Use Of Intravenous Anesthesia Research Articles

Mechanism of isoflurane‑mediated breast cancer growth in vivo.

Use of volatile anesthetics is associated with worse outcome following tumor resection surgery compared with the use of intravenous anesthetics. However, the underlying mechanism has not been clearly delineated yet in vivo. The EO771 cell-based congenic breast cancer model was used in the present study. Isoflurane directly binds to and inhibits two adhesion molecules, leukocyte function-associated antigen-1 (LFA-1) and macrophage-1 antigen (Mac-1). Similarly, exposure to sevoflurane, another volatile anesthetic and LFA-1 inhibitor, is associated with an increase in breast cancer size compared with non-exposure. Thus, the present study first examined the role of LFA-1 and Mac-1 in the EO771 breast cancer model. Both LFA-1 deficiency and inhibition enhanced tumor growth, which was supported by cytokine and eicosanoid data profiles. By contrast, Mac-1 deficiency did not affect tumor growth. The exposure to isoflurane and sevoflurane was associated with an increase in breast cancer size compared with non-exposure. These data suggested that isoflurane enhanced tumor growth by interacting with LFA-1. Isoflurane exposure did not affect tumor growth in LFA-1-deficient mice. In summary, the present data showed that LFA-1 deficiency facilitated breast cancer growth, and isoflurane, an LFA-1 inhibitor, also increased breast cancer growth.

Electroencephalographic manifestations during propofol and xylazine-ketamine anaesthesia in goats

The use of intravenous anaesthesia for short term surgical procedures in animal husbandry practices is increasing. However, information on the quality of an anaesthetic regime in goats has remained inadequate. Therefore, electroencephalographic studies were conducted on twelve apparently healthy adult female Barbari crossbred goats, aged 2 to 4 years, to assess the anaesthetic quality of a propofol and xylazine-ketamine combination. Quantitative analysis of EEG parameters [Total power, Median Frequency, Spectral Edge Frequency 90 (SEF-90) and Relative Power (RP) of different frequency bands delta (δ), theta (θ), alpha (α) and beta (β)] were assessed pre-experimentally (control), and at one, five, 10, 30 min, one hr, and two hr after intravenous propofol (4 mg/kg) and xylazine (0.05 mg/kg)-ketamine (4 mg/kg) administration. After propofol and xylazine-ketamine administration total power, RP-δ and θ increased significantly (P<0.05) while SEF 90, MF, RP-α and RP-β decreased. Most of the EEG changes were adequately depicted in vertex and parietal channels. Spectral analysis of EEG tracings suggested that propofol produced minimum anaesthetic stress and is a safer and better choice for short term anaesthesia in goats.

A less aggressive approach to the management of super refractory status epilepticus

Febrile infection-related epilepsy syndrome (FIRES) is a rare catastrophic encephalopathy of unknown etiology. It commonly affects previously healthy children. FIRES is a subcategory of new-onset refractory status epilepticus (NORSE), term used specifically for adult population, and FIRES is used for pediatric population. Uniformly, both FIRES and NORES have poor outcomes with chronic drug-resistant epilepsy, severe neurological sequelae, and mortality in one-fifth of patients. We report a case of FIRES in a 9-year-old previously healthy child in whom a less aggressive approach was used to manage anesthetic resistant super refractory status epilepticus, which has reduced the potentially fatal complications of prolonged use of intravenous anesthetics and also the need for tracheostomy.

A multimodal sevoflurane-based sedation regimen in combination with targeted temperature management in post-cardiac arrest patients reduces the incidence of delirium: An observational propensity score-matched study

BackgroundRecent studies suggest that volatile anaesthetics are safe, efficient, and reliable alternatives to the use of intravenous anaesthetics for out-of-hospital cardiac arrest (OHCA) patients admitted to the intensive care unit (ICU). We hypothesised that volatile anaesthetics may reduce the incidence of delirium rather than intravenous sedatives. This retrospective study aimed to investigate whether sevoflurane combined with higher targeted temperature management could decrease the incidence of delirium when compared with intravenous anaesthetics with lower targeted temperature management. MethodsUsing a propensity score-matched analysis, we retrospectively compared a target temperature management (32−34 °C) method along with intravenous sedation (TTM-33/IV) and a modified target temperature management (34−36 °C) method along with sevoflurane sedation (mTTM-36/sevo). We used the confusion assessment method for the ICU to measure the incidence of delirium. We calculated the time-dependent risk on delirium using the multivariate Cox regression model. ResultsThe incidence of delirium was significantly lower (p = 0.001) in OHCA patients of the mTTM-36/sevo group (9/56, 16.1%) than in those of the TTM-33/IV group (25/67, 37.3%). Mechanical ventilation and lengths of stay in the ICU (p < 0.001) and hospital stay (p = 0.04) were shorter in the mTTM-36/sevo group. Patients in the TTM-33/IV group required more midazolam, propofol, and fentanyl. We observed no significant difference in mortality. ConclusionA multimodal sevoflurane-based sedation regimen together with targeted temperature management resulted in a lower incidence of delirium and a shorter duration for mechanical ventilation and ICU length of stay than did the treatment with intravenous sedation combined with the classical cooling protocol.

Study on prevention of hypercapnia by nasal high flow in patients undergoing endoscopic retrograde cholangiopancreatography during intravenous anesthesia.

Background:For relatively invasive upper gastrointestinal endoscopy procedures, such as an endoscopic retrograde cholangiopancreatography (ERCP), and also lower gastrointestinal endoscopy procedures, intravenous anesthesia is routinely used to reduce patient anxiety. However, with the use of intravenous anesthesia, even at mild to moderate depth of anesthesia, there is always a risk of upper airway obstruction due to a relaxation of the upper airway muscles.With the advent of nasal high flow (NHF) devices that allow humidified high flow air through the nasal cavity, can be used as a respiratory management method in the context of anesthesia. AIRVO is commonly used for patients with obstructive sleep apnea and other respiratory disorders. This device uses a mild positive pressure load (several cmH2O) that improves carbon dioxide (CO2) washout and reduces rebreathing to improve respiratory function and therefore is widely used to prevent hypoxemia and hypercapnia.This study aims to maintain upper airway patency by applying NHF with air (AIRVO) as a respiratory management method during intravenous anesthesia for patients undergoing an ERCP. In addition, this study investigates whether the use of an NHF device in this context can prevent intraoperative hypercapnia and hypoxemia.Methods/design:This study design employed 2 groups of subjects. Both received intravenous anesthesia while undergoing an ERCP, and 1 group also used a concurrent nasal cannula NHF device. Here we examine if the use of an NHF device during intravenous anesthesia can prevent hypoxemia and hypercapnia, which could translate to improved anesthesia management.Efficacy endpoints were assessed using a transcutaneous CO2 monitor (TCM). This device measured the changes in CO2 concentration during treatment. Transcutaneous CO2 (PtcCO2) concentrations of 60 mm Hg or more (PaCO2 > 55 mm Hg) were considered marked hypercapnia. PtcCO2 concentrations of 50 to 60 mm Hg or more (equivalent to PaCO2 > 45 mm Hg) were considered moderate hypercapnia.Furthermore, the incidence of hypoxemia with a transcutaneous oxygen saturation value of 90% or less, and whether the use of NHF was effective in preventing this adverse clinical event were evaluated.Discussion:The purpose of this study was to obtain evidence for the utility of NHF as a potential therapeutic device for patients undergoing an ERCP under sedation, assessed by determining if the incidence rates of hypercapnia and hypoxemia decreased in the NHF device group, compared to the control group that did not use this device.Trial registration:The study was registered in the jRCTs 072190021.URL https://jrct.niph.go.jp/en-latest-detail/jRCTs072190021.

Changes in anaesthetic use for trauma patients in German HEMS \u2013 a retrospective study over a ten-year period

BackgroundAirway management and use of intravenous anaesthetics to facilitate tracheal intubation after major trauma remains controversial. Numerous agents are available and used for pre-hospital rapid-sequence induction (RSI). The aim was to investigate usage and potential changes in administration of intravenous anaesthetics for pre-hospital RSI in trauma patients over a ten-year period.MethodsBased on a large helicopter emergency medical service (HEMS) database in Germany between 2006 and 2015, a total of 9720 HEMS missions after major trauma leading to RSI on scene were analysed. Administration practice of sedatives and opioids were investigated, while neuromuscular blocking agents were not documented in the database.ResultsWith respect to administration of sedatives, independent from trauma mechanism and specific injury patterns the use of Etomidate decreased dramatically (52 to 6%) in favour of a more frequent use of Propofol (3 to 32%) and Ketamine (9 to 24%; all p < 0.001) from 2006 to 2015. The use of Benzodiazepines increased slightly, while the utilization rate of Barbiturates remained constant. In patients with Shock Index > 1 at initial contact, the administration rate of Etomidate dropped significantly as well. This decline was mainly substituted by Ketamine and particularly Propofol. In patients with GCS ≤ 8 upon initial contact, a similar distribution compared to the general trauma population could be observed.With respect to opioids, mainly Fentanyl has been administered for RSI in trauma patients (2006: 69,6% to 2015: 60.2%; p < 0.001), while the use of sufentanyl showed a significant increase (0.2 to 8.8%; p < 0.001).ConclusionsThis large study analysed prehospital administration of anaesthetics in trauma patients, showing a substantial change from 2006 to 2015 despite the lack of any high-level evidence. Etomidate has shifted from the main sedative substance to virtual absence, indicating that the recommendation of an established national guideline was transferred into clinical practice, although based on weak evidence as well. The pre-hospital use of Propofol showed a particular increase. Fentanyl has been the main opioid drug for RSI in trauma, however Sufentanyl has become increasingly popular. The mechanisms and advantages of the different substances still have to be elucidated, especially in head injury and bleeding trauma.

Do Inhalational Anesthetic Agents Still Hold Their Place in Modern Anesthesia Practice?

Inhalational anesthetic agents are chemi-cal substances that are administered into the body via lungs and distributed to or-gans and tissues by blood circulation.The main site of their action is the brain, but they also affect other parts of central nervous system. Volatile and intravenous anesthetics alike have nearly reached the characteristics of an ideal anesthetic, but at a first glance, the increase in use of in-travenous anesthetics could likely push out their volatile counterparts. Looking at the situation more thoroughly, positive side effects of volatile anesthetics that are not found in their intravenous counterparts, still give them a place in modern anesthe-sia practice. It is also possible to combine both techniques to reduce negative adverse effects, while making use of the positive ones.opioids, nitrogenous oxide, muscle relax-ants). Most often, we use them in so called “balanced anesthesia”. This way, safety is increased, while negative adverse effects are decreased.Recently, TCI (target-controlled anesthe-sia) with intravenous anesthetics is being used more and more. It would appear that intravenous anesthetics are going to com-pletely push out the volatile anesthetics that had been used a lot in the past. But is this really going to happen?

160: Use of intravenous anesthetics minimizes fetal cardiac dysfunction during prenatal myelomeningocele repair

160: Use of intravenous anesthetics minimizes fetal cardiac dysfunction during prenatal myelomeningocele repair

A History of Intravenous Anesthesia in War (1656-1988)

The practice of anesthesia in war places significant restraints on the choice of anesthetic technique used; these include, but are not limited to, safety, simplicity, and portability. Ever since intravenous anesthesia became a practical alternative, there have been military doctors who felt that this technique was particularly suited to this environment. The challenge, as in civilian practice, has been to find the appropriate drugs as well as simple and safe delivery systems.The urgency of war has always stimulated innovation in medicine to counteract the ongoing development of weapons of war and their effects on the human body and to achieve improved survival as public expectations rise.This article traces the development of and the use of intravenous anesthesia by military physicians for battle casualties. The story starts long before the era of modern anesthesia, and the discussion concludes in the dog days of the cold war. The rapidly increasing interest in intravenous anesthesia in both civilian and military practice since the early 1990s is left for other authors to examine.

Radiation treatment for the right naris in a pediatric anesthesia patient using an adaptive oral airway technique

Radiation therapy for pediatric patients often includes the use of intravenous anesthesia with supplemental oxygen delivered via the nasal cannula. Here, we describe the use of an adaptive anesthesia technique for electron irradiation of the right naris in a preschool-aged patient treated under anesthesia. The need for an intranasal bolus plug precluded the use of standard oxygen supplementation. This novel technique required the multidisciplinary expertise of anesthesiologists, radiation therapists, medical dosimetrists, medical physicists, and radiation oncologists to ensure a safe and reproducible treatment course.

Anesthetic Techniques and Cancer Recurrence after Surgery

Many of the most common anesthetics are used in surgical oncology, yet effects on cancer cells are still not known. Anesthesia technique could differentially affect cancer recurrence in oncologic patients undergoing surgery, due to immunosuppression, stimulation of angiogenesis, and dissemination of residual cancer cells. Data support the use of intravenous anesthetics, such as propofol anesthesia, thanks to antitumoral protective effects inhibiting cyclooxygenase 2 and prostaglandins E2 in cancer cells, and stimulation of immunity response; a restriction in the use of volatile anesthetics; restriction in the use of opioids as they suppress humoral and cellular immunity, and their chronic use favors angiogenesis and development of metastases; use of locoregional anesthesia compared with general anesthesia, as locoregional appears to reduce cancer recurrence after surgery. However, these findings must be interpreted cautiously as there is no evidence that simple changes in the practice of anesthesia can have a positive impact on postsurgical survival of cancer patients.

Anestesia total intravenosa en un sistema de lazo cerrado: reporte del primer caso en Colombia

Total intravenous anesthesia is a widely used technique that relies on the use of intravenousanesthetics, propofol being the most frequently used and studied. At present, there are pharmaceutical and pharmacokinetic tools that are used to generate mathematical models to ensure the safe and moderately effective use of this technique. However, the depth of anesthesia is determined purely on the clinical findings and this requires neurological monitoring such as the bi-spectral index (BIS) in order to correlate the data derived from the pharmacokinetic models used for the administration of the anesthetic with the determination of its desired clinical effect.We designed an operating system for automated control of the propofol infusion that provides feedback on the basis of the data generated by the BIS monitor. The system is programmed to increase or decrease the propofol infusion within a specific BIS range and, consequently, in accordance with the needs of the individual patient.We describe anesthetic management using this technique in a female patient taken to surgery for prosthetic mammary implantation under general anesthesia at the University Hospital. An intraoperative record was generated including the depth of anesthesia and its action on propofol concentration at the effective site using the automated administration and control system.We concluded that the use of closed-loop total intravenous anesthesia under neurologic monitoring is the next step in the evolution of this technique. It is less reliant on the pharmacokinetic models available at present, and is better suited to adapt to the specific needs of individual patients and to the type of surgical intervention.

Total intravenous anesthesia in a closed loop system: Report of the first case in Colombia

Total intravenous anesthesia is a widely used technique that relies on the use of intravenous anesthetics, propofol being the most frequently used and studied. At present, there are pharmaceutical and pharmacokinetic tools that are used to generate mathematical models to ensure the safe and moderately effective use of this technique. However, the depth of anesthesia is determined purely on the clinical findings and this requires neurological monitoring such as the bi-spectral index (BIS) in order to correlate the data derived from the pharmacokinetic models used for the administration of the anesthetic with the determination of its desired clinical effect.We designed an operating system for automated control of the propofol infusion that provides feedback on the basis of the data generated by the BIS monitor. The system is programmed to increase or decrease the propofol infusion within a specific BIS range and, consequently, in accordance with the needs of the individual patient.We describe anesthetic management using this technique in a female patient taken to surgery for prosthetic mammary implantation under general anesthesia at the University Hospital. An intraoperative record was generated including the depth of anesthesia and its action on propofol concentration at the effective site using the automated administration and control system.We concluded that the use of closed-loop total intravenous anesthesia under neurologic monitoring is the next step in the evolution of this technique. It is less reliant on the pharmacokinetic models available at present, and is better suited to adapt to the specific needs of individual patients and to the type of surgical intervention.

Concerns about non-anesthesiologists administration of intravenous anesthetics

Non-anesthesiologist physicians commonly administer intravenous anesthetics for procedural sedation in Korea. However, an analysis of legal suits shows that such procedural sedation is often performed unsafely. Procedural sedation using potent intravenous anesthetics has similar effect as general anesthesia, which means it has a potential for respiratory and cardiac suppression. There is no training program for non-anesthesiologists to obtain the skills for the adequate control of sedation depth and problem solving. This paper urges the Korean Medical Association and affiliated societies to establish a program to teach doctors the proper use of intravenous anesthetics. The program should cover adequate monitoring of patients, airway management, and cardiopulmonary resuscitation. Access to intravenous anesthetics also poses a risk of drug abuse. Doctors and patients should be cautioned about the abuse potential of intravenous anesthetics, and strict control of such drugs is necessary.

ONE - HUNDREDTH ANNINERSARY OF THE INTRAVENOUS ANESTHESIA CREATION

In 2010 we celebrate the anniversary of intravenous anesthesia, which was invented 100 years ago. Professor N.P. Kravkov (1895-1924) was the first to suggest the use of intravenous anesthesia of gedonal in clinical practice. After successful tests of this anesthesia he suggested a new method of combined anesthesia: inhalation of chloroform for maintenance of anesthesia after intravenous agent gedonal administration

Perioperative Risk Factors for Surgical Complications in Pediatric Urology: A Pilot Study in Preoperative Risk Assessment in Children

To elucidate which perioperative patient characteristics are associated with an increased risk of complications in pediatric urological surgery. There are numerous published studies that have correlated comorbidities, preoperative, and intraoperative parameters with postoperative outcomes in adults. However, there is a paucity of similar data in the pediatric population. Between July 2003 and September 2006, a total of 93 children had an adverse or unexpected event within 35 days of urologic surgery. Thirty-eight preoperative patient characteristics and 20 perioperative parameters were evaluated. The severity of the complications was graded based on the Clavien classification. A total of 163 controls were randomly selected. Statistical significance was assessed by univariate and multivariate analysis. The overall complication rate was 1.1%. Most complications were technical in nature, occurred within 3 days after surgery, and classified as Clavien's grade 3 B. On multivariate analysis, weight less than fifth percentile, pulmonary or hematologic comorbidity, surgery duration >2 hours, first operation, low intraoperative heart rate, and the use of intravenous anesthesia were determined to be independent risk factors, whereas "other" medication was the only independent protective factor. We observed that some of the parameters conventionally thought to be risk factors for surgical complications such as multiple medical comorbidities, repeat operation, and American Society of Anesthesiologists' Classification of Physical Status score were not significant predictors of postoperative complications, whereas others were unexpectedly significant. Future prospective studies will be needed to fully stratify risk and guide risk interventions to improve postoperative outcomes.

Assessment of TVT efficacy in the management of patients with genuine stress incontinence with the use of epidural vs intravenous anesthesia

Our aim was to validate the use of intravenous anesthesia as an alternative to epidural anesthesia for the placement of tension-free vaginal tape (TVT) in patients with urodynamic stress incontinence. Eighty-six patients participated in this prospective study. Forty-five patients were operated with intravenous anesthesia and 41 patients with epidural anesthesia. All patients had a full history taken and a complete gynecological examination performed at initial visit. Preoperative and postoperative urodynamic investigations included filling and voiding cystometry, urethral profilometry, uroflow, and cough stress test. Genuine stress incontinence diagnosis was based on the findings of urodynamic investigations. Patients with prolapse more than first degree or detrusor instability were excluded from the study. The objective success rate for patients operated with intravenous anesthesia was 86.6%, whereas for patients operated with epidural anesthesia was 88% at 12 months of follow-up. We had no cases of postoperative bleeding or hematoma development. Postoperative urinary tract infection developed in three cases (3 of 74). Application of TVT procedure with intravenous anesthesia provides comparable results with the use of epidural anesthesia and could be a very good alternative.

Stanley Arthur Mason MB BS, FRCA, MRCS LRCP, DA, AKC

Stanley Arthur Mason MB BS, FRCA, MRCS LRCP, DA, AKC

Use of intravenous anesthesia for tension-free vaginal tape therapy in elderly women with genuine stress incontinence

Objectives.To study the efficacy of the tension-free vaginal tape (TVT) procedure for elderly patients.Methods.Forty-five women, 65 years old or older (mean 69.1; range 65 to 85), were treated for genuine stress incontinence with the tension-free vaginal tape procedure under intravenous anesthesia with heavy sedation. Urodynamic studies and 1-hour pad test were performed before the procedure and at 1 year postoperatively. Vigorous manual pressure against the abdominal wall and ensuring no lifting of urethra by intraoperative introital ultrasonography were used to position and adjust the vaginal taping.Results.Forty-one (91%) were cured, one improved, and three failed. No major surgical complications occurred. Two bladder perforations were noted. The pad test disclosed a reduction in urine leakage from a mean of 28.9 to 1.6 g/hr (P <0.001). The average blood loss was 72 mL (range 30 to 250), operating time was 21 minutes (range 18 to 35), and postoperative hospital stay was 24.2 hours (range 12 to 72). Spontaneous voiding with an adequate volume of postvoid residual urine was noted for all patients by the fourth day postoperatively. Urodynamic parameters related to the voiding dysfunction showed no significant difference before and after surgery. De novo detrusor instability was observed in 2 patients.Conclusions.With modifications of the technique and the aid of intraoperative ultrasonography, the TVT procedure can be performed under intravenous anesthesia with heavy sedation. The procedure is safe, effective, and minimally invasive for elderly patients. However, long-term follow-up is needed to determine whether this surgery achieves long-lasting results.

The British Journal of Anaesthesia: An informal history of the first 25 years

In 1961, some 7 months after starting anaesthesia in the Leeds General Infirmary, I took out a subscription to the British Journal of Anaesthesia. It cost Pound Sterling3.15s.0d (Pound Sterling3.75) a year. The publishers John Sherratt and Son of Altringham) sent me the back numbers from the start of that year. I first had a paper published in the journal in 1965; first refereed a paper in 1969; joined the editorial board in 1975; and lasted there until 1998. The following account of the early years of the journal derives from the journal itself, and from records, letters and minutes of meetings kindly given to me by Dr Edmund Riding and Professor Andrew Hunter when they demitted offices with the journal. The history cannot be complete. Sadly, the earliest minutes books are lost. But there is much of interest covering the times when anaesthesia developed from the rag-and-bottle inhalation era to the use of intravenous anaesthetics, neuromuscular blocking agents, ventilators and monitoring. Thoracic and neurosurgical anaesthesia were revolutionized; cardiac surgery became possible; and resuscitation with intravenous fluids, blood and plasma all developed. Antibiotics improved care. Anaesthetists pioneered intensive care and latterly extended their roles in pain relief outside the operating theatre. All these developments have appeared in papers at some time in this journal. This is a personal view of the journal over its first 25 years: there will be errors and misinterpretations--these are mine.