Use Of Propofol Research Articles

Effect of propofol versus midazolam on short-term outcomes in patients with sepsis-associated acute kidney injury.

Propofol and midazolam are commonly used sedative drugs in mechanically ventilated patients in the Intensive Care Unit (ICU). However, there is still a lack of relevant studies exploring the influence of midazolam and propofol on the prognosis of patients with Sepsis-associated Acute Kidney Injury (S-AKI). A statistical analysis was conducted on 3,745 patients with S-AKI in the Medical Information Mart for Intensive Care IV database. The patients' baseline characteristics were grouped based on the use of either propofol or midazolam as sedatives. Cox proportional hazards models, logistic regression models, and subgroup analyses were used to compare the effects of propofol and midazolam on the short-term prognosis of S-AKI patients, including 30-day mortality, ICU mortality, and duration of mechanical ventilation. In the statistical analysis, a total of 3,745 patients were included, with 649 patients using midazolam and 3,096 patients using propofol. In terms of the 30-day mortality, compared to patients using midazolam, S-AKI patients using propofol had a lower ICU mortality (hazard ratio = 0.62, 95% confidence interval: 0.52-0.74, p < 0.001), lower 30-day mortality (hazard ratio = 0.56, 95% confidence interval: 0.47-0.67, p < 0.001), and shorter mechanical ventilation time (odds ratio = 0.72, 95% confidence interval: 0.59-0.88, p < 0.001). Kaplan-Meier curves showed lower survival probabilities in the midazolam group (p < 0.001). Subgroup analyses showed that propofol was strongly protective of short-term prognosis in older, male, smaller SOFA score CCI score, no heart failure, and comorbid chronic kidney disease patients with S-AKI. Compared to midazolam, propofol was considered a protective factor for short-term mortality risk and ICU mortality risk in S-AKI patients. Additionally, S-AKI patients using propofol had a lower risk of requiring prolonged mechanical ventilation. Overall, propofol may be more beneficial for the short-term prognosis of S-AKI patients compared to midazolam.

Propofol and salvianolic acid A synergistically attenuated cardiac ischemia-reperfusion injury in diabetic mice via modulating the CD36/AMPK pathway.

Prevention of diabetic heart myocardial ischemia-reperfusion (IR) injury (MIRI) is challenging. Propofol attenuates MIRI through its reactive oxygen species scavenging property at high doses, while its use at high doses causes hemodynamic instability. Salvianolic acid A (SAA) is a potent antioxidant that confers protection against MIRI. Both propofol and SAA affect metabolic profiles through regulating Adenosine 5'-monophosphate-activated protein kinase (AMPK). The aim of this study was to investigate the protective effects and underlying mechanisms of low doses of propofol combined with SAA against diabetic MIRI. Diabetes was induced in mice by a high-fat diet followed by streptozotocin injection, and MIRI was induced by coronary artery occlusion and reperfusion. Mice were treated with propofol at 46mg/kg/h without or with SAA at 10mg/kg/h during IR. Cardiac origin H9c2 cells were exposed to high glucose (HG) and palmitic acid (PAL) for 24h in the absence or presence of cluster of differentiation 36 (CD36) overexpression or AMPK gene knockdown, followed by hypoxia/reoxygenation (HR) for 6 and 12h. Diabetes-exacerbated MIRI is evidenced as significant increases in post-ischemic infarction with reductions in phosphorylated (p)-AMPK and increases in CD36 and ferroptosis. Propofol moderately yet significantly attenuated all the abovementioned changes, while propofol plus SAA conferred superior protection against MIRI to that of propofol. In vitro, exposure of H9c2 cells under HG and PAL decreased cell viability and increased oxidative stress that was concomitant with increased levels of ferroptosis and a significant increase in CD36, while p-AMPK was significantly reduced. Co-administration of low concentrations of propofol and SAA at 12.5μM in H9c2 cells significantly reduced oxidative stress, ferroptosis and CD36 expression, while increasing p-AMPK compared to the effects of propofol at 25μM. Moreover, either CD36 overexpression or AMPK silence significantly exacerbated HR-induced cellular injuries and ferroptosis, and canceled propofol- and SAA-mediated protection. Notably, p-AMPK expression was downregulated after CD36 overexpression, while AMPK knockdown did not affect CD36 expression. Combinational usage of propofol and SAA confers superior cellular protective effects to the use of high-dose propofol alone, and it does so through inhibiting HR-induced CD36 overexpression to upregulate p-AMPK.

Total intravenous anaesthesia in rural sub-Saharan Africa: report of 25 cases.

Total intravenous anesthesia (TIVA) is a potential solution for safe and effective anesthesia administration in rural regions of sub-Saharan Africa, where access to inhalational anesthesia may be limited. However, challenges such as equipment and medication availability, as well as a shortage of trained anesthesiologists, can limit the use of TIVA. In this study, the safety and efficacy of TIVA were evaluated in a case series of 25 female patients undergoing thyroid surgery in a rural area of sub-Saharan Africa. The TIVA protocol involved the use of propofol, fentanyl, rocuronium, and sugammadex. Results showed that TIVA was a safe and effective method of anesthesia administration in this setting, with no major adverse events reported. The use of TIVA may offer advantages such as faster recovery times, reduced incidence of postoperative nausea and vomiting, and reduced risk of environmental pollution compared to inhalational anesthesia. However, the cost and monitoring requirements of TIVA may pose challenges in resource-limited settings. Further research is needed to determine the optimal use of TIVA in this context.

Features of Hemodynamics in Elderly Patients Undergoing CABG Surgery at the Stage of Induction Anesthesia

Due to the global trend of the population ageing, an important task of modern medicine is to improve the provision of medical care for elderly patients. These people have reduced compensatory reserves of the body and numerous chronic pathologies, necessitating a more meticulous approach to anesthesia induction and maintenance by anesthesiologists. According to the authors, the use of propofol and fentanyl leads to decreased myocardial contractility and reduction in overall peripheral vascular resistance. However, the resulting decrease in perfusion pressure in vital organs and tissues, as a consequence of the aforementioned effects, is unacceptable in elderly patients with coronary heart disease (CHD).&#x0D; The aim&#x0D; . To analyze changes in hemodynamics in elderly patients undergoing coronary artery bypass grafting (CABG) during the induction of anesthesia.&#x0D; &#x0D; Materials and methods. A prospective study was conducted which included the results of examination of 20 patients with CHD over 60 years old who underwent CABG without the use of cardiopulmonary bypass at the National Amosov Institute of Cardiovascular Surgery (Kyiv, Ukraine). The mean age of the patients was 67.5±6.8 years. There were 16 (80%) men and 4 (20%) women. Typical manifestations of heart failure were noted (there were 1 [5%], 10 [50%] and 9 [45%] NYHA functional class I, II and III patients, respectively). Also, the patients were classified according to the Canadian classification of angina: 1 (5%), 9 (45%) and 10 (50%) patients fell within class I, II and III, respectively. Stage 2-3 hypertension was reported in 18 patients (90%).&#x0D; For induction of anesthesia, the following medications were used: propofol 1.5 mg/kg, fentanyl 2.0 μg/kg, and rocuronium bromide 0.1 mg/kg. Anesthesia maintenance included: propofol 4 mg/kg/hour, fentanyl 2.0 μg/kg/hour. Hemodynamic parameters saturation indices (SpO2), and transthoracic echocardiography parameters were recorded at the following stages: 1) upon the patient’s arrival in the operating room; 2) prior to tracheal intubation; 3) immediately after tracheal intubation; 4) 25 minutes after intubation.&#x0D; Results. Upon arrival in the operating room, the hemodynamic parameters reflected stable general condition of the examined patients. After administration of induction agents according to the study design, it was recorded that mean blood pressure (BP) was 72.7±4.76% (p&lt;0.001), heart rate was 89.8±5.95% (p=0.0004), cardiac index was 81.47±6.6% (p&lt;0.001), and systemic vascular resistance index (SVRI) was 89.9±7.02% of the baseline values (p=0.063). After intubation, an increase in most hemodynamic indicators was observed, although only mean BP, which constituted 86.7±8.8% of the baseline data (p&lt;0.001), and SVRI (89.8±11.04% of the baseline data, p=0.0315), significantly differed from the baseline values. Within 25 minutes after the intubation, the parameters decreased again: with mean BP 74.9±7.9% (p&lt;0.001), heart rate 91.3±9.5% (p=0.008), cardiac index 79.6±10.1% (p&lt;0.001), and SVRI 91.1±9.34% (p=0.062) of the baseline values.&#x0D; Conclusions. The main changes in hemodynamics were reported during induction of anesthesia, where a significant decrease in most indicators compared to the baseline state was recorded. After intubation, the parameters slightly increased but did not return to the baseline values. During further anesthesia maintenance, a significant decrease in most indicators relative to the baseline data were observed. The instability of hemodynamic parameters during the induction stage of anesthesia in elderly patients with CHD can be an obstacle to the normal course of the perioperative period, necessitating the search for methods to stabilize them.

Anesthetic protocol using propofol and isoflurane in spectacled bear (Tremarctos ornatus)

The management of wild animals generally requires chemical containment with the use of sedatives, tranquilizers, general anesthetics or dissociative drugs. The spectacled bear (Tremarctos ornatus) is the only member of the family Ursidae characteristic of South America. There are few reports on the main anesthetic protocols used in this specie. The aim of the present study was to report the use of propofol and isoflurane in a captive spectacled bear, after sedation with tiletamine-zolazepam. A male bear approximately 15 years old and 264 lb (scale weight) underwent anesthesia for treatment of a recurrent ulcerated wound on the neck. A combination of tiletamine and zolazepam injected intramuscularly was initially used. Due to the need to prolong the anesthetic time, the decision was made to administer propofol 1% (4.0 mg/kg/IV), which proved satisfactory regarding the inhibition of eyelid and laryngotracheal reflexes, thereby facilitating tracheal intubation. The subsequent use of isoflurane provided adequate maintenance of anesthesia, with vital signs within the normal range for the species, but there was hyperthermia. Based on the present findings, the use of tiletamine/zolazepam, propofol and isoflurane proved satisfactory and the doses employed were safe for the spectacled bear (Tremarctos ornatus). Inhalation anesthesia was essential to prolonging the time and maintaining safety throughout the procedure.

Commonly Used Induction and Maintenance Drug for Children Treated Under General Anesthesia - A Retrospective Study

Introduction: General anesthesia is used to produce amnesia and analgesia with or without muscle paralysis. Pediatric General anesthesia is given for children to perform complicated procedures. The most commonly used inducing agent is propofol which is used for its high performance and among the maintaining drugs is sevoflurane which has high blood and tissue solubility. Aim: To find out the commonly used inducing and maintaining drug for children treated under General anesthesia. Materials and Methods: Saveetha Dental College provided data, which was then transferred to an excel file. The spss software was used for statistical analysis. Results: On the data collected it was observed that use of propofol is the most common drug among inducing agents and the most commonly used maintenance drug is sevoflurane for maintaining General anesthesia. Conclusion: According to the findings, propofol is the most regularly used inducing drug, whereas sevoflurane is the most commonly used maintenance drug.

Effect of Propofol and Isoflurane on Postoperative Cognitive Dysfunction Following Elective Laminectomy Surgery in Adult Elderly Patients: A Randomized Controlled Trial Study

Background: Postoperative cognitive dysfunction (POCD) is a significant complication, especially prevalent among elderly individuals following major surgical procedures. Objectives: This study aims to compare the impact of isoflurane and propofol on the occurrence of POCD in patients undergoing elective laminectomy surgery under general anesthesia. Methods: This randomized, double-blind clinical trial took place at Shariati Hospital in Tehran. Patients scheduled for elective laminectomy between December 2020 and November 2021 were enrolled in the study and randomized into 2 groups. Patients in Group P received a Propofol infusion, while patients in Group I were administered isoflurane. Cognitive function assessments were conducted using the Mini-Mental State Examination (MMSE) at 3-time points: Twelve hours before surgery and 6 and 24 hours after surgery. Results: The MMSE scores demonstrated a significant increase in the Propofol group compared to the Isoflurane group at the 6-hour and 24-hour post-surgery time points. However, no significant difference was observed at baseline before surgery (P = 0.04, P = 0.005, and P = 0.2, respectively). Conclusions: These findings suggest that the use of propofol for general anesthesia may be a favorable choice for surgical procedures in elderly patients.

Characterization of Propofol Use For Non-Procedural Sedation in a Pediatric Intensive Care Unit

OBJECTIVE Given the limited literature describing propofol use in pediatric patients, this study aimed to describe the dosing and duration of propofol infusions for non-procedural sedation in the pediatric intensive care unit (PICU). The secondary objectives were to describe the change in concomitant sedative requirements from the 24-hour period before propofol initiation to the 24-hour period after discontinuation of propofol and to review the frequency of adverse events. METHODS This retrospective descriptive cohort study evaluated children 1 month to less than 18 years old who received a continuous infusion of propofol for non-procedural sedation in the PICU between May 2018 and August 2020. RESULTS One hundred thirty propofol infusions representing 127 unique patients (median age, 2.9 years) were included. The median (IQR) propofol infusion duration was 18 (10–28) hours, and the median (IQR) average dose was 4.1 (2.9–5.6) mg/kg/hr. Extubation was attempted in 96 patients (74%) within 24 hours of propofol infusion discontinuation. For patients that remained intubated with continuous sedation, concomitant continuous opioid and midazolam requirements decreased by 20% (p = 0.865) and 43% (p = 0.011), respectively. Patients receiving propofol for over 24 hours experienced the largest percent decrease in concomitant sedation with midazolam. There were no confirmed cases of propofol-related infusion syndrome (PRIS). CONCLUSIONS Durations and doses of propofol infusions for non-procedural sedation vary widely at our institution. Propofol may be beneficial as an adjunct sedative, but prospective studies are needed to further explore the effect of propofol on decreasing the requirements of concomitant opioids and benzodiazepines.

Effects of different anesthesia methods on perioperative immune function and long-term regression of patients undergoing thoracoscopic radical esophagectomy for esophageal cancer

ObjectiveThis study investigated the effects of different anesthetic methods on perioperative immune function and long-term regression of patients undergoing thoracoscopic radical surgery for esophageal cancer. MethodsData from 147 patients undergoing thoracoscopic radical surgery for esophageal cancer in our hospital from January 2017 to June 2019 were selected for retrospective analysis. Patients were divided into control (intravenous anesthesia combined with an epidural block, n = 83) and observation (intravenous anesthesia combined with a thoracic paravertebral nerve block, n = 64) groups. The use of relevant drugs during the surgery, indexes of the peripheral blood T-lymphocyte subpopulation at different time points (before induction of anesthesia, at the completion of surgery, 24 h postoperatively, and 48 h postoperatively), and 3-year postoperative survival were compared between the two groups. ResultsData on propofol and remifentanil use during surgery were not significantly different (P > 0.05) between the two groups. The proportion of vasoactive drug use was lower in the observation group than in the control group (P < 0.05). Differences in data for CD3+, CD4+, and CD4+/CD8+ cells between time points were significant (F = 13.256, 20.307, 18.035, P < 0.05), while those between the two groups were not (F = 1.005, 1.135, 1.204, P > 0.05). There was no interaction between data processing factors and time between the control and observation groups in CD3+, CD4+, and CD4+/CD8+ cells (F = 0.358, 0.778, 1.107, P > 0.05). The median overall survival time was 21.988 (95 % confidence interval: 18.436–25.541) and 26.978 (95 % confidence interval: 20.124–33.833) months in the control and observation groups, respectively, with a significant difference between the two groups (Log-rank χ2 = 3.925, P < 0.05). ConclusionsBoth anesthetic methods achieve satisfactory anesthetic results and reduce postoperative stress and immunosuppression. However intravenous anesthesia combined with an epidural block can increase the incidence of intraoperative hypotension in the patients, thoracic paravertebral nerve block combined with general anesthesia is more favorable for maintaining intraoperative blood pressure and heart rate stability, as well as for postoperative survival.

A comparative study of intraoperative analgesic consumption and recovery profile between sevoflurane- and propofol-based general anesthesia in adults

Background: Many researches were performed in the past to compare propofol and sevoflurane as sole anesthetics. While some studies have reported the advantages of propofol regarding better recovery profile and post-operative analgesic sparing effect, the contrast reporting does exist. Hence, there is a further need of research to explore recovery characteristics. Whether either of these two as sole anesthetics can yield any benefit regarding intraoperative analgesics consumption has not been evaluated. Aims and Objectives: The study primarily aimed at determining total analgesic consumption in the intraoperative period (primary outcome), between those receiving either sevoflurane or propofol for induction as well as maintenance of anesthesia. In addition, intraoperative hemodynamics (heart rate and mean arterial pressure) and recovery profile were compared. Materials and Methods: Total of 168 patients, aged 18–60 years, the American Society of Anesthesiologists’ physical status I/II, undergoing elective and emergency surgeries under general anesthesia for 2–3 h finally recruited. Patients were randomly allocated to receive either sevoflurane (group S, n=84) or propofol (group P, n=84) for both induction and maintenance. Anesthetics were titrated to achieve bispectral index (BIS) value of 60. For both the groups, additional fentanyl was considered aliquots of 25 mcg whenever the hemodynamics changes occurred despite maintaining BIS value in the above-mentioned range. Results: The total intraoperative analgesic consumption was found comparable in both groups of patients. Induction time (38 vs. 59 s) and emergence time (8 vs. 10 s, P&lt;0.001) were found shorter in the propofol group than in sevoflurane. Aldrete score &gt;9 was achieved earlier with propofol compared with sevoflurane (8.5 vs. 12 min). Conclusion: Propofol-based shows no advantage over sevoflurane in view of intraoperative consumption of analgesics and intraoperative hemodynamic stability. However, the use of propofol was associated with faster induction as well as quicker emergence from anesthesia.

Use of sodium thiopental and propofol for intravenous sedation and treatment of delirium in early postoperative period in surgical patient

In emergency surgery with volumetric surgical interventions, there are a number of indications for the continuation of intravenous sedation and artificial lung ventilation (ventilator) in the intensive care unit. Often, this need is due to both the magnitude of the surgical catastrophe and the severe concomitant comorbid back14 ground, high risk of early postoperative complications. There is also the development of delirium of various etiologies in the early postoperative period, which also affects the course of the postoperative process, the duration of stay in the intensive care unit.In connection with the above, on the basis of the Intensive care unit of the Multidisciplinary Hospital No. 1 a comparative characteristic of the effectiveness of the use of sodium thiopental and propofol for intravenous sedation and treatment of delirium in surgical patients was carried out in Karaganda.

S2947 Use of Propofol During Endoscopy May Lead to Arrhythmias in Patients With Brugada Syndrome

S2947 Use of Propofol During Endoscopy May Lead to Arrhythmias in Patients With Brugada Syndrome

AS-IV enhances the antitumor effects of propofol in NSCLC cells by inhibiting autophagy.

Non-small cell lung cancer (NSCLC) is one of the most lethal malignant tumors. It has been shown that the general anesthetic agents, propofol and astragaloside IV (AS-IV) both exert antitumor effects in NSCLC. However, the effects of the combination of propofol with AS-IV in NSCLC remain unclear. Cell counting kit-8, and EdU and Transwell assays were performed to evaluate NSCLC cell viability, proliferation, and migration. Cell apoptosis and autophagy were observed by flow cytometric analysis and TUNEL and LC3 staining, respectively. AS-IV notably enhanced the anti-proliferative, pro-apoptotic, and anti-migratory properties of propofol in NSCLC cells. Moreover, AS-IV remarkably facilitated the anti-autophagy effect of propofol in NSCLC cells by downregulating LC3, Beclin 1, and ATG5. Significantly, the pro-apoptotic ability of the AS-IV/propofol combination in NSCLC cells was further enhanced by the autophagy inhibitor 3-MA, suggesting that autophagy plays a tumor-promoting role in NSCLC cells. Collectively, AS-IV could facilitate the antitumor abilities of propofol in NSCLC cells by inhibiting autophagy. These findings may be beneficial for future studies on the use of AS-IV and propofol for the treatment of NSCLC.

Cannabis Users Require More Anesthetic Agents for General Anesthesia in Ambulatory Oral and Maxillofacial Surgery Procedures

The use of cannabis in the general population has steadily increased over recent years and there is limited literature regarding the anesthetic implications of chronic cannabis use, particularly in the setting of outpatient anesthesia. To determine whether chronic cannabis users undergoing deep sedation or general anesthesia during ambulatory procedures require more anesthetic agents than nonusers. A retrospective cohort study of subjects undergoing deep sedation or general anesthesia at the Oklahoma University Oral and Maxillofacial Surgery Clinic from January to December 2022 was performed. The inclusion criteria were duration of anesthetic procedure between 15 to 40minutes, use of propofol, fentanyl, ketamine, and midazolam, and extraction of at least 2 teeth. The exclusion criterion was patients undergoing adjunctive procedures other than extractions during sedation. Cannabis use status was grouped as users and nonusers. A user was defined as a subject who self-reported any regular use of cannabis. The primary outcome variable was the amount of intravenous anesthetic agents administered. Secondary outcome variables included the length of the procedure and the number of teeth extracted. Age, sex, and the senior-most resident involved in the sedation. IBM SPSS was utilized to perform descriptive statistics, paired t-tests, ANOVA, and multivariate linear regression. A level of significance of 5% (P<.05) was used for all analyses. Four hundred and ninety nine subjects were identified, 189 met the inclusion criteria, and 57 reported using cannabis. The mean age of nonusers was 28.2±7.8years and that of users was 26.6±6.4years (P=.09). Females represented 71.9% of nonusers and 72.7% of users. Cannabis users received significantly more propofol (117.5mg±71.3 vs 152.5mg±101.8; P=.004), midazolam (4.7mg±1.0 vs 5.1mg±1.5; P=.01), ketamine (40.2mg±15.7 vs 46.1mg±16.9; P=.01), and fentanyl (75.2μg±26.3 vs 88.6μg±32.8; P=.002) than nonusers, despite extracting a similar number of teeth (4.5±3.1 vs 4.4±3.5; P=.37) in a similar amount of time (25.5±7.3 vs 27.3±7.8; P=.06). Cannabis users required more propofol, midazolam, ketamine, and fentanyl than non-cannabis users during outpatient oral and maxillofacial surgery procedures.

Propofol Sedation Washouts in Critically Ill Infants: A Case Series.

Medically complex infants are experiencing longer hospital stays, more invasive procedures, and increasingly involved therapeutic interventions that often require long-term analgesia and sedation. This is most commonly achieved with continuous intravenous infusions of opioids and benzodiazepines. There are times when patients develop a tolerance for these medications or the clinical scenario necessitates a rapid wean of them. A rapid wean of either class of medication can lead to increased signs of pain and agitation or withdrawal symptoms. As a result, when a rapid wean is needed or there has been a failure to control symptoms with conventional measures, alternative therapies are considered. Propofol, a sedative hypnotic typically used for general anesthesia and procedural sedation, is one such medication. It has effectively been used for short-term sedation in adults and children to facilitate weaning benzodiazepines and opioids. There is a paucity of data on the use of propofol in infants for this purpose. Here we describe the use of propofol to rapidly wean high-dose sedation and analgesia medications, a propofol sedation washout, in 3 infants. The washouts proved to be safe and efficacious. Based on institutional experience and a literature review, considerations and recommendations are made for propofol sedation washouts in infants.

Median effective dose (ED50) of esketamine combined with propofol for children to inhibit response of gastroscope insertion

BackgroundPropofol is the most commonly used drug for procedural sedation during gastroscopy. However, independent use of propofol can lead to increased dosage and additional side effects. Esketamine was found to be exceptional in combination with propofol for painless gastroscopy. No studies have calculated the median effective dose (ED50) of esketamine combined with propofol in pediatric painless gastroscopy. Here, we designed a research to study the ED50 of esketamine combined with propofol using the Dixon and Massey up-and-down sequential method for inhibiting the response of gastroscope insertion.MethodsChildren who met the inclusion and exclusion criteria were included in this study. Propofol and esketamine were used as anesthetics for painless gastroscopy in children. To explore the ED50, the initial propofol dose was set at 3 mg/kg in all children. The first child was given an esketamine dose of 0.1 mg/kg, followed by 30 s of slow bolus injection propofol. If anesthesia induction failed (coughing or body movement of children during gastroscope insertion), the esketamine dose was elevated in the next child, with a interval difference of 0.05 mg/kg. Otherwise, if the anesthesia induction was successful, the next dosage was reduced by 0.05 mg/kg. The study was stopped if nine crossover inflection points were reached. The ED50 of esketamine was calculated using probit regression, and the blood pressure, pulse oxygen saturation, heart rate, recovery time, and side effects were recorded in all children.ResultsA total of 26 children were included in this study. The ED50 of esketamine combined with 3 mg/kg propofol was 0.143 mg/kg (95% CI 0.047–0.398 mg/kg). The total consumption of propofol was 16.04 ± 5.37 mg. The recovery time was 16.38 ± 8.70 min. Adverse effects recorded were delayed awakening in two cases and increased oral secretions of another child during the examination inducing cough and hypoxemia (86% was the lowest).DiscussionThe ED50 of esketamine was 0.143 mg/kg when combined with 3 mg/kg propofol for successful sedation in pediatric gastroscope insertion. This sub-anaesthetic dose of esketamine was safe and efficacious with few complications in pediatric painless gastroscopy.Trial registrationThe study was registered at the Chinese Clinical Trial Registry (www.chictr.org.cn; registration number: ChiCTR2100052830 on 06/11/2021).

Successful Use of Low-Dose Combination Propofol and Fentanyl in Cataract Surgery Phacoemulsification.

The combination between sedatives and opioids is one of the recommended anesthetic options in ophthalmic procedures and regimens are more advantageous as smaller amounts of each drug can be administered to reduce side effects and have proper outcomes due to the synergistic effects. This study aims to observe the use of low-dose propofol and fentanyl for patients undergoing phacoemulsification surgery. This observational study involves a sample of 125 adult patients who underwent elective cataract procedures using the phacoemulsification technique and had an American Society of Anesthesiologists (ASA) physical status of 1 to 3. Dose amount of fentanyl and propofol, Ramsay score, hemodynamic parameter, side effects, and patient satisfaction were evaluated, recorded, and analyzed using a 5-point Likert scale. The result showed the mean absolute dose of propofol was 12.46±4.376 mg, with a range between 10 and 30 mg, while the mean per body weight was 0.21±0.075 mg. Similarly, the mean absolute dose for fentanyl was 25.04±3.012 mcg within the range of 10-50 mcg, and the per-body weight dose was 0.43±0.080 mcg. About 90.4% and 9.6% of the patients reached Ramsay 2 and 3, respectively. The analysis of systolic, diastolic blood pressure, mean arterial pressure, and pulse rate showed that the combination of low-dose fentanyl and propofol was significantly lower than before therapy administration in all four values (p < 0.05). The combination of low-dose propofol and fentanyl in cataract surgery using phacoemulsification successfully reached the targeted sedation level and a significant decrease in blood pressure, MAP, pulse rate, minimal side effects, and high satisfaction rate.

Impact of ketamine versus propofol for anesthetic induction on cognitive dysfunction, delirium, and acute kidney injury following cardiac surgery in elderly, high-risk patients.

Evaluate the effects of ketamine versus propofol when used for induction of anesthesia in elderly, high-risk cardiac surgical patients on postoperative complications including cognitive dysfunction, delirium, and acute kidney injury. Prospective, randomized study performed at a tertiary medical center. A total of 52 patients aged ≥70 and older presenting for complex cardiac surgery were randomized to receive either ketamine or propofol for induction of anesthesia. Patients underwent a battery of cognitive testing preoperatively and postoperatively and the incidence of delirium and acute kidney injury were measured. Norepinephrine (NEE) equivalents following induction were assessed for each group. A total of 49 patients were included, 25 in the ketamine group and 24 in the propofol group with 3 patients excluded from the analysis. No difference was found between groups in either postoperative cognitive dysfunction or delirium incidence. Acute kidney injury occurred in 6 (24%) patients in the ketamine group in 12 (50%) patients in the propofol group, but the difference did not meet statistical significance (P = 0.08; Relative Risk = 2.1, 95% CI 0.9-4.7). NEE equivalents were lower in the ketamine group, 9.6 ± 22.2 versus 32.7 ± 46.0, P < 0.03. The use of ketamine versus propofol for induction of anesthesia did not impact the incidence of postoperative cognitive dysfunction or delirium. Twice as many patients in the propofol group developed acute kidney injury, although not reaching statistical significance and warranting further investigation. In elderly, high-risk patients, ketamine was associated with a significantly reduced need for vasopressor support following induction.

Comparison of Bispectral index-guided propofol and etomidate infusion for Supraglottic airway insertion

IntroductionSupraglottic airway devices have become extremely popular for minor therapeutic and surgical procedures. Their insertion requires an adequate depth of anesthesia with suppression of pharyngeal reflexes. Propofol is the most commonly used agent, but has hemodynamic side-effects. Etomidate, although hemodynamically stable, does not suppress pharyngeal reflexes adequately. Moreover, the use of clinical signs to assess the depth of anesthesia has questionable accuracy. Using bispectral index (BIS) monitoring, the hypnotic component of the anesthetic can be measured, with values of 40–60 implying adequate depth of anesthesia. MethodsThis randomized controlled trial included 80 ASA I patients, divided into two groups of 40 patients. Each group received either propofol or etomidate infusion, with BIS monitoring. At BIS 50, infusions were stopped and SGA was inserted. Changes in hemodynamic parameters, time for SGA insertion, number of attempts, and SGA insertion scores were recorded. ResultsWhen BIS reached 50, a statistically significant fall in mean arterial pressure was observed in the propofol group. Time for SGA insertion was less in the propofol group (30.7 ± 8.0 s), with successful SGA insertion observed in 92.5% of patients on the first attempt, compared with 47.9 ± 9.1 s and 32.3% in the etomidate group. ConclusionIn comparison with etomidate, the use of propofol is associated with better conditions for SGA insertion but has the side-effect of hypotension, even with BIS-guided titration of dose for maintaining an adequate depth of anesthesia.

Exploring the role of pharmacology in surgical anatomy and patient outcomes

Introduction: This study looked at how pharmacology affected surgical anatomy and patient outcomes. Methods: The research included a total of 162 participants who were having elective surgery. Propofol or sevoflurane was randomly allocated to patients for the initiation and maintenance of anesthesia. Acetaminophen, nonsteroidal anti-inflammatory medications (NSAIDs), and opioids were used in combination to alleviate pain. Results: When compared to patients receiving sevoflurane, those receiving propofol had substantially reduced rates of postoperative nausea and vomiting (PONV) (p 0.05). Additionally, the propofol group saw quicker healing and shorter hospital stays (p 0.05). Multimodal analgesia was linked to better pain management and reduced opioid use. Conclusion: The use of propofol for anesthesia induction and maintenance, as well as multimodal analgesia, may provide superior outcomes for patients undergoing surgery. These findings highlight the importance of pharmacology in surgical anatomy and patient outcomes and emphasize the need for further research to optimize the use of these interventions in the perioperative period.