Effect of desflurane-remifentanil vs. Propofol-remifentanil anesthesia on arterial oxygenation during one-lung ventilation for thoracoscopic surgery: a prospective randomized trial

Association between Oxygen Reserve index and arterial partial pressure of oxygen during one-lung ventilation: a retrospective cohort study

PURPOSE

We aimed to investigate the association between the Oxygen Reserve index (ORi) and arterial partial pressure of oxygen (PaO2) during one-lung ventilation in patients who underwent non-cardiac thoracic surgery requiring one-lung ventilation.

METHODS

This retrospective study assessed the eligibility of 578 adult patients who underwent elective non-cardiac thoracic surgery requiring one-lung ventilation at a tertiary hospital, and their electronic medical records were reviewed. The ORi monitor was used in all patients during anesthesia, and arterial blood gas analysis was routinely performed 15 min after the initiation of one-lung ventilation. The primary endpoint was the association between ORi and PaO2 which were measured simultaneously during one-lung ventilation. We also investigated the risk factors for PaO2 less than 150 mmHg during one-lung ventilation.

RESULTS

Total of 554 patient were included in the analysis. The ORi value measured 15 min after the start of one-lung ventilation was significantly associated with PaO2 in the linear regression model (r2 = 0.5752, P < 0.001), and 0.27 of the ORi value could distinguish PaO2 ≥ 150 mmHg (sensitivity 0.909, specificity 0.932). Risk factors for PaO2 < 150 mmHg during one-lung ventilation included a lower ORi, older age, higher body mass index, left-sided one-lung ventilation, and lower hemoglobin concentrations.

CONCLUSION

This study suggested that ORi could provide useful information on arterial oxygenation even during one-lung ventilation for non-cardiac thoracic surgery.

Effect of dexmedetomidine on intrapulmonary shunt in patients with sevoflurane maintained during one-lung ventilation: A case-control study

BACKGROUND

The effects of dexmedetomidine on the circulatory system are complex. It is difficult to predict its effects on intrapulmonary shunts and hypoxic pulmonary vasoconstriction in patients with one-lung ventilation. This study aimed to investigate the effect of dexmedetomidine on intrapulmonary shunt in patients with sevoflurane during one-lung ventilation.

METHODS

Forty patients requiring thoracoscopic lobectomy were randomly divided into the dexmedetomidine group (Group D, n = 20) and the normal saline group (Group N, n = 20). The arterial partial pressure of oxygen (PaO2), pulmonary shunt fraction (Qs/Qt), mean end-tidal sevoflurane concentration, mean arterial pressure, and heart rate were compared between the 2 groups at 3 time points: (i) after 5 minutes of two-lung ventilation (T0), (ii) after 30 minutes of one-lung ventilation (OLV) (T1), and (iii) after 45 minutes of OLV (T2). The dosage of sevoflurane from the beginning of OLV to T2 was calculated.

RESULTS

There were no significant differences in age, body mass index, and FEV1/FVC between Groups D and N (P > .05). At T0, T1, and T2, the PaO2 levels of Group D and Group N were similar (P > .05), and the PaO2 levels of Group D and Group N decreased after OLV. The Qs/Qt level of Groups D and N were similar at T0 (P > .05), and the level of Groups D and N at T1 and T2 was higher than that at T0. The Qs/Qt of Group D was statistically significantly lower than that of Group N at T1 and T2 (P < .05).

CONCLUSION

Compared with the control group, we found that dexmedetomidine can reduce the intrapulmonary shunt fraction and improve the body's status during OLV.

Comparison of regional cerebral oxygen saturation during one-lung ventilation under desflurane or propofol anesthesia: A randomized trial

BACKGROUND

During one-lung ventilation (OLV), deterioration of pulmonary oxygenation reduces arterial oxygen saturation and cerebral oxygen saturation (rSO2). However, oxidative stress during OLV causes lung injury, so the fraction of inspiratory oxygen (FiO2) should be kept as low as possible. We investigated the changes in rSO2 under propofol or desflurane anesthesia while percutaneous oxygen saturation (SpO2) was kept as low as possible during OLV.

METHODS

Thirty-six patients scheduled for thoracic surgery under OLV in the lateral decubitus position were randomly assigned to propofol (n = 19) or desflurane (n = 17) anesthesia. FiO2 was set to 0.4 at the start of surgery under two-lung ventilation (measurement point: T3) and then adjusted to maintain an SpO2 of 92% to 94% after the initiation of OLV. The primary outcome was the difference in the absolute value of the decrease in rSO2 from T3 to 30 minutes after the initiation of OLV (T5), which was analyzed by an analysis of covariance adjusted for the rSO2 value at T3.

RESULTS

The mean rSO2 values were 61.5% ± 5.1% at T3 and 57.1% ± 5.3% at T5 in the propofol group and 62.2% ± 6.0% at T3 and 58.6% ± 5.3% at T5 in the desflurane group. The difference in the absolute value of decrease between groups (propofol group - desflurane group) was 0.95 (95% confidence interval, [-0.32, 2.2]; P = .152).

CONCLUSIONS

Both propofol and desflurane anesthesia maintain comparable cerebral oxygenation and can be used safely, even when the SpO2 is kept as low as possible during OLV.

Desflurane improves lung collapse more than propofol during one-lung ventilation and reduces operation time in lobectomy by video-assisted thoracic surgery: a randomized controlled trial

Background

This study evaluated whether desflurane improved lung collapse during one-lung ventilation (OLV) more than propofol, and whether it could reduce the operation time of video-assisted thoracic surgery.

Methods

Sixty patients undergoing lobectomy by video-assisted thoracic surgery (VATS) were randomly assigned to general anesthesia with desflurane or propofol. Lungs were inspected by thoracoscope at 10, 30, and 60 min after initiation of OLV. After surgery, the Lung Collapse Score, a composite of lung color and volume assessments, was assigned by two clinicians blinded to the anesthetic regimen. The primary outcome was operation time. The secondary outcome included the complication rate.

Results

Of the 60 participants, 50 completed the study, 26 in Desflurane group and 24 in Propofol group. The Lung Collapse Scores at 30 and 60 min after OLV initiation were significantly better in Desflurane group than in Propofol group, and operation time was significantly shorter in Desflurane group (214 (57) min vs. 262 (72) min [mean (SD)], difference in means, -48; 95% CI, -85 to -11; P = 0.01). The incidence of multiple complications was 1/26 (3%) and 6/24 (25%) in Desflurane and Propofol group, respectively (relative risk, 0.1; 95% CI, 0.02 to 1.18; P = 0.04).

Conclusions

Desflurane improved lung collapse during OLV and significantly shortened VATS lobectomy operation time compared to propofol in our studied patients. Desflurane resulted in fewer postoperative complications. Thus, desflurane may be an appropriate anesthetic during lobectomy by VATS requiring OLV.

Trial registration

The study was registered with the University Hospital Medical Information Network (UMIN000009412). The date of disclosure of this study information is 27/11/2012. On this date, we registered the study into UMIN; patients were included from 2013 to 2014. However, on 11/27/2015, the UMIN system administrator suggested a detailed description. Thereafter, we added it to the Randomization Unit. Despite being prospective, it was retrospectively registered on UMIN for the above reasons.

Anesthesia for thoracic surgery in infants and children

The management of infants and children presenting for thoracic surgery poses a variety of challenges for anesthesiologists. A thorough understanding of the implications of developmental changes in cardiopulmonary anatomy and physiology, associated comorbid conditions, and the proposed surgical intervention is essential in order to provide safe and effective clinical care. This narrative review discusses the perioperative anesthetic management of pediatric patients undergoing noncardiac thoracic surgery, beginning with the preoperative assessment. The considerations for the implementation and management of one-lung ventilation (OLV) will be reviewed, and as will the anesthetic implications of different surgical procedures including bronchoscopy, mediastinoscopy, thoracotomy, and thoracoscopy. We will also discuss pediatric-specific disease processes presenting in neonates, infants, and children, with an emphasis on those with unique impact on anesthetic management.

Inhalational versus intravenous anesthetics during one lung ventilation in elective thoracic surgeries: A narrative review

The anesthesia regimen used during one lung ventilation (OLV) carry the potential to affect intra-operative course and post-operative outcomes, by its effects on pulmonary vasculature and alveolar inflammation. This narrative review aims to understand the pathophysiology of acute lung injury during one lung ventilation, and to study the effects of inhalational versus intravenous anaesthetics on intraoperative and post-operative outcomes, following thoracic surgery. For this purpose, we independently searched 'PubMed', 'Google Scholar' and 'Cochrane Central' databases to find out randomized controlled trials (RCTs), in English language, which compared the effects of intravenous versus inhalational anaesthetics on intraoperative and post-operative outcomes, in elective thoracic surgeries, in human beings. In total, 38 RCTs were included in this review. Salient results of the review are- Propofol reduced intraoperative shunt and maintained better intraoperative oxygenation than inhalational agents. However, use of modern inhalational anaesthetics during OLV reduced alveolar inflammation significantly, as compared to propofol. Regarding post-operative complications, the evidence is not conclusive enough but slightly in favour of inhalational anaesthetics. Thus, we conclude that modern inhalational anaesthetics, by their virtue of better anti-inflammatory properties, exhibit lung protective effects and hence, seem to be safe for maintenance of anesthesia during OLV in elective thoracic surgeries. Further research is required to establish the safety of these agents with respect to long term post-operative outcomes like cancer recurrence.

Anesthetic Management for Pulmonary Resection: Current Concepts and Improving Safety of Anesthesia

Increasingly complex procedures are routinely performed using minimally invasive approaches, allowing cancers to be resected with short hospital stays, minimal postsurgical discomfort, and improved odds of cancer-free survival. Along with these changes, the focus of anesthetic management for lung resection surgery has expanded from the provision of ideal surgical conditions and safe intraoperative patient care to include preoperative patient training and optimization and postoperative pain management techniques that can impact pulmonary outcomes as well as patient lengths of stay.

Effect of desflurane on changes in regional cerebral oxygenation in patients undergoing one-lung ventilation is equivalent to the effect of propofol

OBJECTIVES

Desaturation is an important clinical problem during one-lung ventilation (OLV) since it may induce cerebral hypoxia. Measurement of cerebral oxygenation has been shown to provide accurate information about episodes of cerebral hypoxemia. The purpose of this study was to compare the effect of desflurane on changes in cerebral oxygenation during OLV with the effect of propofol.

METHODS

A randomized, single-blinded, prospective study was conducted. Fifty adult patients who were scheduled to undergo thoracic surgery were randomly assigned to anesthetic management using desflurane with remifentanil (Group D: n = 25) or using propofol and remifentanil (Group P: n = 25).

RESULTS

The characteristics of the patients were very similar. Intergroup analysis of changes in cerebral oxygenation showed no significant difference on the operative side (two-way ANOVA, F (7, 368) = 0.425, p = 0.887) or the non-operative side (two-way ANOVA, F (7, 367) = 1.342, p = 0.229). Intragroup analysis of changes in cerebral oxygenation using one-way ANOVA showed no significant difference on the operative side (Group P; p = 0.585, Group D; p = 0.928) or the non-operative side in both groups (Group P; p = 0.657, Group D; p = 0.602).

CONCLUSIONS

The effects of desflurane and propofol on changes in cerebral oxygenation in patients undergoing OLV were equivalent. Our results indicated that desflurane might be an appropriate anesthetic during OLV for maintaining cerebral oxygenation with an effective equivalent to that of propofol.

Clinical efficacy of intravenous anesthesia on breast segmental surgery and its effects on oxidative stress response and hemodynamics of patients

This study was designed to investigate the clinical efficacy of intravenous anesthesia on breast segmental surgery and the effects on hemodynamics of patients. A total of 267 patients were collected as research subjects. These patients underwent breast segmental surgery in Chun'an First People's Hospital from March 2015 to September 2018. Among them, 137 patients undergoing intravenous anesthesia were the research group, and 130 patients undergoing inhalation anesthesia were the control group. The following parameters were recorded: Clinical efficacy, postoperative adverse conditions, hemodynamic indicators including systolic blood pressure (SBP), diastolic blood pressure (DBP) and heart rate (HR). Visual analogue scale (VAS) was used to observe the analgesic effect of the two groups, the mental state of patients in the two groups was observed by mini-mental state examination (MMSE) scoring method, and systemic evaluation was made by oxidative stress (OS) reaction indicators. The MMSE scores of the two groups decreased one day after surgery, but the score in the research group was higher than that in the control group (P<0.05). The levels of SBP and DBP at T1 and T2 in the control group were significantly higher than those in the research group (P<0.05). HR of research group at T1 and T2 was lower than that at T0 and that at corresponding time of control group (P<0.05). The incidence rate of postoperative adverse reactions in the research group was significantly lower than that in the control group (P<0.05). In conclusion, intravenous anesthesia for breast segmental surgery can reduce the occurrence of adverse reactions after surgery, with complete sedation and analgesia. Patients were able to wake up quickly and stably after surgery, and their cognitive function and OS recovered rapidly. However, due to the great impact on hemodynamics during surgery, attention should be paid to maintain hemodynamic stability during surgery to avoid hypotension and bradycardia.

Effect of Intravenous Propofol and Inhaled Sevoflurane Anesthesia on Postoperative Spirometric Indices: A Randomized Controlled Trial

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.

Can apneic oxygen insufflation become a novel lung protective ventilation strategy? A randomized, controlled, blinded, single center clinical trial

Objective

The aim of this study was to determine whether a AOI strategy on non-ventilated lung could reduce the regional and systemic proinflammatory cytokine and oxidative stress response associated with esophagectomy, and to evaluate whether AOI can be used as a novel lung protective ventilation strategy. Its impact on oxygenation after OLV, surfactant protein A, B, C (SP-A, B, C), postoperative hospital stay and postoperative pulmonary complications (PPCs) was also evaluated.

Methods

Fifty-four adults (ASA II-III) undergoing esophagectomy with OLV were enrolled in the study. Patients were randomly assigned into 2 groups: control group (group C) and treated group (group T). Group C was treated with traditional OLV mode,while group T was given AOI of 5 L/min oxygen on the non-ventilated lung immediately at the beginning of OLV. Arterial blood gas was analyzed before and after OLV. A bronchoalveolar lavage(BAL) was performed after OLV on the non-ventilated lung. Proinflammatory cytokine, oxidative stress markers(TNF-α, NF-κB,sICAM-1,IL-6,IL-10,SOD,MDA) and SP-A, B, C were analyzed in serum and BALF as the primary endpoint.The clinical outcome determined by PPCs was assessed as the secondary endpoint.

Results

Patients with AOI had better oxygenation in the recovery period, oxygenation index(OI) (394[367–426] and 478[440–497]mmHg, respectively) of group T at T₂ and T₃ were significantly higher than those (332[206–434] and 437[331–512]mmHg, respectively) of group C. OLV resulted in an increase in the measured inflammatory markers in both groups, however, the increase of inflammatory markers upon OLV in the group C was significantly higher than those of group T. OLV resulted in an increase in the measured SP-A, B, C in serum of both groups. However, the levels of SP-A, B, C of group T were lower than those of group C in serum after OLV, and the results in BALF were the opposite. The BALF levels of SOD(23.88[14.70–33.93]U/ml) of group T were higher than those(15.99[10.33–24.16] U/ml) of group C, while the levels of MDA in both serum and BALF of group T(8.60[4.14–9.85] and 1.88[1.33–3.08]nmol/ml, respectively) were all lower than those of group C (11.10[6.57–13.75] and 1.280[1.01–1.83]nmol/ml) after OLV. There was no statistical difference between the two groups in terms of postoperative hospital stay and the incidence of PPCs.

Conclusion

AOI on non-ventilated lung during OLV can improve the oxygenation function after OLV, relieve the inflammatory and oxidative stress response in the systemic and non-ventilated lung after OLV associated with esophagectomy.

Trial registration

ChiCTR-IOR-17011037. Registered on 31 March 2017.

Effects of epidural anesthesia combined with inhalation anesthesia or intravenous anesthesia on intrapulmonary shunt and oxygenation in patients undergoing long term single lung ventilation

Objective:

To investigate the effect of epidural anesthesia combined with inhalation or intravenous anesthesia on intrapulmonary shunt and oxygenation in patients undergoing long term single lung ventilation.

Methods:

Eighty patients, aged 35-75, American Society of Anesthesiology (ASA) classification of I-III, undergoing thoracic surgery with one lung ventilation more than three hour, were randomly divided into propofol group (group Pro), propofol combined with epidural anesthesia group (group Pro+Epi), isoflurane group (group Iso) and isoflurane combined with epidural anesthesia group (group Iso+ Epi), 20 patients in each group. Arterial blood and mixed venous blood were taken for blood gas analysis, and hemodynamic data were recorded at following time points: before induction in supine position (T₁), 30min after bilateral lung ventilation (T₂), 15min after one lung ventilation (T₃), 30min after one lung ventilation (T4), 60min after one lung ventilation (T5), 180min after one lung ventilation (T6), intrapulmonary shunt (Qs/Qt) was calculated according to the correlation formula.

Results:

Qs/Qt values at T_2-6 in four groups were significantly higher than that of T1, and Qs/Qt values at T_3-6 was significantly higher than that of T₂ (P< 0.05); PaO2 at T_2-6 were significantly higher than that of T1, with PaO2 at T_3-6 were significantly lower than T₂ (P< 0.05). Between groups, Qs/Qt values in group Iso were significantly higher than that of group Pro, Pro+Epi and Iso+Epi at T_3-5 (P< 0.05). There was no significant difference in PaO₂ between groups (P> 0.05). CI at T3-6 in group Iso and Iso+Epi were significantly higher than that of T₁ (P<0.05), and were significantly higher than that of propofol group (P<0.05). MAP at T_3-6 in group Pro+Epi and Iso+Epi were significantly lower than that at T₁ (P <0.05). Heart rate at T_4-6 in group Iso were significantly higher than T₁, and higher than group Pro and group Iso+Epi (P <0.05).

Conclusion:

One lung ventilation may predispose to increase of intrapulmonary shunt and decrease in arterial partial pressure of oxygen; isoflurane inhalation anesthesia is more likely to cause intrapulmonary shunt, but no changes in arterial partial pressure of oxygen.

Comparison of the effects of isoflurane versus propofol-remifentanil anesthesia on oxygen delivery during thoracoscopic lung lobectomy with one-lung ventilation in dogs

This study compared effects of isoflurane inhalation (ISO) and propofol-remifentanil combined total intravenous anesthesia (TIVA) on oxygenation during thoracoscopic lung lobectomy with 30-min one-lung ventilation (1LV). Thoracoscopic right middle lung lobectomy was performed in ten dogs divided into ISO and TIVA groups, and cardiopulmonary parameters were measured with blood gas analysis. Throughout the study, isoflurane was inhaled up to 1.5%, and the infusion rates of propofol and remifentanil were 0.2 to 0.4 mg/kg/min and 6 to 11 µg/kg/h, respectively. Cardiac index was not affected in the ISO group, but it increased during 1LV in the TIVA group. There were significant alterations in arterial oxygen pressure, arterial oxygen saturation, oxygen content, and shunt fraction associated with 1LV in each group. However, oxygen delivery did not decrease significantly due to open chest condition, 1LV, or surgical maneuver in either group, rather it increased during 1LV in the TIVA group. All parameters showed no significant difference between groups. Pulmonary vascular resistant index was unaffected in both groups, and there was no difference between groups except in re-ventilation phase. Accordingly, the effect of both anesthetic regimens on oxygenation was not different between groups and can be used with short-term 1LV for thoracoscopic lung lobectomy in dogs.

Effect of propofol and isoflurane on gas exchange parameters following one-lung ventilation in thoracic surgery: a double-blinded randomized controlled clinical trial

Background

The use of anesthetic drugs with minimal inhibitory effects on the hypoxic pulmonary vasoconstriction (HPV) could have a decisive role in preventing the hypoxemia during one-lung ventilation (OLV).

Objective

The aim of this study was to compare the effects of propofol and isoflurane on the changes in gas exchange parameters following OLV in thoracic surgery.

Methods

This double-blinded randomized controlled clinical trial was conducted on patients who were candidates for elective right thoracotomy referred to the central operating room of Ghaem Hospital in Mashhad, Iran, during February 2016–2017. Patients with age range of 18 to 75 years, class I and II American Society of Anesthesiologists (ASA) and thoracotomy with OLV for pulmonary resection or cyst drainage were included. The patients were randomly allocated (1:1 ratio) into two groups of propofol (P, 50–100μg/kg/min) and isoflurane (I, 1 minimum alveolar concentration (MAC) 1.1%). Partial pressure of carbon dioxide (PaCO2), partial pressure of oxygen (PaO2), end-tidal carbon dioxide (ETCO2) and arterial oxygen saturation (SPO2) were recorded before and 15 minutes after OLV and compared between the two groups. The comparison of the mean gas exchange parameters before and 15 minutes after OLV was performed using Mann-Whitney test in SPSS version 19 software. P<0.05 was considered statistically significant.

Results

In this study, 122 patients with mean age of 59.4±14.1 years (two groups of 61) were studied. Both groups were matched for age or gender. The two groups had no significant difference in the gas exchange parameters before the OLV. Only PaCO2 (p=0.001) and ETCO2 (p=0.001) were significantly higher in the propofol group after 15 minutes OLV than in the isoflurane group. However, PaO2 (p=0.67), O2Sat (p=0.333) and PaCO2-ETCO2 gradient (p=0.809) showed no significant difference between the two groups at this minute.

Conclusion

Based on the results of this study, the propofol or isoflurane selection seems to have no significant effect on the arterial oxygenation. On the other hand, isoflurane and propofol could be an appropriate anesthetic for thoracic surgery by normalizing the carbon dioxide gradient range during the OLV.

Clinical Trial Registration

The study was also registered at the Iranian Registry of Clinical Trials (IRCT2015123013159N8).

Funding

The study was financially supported by the Deputy of Research of Mashhad University of Medical Sciences (grant number: 940119).

[Efficacy of analgesic and sedative treatments in children with mechanical ventilation in the pediatric intensive care unit]

OBJECTIVE

To compare the efficacy and safety of different analgesic and sedative treatments in children with mechanical ventilation in the pediatric intensive care unit (PICU).

METHODS

Eighty children with mechanical ventilation in the PICU who needed analgesic and sedative treatments were equally and randomly divided into midazolam group and remifentanil+midazolam group. The sedative and analgesic effects were assessed using the Ramsay Scale and the Face, Legs, Activity, Cry and Consolability (FLACC) Scale. The following indices were recorded for the two groups: vital signs, ventilator parameters, organ function, total doses of remifentanil and midazolam, duration of mechanical ventilation, length of PICU stay, PICU cost, and incidence of adverse events.

RESULTS

Satisfactory sedation was achieved in the two groups, but the remifentanil+midazolam group had a significantly shorter time to analgesia and sedation than the midazolam group. The remifentanil+midazolam group had a significantly higher percentage of patients with grade 3-4 on the Ramsay Scale and a significantly lower dose of midazolam than the midazolam group (P<0.05). Both groups showed decreases in heart rate (HR), mean arterial pressure (MAP), and spontaneous breathing frequency (RRs) after treatment. However, the remifentanil+midazolam group had significantly greater decreases in HR at 3-24 hours after treatment and MAP and RRs at 3-12 hours after treatment than the midazolam group (P<0.05). Compared with the midazolam group, the remifentanil+midazolam group had significantly higher ventilator tidal volume and transcutaneous oxygen saturation at 6 and 12 hours after treatment and significantly lower end-tidal carbon dioxide partial pressure at 6 and 12 hours after treatment (P<0.05). The remifentanil+midazolam group had significantly shorter time to awake, extubation time, duration of mechanical ventilation, and length of PICU stay than the midazolam group (P<0.05). There were no significant differences in PICU cost, incidence of adverse events, and hepatic and renal functions before and after treatment between the two groups (P>0.05). Both groups showed a significant decrease in fasting blood glucose level after treatment (P<0.05).

CONCLUSIONS

For children with mechanical ventilation in the PICU, remifentanil+midazolam treatment can rapidly achieve analgesia and sedation, improve the effect of mechanical ventilation, and reduce the dose of sedative compared with midazolam alone, and is well tolerated.

Anesthetic Considerations for Mediastinal Staging Procedures for Lung Cancer

Tumor staging is critical for the treatment of lung malignancies. Invasive techniques of lung tumor staging can be accomplished via mediastinoscopy, endobronchial ultrasound, and video-assisted thoracoscopy. Anesthesiologists taking care of patients undergoing mediastinal staging procedures might face different challenges. In this narrative review, the authors summarize the literature on the anesthetic considerations for mediastinal staging procedures.

Monosialoganglioside 1 may alleviate neurotoxicity induced by propofol combined with remifentanil in neural stem cells

Monosialoganglioside 1 (GM1) is the main ganglioside subtype and has neuroprotective properties in the central nervous system. In this study, we aimed to determine whether GM1 alleviates neurotoxicity induced by moderate and high concentrations of propofol combined with remifentanil in the immature central nervous system. Hippocampal neural stem cells were isolated from newborn Sprague-Dawley rats and treated with remifentanil (5, 10, 20 ng/mL) and propofol (1.0, 2.5, 5.0 μg/mL), and/or GM1 (12.5, 25, 50 μg/mL). GM1 reversed combined propofol and remifentanil-induced decreases in the percentage of 5-bromodeoxyuridine(+) cells and also reversed the increase in apoptotic cell percentage during neural stem cell proliferation and differentiation. However, GM1 with combined propofol and remifentanil did not affect β-tubulin(+) or glial fibrillary acidic protein(+) cell percentage during neural stem cell differentiation. In conclusion, we show that GM1 alleviates the damaging effects of propofol combined with remifentanil at moderate and high exposure concentrations in neural stem cells in vitro, and exerts protective effects on the immature central nervous system.