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Chouhan A, Bhat SN, Rao SV. Comparison of the Influence of Intraoperative Use of Sevoflurane and Isoflurane on Postoperative Nausea, Vomiting, and Cough. Ann Afr Med 2024; 23:385-390. [PMID: 39034563 PMCID: PMC11364307 DOI: 10.4103/aam.aam_26_24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Revised: 02/22/2024] [Accepted: 03/11/2024] [Indexed: 07/23/2024] Open
Abstract
INTRODUCTION Postoperative nausea, vomiting, and cough are the most common adverse effects of general anesthesia resulting in high discomfort to the patient resulting in uneasiness during the recovery period. This study aimed to compare the influence of intraoperative use of sevoflurane and isoflurane on postoperative nausea, vomiting, and cough. MATERIALS AND METHODS After approval from the institutional ethical committee, this quantitative observational institutional study was conducted on all patients aged between 18 and 65 years undergoing surgery under general anesthesia at KMC Hospital, Mangalore. Patients were allocated into the sevoflurane group or isoflurane group. RESULTS All demographic parameters such as age, sex, American Society of Anesthesiologists physical status, and duration were comparable (P > 0.05). The sevoflurane group had higher number of patients (11 [14.86%]) with postoperative nausea at 0 h as compared isoflurane group (7 [9.45%]). Two patients in the isoflurane group reported postoperative vomiting at 0 h, whereas no patient in the sevoflurane group reported vomiting. For cough, a statistically significant correlation was seen between the two groups (P = 0.000) with majority of patients in the isoflurane group, i.e., 50 (67.6%) patients reporting cough at 0 h while only 15 (20.3%) reported cough in the sevoflurane group. CONCLUSION Sevoflurane was found to be better than isoflurane in terms of postoperative nausea vomiting and cough immediately after emergence in our study. Isoflurane cause the emergence of cough whereas no significant difference in nausea and vomiting was observed in both groups.
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Affiliation(s)
- Akansha Chouhan
- Department of Anaesthesiology, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Sonal N Bhat
- Department of Anaesthesiology, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Sunil Vasudev Rao
- Department of Anaesthesiology, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, India
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Doubovikov ED, Serdyukova NA, Greenberg SB, Gascoigne DA, Minhaj MM, Aksenov DP. Electric Field Effects on Brain Activity: Implications for Epilepsy and Burst Suppression. Cells 2023; 12:2229. [PMID: 37759452 PMCID: PMC10527339 DOI: 10.3390/cells12182229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 08/07/2023] [Accepted: 09/04/2023] [Indexed: 09/29/2023] Open
Abstract
Electric fields are now considered a major mechanism of epileptiform activity. However, it is not clear if another electrophysiological phenomenon, burst suppression, utilizes the same mechanism for its bursting phase. Thus, the purpose of this study was to compare the role of ephaptic coupling-the recruitment of neighboring cells via electric fields-in generating bursts in epilepsy and burst suppression. We used local injections of the GABA-antagonist picrotoxin to elicit epileptic activity and a general anesthetic, sevoflurane, to elicit burst suppression in rabbits. Then, we applied an established computational model of pyramidal cells to simulate neuronal activity in a 3-dimensional grid, with an additional parameter to trigger a suppression phase based on extra-cellular calcium dynamics. We discovered that coupling via electric fields was sufficient to produce bursting in scenarios where inhibitory control of excitatory neurons was sufficiently low. Under anesthesia conditions, bursting occurs with lower neuronal recruitment in comparison to seizures. Our model predicts that due to the effect of electric fields, the magnitude of bursts during seizures should be roughly 2-3 times the magnitude of bursts that occur during burst suppression, which is consistent with our in vivo experimental results. The resulting difference in magnitude between bursts during anesthesia and epileptiform bursts reflects the strength of the electric field effect, which suggests that burst suppression and epilepsy share the same ephaptic coupling mechanism.
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Affiliation(s)
- Evan D. Doubovikov
- Department of Radiology, NorthShore University HealthSystem, Evanston, IL 60201, USA
| | - Natalya A. Serdyukova
- Department of Biomedical Engineering, Northwestern University, Evanston, IL 60208, USA
- Department of Pediatrics, NorthShore University HealthSystem, Evanston, IL 60201, USA
| | - Steven B. Greenberg
- Department of Anesthesiology, NorthShore University HealthSystem, Evanston, IL 60201, USA
| | - David A. Gascoigne
- Department of Radiology, NorthShore University HealthSystem, Evanston, IL 60201, USA
| | - Mohammed M. Minhaj
- Department of Anesthesiology, NorthShore University HealthSystem, Evanston, IL 60201, USA
| | - Daniil P. Aksenov
- Department of Radiology, NorthShore University HealthSystem, Evanston, IL 60201, USA
- Department of Biomedical Engineering, Northwestern University, Evanston, IL 60208, USA
- Department of Anesthesiology, NorthShore University HealthSystem, Evanston, IL 60201, USA
- Pritzker School of Medicine, University of Chicago, Chicago, IL 60637, USA
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Qiu L, Cai J, Mei A, Wang X, Zhou Z, Sun J. Predictors of Postoperative Nausea and Vomiting After Same-Day Surgery: A Retrospective Study. Clin Ther 2023; 45:210-217. [PMID: 36781358 DOI: 10.1016/j.clinthera.2023.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 12/06/2022] [Accepted: 01/22/2023] [Indexed: 02/14/2023]
Abstract
PURPOSE Postoperative nausea and vomiting (PONV) are main issues after same-day surgery. This study aimed to retrospectively evaluate the electronic medical records of patients who underwent same-day operations under general anesthesia to identify the potential risk factors for PONV. METHODS Records of 7759 adult patients who received general anesthesia with remifentanil were reviewed. The patients were assessed for the incidence and severity of PONV. Multiple logistic regression was used to identify risk factors for PONV. A nomogram was established to predict PONV after same-day operations. FINDINGS Of 7759 patients, 2317 (29.9%) experienced PONV. In multiple logistic regression analysis, female sex, nonsmoker status, history of motion sickness or nausea, high body mass index (BMI), long surgical duration, laparoscopic procedure, and preoperative analgesic intake within 30 days were independent risk factors for PONV. No correlation was found between the severity of PONV and remifentanil exposure (odds ratio = 1.018; 95% CI, 0.861-1.204; P = 0.834) or remifentanil dose (odds ratio = 1.294; 95% CI, 0.760-2.205; P = 0.343). For the nomogram, which involved sex, laparoscopic procedure, BMI, history of nausea or motion sickness, and analgesic intake within 30 days, the receiver operating characteristic analysis revealed that the AUC values in the training and validation cohorts were 0.81 and 0.83, respectively. IMPLICATIONS Predictors for PONV in same-day surgery include female sex, nonsmoker, history of motion sickness or nausea, high BMI, surgical duration >1 hour, laparoscopic procedure, and preoperative analgesic intake within 30 days. A new predictive model is feasible for predicting the incidence of PONV based on the preoperative and intraoperative predictors.
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Affiliation(s)
- Lili Qiu
- Department of Anesthesiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Jinxia Cai
- Department of Anesthesiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Aishuang Mei
- Postanesthesia Care Nursing, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Xiaofeng Wang
- Department of Thyroid Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Zijun Zhou
- Department of Anesthesiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.
| | - Jiehao Sun
- Department of Anesthesiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.
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Yang H, Zhang Y, Liu C, Ou Y, Zhu Y, Xue Y, Zhao G, Lin Y, Chen C, Xu G, Yuan K, Wang Q, Zhang M, Li L, Liu J, Zhang W. A Multicenter, Randomized, Double-Blind, Positive-Controlled, Non-Inferiority, Phase III Clinical Trial Evaluating the Efficacy and Safety of Emulsified Isoflurane for Anesthesia Induction in Patients. CNS Drugs 2022; 36:1301-1311. [PMID: 36385453 DOI: 10.1007/s40263-022-00970-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/13/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND Emulsified isoflurane was designed to circumvent the deficiencies of inhalation anesthetics, which have a longer time to onset, result in a higher drug consumption, and for which a specific anesthesia machine is required for clinical use. The aim of this study was to compare the efficacy and safety of emulsified isoflurane with propofol for anesthesia induction in adults patients. METHODS This multicenter, randomized, double-blind, positive-controlled, non-inferiority, phase III clinical trial compared the efficacy and safety of emulsified isoflurane with propofol for anesthesia induction. Each patient in the emulsified isoflurane group received a single bolus injection of 12% emulsified isoflurane at a dose of 30 mg/kg, and each patient in the propofol group received a single bolus injection of 0.8% propofol at a dose of 2 mg/kg. The primary outcome of the efficacy evaluation was the proportion of participants with successful anesthesia induction, which was regarded as a Modified Observer's Assessment of Alertness/Sedation (MOAA/S) score of < 1 and lack of use of other sedative drugs. A number of secondary efficacy outcomes were also assessed. Safety was monitored based on (1) adverse events, (2) repeated measurement of vital signs; (3) physical examination, (4) routine laboratory examinations of hematology, biochemistry, urine, coagulation function, and (5) 12-lead electrocardiogram. RESULTS A total of 416 patients were enrolled (n = 208 in each group) and 398 patients were administered study drug. The proportion of participants with successful anesthesia induction was 100% with a 95% confidence interval of - 1.9% to + 1.9% for the emulsified isoflurane and propofol groups, which met the predesigned non-inferiority criteria of 5%. The study demonstrated the non-inferiority of sedation produced by emulsified isoflurane compared to propofol. Among the secondary efficacy outcomes, emulsified isoflurane showed a better cardiovascular stability than propofol. The number of patients from the emulsified isoflurane group who experienced drug-related adverse events was significantly higher than that of patients from the propofol group. However, there was no significant difference between the two groups in terms of adverse events or drug-related adverse events of grades 3-5. CONCLUSIONS Emulsified isoflurane exhibited non-inferiority of anesthesia/sedation compared to propofol in patients undergoing anesthesia induction. CLINICAL TRIAL REGISTRATION ChiCTR2000038185, registered on 12 December, 2020 ( www.chictr.org.cn ).
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Affiliation(s)
- Hui Yang
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - YuJun Zhang
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China.,Laboratory of Anaesthesia and Critical Care Medicine, Department of Anesthesiology, National-Local Joint Engineering Research Center of Translational Medicine of Anesthesiology, West China Hospital, Sichuan University, Sichuan, 610041, Chengdu, P. R. China.,National-Local Joint Engineering Research Center of Translational Medicine of Anesthesiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - ChuiLiang Liu
- Department of Anesthesiology, Chancheng District Central Hospital of Foshan City, Foshan, Fujian, China
| | - YangWen Ou
- Department of Anesthesiology, The Third Xiangya Hospital of Central South University, Xiangya, Hunan, China
| | - YuHang Zhu
- Department of Anesthesiology, Affiliated Hospital of Zunyi Medical College, Zunyi, Guizhou, China
| | - Yun Xue
- Department of Anesthesiology, Chongqing University Fuling Hospital, Fuling, Chongqing, China
| | - GaoFeng Zhao
- Department of Anesthesiology, Guangdong Provincial Hospital of Traditional Chinese Medicine, Guangzhou, Guangdong, China.,Department of Anesthesiology, Guangdong Hospital of Traditional Chinese Medicine, University City Branch, Guangzhou, Guangdong, China
| | - YuShuang Lin
- Department of Anesthesiology, Zhangzhou Affiliated Hospital of FuJian Medical University, Zhangzhou, Fujian, China
| | - Chun Chen
- Department of Anesthesiology, Yichang Central People's Hospital, Yichang, Hubei, China
| | - GuoHai Xu
- Department of Anesthesiology, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - KaiMing Yuan
- Department of Anesthesiology, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Qiang Wang
- Department of Anesthesiology, The First Affiliated Hospital of Xi'an Jiaotong University, Xian, Shanxi, China
| | - Min Zhang
- Humanwell Healthcare (Group) Co., Ltd, Yichang, Hubei, China
| | - LiE Li
- Humanwell Healthcare (Group) Co., Ltd, Yichang, Hubei, China
| | - Jin Liu
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China.,Laboratory of Anaesthesia and Critical Care Medicine, Department of Anesthesiology, National-Local Joint Engineering Research Center of Translational Medicine of Anesthesiology, West China Hospital, Sichuan University, Sichuan, 610041, Chengdu, P. R. China.,National-Local Joint Engineering Research Center of Translational Medicine of Anesthesiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - WenSheng Zhang
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China. .,Laboratory of Anaesthesia and Critical Care Medicine, Department of Anesthesiology, National-Local Joint Engineering Research Center of Translational Medicine of Anesthesiology, West China Hospital, Sichuan University, Sichuan, 610041, Chengdu, P. R. China. .,National-Local Joint Engineering Research Center of Translational Medicine of Anesthesiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
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Wang TT, Lu HF, Poon YY, Wu SC, Hou SY, Chiang MH, Hung KC, Hsu SW. Sevoflurane versus desflurane for early postoperative vomiting after general anesthesia in hospitalized adults: A systematic review and meta-analysis of randomized controlled trials. J Clin Anesth 2021; 75:110464. [PMID: 34311245 DOI: 10.1016/j.jclinane.2021.110464] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 07/13/2021] [Accepted: 07/14/2021] [Indexed: 11/28/2022]
Abstract
STUDY OBJECTIVE This systematic review and meta-analysis aimed at assessing the effects of two commonly used anesthetics in general anesthesia (GA), sevoflurane and desflurane, on early postoperative vomiting (POV) in hospitalized adults. DESIGN Systematic review and meta-analysis of randomized controlled trials (RCTs). SETTING Early postoperative vomiting after GA. PATIENTS A total of 266 adult patients receiving inpatient surgeries under GA maintained with sevoflurane or desflurane. INTERVENTIONS We searched PubMed, Medline, Cochrane Central Register of Controlled Trials, ScienceDirect, and Embase for eligible RCTs comparing postoperative outcomes following sevoflurane- or desflurane-maintained anesthesia. MEASUREMENTS The primary outcome was early POV. Secondary outcomes included late POV, early and late postoperative nausea (PON), time to extubation, and emergence time. MAIN RESULTS Eight trials were included. There was no significant difference in the risk of early POV (risk ratio [RR] 1.03, 95% confidence interval [CI] 0.64-1.64, p = 0.91). No significant difference in early PON was observed (RR 1.09; 95% CI, 0.77-1.56; p = 0.62). Nevertheless, the incidence of late POV and late PON were significantly lower in the sevoflurane group than that in the desflurane group (RR 0.47, 95% CI 0.23-0.94, p = 0.03; RR 0.45, 95% CI 0.24-0.84, p = 0.01, respectively). The extubation time was longer in the sevoflurane group than in the desflurane group (standardized mean difference [SMD] 0.56, 95% CI 0.14-0.97, p = 0.009). The emergence time of patients in the sevoflurane group was longer than that in those receiving desflurane (SMD 0.76, 95% CI 0.1-1.42, p = 0.02). CONCLUSIONS Desflurane had the same effects on early POV and early PON as sevoflurane. However, the association between late POV and late PON with desflurane was stronger than that with sevoflurane if the effects of opioids were not considered. The desflurane group had shorter time to extubation and emergence time than the sevoflurane group. PROSPERO registration number: CRD42020218988.
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Affiliation(s)
- Tzu-Tao Wang
- Department of Anesthesiology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, No.123, Ta-Pei Rd., Niao-Song Dist., Kaohsiung City 833, Taiwan.
| | - Hsiao-Feng Lu
- Department of Anesthesiology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, No.123, Ta-Pei Rd., Niao-Song Dist., Kaohsiung City 833, Taiwan.
| | - Yan-Yuen Poon
- Department of Anesthesiology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, No.123, Ta-Pei Rd., Niao-Song Dist., Kaohsiung City 833, Taiwan.
| | - Shao-Chun Wu
- Department of Anesthesiology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, No.123, Ta-Pei Rd., Niao-Song Dist., Kaohsiung City 833, Taiwan.
| | - Shao-Yun Hou
- Department of Anesthesiology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, No.123, Ta-Pei Rd., Niao-Song Dist., Kaohsiung City 833, Taiwan.
| | - Min-Hsien Chiang
- Department of Anesthesiology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, No.123, Ta-Pei Rd., Niao-Song Dist., Kaohsiung City 833, Taiwan; Department of Anesthesiology, Shin Huey Shin Hospital, Kaohsiung, Taiwan; No. 541, Mingcheng 2nd Rd., Zuoying Dist., Kaohsiung City 813, Taiwan.
| | - Kuo-Chuan Hung
- Department of Anesthesiology, Chi Mei Medical Center, No.901, ChungHwa Road, YungKung Dist, Tainan 710, Taiwan.
| | - Shih-Wei Hsu
- Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, No.123, Ta-Pei Rd., Niao-Song Dist., Kaohsiung City 833, Taiwan.
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6
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Ghosh S, Rai KK, Shivakumar HR, Upasi AP, Naik VG, Bharat A. Incidence and risk factors for postoperative nausea and vomiting in orthognathic surgery: a 10-year retrospective study. J Korean Assoc Oral Maxillofac Surg 2020; 46:116-124. [PMID: 32364351 PMCID: PMC7222617 DOI: 10.5125/jkaoms.2020.46.2.116] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Revised: 04/06/2019] [Accepted: 04/08/2019] [Indexed: 11/17/2022] Open
Abstract
Objectives Postoperative nausea and vomiting (PONV) is considered as one of the most incessant and anguishing factors for patients who have surgery under general anesthesia. The occurrence of PONV after orthognathic surgery can lead to dehydration, infection, bleeding at the surgical site, and patient discomfort, all of which leave a patient with a negative impression of anesthesia and surgery. The purpose of this study is to assess the incidence of PONV after orthognathic surgery and to correlate it with factors related to patient, anesthesia, and surgery. Materials and Methods A 10-year retrospective survey was done for patients who underwent orthognathic surgery between January 2008 and March 2018. The incidence of PONV was evaluated, correlations with factors related to patient, anesthesia, and surgery were studied, and the duration between the end of surgery and the occurrence of the first episode of PONV was tabulated. Results The medical records of 109 patients were screened, out of which 101 satisfied the inclusion criteria. Amongst these patients, 60 patients (59.4%) suffered from PONV. Patient’s sex, induction agent used, intravenous fluids administered intraoperatively, duration and type of surgery, and the presence of a nasogastric tube were seen to have a significant influence on precipitating PONV. It was noted that among the patients who suffered from PONV, 61.7% of them experienced it 48-96 hours after the end of surgery. Conclusion Despite the improved anesthetic equipments, drugs, and surgical techniques currently used, the incidence of PONV was high in our study. Certain factors that were seen to influence PONV in this study need to be considered in order to develop an efficacious protocol to reduce PONV in orthognathic surgeries.
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Affiliation(s)
- Subhabrata Ghosh
- Department of Oral and Maxillofacial Surgery, Bapuji Dental College and Hospital, Davangere, India
| | - Kirthi Kumar Rai
- Department of Oral and Maxillofacial Surgery, Bapuji Dental College and Hospital, Davangere, India
| | | | - Amarnath P Upasi
- Department of Oral and Maxillofacial Surgery, Bapuji Dental College and Hospital, Davangere, India
| | - Vinayak Gourish Naik
- Department of Oral and Maxillofacial Surgery, Bapuji Dental College and Hospital, Davangere, India
| | - Avijit Bharat
- Department of Oral and Maxillofacial Surgery, Bapuji Dental College and Hospital, Davangere, India
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7
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Gangakhedkar GR, Monteiro JN. A prospective randomized double-blind study to compare the early recovery profiles of desflurane and sevoflurane in patients undergoing laparoscopic cholecystectomy. J Anaesthesiol Clin Pharmacol 2019; 35:53-57. [PMID: 31057241 PMCID: PMC6495605 DOI: 10.4103/joacp.joacp_375_17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background and Aims General anesthesia using agents like Desflurane or Sevoflurane are beneficial for early recovery especially for ambulatory procedures. The aim of this randomised controlled double-blind study was to compare the early recovery profiles of sevoflurane and desflurane in patients undergoing laparoscopic cholecystectomy. Material and Methods ASA I, II patients, undergoing laparoscopic cholecystectomy were randomly assigned to receive desflurane (n = 30) or sevoflurane (n = 30), using Bispectral Index System (BIS) to determine the depth of anaesthesia. An independent adjudicator, who was blinded to the agent used, recorded the events during the recovery phase. The time required for extubation, eye opening, verbal response and achievement of a modified Aldrete score of 9 were recorded. Results The time required for extubation and for eye opening was significantly shorter in the Desflurane group as compared to the Sevoflurane group [9.1 min ± 5.0 versus 12.5 min ± 7.1, P = 0.049 and 10.1 min ± 5.2 versus 6.3 min ± 4.0, P = 0.008]. Verbal Response also occurred significantly faster in the Desflurane group [12.7 min ± 5.4 versus 8.7 min ± 4.7, P = 0.002]. A significantly higher mean modified Aldrete score was seen at extubation [7.1 ± 0.6 vs 6.0 ± 0.8, P < 0.001] in the Desflurane group, which also achieved a modified Aldrete score of ≥9 significantly sooner [11.1 min ± 4.6 versus 17.8 min ± 6.9, P < 0.001] than the Sevoflurane group. The frequency of adverse effects was not significantly different in either of the groups. Conclusion The time required for early recovery from anaesthesia, was significantly shorter in the Desflurane group compared to the Sevoflurane group.
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Affiliation(s)
- Gauri R Gangakhedkar
- Department of Anaesthesiology, Seth G.S. Medical College and K. E. M. Hospitals, Mumbai, Maharashtra, India.,Department of Anaesthesiology, P.D. Hinduja National Hospital and MRC, Veer Savarkar Marg, Mahim, Mumbai, Maharashtra, India
| | - Joseph N Monteiro
- Department of Anaesthesiology, P.D. Hinduja National Hospital and MRC, Veer Savarkar Marg, Mahim, Mumbai, Maharashtra, India
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8
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Boisson-Bertrand D, Laxenaire MC, Mertes PM. Recovery after Prolonged Anaesthesia for Acoustic Neuroma Surgery: Desflurane versus Isoflurane. Anaesth Intensive Care 2019; 34:338-42. [PMID: 16802487 DOI: 10.1177/0310057x0603400302] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In this study, 33 patients were randomly assigned to receive desflurane (D) or isoflurane (I) for acoustic neuroma surgery. The time from end of the procedure to spontaneous breathing, extubation, eye-opening, hand-squeezing to command, and ability to state name, birthdate and phone number were recorded. The Steward recovery score was also recorded every five minutes during the first 20 minutes postoperatively and then every 10 to 15 minutes. Groups were similar regarding patient characteristics, depth of anaesthesia, sufentanil total dose, anaesthesia duration (D: 349.1 ±19.1 min; I: 349.2±22.9 min), haemodynamic/respiratory parameters, and surgical conditions (assessed by a bleeding score). The emergence time in the D group was significantly faster than the I group (D: 14.9±2.4 min vs I: 29.2±2.4 min for eye-opening). Full recovery also occurred earlier in the D group (D: 22.1±3.1 min vs I: 37.6±4.0 min, P<0.005 for stating name). Steward recovery scores were also better during the first postoperative hour in the D group (D: 40 min vs I: 90 min, P<0.005 for 100% of patients with Steward score of 6). The results indicate that desflurane is associated with similar operating conditions and faster postoperative recovery following acoustic neuroma surgery. The faster recovery following desflurane may be desirable after long surgical procedures, enabling the patient's full cooperation and facilitating early diagnosis of any potential neurological deficit.
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Affiliation(s)
- D Boisson-Bertrand
- Department ofAnaesthesia and Intensive Care, University Hospital of Nancy, France
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9
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Relationship between the incidence and risk factors of postoperative nausea and vomiting in patients with intravenous patient-controlled analgesia. Asian J Surg 2018; 41:301-306. [DOI: 10.1016/j.asjsur.2017.01.005] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Revised: 01/13/2017] [Accepted: 01/16/2017] [Indexed: 11/18/2022] Open
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10
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Eden C, Esses G, Katz D, DeMaria S. Effects of anesthetic interventions on breast cancer behavior, cancer-related patient outcomes, and postoperative recovery. Surg Oncol 2018; 27:266-274. [PMID: 29937181 PMCID: PMC6309684 DOI: 10.1016/j.suronc.2018.05.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Accepted: 05/02/2018] [Indexed: 12/17/2022]
Abstract
This narrative review will summarize our current understanding of the effects of perioperative interventions on patients undergoing surgical removal of breast malignancies. It will focus on how different anesthetic agents and perioperative interventions might affect both breast cancer behavior and/or tumor recurrence as well as postoperative recovery. The main objective of this study will be to describe the evidence and critically analyze preclinical and clinical studies on the use of intravenous versus inhaled anesthetic agents, opioids, regional anesthetics, and anesthetic adjuncts in patients undergoing breast cancer resection. We will look both at the evidence regarding cancer-related outcomes and postoperative recovery. A search of PubMed, from inception to May 2017 was performed using Mesh terms Breast Neoplasms [Mesh] OR cancer AND breast AND Anesthesia [Mesh]; "Anesthetics"[Mesh] AND "Breast Neoplasms/surgery"[Mesh]. Although no optimal anesthetic combination has been identified for patients undergoing breast cancer resection, it should be noted that based on the available evidence, an ideal anesthetic in this patient population would involve a combination of TIVA (propofol), regional anesthesia (paravertebral block)), non opioid sedatives (clonidine or dexmedetomidine), and COX-2 inhibition (ketorolac). Based on the current evidence, this combination of anesthetic and analgesic agents has the best chance of improving cancer-related outcomes and postoperative recovery.
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Affiliation(s)
- Caroline Eden
- Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | - Gary Esses
- Department of Anesthesiology, The Mount Sinai Medical Center, New York, NY, USA
| | - Daniel Katz
- Department of Anesthesiology, The Mount Sinai Medical Center, New York, NY, USA
| | - Samuel DeMaria
- Department of Anesthesiology, The Mount Sinai Medical Center, New York, NY, USA
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Attri JP, Singh M, Bhatt H, Jyoti K, Kaur H. Application of Discharge Criteria for Home Readiness Using Bispectral and Supraglottic Airway Devices in Day-care Surgery without Using Muscle Relaxants. Anesth Essays Res 2017; 11:816-820. [PMID: 29284832 PMCID: PMC5735471 DOI: 10.4103/aer.aer_20_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Introduction The availability of rapid and short-acting intravenous and volatile anesthetics has facilitated early recovery that is why nowadays ambulatory surgery is becoming more common. If the criteria used to discharge patients from the Postanesthesia Care Unit (PACU) are met in the operating room (OR), it would be appropriate to consider bypassing the PACU and transferring the patient directly to the step-down unit. This process is known as "fast-tracking" after ambulatory surgery. Aims To compare hemodynamic characteristics and recovery profile as per fast-track criteria (FTC) of recovery and postanesthesia discharge scoring system (PADSS) between sevoflurane and desflurane. Materials and Methods One hundred American Society of Anesthesiologists Class I-II patients aged 20-50 years were randomly divided into two groups. Following anesthesia induction with injection propofol and injection dexmedetomidine airway was secured with i-gel, Group D (n = 50) received desflurane + dexmedetomidine + O2 + N2O and Group S (n = 50) received sevoflurane in place of desflurane. Emergence time was noted and FTC was evaluated in the OR, Score >12 is considered as shifting criteria for ambulatory surgery unit (ASU). PADSS was noted in ASU at an interval of 15 min for 3 h and Score >9 is considered as ready to discharge home. Results Response to pain, verbal commands, and spontaneous eye opening in Group D was shorter than that in Group S (P = 0.001). Mean time to achieve FTC score >12 was 15 min in both the groups. Eighty-six percent of patients were ready to go home between 60 and 90 min using PADSS. Conclusion We concluded that early recovery is faster for desflurane, and there is no difference in ready to go home time between desflurane and sevoflurane.
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Affiliation(s)
- Joginder Pal Attri
- Department of Anaesthesia, Government Medical College, Amritsar, Punjab, India
| | - Manjit Singh
- Department of Anaesthesia, Government Medical College, Amritsar, Punjab, India
| | - Hemchandra Bhatt
- Department of Anaesthesia, Government Medical College, Amritsar, Punjab, India
| | - Kamal Jyoti
- Department of Anaesthesia, Government Medical College, Amritsar, Punjab, India
| | - Harjinder Kaur
- Department of Anaesthesia, Government Medical College, Amritsar, Punjab, India
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12
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Yoon IJ, Kang H, Baek CW, Choi GJ, Park YH, Jung YH, Woo YC, Lee S. Comparison of effects of desflurane and sevoflurane on postoperative nausea, vomiting, and pain in patients receiving opioid-based intravenous patient-controlled analgesia after thyroidectomy: Propensity score matching analysis. Medicine (Baltimore) 2017; 96:e6681. [PMID: 28422881 PMCID: PMC5406097 DOI: 10.1097/md.0000000000006681] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
In this study, we aimed to compare the effect of desflurane and sevoflurane on postoperative nausea and vomiting and pain in patients receiving opioid-based intravenous patient-controlled analgesia (IV-PCA) after thyroidectomy.We reviewed the electronic medical records of 1042 patients administered opioid-based IV-PCA after a thyroidectomy at Chung-Ang University Hospital between January 1, 2010 and June 30, 2016. We classified the patients into 2 groups according to the inhalation anesthetic used for anesthesia: desflurane versus sevoflurane (groups D and S, n = 587 and 455, respectively). Then, propensity scoring was used to select 234 matched subjects between both groups based on their confounding factors. A propensity score matching method was used to match patients from the 2 groups in a 1:1 ratio.Before the propensity score analysis, there was no significant difference between the 2 groups. However, after the propensity score matching, the frequency of complete remission (CR, defined as no nausea and vomiting) was significantly higher in group S than it was in group D. The number of patients administered rescue antiemetics on day 0 in group S was lower than that in group D, although it was not statistically significant.In patients receiving opioid-based IV-PCA after thyroidectomy, sevoflurane seems to be more beneficial in achieving CR than desflurane was. However, further randomized controlled studies are needed to confirm this conclusion.
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Affiliation(s)
- Il Jae Yoon
- Department of Anesthesiology and Pain Medicine, Chung-Ang University College of Medicine
| | - Hyun Kang
- Department of Anesthesiology and Pain Medicine, Chung-Ang University College of Medicine
| | - Chong Wha Baek
- Department of Anesthesiology and Pain Medicine, Chung-Ang University College of Medicine
| | - Geun Joo Choi
- Department of Anesthesiology and Pain Medicine, Chung-Ang University College of Medicine
| | - Yong-Hee Park
- Department of Anesthesiology and Pain Medicine, Chung-Ang University College of Medicine
| | - Yong Hun Jung
- Department of Anesthesiology and Pain Medicine, Chung-Ang University College of Medicine
| | - Young Cheol Woo
- Department of Anesthesiology and Pain Medicine, Chung-Ang University College of Medicine
| | - Sangseok Lee
- Department of Anesthesiology and Pain Medicine, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
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Miller SA, Aschenbrenner CA, Traunero JR, Bauman LA, Lobell SS, Kelly JS, Reynolds JE. $1.8 Million and counting: how volatile agent education has decreased our spending $1000 per day. J Clin Anesth 2016; 35:253-258. [DOI: 10.1016/j.jclinane.2016.07.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Revised: 05/18/2016] [Accepted: 07/01/2016] [Indexed: 10/20/2022]
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Jellish WS, Owen K, Edelstein S, Fluder E, Leonetti JP. Standard Anesthetic Technique for Middle Ear Surgical Procedures: A Comparison of Desflurane and Sevoflurane. Otolaryngol Head Neck Surg 2016; 133:269-74. [PMID: 16087026 DOI: 10.1016/j.otohns.2005.04.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2004] [Indexed: 11/24/2022]
Abstract
Objective: This study was designed to compare desflurane and sevoflurane anesthesia for middle ear microsurgery. Study Design: One hundred healthy adults undergoing middle ear surgery were assigned to receive either desflurane or sevoflurane as their anesthetic. Intraoperative hemodynamics and BIS numbers were recorded. Hemodynamics, pain, nausea/vomiting, discharge readiness, and other parameters were compared postoperatively and 24 hours later. Results: No intraoperative differences were noted except in BIS scores which trended lower with desflurane. PACU blood pressures were higher after desflurane but pain scores, nausea/vomiting, rescue anti-emetics, recovery scores, and discharge times were similar. A significant difference was noted in anesthetic costs (desflurane > sevoflurane), and in patients with the lowest BIS scores associated with more nausea/vomiting. Conclusions: Both anesthetics may be used for ototic surgery but propofol anesthesia should still be considered in patients with a history of emetic sequelae. Significance: Short-acting inhalational anesthetics produce excellent operating conditions and reduce costs for otologic surgery.
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Affiliation(s)
- W Scott Jellish
- Department of Anesthesiology, Loyola University Medical Center, Maywood, IL 60153, USA.
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15
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Postoperative nausea and vomiting in the post-anesthetic care unit, a 5-year survey of a quality assurance program in surgical cancer patients. Bull Cancer 2015; 102:405-10. [DOI: 10.1016/j.bulcan.2015.03.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Accepted: 03/05/2015] [Indexed: 11/18/2022]
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16
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Sinha AC, Singh PM, Williams NW, Ochroch EA, Goudra BG. Aprepitant's prophylactic efficacy in decreasing postoperative nausea and vomiting in morbidly obese patients undergoing bariatric surgery. Obes Surg 2014; 24:225-31. [PMID: 23990451 DOI: 10.1007/s11695-013-1065-1] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND Postoperative nausea and vomiting is a major cause of patient dissatisfaction towards surgery. For bariatric surgery, increased vomiting/retching is detrimental to surgical anastomosis. The present study evaluated the efficacy of aprepitant (neurokinin-1 inhibitor) as a prophylactic antiemetic in morbidly obese patients for laparoscopic bariatric surgery. METHODS After institutional review board approval, 125 morbidly obese patients were recruited into this double-blind placebo-controlled trial. On random division, the patients received a tablet of aprepitant (80 mg) in group A, or a similar-appearing placebo in group P, an hour prior to surgery. All patients received intravenous ondansetron (4 mg) intraoperatively. Postoperatively, the patients were evaluated for nausea and vomiting by a blinded evaluator at 30 min, 1, 2, 6, 24, 48, and 72 h. RESULTS Both groups were evenly distributed for age, body mass index, type, and length of surgery. Cumulative incidence of vomiting at 72 h was significantly lower in group A (3%) compared to group P (15%; p = 0.021). Odds ratio for vomiting in group P compared to group A was 5.47 times. On Kaplan-Meier plot, time to first vomiting was also significantly delayed in group A (p = 0.019). A higher number of patients showed complete absence of nausea or vomiting in group A compared to group P (42.18 vs. 36.67%). On the other hand, nausea scores were unaffected by aprepitant, and no significant difference between groups was found at any of the measured time points. CONCLUSIONS In morbidly obese patients undergoing laparoscopic bariatric surgery, addition of aprepitant to ondansetron can significantly delay vomiting episodes simultaneously lowering the incidence of postoperative vomiting.
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Affiliation(s)
- Ashish C Sinha
- Anesthesiology and Perioperative Medicine, Drexel University College of Medicine, 245 N. 15th Street, MS 310, Philadelphia, PA, 19102, USA,
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17
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Shimizu Y, Nagasao T, Taneda H, Sakamoto Y, Asou T, Imanishi N, Kishi K. Combined usage of intercostal nerve block and tumescent anaesthesia: an effective anaesthesia technique for breast augmentation. J Plast Surg Hand Surg 2013; 48:51-5. [PMID: 24325759 DOI: 10.3109/2000656x.2013.800529] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Patients are occasionally unhappy with the size, shape, and positioning of breast implants. An option to improve their satisfaction with breast augmentation includes directly involving them in the process with awake surgery done under nerve block and tumescence. This study describes the resultsof using such an awake anaesthesia technique in 35 patients. After the intercostal nerves dominating the Th3 to Th6 regions were anaesthetized using 0.5% bupivacaine, a tumescent solution consisting of lidocaine, epinephrine, and saline was injected around the mammary gland, and breast augmentation was conducted using silicon implants. The majority of patients (31/35) reported no pain during the procedure and all patients were able to choose and confirm their final implant size and positioning. In all cases, blood loss was less than 10 ml. No patient experienced pneumothorax or toxicity of local anaesthetics. Combined usage of the intercostal nerve block and tumescent anaesthesia effectively reduces pain during breast augmentation. Keeping patient conscious enables meeting their requests during operation, contributing to increased satisfaction. For these advantages, combined usage of the intercostal nerve block and tumescent anaesthesia is recommended as a useful anaesthetic technique for breast augmentation.
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Affiliation(s)
- Yusuke Shimizu
- Department of Plastic Surgery, Medical Department of Keio University , Tokyo , Japan
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18
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Isoflurane inhibits bronchopulmonary C-fiber-mediated apneic response to phenylbiguanide by depressing 5-HT3 receptor function in anesthetized rats. Neurosci Lett 2013; 552:1-4. [PMID: 23896531 DOI: 10.1016/j.neulet.2013.07.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2013] [Revised: 07/10/2013] [Accepted: 07/16/2013] [Indexed: 11/21/2022]
Abstract
A previous study by the authors has shown that isoflurane (ISO), a commonly used volatile anesthetic, has an excitatory effect on bronchopulmonary C-fibers (PCFs). Since selective stimulation of PCFs by action on local 5-HT3 receptors could evoke an apnea, this current study addresses whether inhalation of ISO would facilitate the PCF 5-HT3 receptor-mediated apneic response and, if so, how. In anesthetized and spontaneously breathing rats, inhalation of 5% ISO markedly inhibited the apneic response to intra-atrium injection of phenylbiguanide (PBG, 25 μg/kg), a 5-HT3 receptor agonist, which was contrary to the hypothesis. Extracellular recording of the nodose ganglion neurons in anesthetized, paralyzed and ventilated rats revealed that ISO attenuated the PBG-elicited excitation of pulmonary C neurons. Furthermore, using the patch clamp technique, it was found that ISO depressed the PBG-induced inward current of the pulmonary C neurons labeled with 1,1'-dioctadecyl-3,3,3',3'-tetramethylindocarbocyanine perchlorate (DiI) instilled previously into the lungs. These results suggest that ISO inhibits PCF 5-HT3 channel functions, and thereby attenuates PCF excitatory response to PBG, likely contributing to the diminution of the PBG-induced apnea by ISO in rats.
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19
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Jindal R, Kumra VP, Narani KK, Sood J. Comparison of maintenance and emergence characteristics after desflurane or sevoflurane in outpatient anaesthesia. Indian J Anaesth 2011; 55:36-42. [PMID: 21431051 PMCID: PMC3057243 DOI: 10.4103/0019-5049.76604] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Both sevoflurane and desflurane have shorter emergence times compared to isoflurane based anaesthesia. Because of its pharmacological properties, desflurane appears to yield a rapid early and intermediate recovery compared with sevoflurane. The aim of this study was to assess the maintenance and emergence characteristics after anaesthesia with sevoflurane or desflurane. One hundred female patients scheduled to undergo daycare laparoscopic gynaecological surgery were enrolled for this prospective study. Patients were randomised into two groups to receive either desflurane [group I (D); n = 50] or sevoflurane [group II (S); n = 50] for maintenance of anaesthesia. The demographic data and the duration of procedure were comparable in both the groups. The early recovery time was shorter after maintenance of anaesthesia with desflurane compared with sevoflurane. However, this faster early recovery failed to lead to early readiness for home discharge. The intraoperative haemodynamic characteristics were comparable with both sevoflurane and desflurane. Both sevoflurane and desflurane provide a similar time to home readiness despite a faster early recovery with desflurane. The intraoperative haemodynamics are similar with both the agents.
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Affiliation(s)
- Ravi Jindal
- Department of Anaesthesiology, Pain and Perioperative Medicine, Sir Ganga Ram Hospital, New Delhi, India
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20
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Weinberg L, Story D, Nam J, McNicol L. Pharmacoeconomics of Volatile Inhalational Anaesthetic Agents: An 11-Year Retrospective Analysis. Anaesth Intensive Care 2010; 38:849-54. [DOI: 10.1177/0310057x1003800507] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
With continuously increasing expenditure on health care resources, various cost containment strategies have been suggested in regard to controlling the cost of inhalational anaesthetic agents. We performed a cost identification analysis assessing inhalational anaesthetic agent expenditure at a tertiary level hospital, along with an evaluation of strategies to contain the cost of these agents. The number of bottles of isoflurane, sevoflurane and desflurane used during the financial years 1997 to 2007 was retrospectively determined and the acquisition costs and cumulative drug expenditure calculated. Pharmacoeconomic modelling using low fresh gas flow anaesthesia was performed to evaluate practical methods of cost reduction. The use of isoflurane decreased from 384 bottles during 1997 to 204 in 2007. In contrast, use of sevoflurane increased from 226 bottles during 1998 to 875 during 2007. Desflurane use increased from 34 bottles per year during 2002 (its year of introduction) to 163 bottles per year in 2007. While the inflation-adjusted cumulative expenditure for these inhalational agents (Australian dollars) increased from $132,000 in 1997 to over $326,000 in 2007, an increase of 168%, patient workload over the same period increased by only 11%. Pharmacoeconomic modelling demonstrated that sevoflurane at 2 l/minute costs 19 times more than isoflurane at 0.5 l/minute. For the financial years 1997 to 2007, we found a progressive shift from the cheaper isoflurane to the more expensive agents, sevoflurane and desflurane, a shift associated with marked increases in costs. Low flow anaesthesia with isoflurane is one strategy to reduce costs.
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Affiliation(s)
- L. Weinberg
- Department of Anaesthesia, Austin Hospital, Melbourne, Victoria, Australia
- Staff Anaesthetist, Department of Anaesthesia and Senior Fellow, Department of Surgery, University of Melbourne, Austin Hospital
| | - D. Story
- Department of Anaesthesia, Austin Hospital, Melbourne, Victoria, Australia
- Head of Research, Department of Anaesthesia and Associate Professor, Department of Surgery, University of Melbourne, Austin Hospital
| | - J. Nam
- Department of Anaesthesia, Austin Hospital, Melbourne, Victoria, Australia
| | - L. McNicol
- Department of Anaesthesia, Austin Hospital, Melbourne, Victoria, Australia
- Department of Anaesthesia; Medical Director, Anaesthesia, Perioperative and Intensive Care, Clinical Services Unit and Associate Professor, Department of Surgery, University of Melbourne, Austin Hospital
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Meta-Analysis of Average and Variability of Time to Extubation Comparing Isoflurane with Desflurane or Isoflurane with Sevoflurane. Anesth Analg 2010; 110:1433-9. [DOI: 10.1213/ane.0b013e3181d58052] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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22
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Wallenborn J, Rudolph C, Gelbrich G, Goerlich TM, Helm J, Olthoff D. The impact of isoflurane, desflurane, or sevoflurane on the frequency and severity of postoperative nausea and vomiting after lumbar disc surgery. J Clin Anesth 2007; 19:180-5. [PMID: 17531725 DOI: 10.1016/j.jclinane.2006.09.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2006] [Revised: 09/06/2006] [Accepted: 09/19/2006] [Indexed: 10/23/2022]
Abstract
STUDY OBJECTIVE To test the hypothesis that anesthesia with the low-soluble inhalation anesthetics, sevoflurane, and desflurane, may result in a lower frequency and severity of postoperative nausea and vomiting (PONV) than anesthesia with isoflurane. DESIGN Prospective, observational study. SETTING Postoperative care unit and neurosurgical ward at a university hospital. PATIENTS 625 ASA physical status I, II, and III patients undergoing elective lumbar disc surgery with general anesthesia were included in this study. INTERVENTIONS Patients were enrolled sequentially to receive either 0.7%-1.2% isoflurane (year 2002), 3.5%-5.5% desflurane (year 2003), or 1.2%-1.9% sevoflurane (year 2004) for maintenance of anesthesia without nitrous oxide. Study personnel, general anesthesia management, and surgical technique remained unchanged over the three-year study period. MEASUREMENTS Occurrence of PONV within 24 hours of the end of surgery was recorded. Secondary outcome measures were occurrence of multiple PONV episodes, maximum severity, time to the first PONV event, need for rescue medication, difference between the occurrence of PONV (indicator variable) and the expected risk of PONV (based on the Apfel score). MAIN RESULTS Type of inhalation anesthetic had no influence on PONV frequency (9.3%, 11.2%, and 10.8% after isoflurane, desflurane, and sevoflurane, respectively; P = 0.8) or its severity (numerical rating scale, 4.5 +/- 2.0, 4.4 +/- 2.4, and 4.2 +/- 2.1; P = 0.9). Patients who received isoflurane experienced fewer early events but had a late peak of PONV frequency (P = 0.031). For every 10 minutes by which the total duration of the anesthesia exceeded the net time between incision and suture, the risk of PONV increased by a factor of 1.36 (95% confidence interval, 1.15-1.61; P < 0.001). CONCLUSIONS There is no difference between the three inhalation anesthetics currently used with regard to frequency or severity of postoperative nausea, vomiting, or both.
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Affiliation(s)
- Jan Wallenborn
- Department of Anesthesiology and Intensive Care Medicine, University of Leipzig, 04103 Leipzig, Germany.
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23
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Vallejo MC, Sah N, Phelps AL, O'Donnell J, Romeo RC. Desflurane versus sevoflurane for laparoscopic gastroplasty in morbidly obese patients. J Clin Anesth 2007; 19:3-8. [PMID: 17321919 DOI: 10.1016/j.jclinane.2006.04.003] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2005] [Revised: 03/04/2006] [Accepted: 04/11/2006] [Indexed: 12/13/2022]
Abstract
STUDY OBJECTIVE To determine if desflurane results in a faster emergence as measured by time to eye opening compared to sevoflurane in morbidly obese patients undergoing laparoscopic gastroplasty. STUDY DESIGN Prospective, randomized, double-blinded study. SETTING Tertiary care hospital. PATIENTS 70 patients with a body mass index of 35 or higher undergoing laparoscopic gastroplasty. INTERVENTIONS Patients were randomized into two groups to receive either desflurane or sevoflurane for maintenance of general anesthesia. MEASUREMENTS Intraoperative measured variables included the time from when the inhalation agent was turned off (no agent delivered) to eye opening and the time from when the inhalation agent was turned off to extubation. Postanesthesia care unit (PACU)-measured variables on admission and at 15 minute intervals until discharge included oxygen saturation (Spo2), blood pressure, heart rate, pain and nausea Visual Analog Scale (VAS) scores, emesis, modified Aldrete score, and Mini-Mental Status (MMS) examination score. MAIN RESULTS No differences were noted in demographic data, total surgical operative time, times from turning inhalation agent off to eye opening and extubation, or average length of stay in PACU. No differences were noted with respect to pain VAS, treatment for pain, modified Aldrete scores, emesis, or treatment for postoperative nausea or emesis. Differences were noted in PACU nausea VAS at 15 minutes, PACU nausea VAS at discharge, and PACU-MMS score at 45 minutes; however, multivariate analysis of variance revealed no differences between groups over the repeated PACU measured time periods in nausea VAS (P=0.17) or in MMS (P=0.34). Higher heart rates in the desflurane group were observed during PACU admission (82.3+/-9.8 vs 74.4+/-13.4 bpm, P<0.01) and 15 minutes post PACU admission (79.4+/-12.1 vs 71.3+/-13.2 bpm, P=0.01). CONCLUSIONS In morbidly obese patients undergoing laparoscopic gastroplasty, emergence, as measured by time to eye opening, did not differ between desflurane and sevoflurane, with similar recovery characteristics.
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Affiliation(s)
- Manuel C Vallejo
- Department of Anesthesiology, University of Pittsburgh, Magee-Womens Hospital, Pittsburgh, PA 15213, USA.
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Shirakami G, Teratani Y, Segawa H, Matsuura S, Shichino T, Fukuda K. Omission of fentanyl during sevoflurane anesthesia decreases the incidences of postoperative nausea and vomiting and accelerates postanesthesia recovery in major breast cancer surgery. J Anesth 2006; 20:188-95. [PMID: 16897238 DOI: 10.1007/s00540-006-0413-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2006] [Accepted: 04/11/2006] [Indexed: 12/18/2022]
Abstract
PURPOSE Our purpose was to investigate the effect of omission of fentanyl during sevoflurane anesthesia on the incidences of postoperative nausea and vomiting and on postanesthesia recovery in female patients undergoing major breast cancer surgery. METHODS Female patients (American Society of Anesthesiologists [ASA] physical status [PS] class I-II; age, 28-84 years) undergoing major breast cancer surgery were randomized to one of two anesthesia maintenance groups: sevoflurane-fentanyl anesthesia (SF; n = 25) or fentanyl-free sevoflurane anesthesia (S; n = 26). All patients were administered with propofol 2 mg x kg(-1) intravenously for anesthesia induction, a laryngeal mask airway was placed, and they received rectal diclofenac and local infiltration anesthesia. Anesthesia was maintained with sevoflurane in oxygen-air and they breathed spontaneously. The patients in group SF received fentanyl 0.1 mg intravenously and those in group S received normal saline during anesthesia. RESULTS Group SF revealed higher incidences of postoperative nausea (68% vs 27%) and vomiting (32% vs 8%) in the first 24 postoperative hours than group S. The median (25th-75th percentile) length of time from postanesthesia care unit (PACU) admission to ambulation was significantly longer in group SF (n = 23) at 195 min (158-219 min), than in group S, at 141 min (101-175 min). Two patients in group SF could not walk during the PACU stay. CONCLUSION Omission of fentanyl during sevoflurane anesthesia, combined with diclofenac and local infiltration anesthesia, decreases the incidences of postoperative nausea and vomiting and accelerates postanesthesia recovery in patients undergoing major breast cancer surgery.
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Meng L, Quinlan JJ. Assessing risk factors for postoperative nausea and vomiting: a retrospective study in patients undergoing retromastoid craniectomy with microvascular decompression of cranial nerves. J Neurosurg Anesthesiol 2006; 18:235-9. [PMID: 17006120 DOI: 10.1097/00008506-200610000-00003] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We have observed that patients, after retromastoid craniectomy (RMC) with microvascular decompression (MVD) of cranial nerves, frequently experienced postoperative nausea and vomiting (PONV). The authors conducted this study to track the incidence of PONV and to identify potential factors for PONV after RMC with MVD. Medical records from 185 adults, who underwent elective RMC with MVD, were identified and reviewed from January 2000 to December 2004. Extracted data included patient, anesthesia, and surgery related variables that were considered to have a possible effect on the patients experiencing PONV after RMC with MVD. Despite the use of intraoperative prophylactic ondansetron in 99% of patients, the overall incidence of PONV (nausea or emesis or both) was 60% during the first 24 hours postoperatively. It was higher for the patients after RMC with MVD of cranial nerve V [69%, 82/119, P=0.005, odds ratio (OR)=2.8]. Regression modeling demonstrated that female sex (OR=3.0, P=0.005) and use of desflurane (OR=2.8, P=0.003) were significant independent predictors of PONV. Prophylactic transdermal scopolamine patch administered preoperatively was associated with less PONV (OR=0.3, P=0.001). We concluded that PONV occurs frequently in adults recovering from RMC with MVD. The results of this study suggest that it may be necessary to administer a combination of antiemetics to decrease the incidence of PONV after RMC.
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Affiliation(s)
- Li Meng
- Department of Anesthesiology, University of Pittsburgh, Pittsburgh, PA 15213, USA.
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Fanelli G, Berti M, Casati A. Fast-track anaesthesia for laparoscopic cholecystectomy: a prospective, randomized, multicentre, blind comparison of desflurane-remifentanil or sevoflurane-remifentanil. Eur J Anaesthesiol 2006; 23:861-8. [PMID: 16723051 DOI: 10.1017/s0265021506000718] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/23/2006] [Indexed: 11/08/2022]
Abstract
BACKGROUND AND OBJECTIVE To evaluate the effects of sevoflurane and desflurane in combination with intravenous remifentanil on time for discharge from the postanaesthesia care unit and need for postanaesthesia care unit management after elective laparoscopic cholecystectomy. METHODS 231 ASA Grade I-II patients, undergoing elective laparoscopic cholecystectomy in seven University teaching hospital, were randomly allocated to receive a desflurane-remifentanil (n = 105) or sevoflurane-remifentanil (n = 126) anaesthetic. A blinded observer recorded times for emergence and postanaesthesia care unit discharge (achievement of an Aldrete score > or =9), number of patients eligible for postanaesthesia care unit discharge when exiting the operating room and occurrence of adverse events. RESULTS Intraoperative cardiovascular stability was similar in the two groups. Emergence, response and extubation occurred earlier after desflurane (5.4 +/- 3 min, 5.5 +/- 3 min and 7.5 +/- 4 min) than sevoflurane (6.6 +/- 3.5 min, 7.2 +/- 4 min and 9.1 +/- 4.2 min) (P = 0.0005, 0.05 and 0.003, respectively). Postanaesthesia care unit bypass was possible in 44 desflurane-remifentanil patients (41%) and 55 sevoflurane- remifenatnil patients (43%) (P = 0.69), while postanaesthesia care unit discharge occurred after 46 min (25th-75th percentiles: 18-40 min) with desflurane and 64 min (25th-75th percentiles: 20-50 min) with sevoflurane (P = 0.04). Postoperative nausea and vomiting was observed in 40 desflurane-remifentanil patients (36%) and 53 sevoflurane-remifentanil patients (42%) (P = 0.42). CONCLUSIONS Both the desflurane-remifentanil and sevoflurane-remifentanil combinations provide a similarly adequate intraoperative cardiovascular stability. Emergence and postanaesthesia care unit discharge were faster with desflurane-remifentanil than sevoflurane-remifentanil, but this was not associated with a larger proportion of postanaesthesia care unit bypass, confirming that no clinically relevant differences are present between the two agents.
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Affiliation(s)
- G Fanelli
- University of Parma, Department of Anaesthesia and Pain Therapy, Parma, Italy
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Abstract
PURPOSE The pharmacology, bioavailability and pharmacokinetics, indications, clinical efficacy, adverse effects and toxicities, and dosage and administration of the inhaled anesthetics are reviewed. SUMMARY The inhaled anesthetics include desflurane, enflurane, halothane, isoflurane, and sevoflurane and are thought to enhance inhibitory postsynaptic channel activity and inhibit excitatory synaptic activity. The mechanism of action of inhaled anesthetics has not been completely defined. A number of factors can influence the pharmacokinetics of inhaled anesthetics, including solubility in blood, cardiac output, tissue equilibration, extent of tissue perfusion, metabolism, and age. All of the available inhaled anesthetics are effective for inducing or maintaining anesthesia or both. Most clinical trials of inhaled anesthetics have evaluated differences in induction and emergence from anesthesia by comparing (1) times to loss of reflex, extubation, and response to verbal commands; orientation to time and place; and ability to sit up without assistance, (2) need for post-surgical analgesia, and (3) time to discharge as measures of efficacy. Adverse effects and toxicities of the inhaled anesthetics include nephrotoxicity, hepatotoxicity, cardiac arrhythmias, neurotoxicity, postoperative nausea and vomiting, respiratory depression and irritation, malignant hyperthermia, and postanesthesia agitation. Safety issues surrounding these gases include occupational exposure and intraoperative fires within the delivery systems used with inhaled anesthetics. Drugs used for anesthesia during surgery can account for 5-13% of a hospital's drug budget. CONCLUSION The inhaled anesthetics have been shown to be both safe and effective in inducing and maintaining anesthesia. These agents differ in potency, adverse-effect profile, and cost. Newer anesthetic gases, such as sevoflurane and desflurane, appear to have more favorable physico-chemical properties. These factors, as well as patient characteristics and duration and type of procedure, must be considered when selecting an inhaled anesthetic.
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Affiliation(s)
- Joan Stachnik
- Department of Pharmacy Practice, College of Pharmacy, University of Illinois Medical Center at Chicago, Chicago, IL, USA
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Arain SR, Barth CD, Shankar H, Ebert TJ. Choice of volatile anesthetic for the morbidly obese patient: sevoflurane or desflurane. J Clin Anesth 2006; 17:413-9. [PMID: 16171660 DOI: 10.1016/j.jclinane.2004.12.015] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2004] [Accepted: 12/01/2004] [Indexed: 12/13/2022]
Abstract
STUDY OBJECTIVE Morbid obesity is associated with significant comorbidities. Desflurane has a low fat-blood solubility coefficient and may be better suited in this population to achieve a rapid emergence; however, sevoflurane has favorable cardiorespiratory properties that might also prove advantageous in the morbidly obese (MO) patient. This study used careful drug titration to determine if emergence differences between sevoflurane and desflurane could be minimized in MO patients. DESIGN A randomized, prospective blinded study to determine the emergence profiles of desflurane and sevoflurane in MO patients when anesthetic drug titration is used. SETTING Operating room of the VA Medical Center, Milwaukee, Wis. PATIENTS Forty American Society of Anesthesiologists II and III, MO patients (body mass index > or = 35 kg/m2), who were scheduled for elective surgery predicted to last for more than 2 hours, were studied. INTERVENTIONS Patients were induced with fentanyl, midazolam, and propofol and maintained with desflurane or sevoflurane, mixed in air and oxygen. Intraoperative bispectral index (BIS) was targeted to 45 to 50 and to 60 in the last 15 minutes of surgery. MEASUREMENTS Intraoperative anesthetic concentration, BIS, and hemodynamics were recorded. During emergence, time to follow command and extubation were noted, with assessments of cognitive function via the Mini-Mental Status Test and psychomotor performance via the Digit Symbol Substitution Test. A blinded observer recorded key recovery events. MAIN RESULTS Demographic data (age, 61 [36-83] years; body mass index, 38 [35-47] kg/m2), surgical procedures, length of anesthesia (approximately 3.5 hours), adjuvant drugs, and intraoperative BIS, heart rate, and mean arterial pressure were not significantly different. Hemodynamics, time to follow commands and to extubation, and results of Digit Symbol Substitution Test and Mini-Mental Status Test did not differ between anesthetic groups during recovery. CONCLUSIONS There were no differences in emergence and recovery profiles in MO patients receiving desflurane or sevoflurane when anesthetic concentration was carefully titrated.
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Affiliation(s)
- Shahbaz R Arain
- Department of Anesthesiology, Medical College of Wisconsin, Milwaukee, WI 53226, USA
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Sakai EM, Connolly LA, Klauck JA. Inhalation Anesthesiology and Volatile Liquid Anesthetics: Focus on Isoflurane, Desflurane, and Sevoflurane. Pharmacotherapy 2005; 25:1773-88. [PMID: 16305297 DOI: 10.1592/phco.2005.25.12.1773] [Citation(s) in RCA: 77] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Clinical pharmacists rarely are involved in the selection and dosing of anesthetic agents. However, when practicing evidence-based medicine in a cost-conscious health care system, optimizing drug therapy is imperative in all areas. Thus, we provide general information on anesthesiology, including the different types of breathing systems and the components of anesthesia machines. Modern inhalation anesthetics that are predominantly used in clinical practice include one gas--nitrous oxide--and new volatile liquid agents--isoflurane, desflurane, and sevoflurane. Desflurane and sevoflurane are the low-soluble inhalation anesthetics, and they offer some clinical advantages over isoflurane, such as fast induction and faster recovery with long procedures. However, efficient use of isoflurane can match the speed of induction and recovery of the other agents in certain cases. In addition, the patient characteristics, duration and type of procedure, type of breathing system, and efficiency in monitoring must be considered when selecting the most optimal therapy for each patient. Maximizing the clinical advantages of these agents while minimizing the waste of an institution's operating room and pharmacy budget requires an understanding of the characteristics, pharmacokinetics, and pharmacodynamics of these anesthetic agents and the collaborated effort from both the anesthesia and pharmacy departments. An anesthetic agent algorithm is provided as a sample decision-process tree for selecting among isoflurane, desflurane, and sevoflurane.
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Affiliation(s)
- Eileen M Sakai
- Department of Pharmacy, Froedtert Memorial Lutheran Hospital, and the Department of Anesthesiology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.
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Hung WT, Chen CC, Chau MY, Tsai WY. Effect of reinforced laryngeal mask airway or endotracheal intubation anesthesia on adverse events: quality of life issues for dental patients requiring general sedation. SPECIAL CARE IN DENTISTRY 2005; 25:188-92. [PMID: 16295223 DOI: 10.1111/j.1754-4505.2005.tb01648.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
This study tested whether the use of a reinforced laryngeal mask airway (LMA) compared to endotracheal intubation (El) anesthesia diminished adverse events and improved the post-operative quality of life for 146 dental patients who required general anesthesia due to developmental disabilities. In this randomized, crossover trial, patients received either reinforced LMA or El anesthesia during an initial dental treatment visit; the other anesthetic method was used during a second visit scheduled after six months or more. Data were assessed with Student's t-test, chi-square test and McNemar's test to evaluate the affect on quality of life by analyzing disturbances in daily activity, such as eating patterns and sleeping behaviors after the procedure. Although the reinforced LMA anesthesia was associated with a significantly lowered incidence of adverse events (p = .04), neither method significantly disturbed quality of life activities.
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Affiliation(s)
- Wei-Te Hung
- Dept. Anesthesiology, School of Medicine, Chung Shan Medical University, Taichung, Taiwan.
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Caverni V, Rosa G, Pinto G, Tordiglione P, Favaro R. Hypotensive Anesthesia and Recovery of Cognitive Function in Long-term Craniofacial Surgery. J Craniofac Surg 2005; 16:531-6. [PMID: 16077295 DOI: 10.1097/01.scs.0000159084.60049.e6] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
The aim of our study was to compare three different anesthesiological techniques with regard to hemodynamics, recovery, and postoperative morbidity, for craniofacial surgery. One hundred twenty patients with American Society of Anesthesiologists (ASA) classification of I or II patients, 18 to 32 years old, and undergoing maxillary and mandibular osteotomies were randomly assigned to receive anesthesia with propofol-remifentanil (group P), desflurane-remifentanil (group D), or sevoflurane-remifentanil (group S). All patients were given premedication: midazolam 0.03 mg/kg, atropine 0.007 mg/kg, desametasone 0.1 mg/kg, NaCl 0.9% 100 mL + 2 mg/kg ketoprofene + 1.5 mg/kg ranitidine + 1 microg/kg clonidine. Anesthesia was induced by O2/air (FiO2 0.5), remifentanil 0.5 microg/kg/min, propofol 2 mg/kg, rocuronium 0.6 mg/kg. Maintenance group P received O2/air (FiO2 0.5), remifentanil 0.25 to 1.5 microg/kg/min, propofol 6 to 10 mg/kg/h; groups D and S received O2/air (FiO2 0.5), remifentanil 0.25 to 1.5 microg/kg/min, and respectively, sevoflurane or desflurane 0.5 minimum alveolar anesthetic concentration. The dosage of propofol, desflurane, and sevoflurane, obtained with a value of bispectral index (BIS) 40, was kept unchanged throughout the course, and remifentanil was titrated to maintain controlled hypotension: systolic arterial blood pressure 70 to 90 mmHg and mean arterial blood pressure 50 to 65 mmHg. A 24-hour elastomeric infusion system (ketoprofene 320 mg) was started 60 minutes before induction and cloridrat ondansetron 0.1 mg/kg was administered 30 minutes before the end of surgery. Hypotension was successfully obtained in all three groups with a bloodless surgical field, and there was no need for additional use of a potent hypotensive agent. Early and late recovery were faster and more complete in the D group; P < 0.05. Postoperative morbidity (nausea, vomiting, shivering, pain, and edema) was slight and did not significantly differ among the groups.
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Affiliation(s)
- Valentina Caverni
- Department of Anesthesiology and Resuscitation, Umberto I Polyclinic, La Sapienza University, Rome, Italy.
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Macario A, Dexter F, Lubarsky D. Meta-analysis of trials comparing postoperative recovery after anesthesia with sevoflurane or desflurane. Am J Health Syst Pharm 2005; 62:63-8. [PMID: 15658074 DOI: 10.1093/ajhp/62.1.63] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
PURPOSE Results of published, randomized controlled trials comparing sevoflurane and desflurane were pooled to measure differences in times until patients obeyed commands, were extubated, were oriented, were discharged from the postanesthesia care unit (PACU), and were ready to be discharged to home, as well as the occurrence of postoperative nausea and vomiting (PONV). METHODS We reviewed all randomized clinical trials in MEDLINE through December 18, 2003, with a title or abstract containing the words sevoflurane and desflurane. Two reviewers independently extracted study data from papers that met inclusion criteria. Endpoints were pooled using random-effects meta-analysis. RESULTS Twenty-two reports of 25 studies (3 reports each described 2 studies) met our inclusion criteria. A total of 746 patients received sevoflurane, and 752 received desflurane. Patients receiving desflurane recovered 1-2 minutes quicker in the operating room than patients receiving sevoflurane. They obeyed commands 1.7 minutes sooner (p < 0.001; 95% confidence interval [CI], 0.7-2.7 minutes), were extubated 1.3 minutes sooner (p = 0.003; 95% CI, 0.4-2.2 minutes), and were oriented 1.8 minutes sooner (p < 0.001; 95% CI, 0.7-2.9 minutes). No significant differences were detected in the phase I or II PACU recovery times or in the rate of PONV. CONCLUSION Meta-analysis of studies in which the duration of anesthesia was up to 3.1 hours indicated that patients receiving either desflurane or sevoflurane did not have significant differences in PACU time or PONV frequency. Patients receiving desflurane followed commands, were extubated, and were oriented 1.0-1.2 minutes earlier than patients receiving sevoflurane.
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Affiliation(s)
- Alex Macario
- Departments of Anesthesia and Health Research and Policy, Stanford University School of Medicine, Stanford, CA 94305-5640, USA.
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Najarian MM, Johnson JM, Landercasper J, Havlik P, Lambert PJ, McCarthy D. Paravertebral Block: An Alternative to General Anesthesia in Breast Cancer Surgery. Am Surg 2003. [DOI: 10.1177/000313480306900307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Alternative forms of anesthesia in breast cancer patients have been sought to reduce the untoward effects of general anesthesia. The purpose of this study was to compare paravertebral block (PVB) and general anesthesia (GA) in terms of pain control, postoperative nausea and vomiting, and resumption of diet in patients undergoing operations for breast cancer. A retrospective chart review was performed on all patients (289) undergoing breast cancer surgery from May 1, 1999 through December 31, 2000 with PVB or GA. The PVB (n = 128) and GA (n = 100) groups had similar demographics. Postoperative narcotics were given to 80.8 and 93 per cent of PVB and GA patients, respectively ( P < 0.01), after an average of 216 and 122 minutes from the end of surgery ( P = 0.028). The PVB group received 6.2 narcotic units compared with 10.1 in the GA group ( P = 0.04). Postoperative nausea and vomiting was present in 16.8 and 24 per cent of patients in the PVB and GA groups, respectively ( P = 0.12). A diet was tolerated on the same day of surgery by 98.4 and 82 per cent of PVB and GA patients, respectively ( P < 0.01). The complication rate of PVB was 1.8 per cent. PVB resulted in better postoperative pain control and earlier resumption of diet compared with GA. The good success rate and low complication rate of PVB make it well suited for breast cancer surgery and can eliminate the need for GA in patients with serious comorbidities.
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Affiliation(s)
- Melissa M. Najarian
- Departments of Surgery, Gundersen Lutheran Medical Center, La Crosse, Wisconsin
| | - Jeanne M. Johnson
- Departments of Surgery, Gundersen Lutheran Medical Center, La Crosse, Wisconsin
| | | | - Paul Havlik
- Departments of Biomedical Statistics, Gundersen Lutheran Medical Center, La Crosse, Wisconsin
| | - Pamela J. Lambert
- Departments of Surgery, Gundersen Lutheran Medical Center, La Crosse, Wisconsin
| | - David McCarthy
- Departments of Surgery, Gundersen Lutheran Medical Center, La Crosse, Wisconsin
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Campbell N, Bryson GL, Rosaeg O, Crossan ML, Bragg P, Bell M. Does Intravenous Dexamethasone Prevent Nausea and Vomiting after Reduction Mammoplasty? THE CANADIAN JOURNAL OF PLASTIC SURGERY = JOURNAL CANADIEN DE CHIRURGIE PLASTIQUE 2002. [DOI: 10.1177/229255030201000503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Postoperative nausea and vomiting (PONV) is a common and unpleasant experience for patients after reduction mammoplasty. PONV may delay discharge from hospital. Dexamethasone is an effective and widely used antiemetic. Objectives This study was designed to evaluate the efficacy of dexamethasone as a single antiemetic agent to reduce the incidence of PONV in patients undergoing reduction mammoplasty. Methods Fifty women scheduled for reduction mammoplasty were randomly assigned to receive either intravenous dexamethasone 0.150 mg/kg or saline before the induction of anesthesia. Postoperative analgesia was provided with intravenous morphine via a patient controlled device and rectally administered indomethacin. The presence or absence of nausea, retching and vomiting, and pain scores were assessed upon arrival in the postanesthesia care unit and at 2, 6, 8 and 12 h, and by phone interview at 24 and 48 h after surgery. Results The two groups were comparable in terms of age, history of motion sickness, duration of anesthesia and opioid consumption, both intraoperatively and postoperatively. There was no difference in the incidence of PONV between the two groups, but the patients who received dexamethasone required fewer doses of rescue antiemetic medication. Conclusion Intravenous dexamethasone before the induction of anesthesia is ineffective as a single agent antiemetic prophylactic treatment in patients undergoing reduction mammoplasty.
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Affiliation(s)
- Nicola Campbell
- Department of Anesthesiology and the Division of Plastic Surgery, The Ottawa Hospital Civic Campus, University of Ottawa, Ottawa, Ontario, K1Y 4E9
| | - Gregory L Bryson
- Department of Anesthesiology and the Division of Plastic Surgery, The Ottawa Hospital Civic Campus, University of Ottawa, Ottawa, Ontario, K1Y 4E9
| | - Ola Rosaeg
- Department of Anesthesiology and the Division of Plastic Surgery, The Ottawa Hospital Civic Campus, University of Ottawa, Ottawa, Ontario, K1Y 4E9
| | - Mary Lou Crossan
- Department of Anesthesiology and the Division of Plastic Surgery, The Ottawa Hospital Civic Campus, University of Ottawa, Ottawa, Ontario, K1Y 4E9
| | - Paul Bragg
- Department of Anesthesiology and the Division of Plastic Surgery, The Ottawa Hospital Civic Campus, University of Ottawa, Ottawa, Ontario, K1Y 4E9
| | - Michael Bell
- Department of Anesthesiology and the Division of Plastic Surgery, The Ottawa Hospital Civic Campus, University of Ottawa, Ottawa, Ontario, K1Y 4E9
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Abstract
Discharge times after ambulatory surgery are determined by postoperative complications and in particular by the presence and severity of nausea and vomiting. Sevoflurane has become a popular agent for day-case surgery despite little evidence of clear advantages over current alternatives. We compared this agent with isoflurane in day-case patients undergoing knee arthroscopy in order to quantify the incidence of complications associated with each agent. One hundred and eighty patients received a standardised anaesthetic induction with propofol and fentanyl followed by maintenance with either isoflurane or sevoflurane. Standardised postoperative analgesic and anti-emetic drugs were prescribed. Any intra-operative cardiovascular or respiratory instability was recorded. After surgery, nausea, vomiting and pain were assessed. Almost all patients made an uneventful recovery and were discharged as scheduled. There was a significantly higher incidence of complications in the sevoflurane group. These included the presence of nausea and vomiting, and cardiovascular and respiratory complications. We found nothing to commend the routine use of sevoflurane rather than isoflurane in the context of day case anaesthesia.
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Affiliation(s)
- D H Elcock
- Department of Anaesthesia, Poole General Hospital, Poole BH15 2JB, UK
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