remimazolam or Sevoflurane in Elderly Patients Undergoing Total Knee Arthroplasty: A Randomized Controlled Trial.

We evaluated the incidence of postoperative acute kidney injury (AKI) and complications when remimazolam (RMMZ) or sevoflurane (SEVO) were used in elderly patients undergoing total knee arthroplasty. Seventy-eight participants aged ≥65 were randomly allocated to either the RMMZ or SEVO group. The primary outcome was the incidence of AKI on postoperative day (POD) 2. The secondary outcomes included intraoperative heart rate (HR), blood pressure (BP), total drug administered, emergence time, postoperative complications on POD 2, and hospital length of stay (HLOS). The incidence of AKI was comparable between the RMMZ and SEVO groups. The doses of intraoperative remifentanil, vasodilators, and additional sedatives were significantly higher in the RMMZ group than in the SEVO group. Overall intraoperative HR and BP tended to remain higher in the RMMZ group. The emergence time in the operating room was significantly faster in the RMMZ group; however, the time required for an Aldrete score ≥ 9 was comparable between the RMMZ and SEVO groups. Postoperative complications and HLOS were comparable between the RMMZ and SEVO groups. RMMZ may be recommended for patients who are expected to decrease in intraoperative vital signs. However, stable hemodynamics with RMMZ were not sufficient to influence the prevention of AKI.

Impact of intravenous propofol and volatile sevoflurane anesthesia on renal function in an experimental pig model of hemorrhage-induced acute kidney injury

Volatile anesthesia has recently been associated with an independent stimulatory effect on the renal sympathetic nervous system, which causes a reduction in renal blood flow (RBF) and renal excretory function. This anesthetic modality could therefore be a significant contributor to renal injury in the surgical setting. We therefore aimed to investigate the role of anesthetic modality on renal function in an experimental pig model and hypothesized that volatile anesthesia aggravates renal recovery after hemorrhage and resuscitation.Pigs (30±2 kg, 1:1 male-female) were anesthetized with either propofol-fentanyl (P) or sevoflurane-fentanyl (S) and surgically prepared. Renal function and hemodynamics were monitored during a baseline period, a 30-min hemorrhage period, and after 1h recovery after fluid resuscitation with the lost volume (1:1 blood-Ringers Acetate).During baseline, RBF and oxygen delivery (DO 2 ) was significantly lower in the pigs with sevoflurane than propofol anesthesia (RBF P: 191±40 vs S: 130±30 ml min -1 , p&lt;0.001; DO 2 P: 31±5 vs S: 15±3 ml min -1 , p&lt;0.001). Renal vascular resistance (RVR) was also higher in the sevoflurane anesthetized pigs during baseline (P: 0.2±0.05 vs S: 0.5±0.1, p=0.002). There was no statistically different effect of hemorrhage on renal function or hemodynamics between the two anesthetic modalities. Moreover, hemorrhage did not significantly reduce diuresis (P: decreased by 0.7±0.4 ml min -1 , p=0.08; S: decreased by 0.4±0.4 ml min -1 , p=0.38). After resuscitation, both groups recovered similarly regarding hemodynamics and renal function however, creatinine clearance was still significantly decreased in the sevoflurane group compared with baseline (decreased by 37±31 ml min -1 , p=0.02) but recovered in the propofol group. Regarding renal excretory function, no significant differences between the anesthetic modalities were revealed during the experimental protocol.Sevoflurane anesthesia reduced RBF and DO 2 and increased RVR. After hemorrhage and resuscitation, creatinine clearance was significantly lower than before the hemorrhage in the sevoflurane group. Even though this reduction in renal perfusion is in alignment with an increase in renal sympathetic nerve activity, no significant impact of anesthetic modality was seen on renal excretory function. However, sevoflurane anesthesia still has an effect on RBF and creatinine clearance. The choice of anesthesia could therefore effect the incidence of acute kidney injury in patients with higher susceptibility for acute kidney injury. Funding sources: Magnus Bergvall Foundation (2017-02295) and Swedish Research Council (2014-02569 and 2014-07606). This is the full abstract presented at the American Physiology Summit 2023 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Effect of sevoflurane-remifentanil and propofol-remifentanil anesthesia on glycocalyx shedding during deep inferior epigastric perforator flap breast reconstruction: a prospective randomized, controlled trial.

The endothelial glycocalyx (EG) is an important structure that regulates vascular homeostasis. Deep inferior epigastric perforator (DIEP) flap is expected to cause substantial EG breakdown owing to the long procedural duration and ischemia- reperfusion injury. This prospective, randomized, controlled study aimed to compare syndecan-1 levels during sevoflurane-remifentanil and propofol-remifentanil anesthesia in patients who underwent DIEP flap breast reconstruction. Fifty-one patients were randomized to either sevoflurane (n = 26) or propofol (n = 25) groups. Anesthesia was maintained with remifentanil in combination with either sevoflurane or propofol. The primary endpoint was the concentration of serum syndecan-1 measured at 1 h after surgery. Fifty patients (98.0%) completed the study. Patients in the propofol group had significantly lower levels of syndecan-1 than patients in the sevoflurane group at 1 h after operation (23.8 ± 1.6 vs. 30.9 ± 1.7 ng/ml, respectively; Bonferroni corrected P = 0.012). There were no significant differences between groups in postoperative complications. The postoperative hospital stay was 8.4 ± 2.5 days in the sevoflurane group and 7.4 ± 1.0 days in the propofol group (P = 0.077). Propofol-remifentanil anesthesia resulted in lesser increases in syndecan-1 levels compared to increases with sevoflurane-remifentanil anesthesia in patients who underwent DIEP flap reconstruction. Our results suggest that propofol-remifentanil anesthesia shows protective effects against EG damage during DIEP flap breast reconstruction in contrast to sevoflurane-remifentanil anesthesia.

Desflurane Protects The Brain Against The Oxidant Activity of Acute Hyperglycemia in Diabetic Rats, Comparison with Sevoflurane

In this study, we investigated the effects of sevoflurane and desflurane administration on the oxidant and antioxidant system in the brain of acute hyperglycemia in diabetic rats. In the study, 30 male Wistar Albino rats were randomly divided into five groups. Diabetes was induced by administering a single dose of intraperitoneal streptozotocin (55 mg/kg) to rats except for the control group (C). To create acute hyperglycemia in diabetic groups, which were hyperglycemia (DH), desflurane (D), and sevoflurane (S) groups, 2.5 g/kg glucose was administered intraperitoneally. After glucose administration, desflurane 6% and sevoflurane 2.3% mixed with 4 L/min oxygen were administered for 2 hours, by which minimal alveolar concentration for rats would be one. Afterward, the animals were sacrificed, and their brain tissues were prepared for biochemical analysis. Catalase (CAT), glutathione-s-transferase (GST), paraoxonase (PON) activities, and TBARS levels were measured to determine oxidant and antioxidant status. GST activity was significantly lower in group D than in group DH (p=0.001). The PON activity was significantly lower in the D group compared with other groups (p&amp;lt;0.001). In the S group, PON activity was significantly lower than in the diabetic control (DC) group and DH groups (p=0.022, p=0.020, respectively). TBARS level was significantly lower in group D than in group DH (p=0.013). As a result, desflurane decreases GST and PON activity and TBARS levels more than sevoflurane. In terms of lipid peroxidation, desflurane shows more protective properties than sevoflurane. Since our study is the first study in this field, it should be supported by other studies to be carried out.

Comparison of effects of volatile and intravenous anesthetics on pupillary function during general anesthesia in children: A prospective observational study.

The light reflex, which reflects central nervous system dysfunction, can also be affected by anesthetic agents. We evaluated whether these effects differed according to the anesthetic agent in pediatric patients. Twenty children aged 3-12 years who were scheduled to undergo elective surgery under general anesthesia were randomly allocated to propofol and sevoflurane groups and underwent pupillometric assessments at five points during anesthesia: T1, after confirming loss of consciousness; T2, after endotracheal intubation; T3, at the time of skin incision; T4, 1 h after skin incision; and T5, before endotracheal extubation. The primary outcome was the Neurological Pupil index at T4, and the secondary outcomes were other pupillometric parameters, including pupil diameter, percentage of change in pupil diameter, dilation velocity, and constriction velocity. At T4, the Neurological Pupil index was significantly lower in the sevoflurane group (median difference, 0.30; 95% CI, 0.00 to 0.70; p = .036). Furthermore, the Neurological Pupil index at all time points was lower in the sevoflurane group. The time-and-group interaction effects on constriction velocity and dilation velocity were significantly different [F(1, 4) = 16.68, p = .002; F(1, 4) = 14.78, p = .008, respectively] but were not different on the Neurological Pupil index, pupil diameter, and percentage of change in pupil diameter. No intergroup differences were observed in the baseline characteristics, the flow rate of remifentanil at each time point, and total infused remifentanil. The Neurological Pupil index value in pediatric patients under general anesthesia is affected by the anesthetic agent used; this factor requires consideration in evaluations of the Neurological Pupil index during general anesthesia.

A Comparative Study of Propofol and Sevoflurane for General Anesthesia in Laparoscopic Appendectomy

Introduction: Anesthesia plays a vital role in the success of surgical procedures, with the choice of anesthetic agents influencing patient recovery and postoperative complications. Propofol and sevoflurane are two commonly used anesthetic agents, each with distinct properties and implications on patient outcomes. The primary objective of this study was to compare the effects of propofol and sevoflurane on intraoperative hemodynamic parameters, recovery profiles, and postoperative complications in patients undergoing laparoscopic appendectomy. Methods: This prospective randomized trial was conducted over 2 years at Holy Family Red Crescent Medical College Hospital, Dhaka, Bangladesh, and included 180 laparoscopic appendectomy cases. Participants were randomized into two groups: 90 receiving propofol and 90 receiving sevoflurane for general anesthesia. The study received ethical approval from the hospital's review committee. Result: The mean age of patients in the Propofol group was 59.5 years (SD=2.6), while in the Sevoflurane group, it was 56.3 years (SD=7.9). Intraoperative heart rate and recovery profiles showed statistically significant differences between the two groups (p&lt;0.05). The time to eye opening was 6.8 minutes (SD=1.5) for Propofol and 7.4 minutes (SD=1.7) for Sevoflurane. Postoperative complications were significantly higher in the Sevoflurane group: pain (35.56% vs. 24.44%), nausea and vomiting (27.78% vs. 16.67%), and analgesic requirements (44.44% vs. 30.00%). Conclusion: The findings of this study suggest that propofol may be a more favorable anesthetic agent compared to sevoflurane in laparoscopic appendectomy procedures. Propofol demonstrated better intraoperative heart rate control, faster recovery profiles, and reduced postoperative complications, potentially enhancing overall patient outcomes and satisfaction.

Effects of exposure to the inhalational anaesthetic sevoflurane on the male reproductive system in rats.

The purpose of this study was to explore the effects of inhalational anaesthetics on the male reproductive system in neonatal rats. Postnatal day 6 (P6) male rat pups were assigned to 2 groups of 40 rats each. The control group did not receive anaesthesia, and the test group was exposed to air containing 3% sevoflurane in a chamber. After sevoflurane exposure, the effects on the male reproductive system in neonatal rats exposed to inhalational anaesthetics were tested. The rats were maintained to P60. The fertility, sperm and spermatid count, sperm motility, organ weights and histological changes in rats were determined. Compared with those of the control group, the sperm count and motility of the sevoflurane group were significantly decreased (p< 0.05), and there was also a decrease in the number of foetal rats from the sevoflurane group (p < 0.05). Furthermore, the arrangement of the seminiferous tubule was regular in the control group, whereas the arrangement of the seminiferous tubule was distorted and the spermatocytes were detached and irregularly lined in the sevoflurane group. TUNEL analysis showed that the number of apoptotic cells in the testes of the sevoflurane group was significantly increased (p < 0.05). SOD and MDA analyses showed that SOD was decreased, while MDA expression was increased. These data indicated that young rats suffered as a result of inhalation of the anaesthetic sevoflurane and had reduced reproductive system function during adolescence in males. These studies are useful as a foundation for clinical studies.

Dexmedetomidine-mediated neuroprotection against sevoflurane-induced brain development abnormality in fetal mice brain.

Brain development is susceptible to external influences during the gestation period so the neurotoxicity of anesthetics has gained a lot of attention. We aimed to investigate the neurotoxicity of sevoflurane to fetal mice brain as well as the neuroprotective effects of dexmedetomidine. Pregnant mice were treated with 2.5% sevoflurane for 6 hours. The changes in fetal brain development were assayed with immunofluorescence and western blot. The pregnant mice were intraperitoneally injected with dexmedetomidine or vehicle from gestation day (G) 12.5 to G15.5. Our results showed maternal sevoflurane exposure could not only inhibit neurogenesis but also lead to precocious generation of astrocytes in fetal mice brains. The fetal mice brain of sevoflurane group exhibited a significant inhibition in the activity of Wnt signaling and the expression of CyclinD1, Ngn2. Chronic dexmedetomidine administration could minimize the negative effects caused by sevoflurane by activating the Wnt signaling pathway. This study has uncovered a Wnt signaling-related mechanism of the neurotoxicity of sevoflurane and confirmed the neuroprotective effect of dexmedetomidine, which could provide pre-clinical evidence for clinical decision-making.

Comparison of 4.5% Versus 8% Sevoflurane for Inhalational Induction in Adults

Background: Inhalational induction is a frequently used anesthetic technique in pediatric patients. However, it is less frequently used in adult patients undergoing surgery. General anesthesia can be induced either by intravenous injection or inhalation of anesthetic drugs. There are no established guidelines about the usage of 4.5% vs 8% sevoflurane for inhalation induction in adults undergoing elective day care surgery. Aim: To compare mean time to loss of eyelash reflex using 4.5% vs 8% sevoflurane for inhalational induction in adult patients undergoing elective day care surgery. Methodology: This randomized controlled trial was conducted in the department of anesthesia, Mayo Hospital Lahoreover a period of six months from June 2018 to December 2018. A total of 60 patients were enrolled in the study. We included adult patients aged 18-60 years of either gender and ASA status I &amp; II undergoing elective day care surgery. While, patients having history of adverse reaction to inhalational agents and those who were on chronic sedatives, antipsychotic treatment were excluded. Demographic data of age and gender were obtained along with their body weight, height and BMI. They were randomly divided into two study groups using lottery method. After routine pre-op check and attaching standard anesthesia monitoring, patients in group-A and group-B were given 4.5% sevoflurane &amp; 8% sevoflurane respectively at a fresh gas flow of 8 L/min of oxygen and they were instructed to take deep breaths while inhaling gas with help of face mask. Results: The mean age in 4.5% sevoflurane group was 42.27±11.83 years while in 8% sevoflurane group it was 45.43±12.76 years. In 4.5% sevoflurane group there were 12(40%) male and 18(60%) female cases while in 8% sevoflurane group there were 11(36.67%) male and 19(63.33%) female cases. The mean time to loss of eyelash reflex in 4.5% sevoflurane group was 88.57±6.71 seconds and in 8% sevoflurane group the mean time to loss eyelashes reflex was 67.87±5.90 seconds. The mean time to loss eyelashes reflex was statistically less in 8% sevoflurane group, with p-value 0.001. Conclusion: We concluded that mean time to loss eyelashes reflex was considerably lesser with8% sevoflurane when compared with 4.5% sevoflurane for inhalational induction in adult patients for elective day care surgery. Keywords: Inhalational induction, sevoflurane, eyelash reflex, day care surgery.

Influence of Anesthetics on Cardiac Index and Metabolic Outcomes in Mitral and Aortic Valve Replacement in Adults: A Randomized Clinical Study.

Cardiac index (CI) and metabolic response to surgery are important indicators of the course of the intraoperative period. This study aimed to determine the effect of sevoflurane, isoflurane, and propofol on CI and metabolic outcomes during aortic and mitral valve replacement in adults. In this single-center prospective randomized controlled clinical study, a total of 75 patients were randomly assigned into 3 groups according to the type of anesthesia: The propofol group (n = 25), the sevoflurane group (n = 25), and the isoflurane group (n = 25). Cardiac stroke volume (SV) was determined by intraesophageal echocardiography (SV = end-diastolic volume - end-systolic volume). Cardiac output (CO) and CI were calculated according to the formulas. Oxygen consumption during surgery = CI × arteriovenous difference. Indirect calorimetry was used to determine energy expenditure during anesthesia using a spirometry device. The use of anesthetics did not change CI. Cardiac index decreased from 3 to 2.9 L/min/m2 in the propofol group, increased from 3.1 to 3.2 L/min/m2 in the sevoflurane group, and decreased from 2.9 to 2.7 L/min/m2 in the isoflurane group. Compared to inhaled anesthetics, propofol significantly reduced VO2 from 179.1 to 135.7 mL/min/m2. Propofol reduced energy expenditure from 1483.7 to 1333.5 kcal. Volatile anesthetics, propofol has practically no effect on CI in an uncomplicated surgery. Anesthesia with propofol is associated with lower VO2 and better oxygen delivery to tissues. Energy consumption during propofol anesthesia decreases.

Comparative effects of desflurane and sevoflurane on intraoperative peripheral perfusion index: a retrospective, propensity score matched, cohort study

Desflurane is known to have a larger vasodilatory effect than that of sevoflurane. However, its generalizability and effect size in actual clinical practice are yet to be proven. Patients aged ≥ 18 years who underwent noncardiac surgery under general anesthesia using inhalation anesthetics (desflurane or sevoflurane) were matched 1:1 by propensity score. The mean intraoperative perfusion index (PI) of each patient were compared between the two groups. Propensity score matching of 1680 patients in the study cohort identified 230 pairs of patients. PI was significantly higher in the desflurane group (median of paired difference, 0.45; 95% CI 0.16 to 0.74, p = 0.002). PI durations below 1.0 and 1.5 were significantly longer in the sevoflurane group. Mean arterial pressure (MAP) and durations of low MAP did not differ significantly between the two groups. Generalized linear mixed models revealed that the use of sevoflurane, mean MAP, mean heart rate, age, and duration of anesthesia had significant negative effects (lower PI), whereas mean age-adjusted minimum alveolar concentration of inhalation agent had a positive effect on PI (higher value). Intraoperative PI was significantly higher in patients administered desflurane than sevoflurane. However, the impact of the choice between desflurane and sevoflurane on intraoperative PI in this clinical setting was minimal.

Sevoflurane preconditioning improves neuroinflammation in cerebral ischemia/reperfusion induced rats through ROS-NLRP3 pathway

AimWe aimed to study the influence of sevoflurane on the nucleotide-binding domain and Leucine-rich repeat protein 3 (NLRP3) pathways in rats with cerebral ischemia/reperfusion (I/R) injury. MethodsSixty Sprague–Dawley rats were equally divided into five groups randomly: sham-operated, cerebral I/R, sevoflurane (Sevo), NLRP3 inhibitor-treated (MCC950), and sevoflurane and NLRP3 inducer-treated groups. Rats’ neurological functions were assessed using Longa scoring after 24 h of reperfusion, after which they were sacrificed, and cerebral infarction area was determined by triphenyl tetrazolium chloride staining. Pathological changes in damaged portions were assessed using hematoxylin-eosin and Nissl staining, and cell apoptosis was detected by terminal-deoxynucleotidyl transferase-mediated nick end labeling staining. Interleukin 1 beta (IL-1β), tumor necrosis factor α (TNF-α), interleukin-6 (IL-6), interleukin-18 (IL-18), malondialdehyde (MDA), and superoxide dismutase (SOD) levels in brain tissues were determined using enzyme-linked immunosorbent assay. Reactive oxygen species (ROS) levels were analyzed using a ROS assay kit. Protein levels of NLRP3, caspase-1, and IL-1β were determined by western blot. ResultsNeurological function scores, cerebral infarction areas, and neuronal apoptosis index were decreased in the Sevo and MCC950 groups than in the I/R group. IL-1β, TNF-α, IL-6, IL-18, NLRP3, caspase-1, and IL-1β levels decreased in the Sevo and MCC950 groups (p < 0.05). ROS and MDA levels increased, but SOD levels increased in the Sevo and MCC950 groups than in the I/R group. NLPR3-inducer nigericin eliminated the protective effects of sevoflurane on cerebral I/R injury in rats. ConclusionSevoflurane could alleviate cerebral I/R-induced brain damage by inhibiting the ROS-NLRP3 pathway.