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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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Chung PK, Dhanrajani P. Comparative randomized study of propofol target-controlled infusion versus sevoflurane anesthesia for third molar extraction. J Dent Anesth Pain Med 2018; 18:169-175. [PMID: 29984321 PMCID: PMC6031969 DOI: 10.17245/jdapm.2018.18.3.169] [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: 06/06/2018] [Revised: 06/15/2018] [Accepted: 06/18/2018] [Indexed: 11/15/2022] Open
Abstract
Background The objective of this study was to compare hemodynamic and recovery characteristics of total intravenous anesthesia using propofol target-controlled infusion (TCI) versus sevoflurane for extraction of four third molar teeth. Methods One hundred patients undergoing extraction of four third molar teeth under general anesthesia were randomized to one of two groups. Group 1 received propofol TCI-oxygen for induction and propofol TCI-oxygen-air for maintenance. Group II received a propofol bolus of 2 mg/kg for induction and sevoflurane-oxygen-air for maintenance. Heart rate, mean arterial pressure (MAP), operating time, time to emergence, nausea and vomiting, and sedation and pain scores were measured in each group. Results Demographic data, including age, gender, weight, and height, were not significantly different between the two groups. The MAP was significantly higher after intubation (P = 0.007) and injection of anesthesia (P = 0.004) in the propofol group than in the sevoflurane group, with significant reflex bradycardia (P = 0.028). The mean time to emergence from anesthesia using propofol was 25 s shorter than that of sevoflurane (P = 0.02). Postoperatively, the propofol group was less sedated than the sevoflurane group at 30 min (0.02 versus 0.12), but this difference was not significant (P = 0.065). Conclusion Both propofol TCI and sevoflurane are good alternatives for induction and maintenance of anesthesia for short day-case surgery. However, propofol TCI does not blunt the hemodynamic response to sudden, severe stimuli as strongly as sevoflurane, and this limitation may be a cause for concern in patients with cardiac comorbidities.
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Peng K, Liu HY, Wu SR, Liu H, Zhang ZC, Ji FH. Does Propofol Anesthesia Lead to Less Postoperative Pain Compared With Inhalational Anesthesia?: A Systematic Review and Meta-analysis. Anesth Analg 2017; 123:846-58. [PMID: 27636574 DOI: 10.1213/ane.0000000000001504] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Many studies have compared propofol-based anesthesia with inhalational anesthesia. Results from several studies have shown improved postoperative analgesia after propofol anesthesia, but other studies showed contradictory results. There are no large prospective studies that compare postoperative pain after propofol versus inhalational anesthesia. This meta-analysis was designed to focus on this question. METHODS A systematic literature search for randomized controlled trials that compared propofol-based anesthesia with volatile agents-based anesthesia in adults undergoing surgery was conducted. Published data were pooled for the meta-analysis with Review Manager (ie, RevMan). The main outcomes included postoperative pain intensity, opioid consumption, need for rescue analgesics, and time to first analgesia. RESULTS Thirty-nine clinical trials with a combined subject population of 4520 patients came within the purview of this meta-analysis. The investigated volatile agents included isoflurane, sevoflurane, and desflurane. Compared with inhalational anesthetics, the propofol use was associated with a reduced postoperative pain intensity at rest at 30 minutes, 1 hour, and 12 hours (mean difference in pain scores, 30 minutes, -0.48 [visual analog scale, 0-10]; 99% confidence interval [CI], -1.07 to 0.12, P = 0.04) and reduced morphine-equivalent consumption 0 to 24 hours postoperatively (mean difference in morphine-equivalent consumption, -2.68 mg; 99% CI, -6.17 to 0.82; P = 0.05). Fewer patients required postoperative rescue analgesics during 0 to 24 hours after surgery under propofol anesthesia (risk ratio, 0.87; 99% CI, 0.74-1.03; P = 0.04). In addition, patients anesthetized with propofol required administration of postoperative analgesia later than those anesthetized with volatiles (mean difference in time to first analgesic administration, 6.12 minutes; 99% CI, 0.02-12.21; P = 0.01). Considering that Z statistic in RevMan 5.3 does not perform optimally in highly heterogeneous samples among groups or many combinations of groups with small sample sizes, a P value of <.01 was considered statistically significant. On the basis of this threshold, none of the aforementioned results are statistically significant. CONCLUSIONS The current results are affected by substantial heterogeneity, which makes it difficult to predict significant differences in postoperative pain control between propofol anesthesia and inhalational anesthesia. Further large, randomized controlled trials are needed to corroborate these results and to detect differences (if any) between propofol and inhalational anesthesia on postoperative pain.
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Affiliation(s)
- Ke Peng
- From the *Department of Anesthesiology, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China; †Department of Anesthesiology and Pain Medicine, University of California Davis Health System, Sacramento, California; and ‡Department of Intensive Care Medicine, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
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Qiu Q, Choi SW, Wong SSC, Irwin MG, Cheung CW. Effects of intra-operative maintenance of general anaesthesia with propofol on postoperative pain outcomes - a systematic review and meta-analysis. Anaesthesia 2016; 71:1222-33. [DOI: 10.1111/anae.13578] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/27/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Q. Qiu
- Laboratory and Clinical Research Institute for Pain; Department of Anaesthesiology; The University of Hong Kong; Hong Kong China
| | - S. W. Choi
- Laboratory and Clinical Research Institute for Pain; Department of Anaesthesiology; The University of Hong Kong; Hong Kong China
| | - S. S. C. Wong
- Laboratory and Clinical Research Institute for Pain; Department of Anaesthesiology; The University of Hong Kong; Hong Kong China
| | - M. G. Irwin
- Laboratory and Clinical Research Institute for Pain; Department of Anaesthesiology; The University of Hong Kong; Hong Kong China
| | - C. W. Cheung
- Laboratory and Clinical Research Institute for Pain; Department of Anaesthesiology; The University of Hong Kong; Hong Kong China
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Singh Y, Singh AP, Jain G, Yadav G, Singh DK. Comparative evaluation of cost effectiveness and recovery profile between propofol and sevoflurane in laparoscopic cholecystectomy. Anesth Essays Res 2015; 9:155-60. [PMID: 26417120 PMCID: PMC4563962 DOI: 10.4103/0259-1162.156290] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: Anesthetic agents should be chosen not only on the basis of safety-efficacy profile, but also on the economic aspect. Propofol and sevoflurane are commonly utilized anesthetic agent for general anesthesia. Aim: The present study was designated to compare cost-effectiveness and recovery profile between propofol and sevoflurane for induction, maintenance or both. Settings and Design: Randomized controlled, participant and data operator blinded trial. Materials and Methods: Ninety patients undergoing laparoscopic cholecystectomy were randomized into three equal groups to receive: Group P to receive injection propofol for both induction and maintenance; Group PS to receive injection propofol for induction and sevoflurane for maintenance; and Group S to receive sevoflurane for both induction and maintenance of general anesthesia, respectively. Cost analysis, hemodynamic parameter, and recovery profile were compared between these groups. Statistical Analysis: One-way analysis of variance test or Fisher's exact test/Chi-square test whichever appropriate. Results: Total cost of anesthesia was highest in Group P and lowest in Group S. Mean time to extubation and time to follow verbal commands was lowest in Group S than Group P or Group P/S. Hemodynamic parameter was more stable in Group S. Conclusion: We conclude that sevoflurane appears to be better anesthetic agents in terms of cost-effectiveness and recovery profile.
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Affiliation(s)
- Yashpal Singh
- Department of Anaesthesiology and Intensive Care, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Anil P Singh
- Department of Anaesthesiology and Intensive Care, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Gaurav Jain
- Department of Anaesthesiology and Intensive Care, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Ghanshyam Yadav
- Department of Anaesthesiology and Intensive Care, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Dinesh Kumar Singh
- Department of Anaesthesiology and Intensive Care, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
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Choi JB, Shim YH, Lee YW, Lee JS, Choi JR, Chang CH. Incidence and risk factors of postoperative nausea and vomiting in patients with fentanyl-based intravenous patient-controlled analgesia and single antiemetic prophylaxis. Yonsei Med J 2014; 55:1430-5. [PMID: 25048507 PMCID: PMC4108834 DOI: 10.3349/ymj.2014.55.5.1430] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
PURPOSE We evaluated the incidence and risk factors of postoperative nausea and vomiting (PONV) in patients with fentanyl-based intravenous patient-controlled analgesia (IV-PCA) and single antiemetic prophylaxis of 5-hydroxytryptamine type 3 (5 HT₃)-receptor antagonist after the general anesthesia. MATERIALS AND METHODS In this retrospective study, incidence and risk factors for PONV were evaluated with fentanyl IV-PCA during postoperative 48 hours after various surgeries. RESULTS Four hundred-forty patients (23%) of 1878 had showed PONV. PCA was discontinued temporarily in 268 patients (14%), mostly due to PONV (88% of 268 patients). In multivariate analysis, female, non-smoker, history of motion sickness or PONV, long duration of anesthesia (>180 min), use of desflurane and intraoperative remifentanil infusion were independent risk factors for PONV. If one, two, three, four, five, or six of these risk factors were present, the incidences of PONV were 18%, 19%, 22%, 31%, 42%, or 50%. Laparoscopic surgery and higher dose of fentanyl were not risk factors for PONV. CONCLUSION Despite antiemetic prophylaxis with 5 HT₃-receptor antagonist, 23% of patients with fentanyl-based IV-PCA after general anesthesia showed PONV. Long duration of anesthesia and use of desflurane were identified as risk factors, in addition to risk factors of Apfel's score (female, non-smoker, history of motion sickness or PONV). Also, intraoperative remifentanil infusion was risk factor independent of postoperative opioid use. As the incidence of PONV was up to 50% according to the number of risk factors, risk-adapted, multimodal or combination therapy should be applied.
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Affiliation(s)
- Jong Bum Choi
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Yon Hee Shim
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Youn-Woo Lee
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Jeong Soo Lee
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Jong-Rim Choi
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Chul Ho Chang
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea.
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Sevoflurane/propofol coadministration provides better recovery than sevoflurane in combined general/epidural anesthesia: a randomized clinical trial. J Anesth 2014; 28:721-6. [DOI: 10.1007/s00540-014-1803-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2014] [Accepted: 02/01/2014] [Indexed: 12/15/2022]
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The anesthesia in abdominal aortic surgery (ABSENT) study: a prospective, randomized, controlled trial comparing troponin T release with fentanyl-sevoflurane and propofol-remifentanil anesthesia in major vascular surgery. Anesthesiology 2014; 119:802-12. [PMID: 23838709 DOI: 10.1097/aln.0b013e31829bd883] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND On the basis of data indicating that volatile anesthetics induce cardioprotection in cardiac surgery, current guidelines recommend volatile anesthetics for maintenance of general anesthesia during noncardiac surgery in hemodynamic stable patients at risk for perioperative myocardial ischemia. The aim of the current study was to compare increased troponin T (TnT) values in patients receiving sevoflurane-based anesthesia or total intravenous anesthesia in elective abdominal aortic surgery. METHODS A prospective, randomized, open, parallel-group trial comparing sevoflurane-based anesthesia (group S) and total intravenous anesthesia (group T) with regard to cardioprotection in 193 patients scheduled for elective abdominal aortic surgery. Increased TnT level on the first postoperative day was the primary endpoint. Secondary endpoints were postoperative complications, nonfatal coronary events and mortality. RESULTS On the first postoperative day increased TnT values (>13 ng/l) were found in 43 (44%) patients in group S versus 41 (43%) in group T (P = 0.999), with no significant differences in TnT levels between the groups at any time point. Although underpowered, the authors found no differences in postoperative complications, nonfatal coronary events or mortality between the groups. CONCLUSIONS In elective abdominal aortic surgery sevoflurane-based anesthesia did not reduce myocardial injury, evaluated by TnT release, compared with total intravenous anesthesia. These data indicate that potential cardioprotective effects of volatile anesthetics found in cardiac surgery are less obvious in major vascular surgery.
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Orhon ZN, Devrim S, Celik M, Dogan Y, Yildirim A, Basok EK. Comparison of recovery profiles of propofol and sevoflurane anesthesia with bispectral index monitoring in percutaneous nephrolithotomy. Korean J Anesthesiol 2013; 64:223-8. [PMID: 23560187 PMCID: PMC3611071 DOI: 10.4097/kjae.2013.64.3.223] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2012] [Revised: 10/24/2012] [Accepted: 10/24/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The aim of the study was to evaluate the comparative effects of propofol infusion versus sevoflurane for maintenance of anesthesia with respect to hemodynamics, recovery characteristics, nausea and vomiting in patients undergoing percutaneous nephrolithotomy. METHODS Forty American Society of Anesthesiologists physical status I-II patients, aged between 22 and 65 years were randomly divided to receive either intravenous anesthesia with propofol (group P) or sevoflurane (group S). Cardiovascular variables, peripheral oxygen saturation (SpO2), end-tidal carbon dioxide (ETCO2), bispectral index (BIS) and train-of-four (TOF) values were recorded at intervals throughout the procedure. Time to spontaneous respiration, eye opening, extubation, obey commands, hand squeezing, Aldrete Score > 9 and the incidence of postoperative nausea and vomiting were recorded. RESULTS Early recovery times [spontaneous respiration (P = 0.002), eye opening (P = 0.006), extubation (P = 0.013), obey commands (P < 0.05), hand squeezing (P = 0.005)] were significantly longer in group P. The incidence of vomiting was significantly higher in group S (P < 0.05). Hemodynamic parameters, levels of SpO2, ETCO2, and BIS and TOF values were not significantly different between the groups (P > 0.05). CONCLUSIONS The present study which adjusted sevoflurane concentration and propofol infusion rate according to BIS values revealed that maintenance of anesthesia with sevoflurane is associated with faster recovery than anesthesia with propofol. Propofol resulted in a significantly lower incidence of postoperative nausea and vomiting. Hemodynamic parameters and levels of SpO2 and ETCO2 were comparable between the groups during percutaneous nephrolithotomy.
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Affiliation(s)
- Zeynep Nur Orhon
- Department of Anaesthesiology and Reanimation, S.B. Istanbul Medeniyet University, Goztepe Training and Research Hospital, Istanbul, Turkey
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Konstantopoulos K, Makris A, Moustaka A, Karmaniolou I, Konstantopoulos G, Mela A. Sevoflurane versus propofol anesthesia in patients undergoing lumbar spondylodesis: a randomized trial. J Surg Res 2012; 179:72-7. [PMID: 23073511 DOI: 10.1016/j.jss.2012.09.038] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2012] [Revised: 09/19/2012] [Accepted: 09/27/2012] [Indexed: 11/26/2022]
Abstract
BACKGROUND Spondylodesis is a procedure aiming at providing stability in one or more spinal segments. The aim of our study was to compare sevoflurane and propofol as induction and maintenance agents, focusing on hemodynamic stability, recovery characteristics, postoperative nausea and vomiting, and pain intensity. MATERIALS AND METHODS Seventy patients, with a physical status according to American Society of Anesthesiologists (ASA) I-II, 50-72 y old, undergoing selective lumbar spondylodesis were enrolled. RESULTS There was no statistically significant difference between groups in overall mean hemodynamic parameters. No differences in fluid administration and vasoactive substances used were noted. Postoperatively, there was a significant difference in overall mean visual analog score at rest and at cough, with the sevoflurane group showing lower values. No differences in the incidence of nausea, vomiting, shivering, postoperative sedation scores, and orientation to place were revealed. Orientation to time exhibited a statistically significant difference at the time just after transfer to the post-anesthesia care unit, where more patients of the sevoflurane group seemed to be well oriented. CONCLUSIONS Sevoflurane and propofol anesthesia for lumbar spondylodesis surgery provide safe and comparable results.
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Mellema A, Borner M, Joppich R, Burmester S, Schütte JK, Wappler F. Vergleich inhalativer versus intravenöser Anästhesieverfahren für elektive Bandscheibenoperationen unter vergleichbarer Narkosetiefe mittels BIS-Monitoring. Eine randomisierte, prospektive klinische Untersuchung. ACTA ACUST UNITED AC 2010. [DOI: 10.1016/j.periop.2010.02.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Vater Y, Dembo G, Martay K, Klein Y, Vitin A, Weinbroum AA. Drug management in emergent liver transplantation of mitochondrial disorder carriers: review of the literature. Clin Transplant 2010; 24:E43-53. [PMID: 20141521 DOI: 10.1111/j.1399-0012.2009.01203.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Mitochondrial respiratory-chain disorders (MRCD) lead to progressive disabling of neurological and cellular conditions that involve muscles, brain, kidney, and liver dysfunction. Affected individuals may need surgery, including orthotopic liver transplantation (OLT). Surgery poses anesthesia challenges because of the prolonged use of anesthetic drugs and sedatives, which may inhibit oxidative phosphorylation, mimic mitochondrial cytopathic disorders, or unveil them ex novo. MATERIALS AND METHODS We conducted a multilingual PubMed search of surgical and non-surgical anesthesia reports between the years 1992 and 2008, where anesthetic drugs were used in MRCD patients, especially for those undergoing urgent OLTs. RESULTS There were 51 case reports of 210 anesthesia and critical care interventions in patients with MRCD, a large part of them were children. Data pertaining to the safe usage of anesthesia and perioperative drugs were limited and conflicting. We found no article that addressed the issue of perioperative handling of urgent OLT in MRCD patients. We therefore suggest our own - although limited - experience for such occasions. CONCLUSION There are no randomized, controlled, trial-based indications regarding safe anesthetic drugs to be used perioperatively in MRCD carriers. Consultation among geneticists, anesthesiologists, intensivists, and surgeons is essential in patients with known/suspected metabolic syndrome for planning appropriate perioperative care.
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Affiliation(s)
- Youri Vater
- Department of Anesthesiology and Pain Medicine, University of Washington School of Medicine, Seattle, WA, USA
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[Implications of anesthetic techniques on patients' recovery in laparoscopic cholecystectomy]. VOJNOSANIT PREGL 2009; 66:421-6. [PMID: 19583138 DOI: 10.2298/vsp0906421s] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND/AIM Different techniques of general anesthesia are used for laparoscopic cholecystectomy (LC). The aim of the study was to establish the best anesthetic technique for achieving better results during awakening affecting not only patient's recovery, but activities of anesthesiological team, as well. METHODS The study was conducted as a prospective comparative clinical trial. The patients (n=90) were classified according to the applied anesthetic technique into two groups: Volatile Induction and Maintenance Anaesthesia (VIMA) with sevofluran and Target Controlled Infusion (TCI). The results relating to parameters of recovery after anesthesia and surgery were compared between these two groups. The following parameters were analysed: demographic patients' characteristics, duration of anesthesia, the times to eye opening, to respond to a command, to extubation, and to orientation, from the last anesthetic dose receiving until post anesthesia discharge (PAD), frequency of postoperative nausea, vomiting and agitation (PONVA). RESULTS In the examined groups there were no statistically significant differences in the duration of anesthesia (68.29 +/- 6.47 vs 66.29 +/- 11.97 min, p = 0.327). The time to eye opening was significantly shorter in the group VIMA compared to the group TCI (4.49 +/- 1.20 vs 7.42 +/- 1.25 min, p = 0.000), as well as the time to respond to a command (5.93 +/- 1.12 vs 8.47 +/- 1.08 min, p = 0.000). The patients anesthetised with VIMA technique wer estatistically significantly extubated earlier (6.84 +/- 1.19 vs 9.69 +/- 1.31 min, p = 0.000). Considering orientation time, there was also statistically significant difference between the two groups (7.51 +/- 0.97 vs 11.60 +/- 1.75 min, p = 0.000). There was no statistically significant difference in PAD time duration (19.42 +/- 5.99 vs 20.80 +/- 1.59 min, p = 0.142). There were no statistically significant differences in PONVA events between the examined groups. CONCLUSION This study showed that VIMA technique with sevofluran in LC provides faster and more qualitative recovery of patients. Thus this technique should be applied in everyday anesthesiological procedures in LC, as well as in other minimally invasive videoendoscopic surgical procedures.
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Effects of clonidine and midazolam premedication on bispectral index and recovery after elective surgery. Eur J Anaesthesiol 2009; 26:603-10. [DOI: 10.1097/eja.0b013e32832a0c7c] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Kim HS, Shin OY, Choi YK, Kim DS, Yi JW. Comparison of Posterior Pharyngeal Airway Space at Sitting and Supine Positions in the PACU after Uvulopalatopharyngoplasty in Patients with Obstructive Sleep Apnea Syndrome. Korean J Anesthesiol 2008. [DOI: 10.4097/kjae.2008.54.2.180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- Hyun Suk Kim
- Department of Anesthesiology and Pain Medicine, College of Medicine, Kyunghee University, Seoul, Korea
| | - Ok Young Shin
- Department of Anesthesiology and Pain Medicine, College of Medicine, Kyunghee University, Seoul, Korea
| | - Young Kyoo Choi
- Department of Anesthesiology and Pain Medicine, College of Medicine, Kyunghee University, Seoul, Korea
| | - Dong Soo Kim
- Department of Anesthesiology and Pain Medicine, College of Medicine, Kyunghee University, Seoul, Korea
| | - Jae Woo Yi
- Department of Anesthesiology and Pain Medicine, College of Medicine, Kyunghee University, Seoul, Korea
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Gruenewald M, Zhou J, Schloemerkemper N, Meybohm P, Weiler N, Tonner PH, Scholz J, Bein B. M-Entropy guidance vs standard practice during propofol-remifentanil anaesthesia: a randomised controlled trial. Anaesthesia 2007; 62:1224-9. [PMID: 17991257 DOI: 10.1111/j.1365-2044.2007.05252.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Seventy-two patients undergoing routine surgical procedures under propofol-remifentanil anaesthesia were randomly assigned to receive either standard clinical practice (n = 35) or standard practice plus monitoring of depth of anaesthesia with M-Entropy (n = 37). Patients in the standard practice group received more propofol than the entropy group (mean (SD) 95 (14) vs 81 (22) microg.kg(-1).min(-1), respectively; p < 0.01), and less remifentanil (0.39 (0.08) vs 0.46 (0.08) microg.kg(-1).min(-1), respectively; p < 0.001). Loss of consciousness was best predicted by BIS (prediction probability (P(K)) 0.96) and response entropy (P(K) 0.93), whereas emergence was best predicted by response entropy (P(K) 0.94). The frequency of unwanted patient responses was higher in the standard practice group than in the entropy group (47 vs 27 total events, respectively; p < 0.01). Both regimens resulted in fast recovery with no clinical advantage for either one. There were no significant differences in haemodynamic parameters, postoperative nausea and vomiting or satisfaction with the procedure.
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Affiliation(s)
- M Gruenewald
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital Schleswig-Holstein, Campus Kiel, 24105 Kiel, Germany.
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Current World Literature. Curr Opin Anaesthesiol 2007; 20:388-94. [PMID: 17620851 DOI: 10.1097/aco.0b013e3282c3a878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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