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Kampman JM, Hermanides J, Hollmann MW, Gilhuis CN, Bloem WAH, Schraag S, Pradelli L, Repping S, Sperna Weiland NH. Mortality and morbidity after total intravenous anaesthesia versus inhalational anaesthesia: a systematic review and meta-analysis. EClinicalMedicine 2024; 72:102636. [PMID: 38774674 PMCID: PMC11106536 DOI: 10.1016/j.eclinm.2024.102636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Revised: 04/24/2024] [Accepted: 04/25/2024] [Indexed: 05/24/2024] Open
Abstract
Background General anaesthesia is provided to more than 300 million surgical patients worldwide, every year. It is administered either through total intravenous anaesthesia, using only intravenous agents, or through inhalational anaesthesia, using volatile anaesthetic agents. The debate on how this affects postoperative patient outcome is ongoing, despite an abundance of published trials. The relevance of this topic has grown by the increasing concern about the contribution of anaesthetic gases to the environmental impact of surgery. We aimed to summarise all available evidence on relevant patient outcomes with total intravenous anaesthesia versus inhalational anaesthesia. Methods In this systematic review and meta-analysis, we searched PubMed/Medline, Embase and Cochrane Central Register of Controlled trials for works published from January 1, 1985 to August 1, 2023 for randomised controlled trials comparing total intravenous anaesthesia using propofol versus inhalational anaesthesia using the volatile anaesthetics sevoflurane, desflurane or isoflurane. Two reviewers independently screened titles, abstracts and full text articles, and assessed risk of bias using the Cochrane Collaboration tool. Outcomes were derived from a recent series of publications on consensus definitions for Standardised Endpoints for Perioperative trials (StEP). Primary outcomes covered mortality and organ-related morbidity. Secondary outcomes were related to anaesthetic and surgical morbidity. This study is registered with PROSPERO (CRD42023430492). Findings We included 317 randomised controlled trials, comprising 51,107 patients. No difference between total intravenous and inhalational anaesthesia was seen in the primary outcomes of in-hospital mortality (RR 1.05, 95% CI 0.67-1.66, 27 trials, 3846 patients), 30-day mortality (RR 0.97, 95% CI 0.70-1.36, 23 trials, 9667 patients) and one-year mortality (RR 1.14, 95% CI 0.88-1.48, 13 trials, 9317 patients). Organ-related morbidity was similar between groups except for the subgroup of elderly patients, in which total intravenous anaesthesia was associated with a lower incidence of postoperative cognitive dysfunction (RR 0.62, 95% CI 0.40-0.97, 11 trials, 3834 patients) and a better score on postoperative cognitive dysfunction tests (standardised mean difference 1.68, 95% CI 0.47-2.88, 9 trials, 4917 patients). In the secondary outcomes, total intravenous anaesthesia resulted in a lower incidence of postoperative nausea and vomiting (RR 0.61, 95% CI 0.56-0.67, 145 trials, 23,172 patients), less emergence delirium (RR 0.40, 95% CI 0.29-0.56, 32 trials, 4203 patients) and a higher quality of recovery score (QoR-40 mean difference 6.45, 95% CI 3.64-9.25, 17 trials, 1835 patients). Interpretation The results indicate that postoperative mortality and organ-related morbidity was similar for intravenous and inhalational anaesthesia. Total intravenous anaesthesia offered advantages in postoperative recovery. Funding Dutch Society for Anaesthesiology (NVA).
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Affiliation(s)
- Jasper M. Kampman
- Department of Anaesthesiology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
- Amsterdam UMC Centre for Sustainable Healthcare, Amsterdam UMC, Amsterdam, the Netherlands
| | - Jeroen Hermanides
- Department of Anaesthesiology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Markus W. Hollmann
- Department of Anaesthesiology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | | | | | | | | | - Sjoerd Repping
- Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
- Healthcare Evaluation and Appropriate Use, National Healthcare Institute, Diemen, the Netherlands
| | - Nicolaas H. Sperna Weiland
- Department of Anaesthesiology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
- Amsterdam UMC Centre for Sustainable Healthcare, Amsterdam UMC, Amsterdam, the Netherlands
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Yoon HK, Joo S, Yoon S, Seo JH, Kim WH, Lee HJ. Randomized controlled trial of the effect of general anesthetics on postoperative recovery after minimally invasive nephrectomy. Korean J Anesthesiol 2024; 77:95-105. [PMID: 37232074 PMCID: PMC10834716 DOI: 10.4097/kja.23083] [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: 02/03/2023] [Revised: 05/21/2023] [Accepted: 05/25/2023] [Indexed: 05/27/2023] Open
Abstract
BACKGROUND General anesthetic techniques can affect postoperative recovery. We compared the effect of propofol-based total intravenous anesthesia (TIVA) and desflurane anesthesia on postoperative recovery. METHODS In this randomized trial, 150 patients undergoing robot-assisted or laparoscopic nephrectomy for renal cancer were randomly allocated to either the TIVA or desflurane anesthesia (DES) group. Postoperative recovery was evaluated using the Korean version of the Quality of Recovery-15 questionnaire (QoR-15K) at 24 h, 48 h, and 72 h postoperatively. A generalized estimating equation (GEE) was performed to analyze longitudinal QoR-15K data. Fentanyl consumption, pain severity, postoperative nausea and vomiting, and quality of life three weeks after discharge were also compared. RESULTS Data were analyzed for 70 patients in each group. The TIVA group showed significantly higher QoR-15K scores at 24 and 48 h postoperatively (24 h: DES, 96 [77, 109] vs. TIVA, 104 [82, 117], median difference 8 [95% CI: 1, 15], P = 0.029; 48 h: 110 [95, 128] vs. 125 [109, 130], median difference 8 [95% CI: 1, 15], P = 0.022), however not at 72 h (P = 0.400). The GEE revealed significant effects of group (adjusted mean difference 6.2, 95% CI: 0.39, 12.1, P = 0.037) and time (P < 0.001) on postoperative QoR-15K scores without group-time interaction (P = 0.051). However, there were no significant differences in other outcomes, except for fentanyl consumption, within the first 24 h postoperatively. CONCLUSIONS Propofol-based TIVA showed only a transient improvement in postoperative recovery than desflurane anesthesia, without significant differences in other outcomes.
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Affiliation(s)
- Hyun-Kyu Yoon
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Korea
- Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Somin Joo
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Korea
| | - Susie Yoon
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Korea
- Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Jeong-Hwa Seo
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Korea
- Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Won Ho Kim
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Korea
- Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Ho-Jin Lee
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Korea
- Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul, Korea
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Javed U, Bhatia K. Total intravenous anaesthesia for caesarean delivery: incidence, maternal and neonatal outcomes from a tertiary unit. Int J Obstet Anesth 2024; 57:103933. [PMID: 37866971 DOI: 10.1016/j.ijoa.2023.103933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 09/01/2023] [Accepted: 09/23/2023] [Indexed: 10/24/2023]
Affiliation(s)
- U Javed
- Department of Anaesthesia, Health Education England North-West, Manchester, UK
| | - K Bhatia
- Department of Anaesthesia, Saint Mary's Hospital, Manchester University Hospital NHS Foundation Trust, Manchester, UK.
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Wong SSC, Wang F, Chan TCW, Cheung CW. The analgesic effect of total intravenous anaesthesia with propofol versus inhalational anaesthesia for acute postoperative pain after hepatectomy: a randomized controlled trial. BMC Anesthesiol 2023; 23:112. [PMID: 37013472 PMCID: PMC10069060 DOI: 10.1186/s12871-023-02063-7] [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: 01/11/2023] [Accepted: 03/22/2023] [Indexed: 04/05/2023] Open
Abstract
BACKGROUND Postoperative pain control can be challenging in patients undergoing hepatectomy. A previous retrospective study on hepatobiliary/ pancreatic surgeries showed better postoperative pain control in patients who received propofol TIVA. The aim of this study was to determine the analgesic effect of propofol TIVA for hepatectomy. This clinical study has been registered at ClinicalTrials.gov (NCT03597997). METHODS A prospective randomized controlled trial was performed to compare the analgesic effect of propofol TIVA versus inhalational anaesthesia. Patients aged between 18 and 80 years old with an American Society of Anesthesiologist (ASA) physical status of I-III scheduled for elective hepatectomy were recruited. Ninety patients were randomly allocated to receive either propofol TIVA (TIVA group) or inhalational anaesthesia with sevoflurane (SEVO group). Perioperative anaesthetic/analgesic management was the same for both groups. Numerical rating scale (NRS) pain scores, postoperative morphine consumption, quality of recovery, patient satisfaction and adverse effects were evaluated during the acute postoperative period and at 3 and 6 months after surgery. RESULTS No significant differences were found for acute postoperative pain scores (both at rest and during coughing) and postoperative morphine consumption between TIVA and SEVO groups. Patients given TIVA had lower pain scores with coughing at 3 months after surgery (p = 0.014, and FDR < 0.1). TIVA group was associated with better quality of recovery on postoperative day (POD) 3 (p = 0.038, and FDR < 0.1), less nausea (p = 0.011, and FDR < 0.1 on POD 2; p = 0.013, and FDR < 0.1 on POD 3) and constipation (p = 0.013, and FDR < 0.1 on POD 3). CONCLUSION Propofol TIVA did not improve acute postoperative pain control compared to inhalational anaesthesia in patients who underwent hepatectomy. Our results do not support the use of propofol TIVA for reducing acute postoperative pain after hepatectomy.
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Affiliation(s)
- Stanley S C Wong
- Department of Anaesthesiology, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China.
| | - Fengfeng Wang
- Department of Anaesthesiology, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Timmy C W Chan
- Department of Anaesthesiology, Queen Mary Hospital, Hong Kong, China
| | - C W Cheung
- Department of Anaesthesiology, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
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Dong J, Wang D, Sun H, Zeng M, Liu X, Yan X, Li R, Li S, Peng Y. Effect of anesthesia on the outcome of high-grade glioma patients undergoing supratentorial resection: study protocol for a pragmatic randomized controlled trial. Trials 2022; 23:816. [PMID: 36167574 PMCID: PMC9513932 DOI: 10.1186/s13063-022-06716-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 09/03/2022] [Indexed: 11/19/2022] Open
Abstract
Background High-grade glioma (HGG) is the most malignant brain tumor with poor outcomes. Whether anesthetic methods have an impact on the outcome of these patients is still unknown. Retrospective study has found no difference between intravenous and inhalation anesthesia on the overall survival (OS) of the HGG patients, however, intravenous anesthesia with propofol might be beneficial in a subgroup of patients with a Karnofsky Performance Status (KPS) Scale less than 80. Further prospective studies are needed to evaluate the results. Methods This is a single-centered, randomized controlled, parallel-group trial. Three hundred forty-four patients with primary HGG for tumor resection will be randomly assigned to receive either intravenous anesthesia with propofol or inhalation anesthesia with sevoflurane. The primary outcome is the OS of the patients within 18 months. Secondary outcomes include progression-free survival (PFS), the numerical rating scale (NRS) of pain intensity and sleep quality, the postoperative encephaloedema volume, complications, and the length of hospital stay of the patients. Discussion This is a randomized controlled trial to compare the effect of intravenous and inhalation anesthesia maintenance on the outcome of supratentorial HGG patients. The results will contribute to optimizing the anesthesia methods in these patients. Trial registration ClinicalTrials.gov NCT02756312. Registered on 29 April 2016 and last updated on 9 Sep 2020 Supplementary Information The online version contains supplementary material available at 10.1186/s13063-022-06716-9.
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Affiliation(s)
- Jia Dong
- Department of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Dexiang Wang
- Department of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Huizhong Sun
- Department of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Min Zeng
- Department of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Xiaoyuan Liu
- Department of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Xiang Yan
- Department of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Ruowen Li
- Department of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Shu Li
- Department of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Yuming Peng
- Department of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China.
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Altered functional and directed connectivity in propofol-induced loss of consciousness: A source-space resting-state EEG study. Clin Neurophysiol 2022; 142:209-219. [DOI: 10.1016/j.clinph.2022.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 07/26/2022] [Accepted: 08/01/2022] [Indexed: 11/19/2022]
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Wong SSC, Choi EKY, Chan WS, Cheung CW. Propofol total intravenous anaesthesia versus inhalational anaesthesia for acute postoperative pain in patients with morphine patient-controlled analgesia: a large-scale retrospective study with covariate adjustment. BMC Anesthesiol 2022; 22:140. [PMID: 35538421 PMCID: PMC9088064 DOI: 10.1186/s12871-022-01683-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 04/27/2022] [Indexed: 11/15/2022] Open
Abstract
Background To compare the postoperative analgesic effect of propofol total intravenous anaesthesia (TIVA) versus inhalational anaesthesia (GAS) in patients using morphine patient-controlled analgesia (PCA). Methods A retrospective cohort study was performed in a single tertiary university hospital. Adult patients who used PCA morphine after general anaesthesia across 15 types of surgeries were included. Patients who received propofol TIVA were compared to those who had inhalational anaesthesia. Primary outcomes assessed were postoperative numerical rating scale (NRS) pain scores and postoperative opioid consumption. Results Data from 4202 patients were analysed. The overall adjusted NRS pain scores were significantly lower in patients who received propofol TIVA at rest (GEE: β estimate of the mean on a 0 to 10 scale = -0.56, 95% CI = (-0.74 to -0.38), p < 0.001; GAS as reference group) and with movement (β estimate = -0.89, 95% CI = (-1.1 to -0.69), p < 0.001) from postoperative days (POD) 1–3. Propofol TIVA was associated with lower overall adjusted postoperative morphine consumption (β estimate = -3.45, 95% CI = (-4.46 to -2.44), p < 0.001). Patients with propofol TIVA had lower adjusted NRS pain scores with movement for hepatobiliary/pancreatic (p < 0.001), upper gastrointestinal (p < 0.001) and urological surgeries (p = 0.005); and less adjusted postoperative morphine consumption for hepatobiliary/pancreatic (p < 0.001), upper gastrointestinal (p = 0.006) and urological surgeries (p = 0.002). There were no differences for other types of surgeries. Conclusion Propofol TIVA was associated with statistically significant, but small reduction in pain scores and opioid consumption in patients using PCA morphine. Subgroup analysis suggests clinically meaningful analgesia possibly for hepatobiliary/pancreatic and upper gastrointestinal surgeries. Trial registration This study is registered at ClinicalTrials.gov (NCT03875872). Supplementary Information The online version contains supplementary material available at 10.1186/s12871-022-01683-9.
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Affiliation(s)
- Stanley Sau Ching Wong
- Laboratory and Clinical Research Institute for Pain, Department of Anaesthesiology, The University of Hong Kong, HKSAR, Hong Kong, China. .,Department of Anaesthesiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, HKSAR, Hong Kong, China.
| | - Edward Kwok Yiu Choi
- Department of Anaesthesiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, HKSAR, Hong Kong, China
| | - Wing Shing Chan
- Department of Anaesthesiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, HKSAR, Hong Kong, China
| | - Chi Wai Cheung
- Laboratory and Clinical Research Institute for Pain, Department of Anaesthesiology, The University of Hong Kong, HKSAR, Hong Kong, China.,Department of Anaesthesiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, HKSAR, Hong Kong, China
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Liao J, Li M, Huang C, Yu Y, Chen Y, Gan J, Xiao J, Xiang G, Ding X, Jiang R, Li P, Yang M. Pharmacodynamics and Pharmacokinetics of HSK3486, a Novel 2,6-Disubstituted Phenol Derivative as a General Anesthetic. Front Pharmacol 2022; 13:830791. [PMID: 35185584 PMCID: PMC8851058 DOI: 10.3389/fphar.2022.830791] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 01/12/2022] [Indexed: 01/27/2023] Open
Abstract
Background: The purpose of this study was to characterize the novel sedative/hypnotic agent HSK3486, a 2,6-disubstituted alkylphenol analogue. Methods: The mechanism of action of HSK3486 was studied in competitive binding assays and whole-cell patch clamp assays. HSK3486 was administered by bolus intravenous injection to dogs and rats, and the loss of righting reflex as well as effects on the cardiovascular and respiratory systems were assessed. The in vitro metabolism of HSK3486 was analyzed by CYP450 genotyping and enzyme inhibition. Results: HSK3486 competed with t-butylbicycloorthobenzoate (TBOB) and t-butylbicyclophosphorothionate (TBPS) for binding to the gamma-aminobutyric acid type A (GABAA) receptor. HSK3486 potentiated GABA-evoked chloride currents at lower concentrations while activating GABAA receptor at higher concentrations. HSK3486 induced hypnosis in rats and dogs, and had a higher therapeutic index than propofol in rats. The hypnotic potency of HSK3486 was approximately 4-5 fold higher than that of propofol. HSK3486 exerted minimal effects on the cardiovascular system. Conclusions: HSK3486 is a positive allosteric regulator and direct agonist of GABAA receptor. It has a promising sedative/hypnotic effect and good in vivo pharmacokinetic properties, which justify further studies towards its clinical application.
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Affiliation(s)
- Juan Liao
- Department of Stomatology, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Meiting Li
- Department of Anesthesiology, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Chaoli Huang
- East Hospital, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Yan Yu
- Haisco Pharmaceutical Group Co. Ltd., Chengdu, China
| | - Yashu Chen
- Haisco Pharmaceutical Group Co. Ltd., Chengdu, China
| | - Jiaqi Gan
- Department of Anesthesiology, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Jie Xiao
- Department of Anesthesiology, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Guilin Xiang
- Department of Anesthesiology, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Xizhi Ding
- Department of Anesthesiology, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Rong Jiang
- Department of Anesthesiology, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Peng Li
- Department of Anesthesiology, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu, China
- *Correspondence: Peng Li, ; Mengchang Yang,
| | - Mengchang Yang
- Department of Anesthesiology, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu, China
- *Correspondence: Peng Li, ; Mengchang Yang,
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Guevara-Farias JC, Rincón-Valenzuela DA, Gómez-Ardila C. Comparison of direct costs associated with the use of balanced general anesthesia and total intravenous anesthesia (TIVA) techniques. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2022. [DOI: 10.5554/22562087.e1021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Introduction: Healthcare costs are increasing against the backdrop of scarce resources. Surgical procedures are an important part of healthcare spending, and the cost of anesthetic techniques is relevant as part of the total cost of care and it is a potential target for expenditure optimization. Although important economic differences have been reported internationally for general anesthesia options, there are no publications in Colombia that compare current costs and allow for informed and financially responsible decision-making.
Objective: To quantify and compare direct costs associated with the various general anesthesia options most frequently used at the present time.
Methods: Cost minimization analysis based on a theoretical model of balanced general anesthesia using isoflurane, sevoflurane, desflurane in combination with remifentanil, and TIVA (propofol and remifentanil). Initial results were obtained using a deterministic simulation method and a sensitivity analysis was performed using a Monte Carlo simulation.
Results: The average total cost per case for the different anesthetic techniques was COP 126381 for sevoflurane, COP 97706 for isoflurane, COP 288605 for desflurane and COP 222 960 for TIVA.
Conclusions: Balanced general anesthesia with desflurane is the most costly alternative, 1.2 times more expensive than TIVA, and 2 and 3 times more costly than balanced anesthesia with sevoflurane and isoflurane, respectively. TIVA ranks second with a cost 1.8 times higher than balanced anesthesia with sevoflurane and 2.5 times higher than balanced anesthesia with isoflurane.
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Li W, Qin C, Yan J, Zhao Q, You L, Yang Y. Propofol Alleviates Neuropathic Pain Induced by Chronic Contractile Injury by Regulating the Spinal glun2b-p38mapkepac1 Pathway. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2021; 2021:9305076. [PMID: 34804196 PMCID: PMC8601802 DOI: 10.1155/2021/9305076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Accepted: 10/15/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Propofol acts as an intravenous anesthetic cure which is widely used as a therapy for the craniocerebral injury that comprised surgical anesthesia as well as the sedation done in the intensive care units. Propofol is one of the most commonly used and efficient anesthetics where the painful effects are followed by an injection of propofol. In many cases, patients experience pain followed by anxiety, boredom, fear, and even myocardial ischemia. OBJECTIVE This study was performed to investigate the underlying mechanism of propofol and its effect on regulating spinal glun2b-p38mapkepac1 pathways in chronic contractile injury. Material and Methods. Contractile injury was performed by ligation around the nerve of the thigh region postanesthesia. Rats were divided into three groups to analyze the changes like mechanical allodynia by the paw withdrawal threshold and histopathological analysis for assessing cellular degradation. L4-L6 from the spinal dorsal horns were isolated and harvested for studying protein expression, by the method of western blotting and immunofluorescence analysis. RESULTS The pain caused due to mechanical allodynia in the paw region was highest at 1 hour postinduction and lasted for three days postinjury. Pain was significantly less in the group receiving propofol when compared with the isoflurane group for the first two hours of injury. In the propofol group, EPAC1, GluN2B, and p38 MAP K were significantly lower. CONCLUSION In the rat model of induced chronic contractile injury, postsurgery there was a suppression of the GluN2B-p38MAPK/EPAC1 signaling pathway in the propofol group. As the p38MAPK/EPAC pathway has a significant role in the postoperative hyperalgesia, thus our experiment suggests that propofol has analgesic effects.
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Affiliation(s)
- Wen Li
- Department of Anesthesiology, Guizhou Provincial People's Hospital, Guizhou, China
| | - Chenguang Qin
- Department of Anesthesiology, Guizhou Provincial People's Hospital, Guizhou, China
| | - JianYong Yan
- Department of Anesthesiology, Guizhou Provincial People's Hospital, Guizhou, China
| | - Qian Zhao
- Department of Anesthesiology, Guizhou Provincial People's Hospital, Guizhou, China
| | - Lu You
- Department of Anesthesiology, Guizhou Provincial People's Hospital, Guizhou, China
| | - Ye Yang
- Department of Anesthesiology, Guizhou Provincial Orthopaedic Hospital, Guizhou, China
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Sedation in critically ill patients: will the vaporiser replace the syringe? THE LANCET RESPIRATORY MEDICINE 2021; 9:1205-1207. [PMID: 34454655 DOI: 10.1016/s2213-2600(21)00359-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 07/19/2021] [Indexed: 11/22/2022]
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Niu Z, Gao X, Shi Z, Liu T, Wang M, Guo L, Qi D. Effect of total intravenous anesthesia or inhalation anesthesia on postoperative quality of recovery in patients undergoing total laparoscopic hysterectomy: A randomized controlled trial. J Clin Anesth 2021; 73:110374. [PMID: 34090183 DOI: 10.1016/j.jclinane.2021.110374] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 05/14/2021] [Accepted: 05/20/2021] [Indexed: 01/08/2023]
Abstract
STUDY OBJECTIVE To investigate the effect of propofol-based total intravenous anesthesia (TIVA) or sevoflurane-based inhalation anesthesia on postoperative quality of recovery in patients undergoing total laparoscopic hysterectomy. DESIGN A prospective randomized controlled trial. SETTING An operating room, a postoperative recovery area, and a hospital ward. PATIENTS A total of 102 female patients scheduled for elective total laparoscopic hysterectomy were randomly divided into two groups: the propofol group (group P) or sevoflurane group (group S). INTERVENTIONS Anesthesia in group P was induced by propofol, fentanyl and rocuronium, and maintained by intravenous infusion of propofol and remifentanil. Anesthesia in group S was induced by a tidal volume inhalation technique with sevoflurane and rocuronium and maintained with sevoflurane and remifentanil. Patients in group P did not receive any volatile drugs. MEASUREMENTS Quality of Recovery-40 (QoR-40), Pittsburgh Sleep Quality Index (PSQI) and Numerical Rating Scale (NRS) scores were assessed at 8, 24, 48, 72 h, 7 days and 30 days after surgery. Intraoperative hemodynamics, postoperative inflammatory indicators and adverse reactions were also recorded. MAIN RESULTS The QoR-40 score and its 5 dimensions were similar in the two groups at each point in time (P > 0.05). Group S had less consumption of remifentanil (P < 0.001) but increased use of phenylephrine (P = 0.001) intraoperatively. PSQI scores were also comparable between groups at each point in time (P > 0.05). NRS scores at 72 h (P = 0.023) and 7 days (P = 0.017) after surgery, postoperative NLR (P = 0.024) and hs-CRP (P = 0.042), and the incidence of abdominal distension (P = 0.017) were significantly lower in group P than in group S. Multiple linear regression analyses demonstrated that duration of pneumoperitoneum and sleep quality were associated with postoperative recovery. CONCLUSIONS The choice of intravenous or inhalation maintenance anesthesia did not affect overall postoperative recovery as measured by the QoR-40 in patients undergoing total laparoscopic hysterectomy. Reducing the duration of pneumoperitoneum and improving sleep quality were conducive to postoperative recovery.
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Affiliation(s)
- Zheng Niu
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, 209 Tongshan, Xuzhou, Jiangsu, China; Department of Anesthesiology, The Affiliated Hospital of Xuzhou Medical University, No.99 Huaihai West Road, Xuzhou, Jiangsu, China
| | - Xiuxiu Gao
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, 209 Tongshan, Xuzhou, Jiangsu, China; Department of Anesthesiology, The Affiliated Hospital of Xuzhou Medical University, No.99 Huaihai West Road, Xuzhou, Jiangsu, China
| | - Zeshu Shi
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, 209 Tongshan, Xuzhou, Jiangsu, China; Department of Anesthesiology, The Affiliated Hospital of Xuzhou Medical University, No.99 Huaihai West Road, Xuzhou, Jiangsu, China
| | - Tianyu Liu
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, 209 Tongshan, Xuzhou, Jiangsu, China; Department of Anesthesiology, The Affiliated Hospital of Xuzhou Medical University, No.99 Huaihai West Road, Xuzhou, Jiangsu, China
| | - Min Wang
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, 209 Tongshan, Xuzhou, Jiangsu, China; Department of Anesthesiology, The Affiliated Hospital of Xuzhou Medical University, No.99 Huaihai West Road, Xuzhou, Jiangsu, China
| | - Lulu Guo
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, 209 Tongshan, Xuzhou, Jiangsu, China; Department of Anesthesiology, The Affiliated Hospital of Xuzhou Medical University, No.99 Huaihai West Road, Xuzhou, Jiangsu, China
| | - Dunyi Qi
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, 209 Tongshan, Xuzhou, Jiangsu, China; Department of Anesthesiology, The Affiliated Hospital of Xuzhou Medical University, No.99 Huaihai West Road, Xuzhou, Jiangsu, China.
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Clendenen N, Ahlgren B, Robitaille MJ, Christensen E, Morabito J, Grae L, Lyman M, Weitzel N. Year in Review 2020: Noteworthy Literature in Cardiothoracic Anesthesiology. Semin Cardiothorac Vasc Anesth 2021; 25:94-106. [PMID: 33938302 PMCID: PMC10088871 DOI: 10.1177/10892532211013614] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The year 2020 was marred by the emergence of a deadly pandemic that disrupted every aspect of life. Despite the disruption, notable research accomplishments in the practice of cardiothoracic anesthesiology occurred in 2020 with an emphasis on optimizing care, improving outcomes, and expanding what is possible for patients undergoing cardiac surgery. This year's edition of Noteworthy Literature Review will focus on specific themes in cardiac anesthesiology that include preoperative anemia, predictors of acute kidney injury following cardiac surgery, pain management modalities, anticoagulation strategies after transcatheter aortic valve replacement, mechanical circulatory support, and future directions in research.
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Affiliation(s)
| | - Bryan Ahlgren
- University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Mark J Robitaille
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | | | - Joseph Morabito
- University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Lyndsey Grae
- University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Matthew Lyman
- University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Nathaen Weitzel
- University of Colorado Anschutz Medical Campus, Aurora, CO, USA
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Shim J, Cho EA, Ryu KH, Lee SH, Kim JI, Kim D, Oh EJ, Ahn JH. Effects of prophylactic atropine on the time to tracheal intubation with the pre-administration of remifentanil. Acta Anaesthesiol Scand 2021; 65:335-342. [PMID: 33165918 DOI: 10.1111/aas.13739] [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: 06/15/2020] [Revised: 10/15/2020] [Accepted: 10/16/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Pre-administration of remifentanil in target-controlled propofol and remifentanil anaesthesia could prolong the time of onset of muscle relaxation owing to haemodynamic effects, thereby prolonging the time to tracheal intubation. Although the sympatholytic effects of remifentanil result in bradycardia and hypotension, these responses can be attenuated by the administration of atropine. Therefore, we investigated whether prophylactic administration of atropine could prevent the prolongation of the time to tracheal intubation. METHODS Sixty-four patients were included in this study. They were randomised into Group A (atropine 0.5 mg, n = 32) and Group S (saline 0.9%, n = 32), immediately before the pre-administration of remifentanil. The primary outcome was the time to tracheal intubation and the secondary outcomes were rocuronium onset time, time to loss of consciousness (LOC), time to reach a value of 60 on the bispectral index (BIS) and haemodynamic variables. RESULTS The median [Interquartile range] of the time to tracheal intubation was 240 [214, 288]s in Group S and 190 [176, 212]s in Group A(median difference: 50 s, 95% confidence interval: 27-80 s, P = .001). Rocuronium onset time was significantly decreased in Group A compared to that in Group S (129 [110, 156] vs 172 [154, 200], P = .001). The times to LOC and reach 60 on the BIS were not significantly different between the two groups. Cardiac output(CO) and heart rate were less decreased in Group A than in Group S (P = .02, P < .001, respectively). CONCLUSIONS Prophylactic administration of atropine could compensate for the reduction in CO in cases pre-administered with remifentanil in target-controlled propofol and remifentanil anaesthesia. This in turn prevented the prolongation of rocuronium onset time and reduced the time to tracheal intubation.
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Affiliation(s)
- Jae‐Geum Shim
- Department of Anesthesiology and Pain Medicine Kangbuk Samsung HospitalSungkyunkwan University School of Medicine Seoul Korea
| | - Eun A. Cho
- Department of Anesthesiology and Pain Medicine Kangbuk Samsung HospitalSungkyunkwan University School of Medicine Seoul Korea
| | - Kyoung Ho Ryu
- Department of Anesthesiology and Pain Medicine Kangbuk Samsung HospitalSungkyunkwan University School of Medicine Seoul Korea
| | - Sung Hyun Lee
- Department of Anesthesiology and Pain Medicine Kangbuk Samsung HospitalSungkyunkwan University School of Medicine Seoul Korea
| | - Jeong In Kim
- Department of Anesthesiology and Pain Medicine Kangbuk Samsung HospitalSungkyunkwan University School of Medicine Seoul Korea
| | - Doyeon Kim
- Department of Anesthesiology and Pain Medicine Samsung Medical Centre Sungkyunkwan University School of Medicine Seoul Korea
| | - Eun Jung Oh
- Department of Anesthesiology and Pain Medicine Samsung Medical Centre Sungkyunkwan University School of Medicine Seoul Korea
| | - Jin Hee Ahn
- Department of Anesthesiology and Pain Medicine Kangbuk Samsung HospitalSungkyunkwan University School of Medicine Seoul Korea
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Kim SH, Ju HM, Choi CH, Park HR, Shin S. Inhalational versus intravenous maintenance of anesthesia for quality of recovery in patients undergoing corrective lower limb osteotomy: A randomized controlled trial. PLoS One 2021; 16:e0247089. [PMID: 33606764 PMCID: PMC7894931 DOI: 10.1371/journal.pone.0247089] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 01/29/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Inhalational anesthesia and propofol-based total intravenous anesthesia (TIVA) are the two most popular methods of general anesthesia with distinct characteristics that may affect quality of recovery (QOR) differently. This study compared QOR after corrective lower limb osteotomy between desflurane-based inhalational anesthesia and propofol-based TIVA. METHODS Sixty-eight patients, ASA class I or II who underwent corrective lower limb osteotomy were randomized to receive either desflurane anesthesia or propofol TIVA. The primary outcome was quality of recovery 40 (QoR-40) questionnaire scores on postoperative day (POD) 1 and 2. Postoperative nausea scores, antiemetic requirements, and amount of opioid consumption via intravenous patient-controlled analgesia (IV PCA) were assessed as secondary outcomes. RESULTS Global QoR-40 scores on POD 1 (153.5 (140.3, 171.3) vs. 140.0 (120.0, 173.0), P = 0.056, 95% CI; -22.5, 0.2) and POD 2 (155.5 (146.8, 175.5) vs. 152.0 (134.0, 179.0), P = 0.209, 95% CI; -17.5, 3.9) were comparable between the two groups. Among the five dimensions of QoR-40, physical independence scores were significantly higher in the TIVA group compared to the Desflurane group on POD both 1 and 2. Nausea scores (0.0 (0.0, 0.0) vs. 1.0 (0.0, 3.5), P < 0.001) and number of patients requiring rescue antiemetics (0% vs. 15.2%, P = 0.017) were significantly lower in the TIVA group at the post anesthesia care unit (PACU). Although the number of bolus attempts between 0-24 h and the morphine equivalent dose of analgesics administered via IV PCA between 12-24 h were significantly less in the TIVA group compared to the Desflurane group, there was no significant difference between groups for the overall 48 h postoperative period. CONCLUSIONS Propofol-based TIVA did not improve global QoR-40 scores compared with desflurane-based inhalational anesthesia. However, considering the better QoR-40 scores in the domain of physical independence and less nausea in the early postoperative period, propofol TIVA should be considered as a useful option in patients undergoing corrective lower limb osteotomy.
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Affiliation(s)
- Seung Hyun Kim
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Hyang Mi Ju
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yongin Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Chong-Hyuck Choi
- Department of Orthopedic Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Hae Ri Park
- Department of Anesthesiology and Pain Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Seokyung Shin
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
- * E-mail:
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16
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Yu H, Xu Z, Dai SH, Jiang JL, He LL, Zheng JQ, Yu H. The Effect of Propofol Versus Volatile Anesthetics on Persistent Pain After Cardiac Surgery: A Randomized Controlled Trial. J Cardiothorac Vasc Anesth 2020; 35:2438-2446. [PMID: 33183935 DOI: 10.1053/j.jvca.2020.10.025] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 10/01/2020] [Accepted: 10/14/2020] [Indexed: 02/08/2023]
Abstract
OBJECTIVES Sternal incisions can generate persistent and intense post-sternotomy pain. Propofol has been shown to improve postoperative analgesia, but the preventive effect on persistent pain after cardiac surgery is unknown. The hypothesis of the present study was that intraoperative propofol-based anesthesia compared with volatile anesthesia could reduce the risk of chronic pain after cardiac surgery. DESIGN A single-center, two-arm, patient-and-evaluator-blinded, randomized controlled trial. SETTING A single major urban teaching and university hospital. PATIENTS Five-hundred adult patients undergoing cardiac surgery via sternotomy randomly were assigned. With six withdrawals from the study and five from surgery, 244 in the total intravenous anesthesia group and 245 in the volatile group were included in the modified intention-to-treat analysis. INTERVENTIONS Patients randomly were assigned to receive either propofol-based total intravenous anesthesia or volatile anesthesia during surgery. MEASUREMENTS AND MAIN RESULTS The primary outcomes were the incidence of pain at three, six, and 12 months after surgery defined as pain score >0 on the numeric rating scale. The secondary outcomes included acute pain, opioid use during the first 72 hours after surgery, and quality of life. The use of propofol did not significantly affect chronic pain at three months (55.4% v 52.9%, difference 2.5%, 95% confidence interval [CI] -6.6 to 11.6; p = 0.656), six months (35.5% v 37.5%, difference -2.0%, 95% CI -10.9 to 6.9; p = 0.657), or 12 months (18.2% v 20.7%, difference -2.5%, 95% CI -9.8 to 4.8; p = 0.495) compared with volatile anesthetics. Furthermore, there were no differences in acute pain score; morphine-equivalent consumption during the first 72 hours; and quality of life at three, six, and 12 months after surgery. CONCLUSIONS Intraoperative administration of propofol did not reduce persistent pain after cardiac surgery compared with volatile anesthetics.
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Affiliation(s)
- Hong Yu
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, China; The Research Units of West China (2018RU012), Chinese Academy of Medical Sciences, Chengdu, China
| | - Zhao Xu
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, China; The Research Units of West China (2018RU012), Chinese Academy of Medical Sciences, Chengdu, China
| | - Shun-Hui Dai
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, China; The Research Units of West China (2018RU012), Chinese Academy of Medical Sciences, Chengdu, China
| | - Jia-Li Jiang
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, China; The Research Units of West China (2018RU012), Chinese Academy of Medical Sciences, Chengdu, China
| | - Lei-Lei He
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, China; The Research Units of West China (2018RU012), Chinese Academy of Medical Sciences, Chengdu, China
| | - Jian-Qiao Zheng
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, China; The Research Units of West China (2018RU012), Chinese Academy of Medical Sciences, Chengdu, China
| | - Hai Yu
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, China; The Research Units of West China (2018RU012), Chinese Academy of Medical Sciences, Chengdu, China.
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Dou H, Hu F, Wang W, Ling L, Wang D, Liu F. Assessment of the sedative effects of dexmedetomidine and propofol treatment in patients undergoing mechanical ventilation in the ICU and relationship between treatment and occurrence of ventilator-associated pneumonia and detection of pathogenic bacteria. Exp Ther Med 2020; 20:599-606. [PMID: 32537018 DOI: 10.3892/etm.2020.8699] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Accepted: 02/13/2020] [Indexed: 12/15/2022] Open
Abstract
The present study aimed to investigate the sedative effects of dexmedetomidine combined with propofol in patients undergoing mechanical ventilation in the intensive care unit (ICU), and to reveal the risk factors of ventilator-associated pneumonia (VAP). A retrospective analysis of 322 patients who had been subject to mechanical ventilation in the ICU ward was performed. Subjects were divided into two groups: A group treated with dexmedetomidine and propofol (combined group) and a group treated with dexmedetomidine alone (monotherapy group). Clinical data, sedative effects, the number of VAP patients and the distribution of VAP pathogens were assessed. Multivariate analysis and receiver operating characteristic (ROC) curves were used to predict VAP. Significant differences in the sedative effects between the two groups were observed (P<0.001). The incidence of VAP was significantly higher in the monotherapy group compared with the combined group (P<0.05). Multivariate logistic regression analysis demonstrated that age, acute physiology chronic health evaluation score, consciousness, invasive operations, recovery time, extubation time and sedation regimen were independent risk factors for VAP in the ICU during mechanical ventilation. ROC curves indicated that the areas under the curve for age, acute physiology chronic health score, consciousness, invasive operations, recovery time, extubation time and sedation regimen were 0.934, 0.870, 0.632, 0.677, 0.865, 0.950 and 0.603, respectively. In summary, dexmedetomidine combined with propofol can shorten the recovery and extubation times of mechanical ventilation patients in the ICU. Different sedation schemes are also independent risk factors for VAP during mechanical ventilation in the ICU.
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Affiliation(s)
- Hongjie Dou
- Intensive Care Unit, Shanghai Fengxian District Central Hospital, Fengxian, Shanghai 201499, P.R. China
| | - Fangbao Hu
- Intensive Care Unit, Shanghai Fengxian District Central Hospital, Fengxian, Shanghai 201499, P.R. China
| | - Wen Wang
- Intensive Care Unit, Shanghai Fengxian District Central Hospital, Fengxian, Shanghai 201499, P.R. China
| | - Lin Ling
- Intensive Care Unit, Shanghai Fengxian District Central Hospital, Fengxian, Shanghai 201499, P.R. China
| | - Deqiang Wang
- Intensive Care Unit, Shanghai Fengxian District Central Hospital, Fengxian, Shanghai 201499, P.R. China
| | - Fenlian Liu
- Intensive Care Unit, Shanghai Fengxian District Central Hospital, Fengxian, Shanghai 201499, P.R. China
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Wong SS, Chan WS, Fang C, Chan CW, Lau TW, Leung F, Cheung CW. Infraclavicular nerve block reduces postoperative pain after distal radial fracture fixation: a randomized controlled trial. BMC Anesthesiol 2020; 20:130. [PMID: 32466746 PMCID: PMC7254671 DOI: 10.1186/s12871-020-01044-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Accepted: 05/20/2020] [Indexed: 12/22/2022] Open
Abstract
Background It is unclear whether regional anesthesia with infraclavicular nerve block or general anesthesia provides better postoperative analgesia after distal radial fracture fixation, especially when combined with regular postoperative analgesic medications. The aim of this study was to compare the postoperative analgesic effects of regional versus general anesthesia. Methods In this prospective, observer blinded, randomized controlled trial, 52 patients undergoing distal radial fracture fixation received either general anesthesia (n = 26) or regional anesthesia (infraclavicular nerve block, n = 26). Numerical rating scale pain scores, analgesic consumption, patient satisfaction, adverse effects, upper limb functional scores (Patient-Rated Wrist Evaluation, QuickDASH), health related quality of life (SF12v2), and psychological status were evaluated after surgery. Result Regional anesthesia was associated with significantly lower pain scores both at rest and with movement on arrival to the post-anesthetic care unit; and at 1, 2, 24 and 48 h after surgery (p ≤ 0.001 at rest and with movement). Morphine consumption in the post-anesthetic care unit was significantly lower in the regional anesthesia group (p<0.001). There were no differences in oral analgesic consumption. Regional anesthesia was associated with lower incidences of nausea (p = 0.004), and vomiting (p = 0.050). Patient satisfaction was higher in the regional anesthesia group (p = 0.003). There were no long-term differences in pain scores and other patient outcomes. Conclusion Regional anesthesia with ultrasound guided infraclavicular nerve block was associated with better acute pain relief after distal radial fracture fixation, and may be preferred over general anesthesia. Trial registration Before subject enrollment, the study was registered at ClinicalTrials.gov (NCT03048214) on 9th February 2017.
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Affiliation(s)
- Stanley S Wong
- Laboratory and Clinical Research Institute for Pain, Department of Anaesthesiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Queen Mary Hospital, Room 424, Block K, 102, Pokfulam Road, Hong Kong SAR, China.
| | - Wing S Chan
- Laboratory and Clinical Research Institute for Pain, Department of Anaesthesiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Queen Mary Hospital, Room 424, Block K, 102, Pokfulam Road, Hong Kong SAR, China
| | - Christian Fang
- Department of Orthopaedics and Traumatology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Chi W Chan
- Department of Anaesthesiology, Queen Mary Hospital, Hong Kong SAR, China
| | - Tak W Lau
- Department of Orthopaedics and Traumatology, Queen Mary Hospital, Hong Kong SAR, China
| | - Frankie Leung
- Department of Orthopaedics and Traumatology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Chi W Cheung
- Laboratory and Clinical Research Institute for Pain, Department of Anaesthesiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Queen Mary Hospital, Room 424, Block K, 102, Pokfulam Road, Hong Kong SAR, China
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Irwin MG, Chung CKE, Ip KY, Wiles MD. Influence of propofol-based total intravenous anaesthesia on peri-operative outcome measures: a narrative review. Anaesthesia 2020; 75 Suppl 1:e90-e100. [PMID: 31903578 DOI: 10.1111/anae.14905] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/03/2019] [Indexed: 12/12/2022]
Abstract
Propofol-based total intravenous anaesthesia is well known for its smooth, clear-headed recovery and anti-emetic properties, but there are also many lesser known beneficial properties that can potentially influence surgical outcome. We will discuss the anti-oxidant, anti-inflammatory and immunomodulatory effects of propofol and their roles in pain, organ protection and immunity. We will also discuss the use of propofol in cancer surgery, neurosurgery and older patients.
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Affiliation(s)
- M G Irwin
- Department of Anaesthesiology, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - C K E Chung
- Department of Anaesthesiology, Queen Mary Hospital, Hong Kong Special Administrative Region, China
| | - K Y Ip
- Department of Anaesthesiology, Queen Mary Hospital, Hong Kong Special Administrative Region, China
| | - M D Wiles
- Department of Anaesthesia, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
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Liu J, Yang L. Effects of propofol and sevoflurane on blood glucose, hemodynamics, and inflammatory factors of patients with type 2 diabetes mellitus and gastric cancer. Oncol Lett 2019; 19:1187-1194. [PMID: 31966048 PMCID: PMC6955649 DOI: 10.3892/ol.2019.11201] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Accepted: 11/05/2019] [Indexed: 01/18/2023] Open
Abstract
Effects of propofol and sevoflurane on blood glucose, hemodynamics, and inflammatory factors of patients with type 2 diabetes mellitus (T2DM) and gastric cancer (GC) were investigated. One hundred and ten patients with T2DM and GC, treated in The First Affiliated Hospital of Baotou Medical College (Baotou, China) from January 2017 to December 2018, were selected. Sixty patients anesthetized by propofol were included in the propofol group, whereas 50 patients anesthetized by sevoflurane were included in the sevoflurane group. The level of blood glucose, hemodynamic indicators, and inflammatory factors of the patients in the two groups were compared at T0 (before anesthesia), T1 (2 min after intubation), T2 (5 min after pneumoperitoneum), and T3 (60 min after surgery). Mini-Mental State Examination (MMSE) cognitive function scores were compared at T0 (before anesthesia), T4 (6 h after surgery), and T5 (72 h after surgery) between the two groups. The anesthetic effect and the incidence of adverse reactions were also compared between the two groups. The heart rate (HR), oxygen saturation (SpO2) and average artery pressure decreased slightly and then increased after the surgery was started; whereas, the levels of the serum inflammatory factors first increased and then decreased, to return to their initial levels. MMSE scores of the patients in two groups at T4 were significantly lower than those at T0 (P<0.05), and the MMSE score at T4 was significantly higher in the propofol group than that in the sevoflurane group (P<0.05). The time of spontaneous breathing, verbal response, eye opening, and extubation in the propofol group was significantly shorter than that in the sevoflurane group (P<0.05). The incidence of adverse reactions in the propofol group was lower than that in the sevoflurane group. The effect of propofol is less than that of sevoflurane, thus propofol is more suitable for the anesthesia of patients with T2DM and GC.
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Affiliation(s)
- Jinhui Liu
- Department of Anesthesiology, The First Affiliated Hospital of Baotou Medical College, Inner Mongolia University of Science and Technology, Baotou, Inner Mongolia 014010, P.R. China
| | - Li Yang
- Department of Laboratory Medicine, The First Affiliated Hospital of Baotou Medical College, Inner Mongolia University of Science and Technology, Baotou, Inner Mongolia 014010, P.R. China
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Hajijafari M, Mehrzad L, Asgarian FS, Akbari H, Ziloochi MH. Effect of Intravenous Propofol and Inhaled Sevoflurane Anesthesia on Postoperative Spirometric Indices: A Randomized Controlled Trial. Anesth Pain Med 2019; 9:e96559. [PMID: 32280616 PMCID: PMC7118678 DOI: 10.5812/aapm.96559] [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] [Received: 07/22/2019] [Revised: 09/25/2019] [Accepted: 09/30/2019] [Indexed: 12/25/2022] Open
Abstract
Background Anesthetic drugs may directly or indirectly affect respiratory function. We investigated the effects of intravenous propofol and inhaled sevoflurane anesthesia on postoperative spirometric indices in patients undergoing inguinal herniorrhaphy surgery. Methods We randomly assigned 111 patients, aged 18 - 65 years, undergoing inguinal herniorrhaphy surgery, to receive either intravenous propofol or inhaled sevoflurane. Forced vital capacity (FVC), forced expiratory volume in the first second (FEV1), and FEV1/FVC were measured before and after anesthesia. Comparisons between the two groups were made using the t-test and ANOVA. Results There were no significant differences between the two groups in terms of age, sex, height, body weight, BMI, pain score, ASA class, operation duration, and received analgesics. The FEV1 and FVC values significantly decreased after the operation in the sevoflurane group. Conclusions Both intravenous propofol and inhaled sevoflurane can decrease postoperative spirometry parameters. However, it seems that patients receiving propofol have less decreased spirometric indices.
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Affiliation(s)
- Mohammad Hajijafari
- Department of Anesthesiology, Beheshti Hospital, Kashan University of Medical Sciences, Kashan, Iran
- Corresponding Author: Department of Anesthesiology, Beheshti Hospital, Kashan University of Medical Sciences, Postal Code: 8719844547, Kashan, Iran. Tel: +98-9132648158,
| | - Leila Mehrzad
- Department of Anesthesiology, Beheshti Hospital, Kashan University of Medical Sciences, Kashan, Iran
| | | | - Hossein Akbari
- School of Public Health, Kashan University of Medical Sciences, Kashan, Iran
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Yu H, Zheng JQ, Hua YS, Ren SF, Yu H. Influence of volatile anesthesia versus total intravenous anesthesia on chronic postsurgical pain after cardiac surgery using the Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials criteria: study protocol for a prospective randomized controlled trial. Trials 2019; 20:645. [PMID: 31775854 PMCID: PMC6880356 DOI: 10.1186/s13063-019-3742-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Accepted: 09/23/2019] [Indexed: 02/05/2023] Open
Abstract
Background Many patients develop chronic postsurgical pain (CPSP) after cardiac surgery, which interferes with their sleep, mood, and quality of life. Studies have suggested that propofol improves postoperative analgesia compared with volatile anesthetics, but its preventive effect on CPSP following cardiac surgery is still unknown. This study compares the incidence of CPSP following cardiac surgery for those receiving volatile anesthesia and those receiving propofol-based total intravenous anesthesia (TIVA) using criteria recommended by the Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials (IMMPACT). Methods/design This is a prospective randomized controlled trial. In total, 500 adults undergoing cardiac surgery will be randomly allocated to the volatile or the TIVA group. The volatile group will receive sevoflurane or desflurane during surgery as general anesthesia. The TIVA group will receive propofol-based intravenous agents and no volatile agents during surgery. The primary outcomes will be the frequency of CPSP at 3 months, 6 months, and 1 year after surgery. In this case, CPSP is sternal or thoracic pain. It is defined as either (1) numerical rating scale (NRS) > 0 or (2) meeting all six IMMPACT criteria for CPSP. The IMMPACT criteria are validated pain instruments. Discussion To our knowledge, this is the first prospective randomized controlled trial to investigate the prevention of CPSP following cardiac surgery for patients receiving volatile anesthesia compared to those receiving propofol-based TIVA using validated pain instruments in accordance with the IMMPACT recommendations. This study will provide important information on which of these two anesthetic regimens is better for preventing CPSP after cardiac surgery. Trial registration Chictr.org.cn, ChiCTR1900020747. Registered on 16 January 2019.
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Affiliation(s)
- Hong Yu
- Department of Anesthesiology, West China Hospital, Sichuan University & The Research Units of West China (2018RU012), Chinese Academy of Medical Sciences, Chengdu, 610041, People's Republic of China
| | - Jian-Qiao Zheng
- Department of Anesthesiology, West China Hospital, Sichuan University & The Research Units of West China (2018RU012), Chinese Academy of Medical Sciences, Chengdu, 610041, People's Republic of China
| | - Yu-Si Hua
- Department of Anesthesiology, West China Hospital, Sichuan University & The Research Units of West China (2018RU012), Chinese Academy of Medical Sciences, Chengdu, 610041, People's Republic of China
| | - Shuo-Fang Ren
- Department of Cardiovascular surgery, West China Hospital, Sichuan University & The Research Units of West China (2018RU012), Chinese Academy of Medical Sciences, Chengdu, 610041, People's Republic of China
| | - Hai Yu
- Department of Anesthesiology, West China Hospital, Sichuan University & The Research Units of West China (2018RU012), Chinese Academy of Medical Sciences, Chengdu, 610041, People's Republic of China.
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23
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Rashed A, Mazer-Amirshahi M, Pourmand A. Current Approach to Undifferentiated Headache Management in the Emergency Department. Curr Pain Headache Rep 2019; 23:26. [PMID: 30868276 DOI: 10.1007/s11916-019-0765-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
PURPOSE OF REVIEW To discuss pharmacological interventions in the emergency department (ED) setting for the management of acute primary headache. RECENT FINDINGS Acute headache treatment in the ED has seen an expansion in terms of possible pharmacological interventions in recent years. After a thorough evaluation ruling out dangerous causes of headache, providers should take the patient's history, comorbidities, and prior therapy into consideration. Antidopaminergics have an established role in the management of acute, severe, headache with manageable side-effect profiles. However, recent studies suggest anesthetic and anti-epileptic drugs may play roles in headache treatment in the ED. Current literature also suggest steroids as a promising tool for emergency department clinicians combating the readmission of patients with recurrent headaches. Emergency medicine providers must be cognizant of these traditional and emerging therapies in order to optimize the care of headache patients.
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Affiliation(s)
- Amir Rashed
- Department of Emergency Medicine, George Washington University School of Medicine and Health Sciences, 2120 L St., Washington, DC, 20037, USA
| | - Maryann Mazer-Amirshahi
- Department of Emergency Medicine, MedStar Washington Hospital Center, Washington, DC, USA.,School of Medicine, Georgetown University, Washington, DC, USA
| | - Ali Pourmand
- Department of Emergency Medicine, George Washington University School of Medicine and Health Sciences, 2120 L St., Washington, DC, 20037, USA.
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24
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Burnett A, Faley B, Nyirenda T, Bamboat ZM. Reply letter to: Liposomal bupivacaine reduces narcotic use and time to flatus in a retrospective cohort of patients who underwent laparotomy. Int J Surg 2019; 64:60-61. [PMID: 30769217 DOI: 10.1016/j.ijsu.2019.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Accepted: 02/08/2019] [Indexed: 11/16/2022]
Affiliation(s)
- Atuhani Burnett
- Department of Surgery, Hackensack University Medical Center, Hackensack, NJ, USA.
| | - Brian Faley
- Department of Surgery, Hackensack University Medical Center, Hackensack, NJ, USA
| | - Themba Nyirenda
- Department of Surgery, Hackensack University Medical Center, Hackensack, NJ, USA
| | - Zubin M Bamboat
- Department of Surgery, Hackensack University Medical Center, Hackensack, NJ, USA
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25
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Wong SSC, Sun L, Qiu Q, Gu P, Li Q, Wang XM, Cheung CW. Propofol attenuates postoperative hyperalgesia via regulating spinal GluN2B-p38MAPK/EPAC1 pathway in an animal model of postoperative pain. Eur J Pain 2019; 23:812-822. [PMID: 30570802 DOI: 10.1002/ejp.1349] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 11/16/2018] [Accepted: 12/11/2018] [Indexed: 12/25/2022]
Abstract
BACKGROUND Total intravenous anesthesia with propofol has been shown to reduce postoperative pain in some clinical studies, but knowledge of its underlying analgesic mechanism remains limited. In this study, we compared the analgesic effects of propofol versus isoflurane in an animal model of postoperative pain and evaluated its underlying molecular mechanisms. METHODS Plantar incision was made in the hind paws of rats under general anesthesia with 2.5% of inhalational isoflurane (isoflurane group) or intravenous infusion of propofol (1.5 mg kg-1 min-1 , propofol group). Mechanical allodynia was assessed by paw withdrawal threshold before and after incision. Spinal dorsal horns (L3-L5) were harvested 1 hr after incision to assess the level of phosphorylated GluN2B, p38MAPK, ERK, JNK, and EPAC using Western blot and immunofluorescence. RESULTS Mechanical allodynia induced by plantar incision peaked at 1 hr and lasted for 3 days after incision. It was significantly less in the propofol group compared with the isoflurane group in the first 2 hr following incision. The incision-induced increases in phosphorylated GluN2B, p38MAPK, and EPAC1 were significantly reduced in the propofol group. The number of spinal dorsal neurons co-expressed with EPAC1 and c-Fos after the incision was significantly lower in the propofol group. CONCLUSION Propofol reduced pain responses in an animal model of postoperative pain and suppressed the spinal GluN2B-p38MAPK/EPAC1 signaling pathway. Since the p38MAPK/EPAC pathway plays a critical role in the development of postoperative hyperalgesia, our results provide evidence-based behavioral, molecular, and cellular mechanisms for the analgesic effects of propofol when used for general anesthesia. SIGNIFICANCE These findings may provide a new mechanism for the postsurgical analgesic effect of propofol, which is particularly interesting during the subacute period after surgery as it is the critical period for the development of persistent postsurgical pain.
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Affiliation(s)
- Stanley S-C Wong
- Laboratory and Clinical Research Institute for Pain, Hong Kong SAR, China.,Department of Anaesthesiology, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Liting Sun
- The First Rehabilitation Hospital of Shanghai, Tongji University School of Medicine, Advanced Institute of Translational Medicine, Tongji University, Shanghai, China
| | - Qiu Qiu
- Laboratory and Clinical Research Institute for Pain, Hong Kong SAR, China
| | - Pan Gu
- Laboratory and Clinical Research Institute for Pain, Hong Kong SAR, China.,Department of Anaesthesiology, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Qing Li
- Department of Anesthesiology, Taihe Hospital, Hubei University of Medicine, Shiyan, Hubei Province, China
| | - Xiao-Min Wang
- Laboratory and Clinical Research Institute for Pain, Hong Kong SAR, China.,Department of Anaesthesiology, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Chi Wai Cheung
- Laboratory and Clinical Research Institute for Pain, Hong Kong SAR, China.,Department of Anaesthesiology, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
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26
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Wang G, Liu J, Gao J, Zheng X. Comparison of the effects of sevoflurane and propofol anesthesia on pulmonary function, MMP-9 and postoperative cognition in patients receiving lung cancer resection. Oncol Lett 2019; 17:3399-3405. [PMID: 30867776 PMCID: PMC6396185 DOI: 10.3892/ol.2019.9993] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Accepted: 01/07/2019] [Indexed: 12/11/2022] Open
Abstract
Effects of sevoflurane and propofol anesthesia on pulmonary function, matrix metalloproteinase-9 (MMP-9) and postoperative cognition were compared in patients undergoing simple resection of lower lobe of left lung. Retrospective method was used to analyze 58 cases of lung cancer patients treated by simple resection of lower lobe of left lung in the Second Hospital of Dalian Medical University from October 2016 to October 2017, and they were divided into two groups: Sevoflurane group (n=32) with sevoflurane anesthesia and propofol group (n=26) with propofol anesthesia. In the present study, the moment before induction of anesthesia (T1), before the start of one-lung ventilation (T2), before the end of one-lung ventilation (T3), after closed chest surgery (T4), 24 h after surgery (T5), calculate alveolar-arterial oxygen difference (A-aDO2), respiratory index (RI) and intrapulmonary shunt ratio (Qs/Qt), were compared between the two groups. The serum MMP-9 concentration at T1, T4 and T5 were detected by enzyme linked immunosorbent assay. The cognitive function of two groups was assessed by Mini-Mental State Examination (MMSE) 1 day before surgery and 1 and 10 days after surgery. The A-aDO2 level at T4 in sevoflurane group was significantly higher than that in propofol group (P<0.05). The RI level at T3, T4, the Qs/Qt and the MMP-9 level at T4 in the sevoflurane group was significantly higher than that in the propofol group (P<0.05). The MMSE score in sevoflurane group was significantly lower than that in propofol group 1 and 10 days after surgery (P<0.05). Propofol has little effect on pulmonary function and can decrease inflammatory factor MMP-9. Both sevoflurane and propofol have an effect on cognitive function after lung cancer resection, but propofol can reduce cognitive impairment in patients with lung cancer.
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Affiliation(s)
- Guan Wang
- Department of Anesthesiology, The Second Hospital of Dalian Medical University, Dalian, Liaoning 116023, P.R. China
| | - Jie Liu
- Department of Anesthesiology, The Second Hospital of Dalian Medical University, Dalian, Liaoning 116023, P.R. China
| | - Jinxia Gao
- Department of Anesthesiology, The Second Hospital of Dalian Medical University, Dalian, Liaoning 116023, P.R. China
| | - Xin Zheng
- Department of Emergency Anesthesiology, The Second Hospital of Dalian Medical University, Dalian, Liaoning 116023, P.R. China
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27
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Grandhi RK, Abd-Elsayed A. Propofol Infusion Therapy. INFUSION THERAPY 2019:27-38. [DOI: 10.1007/978-3-030-17478-1_3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
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28
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Wong SSC, Leung MYY, Cheung CW. The effect of total intravenous anaesthesia with propofol on postoperative pain after third molar surgery: A double-blind randomized controlled trial. Eur J Pain 2018; 23:884-893. [PMID: 30592344 DOI: 10.1002/ejp.1354] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 12/19/2018] [Accepted: 12/21/2018] [Indexed: 01/05/2023]
Abstract
BACKGROUND Total intravenous anaesthesia (TIVA) with propofol may reduce pain after surgery compared with inhalational anaesthetic techniques. Whether propofol provides analgesic benefit may be influenced by the surgical procedure and anaesthetic/analgesic regime. Third molar surgery is a consistent and fairly standard surgical technique that provides a good model for postoperative pain. We investigated whether propofol TIVA or sevoflurane (SEVO) inhalational anaesthesia would produce better quality pain relief after third molar surgery. METHODS In this double-blind, randomized controlled trial, patients scheduled for bilateral third molar surgery received propofol TIVA or SEVO inhalational anaesthesia. Postoperative numerical rating pain scores, analgesic consumption, adverse effects and global pain satisfaction were assessed. RESULTS Data from 48 patients in each group were analysed. The area under curves for numerical rating scale pain scores were significantly lower in the propofol TIVA group at rest and during mouth opening between 1 and 72 hr after surgery (p = 0.013 at rest, p = 0.021 with mouth opening). There was no difference in postoperative analgesic consumption. Propofol TIVA was associated with less postoperative headache (p = 0.041 in the postoperative anaesthetic care unit, p = 0.036 in ward). There were no differences in other adverse effects including postoperative nausea and vomiting. Global pain satisfaction and level of postoperative discomfort at 24 hr after surgery were significantly better in the propofol TIVA group (p = 0.008 and p = 0.009, respectively). CONCLUSION Propofol TIVA was associated with reduced postoperative pain after bilateral third molar surgery, but did not reduce postoperative analgesic consumption. SIGNIFICANCE Choice of general anaesthetic technique can affect postoperative analgesia. The results of this study suggest that propofol TIVA improves postoperative pain and patient satisfaction after third molar surgery compared to inhalational anaesthesia.
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Affiliation(s)
- Stanley Sau Ching Wong
- Laboratory and Clinical Research Institute for Pain, Department of Anaesthesiology, The University of Hong Kong, Hong Kong, China
| | - Mike Yiu Yan Leung
- Department of Oral and Maxillofacial Surgery, The University of Hong Kong, Hong Kong, China
| | - Chi Wai Cheung
- Laboratory and Clinical Research Institute for Pain, Department of Anaesthesiology, The University of Hong Kong, Hong Kong, China
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Schraag S, Pradelli L, Alsaleh AJO, Bellone M, Ghetti G, Chung TL, Westphal M, Rehberg S. Propofol vs. inhalational agents to maintain general anaesthesia in ambulatory and in-patient surgery: a systematic review and meta-analysis. BMC Anesthesiol 2018; 18:162. [PMID: 30409186 PMCID: PMC6225663 DOI: 10.1186/s12871-018-0632-3] [Citation(s) in RCA: 90] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2018] [Accepted: 10/29/2018] [Indexed: 12/29/2022] Open
Abstract
Background It is unclear if anaesthesia maintenance with propofol is advantageous or beneficial over inhalational agents. This study is intended to compare the effects of propofol vs. inhalational agents in maintaining general anaesthesia on patient-relevant outcomes and patient satisfaction. Methods Studies were identified by electronic database searches in PubMed™, EMBASE™ and the Cochrane™ library between 01/01/1985 and 01/08/2016. Randomized controlled trials (RCTs) of peer-reviewed journals were studied. Of 6688 studies identified, 229 RCTs were included with a total of 20,991 patients. Quality control, assessment of risk of bias, meta-bias, meta-regression and certainty in evidence were performed according to Cochrane. Common estimates were derived from fixed or random-effects models depending on the presence of heterogeneity. Post-operative nausea and vomiting (PONV) was the primary outcome. Post-operative pain, emergence agitation, time to recovery, hospital length of stay, post-anaesthetic shivering and haemodynamic instability were considered key secondary outcomes. Results The risk for PONV was lower with propofol than with inhalational agents (relative risk (RR) 0.61 [0.53, 0.69], p < 0.00001). Additionally, pain score after extubation and time in the post-operative anaesthesia care unit (PACU) were reduced with propofol (mean difference (MD) − 0.51 [− 0.81, − 0.20], p = 0.001; MD − 2.91 min [− 5.47, − 0.35], p = 0.03). In turn, time to respiratory recovery and tracheal extubation were longer with propofol than with inhalational agents (MD 0.82 min [0.20, 1.45], p = 0.01; MD 0.70 min [0.03, 1.38], p = 0.04, respectively). Notably, patient satisfaction, as reported by the number of satisfied patients and scores, was higher with propofol (RR 1.06 [1.01, 1.10], p = 0.02; MD 0.13 [0.00, 0.26], p = 0.05). Secondary analyses supported the primary results. Conclusions Based on the present meta-analysis there are several advantages of anaesthesia maintenance with propofol over inhalational agents. While these benefits result in an increased patient satisfaction, the clinical and economic relevance of these findings still need to be addressed in adequately powered prospective clinical trials. Electronic supplementary material The online version of this article (10.1186/s12871-018-0632-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Stefan Schraag
- Department of Perioperative Medicine, Golden Jubilee National Hospital, Clydebank, G81 4DY, Scotland, UK.
| | | | | | - Marco Bellone
- AdRes-Health Economics and Outcome Research, Torino, Italy
| | - Gianni Ghetti
- AdRes-Health Economics and Outcome Research, Torino, Italy
| | - Tje Lin Chung
- Fresenius Kabi Deutschland GmbH, Bad Homburg, Germany
| | - Martin Westphal
- Fresenius Kabi Deutschland GmbH, Bad Homburg, Germany.,Department of Anaesthesiology, Intensive Care and Pain Medicine, University Hospital, Münster, Germany
| | - Sebastian Rehberg
- Department of Anaesthesiology, University Hospital, Greifswald, Germany.,Department of Anaesthesiology, Intensive Care, Emergency, Transfusion and Pain Medicine, Evangelisches Klinikum Bethel, Bielefeld, Germany
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30
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Irwin MG, Wong GTC. Taking on TIVA. Why we need guidelines on total intravenous anaesthesia. Anaesthesia 2018; 74:140-142. [DOI: 10.1111/anae.14456] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/31/2018] [Indexed: 11/29/2022]
Affiliation(s)
- M. G. Irwin
- Department of Anaesthesiology; University of Hong Kong; Hong Kong
| | - G. T. C. Wong
- Department of Anaesthesiology; University of Hong Kong; Hong Kong
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31
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Na SH, Jeong KH, Eum D, Park JH, Kim MS. Patient quality of recovery on the day of surgery after propofol total intravenous anesthesia for vitrectomy: A randomized controlled trial. Medicine (Baltimore) 2018; 97:e12699. [PMID: 30290667 PMCID: PMC6200536 DOI: 10.1097/md.0000000000012699] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Vitrectomy under general anesthesia is considered as a candidate for ambulatory surgery. An anesthetic method with high quality of postoperative recovery should be selected for successful ambulatory surgery. We thus compared quality of postoperative recovery on the day of vitrectomy using the Quality of Recovery (QoR)-40 questionnaire between propofol total intravenous anesthesia (propofol group) and desflurane inhalation anesthesia (desflurane group) as the 2 representative anesthetic methods. METHODS Eighty-four patients (20-80 years old) undergoing elective vitrectomy under general anesthesia were randomized into 2 groups. The propofol group received propofol and remifentanil using effect-site target-controlled infusion (TCI), and the desflurane group received desflurane inhalation and remifentanil using effect-site TCI. We assessed quality of recovery at 6 hours after surgery through interviews using the QoR-40 questionnaire. We also collected data related to recovery and complications during emergence and recovery period. RESULTS The median of QoR-40 score on the day of surgery was significantly higher in the propofol group than that in the desflurane group (181.0 vs 169.5, respectively; P = .033). In particular, propofol group had significantly higher scores for physical comfort and physical independence dimensions. The amount of remifentanil administered was significantly higher, and the emergence time was significantly longer in propofol group. However, there were no significant differences in other complications between the 2 groups. CONCLUSIONS Propofol total intravenous anesthesia provided significantly better quality of recovery on the day of surgery than desflurane inhalation anesthesia.
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Affiliation(s)
- Se Hee Na
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine
| | - Kyu Hee Jeong
- Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Dahae Eum
- Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jin Ha Park
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine
| | - Min-Soo Kim
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine
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32
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Qiu Q, Sun L, Wang XM, Lo ACY, Wong KL, Gu P, Wong SCS, Cheung CW. Propofol produces preventive analgesia via GluN2B-containing NMDA Receptor/ERK1/2 Signaling Pathway in a rat model of inflammatory pain. Mol Pain 2018; 13:1744806917737462. [PMID: 28969472 PMCID: PMC5644366 DOI: 10.1177/1744806917737462] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Abstract Propofol, an intravenous anesthetic, has been shown to offer superior analgesic effect clinically. Whether propofol has preventive analgesic property remains unexplored. The present study investigated the antinociceptive effect of propofol and underlying molecular and cellular mechanisms via pre-emptive administration in a formalin-induced inflammatory pain model in rats. Male adult Sprague–Dawley rats were randomly allocated into four groups: naïve (Group Naïve), formalin injection only (Group Formalin), and formalin injection at 30 min (Group P-30 min) or 2 h (Group P-2 h) after intravenous infusion of propofol (0.6 mg kg−1 min−1) for 1 h. Nociceptive responses and protein expression of phosphorylated- or pan-GluN2B, ERK1/2, p38 mitogen-activated protein kinase, and c-Jun N-terminal kinase in the spinal dorsal horn were evaluated. Alteration of intracellular Ca2+ concentration induced by N-methyl-D-aspartate (NMDA) receptor agonists with or without pre-treatment of propofol was measured using fluorometry in SH-SY5Y cells while neuronal activation in the spinal dorsal horn by immunofluorescence. Pre-emptive propofol reduced pain with a delayed response to formalin and a reduction in hypersensitivity that lasted at least for 2 h. The formalin-induced activation of spinal GluN2B and ERK1/2 but not p38 or c-Jun N-terminal kinase was also diminished by propofol treatment. Preconditioning treatment with 3 µM and 10 µM of propofol inhibited Ca2+ influx mediated through NMDA receptors in SH-SY5Y cells. Propofol also reduced the neuronal expression of c-Fos and p-ERK induced by formalin. This study shows that pre-emptive administration of propofol produces preventive analgesic effects on inflammatory pain through regulating neuronal GluN2B-containing NMDA receptor and ERK1/2 pathway in the spinal dorsal horn.
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Affiliation(s)
- Qiu Qiu
- Laboratory and Clinical Research Institute for Pain, Department of Anaesthesiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Liting Sun
- Laboratory and Clinical Research Institute for Pain, Department of Anaesthesiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Xiao-Min Wang
- Laboratory and Clinical Research Institute for Pain, Department of Anaesthesiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Amy C Y Lo
- Department of Ophthalmology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Kar Lok Wong
- Department of Anesthesiology, and Institute of Clinical Medical Sciences, and Research Group of Cardiovascular Biology, China Medical University and Hospital, Taichung, Taiwan
| | - Pan Gu
- Laboratory and Clinical Research Institute for Pain, Department of Anaesthesiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Sau Ching Stanley Wong
- Laboratory and Clinical Research Institute for Pain, Department of Anaesthesiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
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33
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Wong SSC, Choi SW, Lee Y, Irwin MG, Cheung CW. The analgesic effects of intraoperative total intravenous anesthesia (TIVA) with propofol versus sevoflurane after colorectal surgery. Medicine (Baltimore) 2018; 97:e11615. [PMID: 30075537 PMCID: PMC6081200 DOI: 10.1097/md.0000000000011615] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Clinical studies have shown that total intravenous anesthesia (TIVA) with propofol is associated with better postoperative pain control compared with inhalational anesthesia, while other studies have not shown any benefit. The analgesic effect of TIVA with propofol in colorectal surgery has not been studied. The aim of this study is to evaluate the postoperative analgesic effects of TIVA with propofol versus inhalational sevoflurane in colorectal surgery.This is a retrospective case-control study. Records of patients undergoing colorectal surgery from 2014 to 2016 (36 months) were retrieved. Ninety-five patients who received TIVA with propofol were matched against 95 patients who received inhalational sevoflurane. Acute postoperative numerical rating scale (NRS) pain scores, postoperative morphine consumption, patient satisfaction, and side effects were compared and analyzed for differences between TIVA with propofol and sevoflurane.There were no significant differences in NRS pain scores, incidence of side effects, and patient satisfaction between the 2 groups. Patients receiving TIVA with propofol had significantly reduced total morphine consumption (P < .001), and daily morphine consumption on postoperative days 1 (P = .031), 2 (P = .002), and 3 (P = .031) compared with those receiving sevoflurane.TIVA with propofol was not associated with improved postoperative analgesia, better patient satisfaction, or reduced side effects. It may reduce postoperative opioid consumption after colorectal surgery.
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Ji FH, Wang D, Zhang J, Liu HY, Peng K. Effects of propofol anesthesia versus sevoflurane anesthesia on postoperative pain after radical gastrectomy: a randomized controlled trial. J Pain Res 2018; 11:1247-1254. [PMID: 29983588 PMCID: PMC6025767 DOI: 10.2147/jpr.s164889] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose After a radical gastrectomy, patients may experience severe pain. Some studies have reported that the use of propofol significantly reduced postoperative pain, while others have argued that this effect was not significant. Thus, we aimed to assess whether anesthesia with propofol could help to reduce pain after an open radical gastrectomy procedure. Patients and methods Sixty patients who were scheduled to undergo a laparotomy for radical gastrectomy were randomly assigned to either the propofol or sevoflurane group (n=30 each). A target-controlled infusion of propofol or inhalation of sevoflurane, titrated to bispectral index of 40–60, was maintained. All patients were administered a standardized multimodal analgesic plan, including intraoperative dexmedetomidine, dexamethasone, and postoperative flurbiprofen axetil, as well as patient-controlled fentanyl. Hemodynamics, pain scores, fentanyl consumption, adverse events, and the incidence of chronic pain 1 month and 3 months following hospital discharge were recorded. Results The intensity of postoperative pain was relatively low to moderate in all the patients. The propofol group showed lower pain scores, at rest and while coughing, up to 48 h postoperatively compared to the sevoflurane group (P<0.05). Cumulative fentanyl consumption 0–24 h after surgery was lower for the propofol group (364.4 ± 139.1 vs. 529.3 ± 237.9 µg; P=0.002). However, for fentanyl consumption 0–48 h, the difference between the two groups was not significant (710.9 ± 312.8 vs. 850.9 ± 292.0 µg; P=0.078). There were no differences in the incidences of adverse events or chronic pain between the groups. Conclusions Overall, the multimodal analgesic approach reduced postoperative pain after an open radical gastrectomy procedure in all patients anesthetized with either propofol or sevoflurane. Furthermore, our results indicated better analgesic outcome for the propofol group, especially in the early postoperative period.
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Affiliation(s)
- Fu-Hai Ji
- Department of Anesthesiology, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China,
| | - Dan Wang
- Department of Anesthesiology, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China,
| | - Juan Zhang
- Department of Anesthesiology, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China,
| | - Hua-Yue Liu
- Department of Anesthesiology, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China,
| | - Ke Peng
- Department of Anesthesiology, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China,
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Choi BM, Park C, Lee YH, Shin H, Lee SH, Jeong S, Noh GJ, Lee B. Development of a new analgesic index using nasal photoplethysmography. Anaesthesia 2018; 73:1123-1130. [PMID: 29790159 DOI: 10.1111/anae.14327] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/16/2018] [Indexed: 11/29/2022]
Abstract
Although surrogate measures to quantify pain intensity have been commercialised, there is a need to develop a new index with improved accuracy. The aim of this study was to develop a new analgesic index using nasal photoplethysmography data. The specially designed sensor was placed between the columella and the nasal septum to acquire nasal photoplethysmography in surgical patients. Nasal photoplethysmography and Surgical Pleth Index® (GE Healthcare) data were obtained for 14 min both in the absence (pre-operatively) or presence (postoperatively) of pain in a group of surgical patients, each patient acting as their own control. Various dynamic photoplethysmography variables were extracted to quantify pain intensity; the most accurate index was selected using logistic regression as a classifier. The area under the curve of the receiver-operating characteristic curve was measured to evaluate the accuracy of final model predictions. In total, 12,012 heart beats from 89 patients were used to develop a new Nasal Photoplethysmography Index for analgesic depth quantification. The two-variable model (a combination of diastolic peak point variation and heart beat interval variation) was most accurate in discriminating between the presence and absence of pain (numerical rating scale (NRS) ≥ 3). The accuracy and area under the curve of the receiver-operating characteristic curve for the Nasal Photoplethysmography Index were 75.3% and 0.8018, respectively, and 64.8% and 0.7034, respectively, for the Surgical Pleth Index. The Nasal Photoplethysmography Index clearly distinguished pain (NRS ≥ 3) in awake surgical patients with postoperative pain. The Nasal Photoplethysmography Index performed better than the Surgical Pleth Index. Further validation studies are needed to evaluate its feasibility to quantify pain intensity during general anaesthesia.
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Affiliation(s)
- B M Choi
- Department of Anaesthesiology and Pain Medicine, Department of Clinical Pharmacology and Therapeutics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - C Park
- School of Mechanical Engineering, Department of Biomedical Science and Engineering, Institute of Integrated Technology, Gwangju Institute of Science and Technology, Gwangju, South Korea
| | - Y H Lee
- Department of Anaesthesiology and Pain Medicine, Department of Clinical Pharmacology and Therapeutics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - H Shin
- Department of Biomedical Engineering, Chonnam National University, Yeosu, South Korea
| | - S H Lee
- New Drug Development Center, Osong Medical Innovation Foundation, Chungcheongbuk-do, Korea
| | - S Jeong
- Department of Anesthesiology and Pain Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - G J Noh
- Department of Anesthesiology and Pain Medicine and Department of Clinical Pharmacology and Therapeutics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - B Lee
- Department of Biomedical Science and Engineering, Institute of Integrated Technology, Gwangju Institute of Science and Technology, Gwangju, South Korea
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Comparison of target-controlled infusion and manual infusion for propofol anaesthesia in children. Br J Anaesth 2018; 120:1049-1055. [DOI: 10.1016/j.bja.2017.11.102] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Revised: 11/09/2017] [Accepted: 11/14/2017] [Indexed: 12/29/2022] Open
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Bustamante R, Aguado D, Cediel R, Gómez de Segura I, Canfrán S. Clinical comparison of the effects of isoflurane or propofol anaesthesia on mean arterial blood pressure and ventilation in dogs undergoing orthopaedic surgery receiving epidural anaesthesia. Vet J 2018; 233:49-54. [DOI: 10.1016/j.tvjl.2018.01.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Revised: 01/08/2018] [Accepted: 01/09/2018] [Indexed: 10/18/2022]
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Ross A, Young J, Hedin R, Aran G, Demand A, Stafford A, Worley J, Moore M, Vassar M. A systematic review of outcomes in postoperative pain studies in paediatric and adolescent patients: towards development of a core outcome set. Anaesthesia 2018; 73:375-383. [DOI: 10.1111/anae.14211] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/04/2017] [Indexed: 12/13/2022]
Affiliation(s)
- A. Ross
- Oklahoma State University Centre for Health Sciences; Tulsa Oklahoma USA
| | - J. Young
- Oklahoma State University Centre for Health Sciences; Tulsa Oklahoma USA
| | - R. Hedin
- Oklahoma State University Centre for Health Sciences; Tulsa Oklahoma USA
| | - G. Aran
- Oklahoma State University Centre for Health Sciences; Tulsa Oklahoma USA
| | - A. Demand
- Oklahoma State University Centre for Health Sciences; Tulsa Oklahoma USA
| | | | - J. Worley
- University of Oklahoma-Tulsa; Tulsa Oklahoma USA
| | - M. Moore
- Oklahoma State University Medical Centre; Tulsa Oklahoma USA
| | - M. Vassar
- Oklahoma State University Centre for Health Sciences; Tulsa Oklahoma USA
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Mohaghegh T, Yazdi B, Norouzi A, Fateh S, Modir H, Mohammadbeigi A. Effect of intravenous anesthesia with propofol versus isoflurane inhalation anesthesia in postoperative pain of inguinal herniotomy: a randomized clinical trial. Med Gas Res 2017; 7:86-92. [PMID: 28744360 PMCID: PMC5510298 DOI: 10.4103/2045-9912.208511] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Postoperative pain is a common problem after inguinal herniotomy. We aimed to compare the intravenous anesthesia effects of propofol and isoflurane inhalation anesthesia on postoperative pain after inguinal herniotomy. In a randomized clinical trial, 102 eligible patients were selected based on inclusion and exclusion criteria and were randomly divided in two groups. In the first group, propofol was used for the maintenance of anesthesia, while isoflurane was used in the second group. The patient’s heart rate, systolic and diastolic blood pressure and oxygen saturation before, during and after surgery, recovery time and postoperative pain were measured immediately, 2, 4 and 6 hours after surgery and compared between two groups. T-test, and repeated measurement test were used for statistical analysis. No statistically significant differences were observed in heart rate, blood pressure and oxygen saturation levels between the two groups (P > 0.05). Propofol has higher effect in easing postoperative pain of patients than isoflurane, but no difference in postoperative complications, including chills, nausea and vomiting, occurs in both two groups. Propofol is effective in declining the postoperative pain of patients after anesthesia in comparison with isoflurane. Moreover, due to the antioxidant, anti-inflammatory and analgesic properties of propofol, it is preferred to isoflurane and the authors recommended it to be used.
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Affiliation(s)
- Taherh Mohaghegh
- Department of Anesthesiology and Critical Care, Arak University of Medical Sciences, Arak, Iran
| | - Bijan Yazdi
- Department of Anesthesiology and Critical Care, Arak University of Medical Sciences, Arak, Iran
| | - Afsaneh Norouzi
- Department of Anesthesiology and Critical Care, Arak University of Medical Sciences, Arak, Iran
| | - Shahin Fateh
- Department of surgery, Arak University of Medical Sciences, Arak, Iran
| | - Hesameddin Modir
- Department of Anesthesiology and Critical Care, Arak University of Medical Sciences, Arak, Iran
| | - Abolfazl Mohammadbeigi
- Neurology and Neurosciences Research Center, Qom University of Medical Sciences, Qom, Iran
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Choi SW, Lam DMH. Heterogeneity in meta-analyses. Comparing apples and oranges? Anaesthesia 2017; 72:532-534. [DOI: 10.1111/anae.13832] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Affiliation(s)
- S. W. Choi
- Department of Anaesthesiology; The University of Hong Kong; Hong Kong HKSAR
| | - D. M. H. Lam
- Department of Anaesthesiology; Queen Mary Hospital; Hong Kong HKSAR
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