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Mori K, Komatsu T, Fujiwara Y, Fujita Y. Comparison of the Effects of Desflurane and Sevoflurane on Variations in Salivary Melatonin and Sleep Disturbance After Total Knee Arthroplasty: A Single-center, Prospective, Randomized, Controlled, Open-label Study. J Perianesth Nurs 2024; 39:101-108. [PMID: 37791946 DOI: 10.1016/j.jopan.2023.07.007] [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: 12/05/2022] [Revised: 05/22/2023] [Accepted: 07/16/2023] [Indexed: 10/05/2023]
Abstract
PURPOSE Anesthesia has been shown to disrupt the circadian rhythm. Recovery of the circadian rhythm after general anesthesia might help alleviate symptoms of insomnia and postoperative delirium. We hypothesized that recovery of the circadian rhythm is faster after total knee arthroplasty (TKA) with desflurane than with sevoflurane. This study compared the influence of sevoflurane versus desflurane anesthesia on the postoperative circadian rhythm of melatonin in adults undergoing TKA. DESIGN Single-center, prospective, randomized, controlled, open-label study. METHODS This study involved adult patients undergoing TKA at a university hospital in Japan from May 1, 2018 to December 31, 2019. The primary outcome of the study was the comparison of the effect of sevoflurane and desflurane on the circadian rhythm of salivary melatonin for 3 days postoperatively. The secondary outcomes were postoperative fatigue and sleep quality for 3 days postoperatively. FINDINGS Twenty-eight patients (American Society of Anesthesiologists physical status of I or II) were scheduled for TKA and randomized to receive sevoflurane (n = 14) or desflurane (n = 14) anesthesia. There was no significant difference in the melatonin concentration between the sevoflurane and desflurane groups. The salivary melatonin concentration after sevoflurane or desflurane anesthesia was significantly higher at 9:00 p.m. on a postoperative day (POD)0 and POD1 than on POD3 (P < .05). Patients in the desflurane group had significantly greater fatigue than those in the sevoflurane group at 7:00 a.m. and 12:00 p.m. on POD3 (P < .05). Patients in the sevoflurane group had a deeper sleep than those in the desflurane group on POD0 (P < .05). In the sevoflurane group, the sleep time during the night of POD2 was longer than that on POD0 (6.1 vs 4.2 hours, P < .05). CONCLUSIONS Under the current study conditions, desflurane was equivalent to sevoflurane in terms of the postoperative salivary melatonin concentration and sleep disturbance after TKA but not in terms of recovering the postoperative circadian rhythm.
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Affiliation(s)
- Kazunao Mori
- Nurse Practitioner Office, Aichi Medical University Hospital, Nagakute, Aichi, Japan.
| | - Toru Komatsu
- Department of Anesthesiology, Aichi Medical University, Nagakute, Aichi, Japan
| | | | - Yoshihito Fujita
- Department of Anesthesiology, Aichi Medical University, Nagakute, Aichi, Japan
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Cao S, Wang H, Tang L, An G. Comparing Recovery from Desflurane and Sevoflurane in Patients with Different Body Fat Percentages: A Randomized Controlled Trial. Curr Drug Deliv 2024; 21:623-630. [PMID: 37291773 DOI: 10.2174/1567201820666230328115354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Revised: 02/08/2023] [Accepted: 03/05/2023] [Indexed: 06/10/2023]
Abstract
INTRODUCTION Increased body fat may influence the partition coefficients of inhaled anesthetics. We compared patient responses to desflurane and sevoflurane anesthesia, as measured by a quicker recovery and fewer complications, in patients with higher body fat percentages, not only obese people. METHODS This study included 120 patients. Participants were stratified into low or high body fat percentages groups using bioelectrical impedance analysis and were randomized 1:1 to receive desflurane or sevoflurane as an inhaled anesthetic, recorded as Low-Desflurane, Low-Sevoflurane, High- Desflurane, and High-Sevoflurane. Recovery time, Riker sedation-agitation scale scores, and complications were recorded over 1 hour in the post-anesthesia care unit. RESULTS A total of 106 patients were analyzed. There were no significant differences in the overall recovery time between the patient subgroups with higher and lower body fat percentages; in addition, there were no significant differences in the incidence of nausea, vomiting,dizziness, or headache (all p>0.05). However, the incidence of agitation emergence in the HighSevoflurane subgroup was significantly higher compared to the High-Desflurane subgroup (33.3% vs.7.41%; p = 0.043). CONCLUSION In conclusion, for patients with a lower body fat percentage, both desflurane and sevoflurane can provide good and fast recovery; for patients with a higher body fat percentage,desflurane may provide better recovery with a lower incidence of agitation emergence compared to sevoflurane.
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Affiliation(s)
- Silu Cao
- Department of Anesthesiology and Perioperative Medicine, Shanghai Fourth People's Hospital, School of Medicine, Tongji University, Shanghai, 200434, P.R. China
- Shanghai Key Laboratory of Anesthesiology and Brain Functional Modulation, Shanghai, 200434, China
- Translational Research Institute of Brain and Brain-Like Intelligence, Shanghai Fourth People's Hospital, School of Medicine, Tongji University, Shanghai, 200434, China
- Clinical Research Center for Anesthesiology and Perioperative Medicine, Tongji University, Shanghai, 200434, China
- Department of Anesthesiology, Shanghai Fourth People's Hospital, Affiliated to Tongji University, Shanghai, 200080, China
- Department of Anesthesiology, Shanghai Tenth Hospital, Tongji University School of Medicine, Shanghai, 200080, China
| | - Huijuan Wang
- Department of Anesthesiology, Shanghai General Hospital, Shanghai Jiaotong University Affiliated Shanghai General Hospital, Shanghai, 200080, P.R. China
| | - Lijun Tang
- Department of Anesthesiology, Shanghai General Hospital, Shanghai Jiaotong University Affiliated Shanghai General Hospital, Shanghai, 200080, P.R. China
| | - Guanghui An
- Department of Anesthesiology and Perioperative Medicine, Shanghai Fourth People's Hospital, School of Medicine, Tongji University, Shanghai, 200434, P.R. China
- Shanghai Key Laboratory of Anesthesiology and Brain Functional Modulation, Shanghai, 200434, China
- Translational Research Institute of Brain and Brain-Like Intelligence, Shanghai Fourth People's Hospital, School of Medicine, Tongji University, Shanghai, 200434, China
- Clinical Research Center for Anesthesiology and Perioperative Medicine, Tongji University, Shanghai, 200434, China
- Department of Anesthesiology, Shanghai Fourth People's Hospital, Affiliated to Tongji University, Shanghai, 200080, China
- Department of Anesthesiology, Shanghai General Hospital, Shanghai Jiaotong University Affiliated Shanghai General Hospital, Shanghai, 200080, P.R. China
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Selke S, Winter M, Finger S, Roeher K, Neppert J, Harth V. A straightforward method for determination of the sevoflurane metabolite hexafluoroisopropanol in urinary occupational medical samples by headspace-gas chromatography mass spectrometry. J Chromatogr B Analyt Technol Biomed Life Sci 2023; 1231:123923. [PMID: 37984163 DOI: 10.1016/j.jchromb.2023.123923] [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: 05/22/2023] [Revised: 11/03/2023] [Accepted: 11/04/2023] [Indexed: 11/22/2023]
Abstract
Biological monitoring of the unmodified sevoflurane and its metabolite hexafluoroisopropanol (HFIP) in urine samples was proposed to determine the individual exposure levels of the medical staff. In this study, a method for simultaneous determination of both compounds in urine using static headspace-gas chromatography-mass spectrometry (HS-GC-MS) was developed. The method is linear over a broad concentration range from 1 to 1000 µg/L (r2 > 0.999) and shows high precision. Limits of quantification (LOQ) are 0.6 µg/L for sevoflurane and 3 µg/L for HFIP, representing an excellent sensitivity without the necessity of analyte enrichment. The method was successfully applied in a German pilot-study to monitor both compounds in samples from medical personnel working in operating theatres. Urinary concentrations of HFIP ranged between < LOQ and 145 µg/L, while sevoflurane was below the LOD in all samples.
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Affiliation(s)
- S Selke
- Institute for Occupational and Maritime Medicine (ZfAM), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany.
| | - M Winter
- Institute for Occupational and Maritime Medicine (ZfAM), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - S Finger
- Institute for Occupational and Maritime Medicine (ZfAM), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - K Roeher
- University Medical Center Hamburg-Eppendorf (UKE), Department of Anesthesiology, Hamburg, Germany
| | - J Neppert
- University Medical Center Hamburg-Eppendorf (UKE), Department of Anesthesiology, Hamburg, Germany
| | - V Harth
- Institute for Occupational and Maritime Medicine (ZfAM), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
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4
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Lerman J. Induction of anesthesia with sevoflurane in children: Curiosities and controversies. Paediatr Anaesth 2022; 32:1100-1103. [PMID: 35899582 DOI: 10.1111/pan.14537] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 07/20/2022] [Accepted: 07/25/2022] [Indexed: 11/30/2022]
Abstract
Inhalational inductions with sevoflurane (up to 8% inspired concentration) have been the standard for inducing anesthesia in children for over three decades. However, when sevoflurane was first introduced, clinicians reported isolated cases of unexpected myoclonic jerking movements during the induction in children without epilepsy. These cases raised concerns regarding the widespread use of sevoflurane particularly after reports of seizures and epileptiform electroencephalographic (EEG) discharges surfaced. The latter reports prompted recommendations to reduce the concentration of sevoflurane during induction of anesthesia. More recently, a shift away from the use of nitrous oxide has prompted some to question whether sevoflurane has a role as an induction agent in children. The preponderance of evidence supports the practice of safely inducing anesthesia with 8% sevoflurane with or without nitrous oxide in children but recommended strategies to mitigate against epileptiform discharges may be more harmful than beneficial.
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Affiliation(s)
- Jerrold Lerman
- Department of Anesthesiology, John R. Oishei Children's Hospital, Buffalo, New York, USA.,Jacobs School of Medicine and Biomedical Sciences, University of Buffalo, Buffalo, New York, USA
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Feng Y, Wang K, Wang N, Jia P, Zhang L, Yuan H, Lu P, Lu Y, Zhang H, Li R, Zhang Y, Li Q, Zhang P. Tetramethylpyrazine protects neural stem cells against sevoflurane-induced toxicity through Akt/GSK-3β pathway. Metab Brain Dis 2022; 37:2457-2466. [PMID: 35838869 DOI: 10.1007/s11011-022-01008-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 05/16/2022] [Indexed: 11/28/2022]
Abstract
Sevoflurane, a commonly used anesthetic, has been found to cause neural stem cell (NSC) injury, thereby contributing to neurocognitive impairment following general anesthesia. Tetramethylpyrazine (TMP), one of the most widely used medicinal compounds isolated from a traditional Chinese herb, possess neuroprotective activity. However, its effect on sevoflurane-induced NSC injury remains unclear. NSCs were pretreated with indicated concentrations of TMP for 2 h and then exposed to sevoflurane for 6 h. Cell injury was measured using lactate dehydrogenase (LDH) release assay. Cell viability and proliferation were detected by cell counting kit-8 (CCK-8) assay and 5-bromo-2'-deoxyuridine (BrdU) labeling, respectively. Apoptotic cells were detected using terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL) assay. The levels of cleaved caspase-3, phosphorylated protein kinase B (Akt) and phosphorylated glycogen synthase kinase-3β (GSK-3β) were detected by western blotting. Our results showed exposure to sevoflurane decreased the viability and proliferation of NSCs, while TMP preserved NSC viability and proliferation after sevoflurane exposure. In addition, the expression of cleaved caspase-3 and TUNEL positive cells were markedly decreased in TMP-treated NSCs compared with the control. Furthermore, pretreatment with TMP significantly increased the levels of phosphorylated Akt and GSK-3β in sevoflurane-injured NSCs. However, an upstream inhibitor of Akt, LY294002 abolished the protective of TMP on the cell viability of NSCs. In conclusion, these findings indicate that TMP protects NSCs from sevoflurane-induced toxicity through Akt/GSK-3β pathway.
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Affiliation(s)
- Yan Feng
- Department of Anesthesiology, The Second Affiliated Hospital of Xi'an Jiaotong University, 157# West 5 Road, 710004, Xi'an, Shaanxi, China
- Department of Anesthesiology, Xi'an People's Hospital (Xi'an Fourth Hospital), 710004, Xi'an, Shaanxi, China
| | - Kui Wang
- Department of Anesthesiology, The Second Affiliated Hospital of Xi'an Jiaotong University, 157# West 5 Road, 710004, Xi'an, Shaanxi, China
| | - Ning Wang
- Department of Anesthesiology, The Second Affiliated Hospital of Xi'an Jiaotong University, 157# West 5 Road, 710004, Xi'an, Shaanxi, China
| | - Pengyu Jia
- Department of Anesthesiology, The Second Affiliated Hospital of Xi'an Jiaotong University, 157# West 5 Road, 710004, Xi'an, Shaanxi, China
| | - Lei Zhang
- Department of Anesthesiology, The Second Affiliated Hospital of Xi'an Jiaotong University, 157# West 5 Road, 710004, Xi'an, Shaanxi, China
- Department of Anesthesiology, Xi'an People's Hospital (Xi'an Fourth Hospital), 710004, Xi'an, Shaanxi, China
| | - Haozheng Yuan
- Department of Anesthesiology, The Second Affiliated Hospital of Xi'an Jiaotong University, 157# West 5 Road, 710004, Xi'an, Shaanxi, China
| | - Pan Lu
- Department of Anesthesiology, The Second Affiliated Hospital of Xi'an Jiaotong University, 157# West 5 Road, 710004, Xi'an, Shaanxi, China
| | - Yang Lu
- Department of Anesthesiology, The Second Affiliated Hospital of Xi'an Jiaotong University, 157# West 5 Road, 710004, Xi'an, Shaanxi, China
| | - Hong Zhang
- Department of Anesthesiology, The Second Affiliated Hospital of Xi'an Jiaotong University, 157# West 5 Road, 710004, Xi'an, Shaanxi, China
| | - Rong Li
- Department of Anesthesiology, The Second Affiliated Hospital of Xi'an Jiaotong University, 157# West 5 Road, 710004, Xi'an, Shaanxi, China
| | - Yan Zhang
- Department of Anesthesiology, The Second Affiliated Hospital of Xi'an Jiaotong University, 157# West 5 Road, 710004, Xi'an, Shaanxi, China
| | - Qianqian Li
- Department of Anesthesiology, The Second Affiliated Hospital of Xi'an Jiaotong University, 157# West 5 Road, 710004, Xi'an, Shaanxi, China
| | - Pengbo Zhang
- Department of Anesthesiology, The Second Affiliated Hospital of Xi'an Jiaotong University, 157# West 5 Road, 710004, Xi'an, Shaanxi, China.
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Evaluation of Anesthetic Specific EEG Dynamics during State Transitions between Loss and Return of Responsiveness. Brain Sci 2021; 12:brainsci12010037. [PMID: 35053781 PMCID: PMC8773581 DOI: 10.3390/brainsci12010037] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 12/21/2021] [Accepted: 12/23/2021] [Indexed: 11/17/2022] Open
Abstract
Purpose: electroencephalographic (EEG) information is used to monitor the level of cortical depression of a patient undergoing surgical intervention under general anesthesia. The dynamic state transitions into and out of anesthetic-induced loss and return of responsiveness (LOR, ROR) present a possibility to evaluate the dynamics of the EEG induced by different substances. We evaluated changes in the EEG power spectrum during anesthesia emergence for three different anesthetic regimens. We also assessed the possible impact of these changes on processed EEG parameters such as the permutation entropy (PeEn) and the cerebral state index (CSI). Methods: we analyzed the EEG from 45 patients, equally assigned to three groups. All patients were induced with propofol and the groups differed by the maintenance anesthetic regimen, i.e., sevoflurane, isoflurane, or propofol. We evaluated the EEG and parameter dynamics during LOR and ROR. For the emergence period, we focused on possible differences in the EEG dynamics in the different groups. Results: depending on the substance, the EEG emergence patterns showed significant differences that led to a substance-specific early activation of higher frequencies as indicated by the “wake” CSI values that occurred minutes before ROR in the inhalational anesthetic groups. Conclusion: our results highlight substance-specific differences in the emergence from anesthesia that can influence the EEG-based monitoring that probably have to be considered in order to improve neuromonitoring during general anesthesia.
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Linke AC, Slušná D, Kohli JS, Álvarez-Linera Prado J, Müller RA, Hinzen W. Morphometry and functional connectivity of auditory cortex in school-age children with profound language disabilities: Five comparative case studies. Brain Cogn 2021; 155:105822. [PMID: 34837801 DOI: 10.1016/j.bandc.2021.105822] [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: 07/07/2021] [Revised: 10/27/2021] [Accepted: 11/02/2021] [Indexed: 10/19/2022]
Abstract
Many neurodevelopmental conditions imply absent or severely reduced language capacities at school age. Evidence from functional magnetic resonance imaging is highly limited. We selected a series of five cases scanned with the same fMRI paradigm and the aim of relating individual language profiles onto underlying patterns of functional connectivity (FC) across auditory language cortex: three with neurogenetic syndromes (Coffin-Siris, Landau-Kleffner, and Fragile-X), one with idiopathic intellectual disability, one with autism spectrum disorder (ASD). Compared to both a group with typical development (TD) and a verbal ASD group (total N = 110), they all showed interhemispheric FC below two standard deviations of the TD mean. Children with higher language scores showed higher intrahemispheric FC between Heschl's gyrus and other auditory language regions, as well as an increase of FC during language stimulation compared to rest. An increase of FC in forward vs. reversed speech in the posterior and middle temporal gyri was seen across all cases. The Coffin-Siris case, the most severe, also had the most anomalous FC patterns and showed reduced myelin content, while the Landau-Kleffner case showed reduced cortical thickness. These results suggest potential for neural markers and mechanisms of severe language processing deficits under highly heterogeneous etiological conditions.
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Affiliation(s)
- Annika Carola Linke
- Brain Development Imaging Laboratories, Department of Psychology, San Diego State University, San Diego, CA, USA.
| | - Dominika Slušná
- Department of Translation and Language Sciences, Campus Poblenou, Pompeu Fabra University, Barcelona 08018, Barcelona, Spain
| | - Jiwandeep Singh Kohli
- Brain Development Imaging Laboratories, Department of Psychology, San Diego State University, San Diego, CA, USA
| | | | - Ralph-Axel Müller
- Brain Development Imaging Laboratories, Department of Psychology, San Diego State University, San Diego, CA, USA; San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA
| | - Wolfram Hinzen
- Department of Translation and Language Sciences, Campus Poblenou, Pompeu Fabra University, Barcelona 08018, Barcelona, Spain; Institució Catalana de Recerca i Estudis Avançats, ICREA, 08010 Barcelona, Spain
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Ababneh OA, Suleiman AM, Bsisu IK, Al-Ghanem SM, Samarah WK, Al-Zaben KR, Qudaisat IY, Khreesha LA, Al Edwan GM, Murshidi MM. A Co-Induction Technique Utilizing 4% Sevoflurane Followed by 0.75 mg/kg Propofol in Elderly Patients Undergoing Minimally Invasive Procedures: A Prospective Randomized Control Study. ACTA ACUST UNITED AC 2020; 56:medicina56120682. [PMID: 33321778 PMCID: PMC7763625 DOI: 10.3390/medicina56120682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 12/05/2020] [Accepted: 12/07/2020] [Indexed: 11/23/2022]
Abstract
Background and Objectives: Elderly patients constitute a large segment of healthcare receivers. Considering the functional deterioration of multiple organ systems with aging, achieving a safe perioperative approach is challenging. Our aim is to study the safety and effectiveness of a genuinely regimented co-induction technique in order to minimize anesthesia-related complications. Materials and Methods: One hundred and five patients were assigned to three groups according to the induction technique: propofol, sevoflurane and co-induction group. Inclusion criteria: patients with age ≥65 and American Society of Anesthesiologists physical status classification (ASA) II-III who underwent endoscopic urological procedures. The propofol group received a dose of 1.5 mg kg−1 of propofol over two minutes for induction. The sevoflurane group received 8% of sevoflurane and 100% oxygen through a plastic facemask with the fresh gas flow set at 8 L min−1. The co-induction group received 4% sevoflurane through plastic facemask for two minutes, followed by a 0.75 mg kg−1 dose of propofol. After ensuring full range jaw relaxation, the laryngeal mask airway (LMA) was inserted. Results: Overall, the co-induction technique had a favorable profile in terms of respiratory adverse events, while the sevoflurane group had a favorable profile in terms of hemodynamic stability. Furthermore, 24 (68.6%) patients receiving inhalational sevoflurane had episodes of transient apnea, which constitutes 77.4% of the 31 episodes of transient apnea in the studied sample (p < 0.001). Moreover, six (17.1%) patients in the sevoflurane group had an episode of partial laryngospasm (p = 0.034). Compared with the co-induction group, we found that the propofol group had significantly less systolic and diastolic blood pressures in the second minute, with p values of (0.018) and (0.015), respectively. Conclusions: The co-induction technique utilizing 4% sevoflurane at 8 L min−1 flow of oxygen inhaled over two minutes followed by 0.75 mg kg−1 of propofol achieved less respiratory adverse events compared with the sevoflurane group, and less hemodynamic instability compared with the propofol group.
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Affiliation(s)
- Omar A. Ababneh
- Department of Anesthesia and Intensive Care, School of Medicine, The University of Jordan, Amman 11942, Jordan; (S.M.A.-G.); (W.K.S.); (K.R.A.-Z.); (I.Y.Q.)
- Correspondence: (O.A.A.); (I.K.B.); Tel.: +962-6-5353444 (O.A.A.); +962-6-5355000 (I.K.B.)
| | - Aiman M. Suleiman
- Anesthesia and Intensive Care Department, Alabdali Clemenceau Hospital, Amman 11190, Jordan;
| | - Isam K. Bsisu
- Department of Anesthesia and Intensive Care, School of Medicine, The University of Jordan, Amman 11942, Jordan; (S.M.A.-G.); (W.K.S.); (K.R.A.-Z.); (I.Y.Q.)
- Correspondence: (O.A.A.); (I.K.B.); Tel.: +962-6-5353444 (O.A.A.); +962-6-5355000 (I.K.B.)
| | - Subhi M. Al-Ghanem
- Department of Anesthesia and Intensive Care, School of Medicine, The University of Jordan, Amman 11942, Jordan; (S.M.A.-G.); (W.K.S.); (K.R.A.-Z.); (I.Y.Q.)
| | - Walid K. Samarah
- Department of Anesthesia and Intensive Care, School of Medicine, The University of Jordan, Amman 11942, Jordan; (S.M.A.-G.); (W.K.S.); (K.R.A.-Z.); (I.Y.Q.)
| | - Khaled R. Al-Zaben
- Department of Anesthesia and Intensive Care, School of Medicine, The University of Jordan, Amman 11942, Jordan; (S.M.A.-G.); (W.K.S.); (K.R.A.-Z.); (I.Y.Q.)
| | - Ibraheem Y. Qudaisat
- Department of Anesthesia and Intensive Care, School of Medicine, The University of Jordan, Amman 11942, Jordan; (S.M.A.-G.); (W.K.S.); (K.R.A.-Z.); (I.Y.Q.)
| | - Lubna A. Khreesha
- Department of Otolaryngology, School of Medicine, The University of Jordan, Amman 11942, Jordan;
| | - Ghazi M. Al Edwan
- Department of Urology, School of Medicine, The University of Jordan, Amman 11942, Jordan; (G.M.A.E.); (M.M.M.)
| | - Mujalli M. Murshidi
- Department of Urology, School of Medicine, The University of Jordan, Amman 11942, Jordan; (G.M.A.E.); (M.M.M.)
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Williams CJA, Malte CL, Malte H, Bertelsen MF, Wang T. Ectothermy and cardiac shunts profoundly slow the equilibration of inhaled anaesthetics in a multi-compartment model. Sci Rep 2020; 10:17157. [PMID: 33051496 PMCID: PMC7555730 DOI: 10.1038/s41598-020-74014-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 09/21/2020] [Indexed: 01/08/2023] Open
Abstract
The use of inhalational anaesthesia is ubiquitous in terrestrial vertebrates. Given the dependence of these agents on delivery by the cardiorespiratory system, we developed a new computational model predicting equilibration of inhaled anaesthetics in mammalian and ectotherm conditions including the ability of reptiles to maintain vascular shunts. A multi-compartment model was constructed from simultaneously-solved equations, verified by comparison to the literature for endo and ectotherm physiology. The time to 90% equilibration of anaesthetic in arterial blood (t90) is predicted and used to compare anaesthetics and physiologies. The five to tenfold lower cardiac output and minute ventilation of ectothermic vertebrates is predicted to slow equilibration times by five to ten times leading to 90% equilibration in ectotherm arterial blood of over 200 min, compounded by reduction in body temperature, and the extent of right-to-left vascular shunts. The impact of these findings is also influenced by the solubility coefficient of the anaesthetic, such that at net right-to-left shunt fractions of over 0.8, sevoflurane loses the advantage of faster equilibration, in comparison with isoflurane. We explore clinical strategies to regulate anaesthetic uptake in ectotherms by managing convectional flow especially by supportive ventilation and reduction of the right-to-left shunt.
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Affiliation(s)
- Catherine J A Williams
- Section of Zoophysiology, Department of Biology, Aarhus University, 8000, Aarhus C, Denmark. .,Center for Zoo and Wild Animal Health, Copenhagen Zoo, Roskildevej 38, 2000, Frederiksberg, Denmark. .,Ontario Veterinary College, University of Guelph, 50 Stone Road E, Guelph, ON, N1G 2W1, Canada.
| | - Christian Lind Malte
- Section of Zoophysiology, Department of Biology, Aarhus University, 8000, Aarhus C, Denmark
| | - Hans Malte
- Section of Zoophysiology, Department of Biology, Aarhus University, 8000, Aarhus C, Denmark
| | - Mads F Bertelsen
- Center for Zoo and Wild Animal Health, Copenhagen Zoo, Roskildevej 38, 2000, Frederiksberg, Denmark
| | - Tobias Wang
- Section of Zoophysiology, Department of Biology, Aarhus University, 8000, Aarhus C, Denmark.,Aarhus Institute of Advanced Sciences, Aarhus University, 8000, Aarhus C, Denmark
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10
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Arain SR, Yu S, Dugan S, Pagel PS, Ebert TJ. Titration of sevoflurane anesthesia to optimize the time to regain airway reflexes in patients undergoing elective surgery: A randomized clinical trial comparing desflurane and sevoflurane anesthesia. Acta Anaesthesiol Scand 2020; 64:729-734. [PMID: 32057088 DOI: 10.1111/aas.13565] [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: 12/11/2019] [Revised: 02/04/2020] [Accepted: 02/11/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Desflurane has adverse environmental effects, but has clinical advantages to speed emergence and return of protective airway reflexes compared with sevoflurane. We hypothesized that weaning of the inspired sevoflurane during the final 15 minutes of surgery would eliminate differences in airway reflex recovery between these agents. METHODS After obtaining IRB approval and informed consent, 40 patients undergoing elective surgery (≥1-hour) randomly received desflurane or sevoflurane. Patients swallowed 20 mL of water without drooling or coughing, and then received sedation and PONV pre-medication. Anesthesia was induced using propofol and fentanyl and maintained with desflurane or sevoflurane through a laryngeal mask airway maintaining a bispectral index of 45-50 and 50-60 during the final 15 minutes before surgery end. Cardiorespiratory variables and age-adjusted minimal alveolar concentration were recorded. The duration between anesthetic discontinuation and first appropriate response to command was measured; the laryngeal mask airway was removed. Two minutes after responding to command, patients were positioned semi-upright and attempted to swallow water. If successful swallowing was not achieved, the test was repeated every 4 minutes after each failure until successful swallowing was achieved. RESULTS Average anesthetic concentration and bispectral index was similar in patients receiving desflurane vs sevoflurane. Response times after discontinuation of anesthetics were similar. There were no differences in the recovery of swallowing ability between desflurane and sevoflurane groups. CONCLUSION Weaning of sevoflurane during the final 15 minutes of surgery eliminates clinical advantages of the more rapid return of airway reflexes with desflurane.
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Affiliation(s)
- Shahbaz R. Arain
- Anesthesia Service The Clement J. Zablocki Veterans Affairs Medical Center Milwaukee WI USA
- Department of Anesthesiology The Medical College of Wisconsin Milwaukee WI USA
| | - Sherman Yu
- Anesthesia Service The Clement J. Zablocki Veterans Affairs Medical Center Milwaukee WI USA
- Department of Anesthesiology The Medical College of Wisconsin Milwaukee WI USA
| | - Shannon Dugan
- Anesthesia Service The Clement J. Zablocki Veterans Affairs Medical Center Milwaukee WI USA
- Department of Anesthesiology The Medical College of Wisconsin Milwaukee WI USA
| | - Paul S. Pagel
- Anesthesia Service The Clement J. Zablocki Veterans Affairs Medical Center Milwaukee WI USA
- Department of Anesthesiology The Medical College of Wisconsin Milwaukee WI USA
| | - Thomas J. Ebert
- Anesthesia Service The Clement J. Zablocki Veterans Affairs Medical Center Milwaukee WI USA
- Department of Anesthesiology The Medical College of Wisconsin Milwaukee WI USA
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11
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Dhande K, Kshirsagar J, Dhande A, Patil N, V P. Hemodynamic Stability, Patient Acceptance and Cost of Intravenous Propofol and Inhalational Sevoflurane for Induction of Anaesthesia: A Prospective, Randomized Comparative Study. Cureus 2020; 12:e7687. [PMID: 32431967 PMCID: PMC7233506 DOI: 10.7759/cureus.7687] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Introduction The effects of an anesthetic agent on the hemodynamic stability are of prime importance in patients with compromised hemodynamics. Although comparative studies of sevoflurane and propofol are reported, most of these are aimed to assess maintenance and early postoperative recovery. There are very few studies on hemodynamic changes occurring with these two agents. This study compares the hemodynamic stability, patient acceptance, and cost of intravenous (IV) propofol versus inhalational (IH) sevoflurane for the induction of anesthesia. Methods This prospective, randomized comparative study was conducted among 80 patients with American Society of Anaesthesiologists (ASA) grade-I requiring general anesthesia (GA) for elective surgical procedures. The study was approved by the institutional ethics committee and was conducted as per the principles of the Declaration of Helsinki and Good Clinical Practice (GCP) guidelines. Enrolled patients were randomized to receive either intravenous (IV) propofol 2 mg/kg (n=40) or gradual inhalational (IH) induction with sevoflurane (n=40). All patients were maintained with sevoflurane 2% in 67% nitrous oxide (N2O) and O2. Hemodynamic parameters like pulse rate and mean arterial pressure (MAP) were monitored every minute up to five minutes. Patients' acceptance was assessed on a 10-item questionnaire, and the cost of anesthesia was assessed based on the anesthetic requirement. The hemodynamic parameters were compared between the two groups using two-way repeat-measures ANOVA. The incidence of hypotension was compared using Fischer's test. Results The two groups were similar at baseline with respect to the demography and other baseline characteristics. There was greater (p<0.05) fall in MAP with propofol induction (28.48%) compared to sevoflurane (14.61%). Greater reduction in pulse rate (p<0.05) with sevoflurane (9.18) induction was observed compared to propofol (5.28). Patient acceptance for both drugs was similar (p>0.05). Although sevoflurane was unpleasant, propofol injection was painful. Ninety percent of patients preferred propofol for repeat anesthesia as against 85% of patients with sevoflurane. Considering the quantity of anesthetic consumed and the unit cost, propofol was more costly as compared to sevoflurane. Conclusion Sevoflurane maintains better hemodynamic stability compared to propofol, and patient acceptance of both drugs is similar. Induction with sevoflurane was found to be cheaper as compared to propofol induction.
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Affiliation(s)
| | | | - Ashish Dhande
- Urology, DY Patil University - School of Medicine, Navi Mumbai, IND
| | - Narendra Patil
- Anesthesiology, DY Patil University - School of Medicine, Navi Mumbai, IND
| | - Parvati V
- Anesthesiology, DY Patil University - School of Medicine, Navi Mumbai, IND
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12
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Malásková M, Olivenza-León D, Chellayah PD, Martini J, Lederer W, Ruzsanyi V, Unterkofler K, Mochalski P, Märk TD, Watts P, Mayhew CA. Studies pertaining to the monitoring of volatile halogenated anaesthetics in breath by proton transfer reaction mass spectrometry. J Breath Res 2020; 14:026004. [PMID: 31796655 DOI: 10.1088/1752-7163/ab5e30] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Post-operative isoflurane has been observed to be present in the end-tidal breath of patients who have undergone major surgery, for several weeks after the surgical procedures. A major new non-controlled, non-randomized, and open-label approved study will recruit patients undergoing various surgeries under different inhalation anaesthetics, with two key objectives, namely (1) to record the washout characteristics following surgery, and (2) to investigate the influence of a patient's health and the duration and type of surgery on elimination. In preparation for this breath study using proton transfer reaction time-of-flight mass spectrometry (PTR-TOF-MS), it is important to identify first the analytical product ions that need to be monitored and under what operating conditions. In this first paper of this new research programme, we present extensive PTR-TOF-MS studies of three major anaesthetics used worldwide, desflurane (CF3CHFOCHF2), sevoflurane ((CF3)2CHOCH2F), and isoflurane (CF3CHClOCHF2) and a fourth one, which is used less extensively, enflurane (CHF2OCF2CHFCl), but is of interest because it is an isomer of isoflurane. Product ions are identified as a function of reduced electric field (E/N) over the range of approximately 80 Td to 210 Td, and the effects of operating the drift tube under 'normal' or 'humid' conditions on the intensities of the product ions are presented. To aid in the analyses, density functional theory (DFT) calculations of the proton affinities and the gas-phase basicities of the anaesthetics have been determined. Calculated energies for the ion-molecule reaction pathways leading to key product ions, identified as ideal for monitoring the inhalation anaesthetics in breath with a high sensitivity and selectivity, are also presented.
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Affiliation(s)
- Michaela Malásková
- Institute for Breath Research, Leopold-Franzens-Universität Innsbruck, Rathausplatz 4, A 6850, Dornbirn, Austria
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13
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Maheshwari K, Ahuja S, Mascha EJ, Cummings KC, Chahar P, Elsharkawy H, Kurz A, Turan A, Sessler DI. Effect of Sevoflurane Versus Isoflurane on Emergence Time and Postanesthesia Care Unit Length of Stay. Anesth Analg 2020; 130:360-366. [DOI: 10.1213/ane.0000000000004093] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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14
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Right Structural and Functional Reorganization in Four-Year-Old Children with Perinatal Arterial Ischemic Stroke Predict Language Production. eNeuro 2019; 6:ENEURO.0447-18.2019. [PMID: 31383726 PMCID: PMC6749144 DOI: 10.1523/eneuro.0447-18.2019] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 04/24/2019] [Accepted: 06/03/2019] [Indexed: 11/21/2022] Open
Abstract
Brain imaging methods have contributed to shed light on the mechanisms of recovery after early brain insult. The assumption that the unaffected right hemisphere can take over language functions after left perinatal stroke is still under debate. Here, we report how patterns of brain structural and functional reorganization were associated with language outcomes in a group of four-year-old children with left perinatal arterial ischemic stroke (PAIS). Specifically, we gathered specific fine-grained developmental measures of receptive and productive aspects of language as well as standardized measures of cognitive development. We also collected structural neuroimaging data as well as functional activations during a passive listening story-telling fMRI task and a resting state session (rs-fMRI). Children with a left perinatal stroke showed larger lateralization indices of both structural and functional connectivity of the dorsal language pathway towards the right hemisphere that, in turn, were associated with better language outcomes. Importantly, the pattern of structural asymmetry was significantly more right-lateralized in children with a left perinatal brain insult than in a group of matched healthy controls. These results strongly suggest that early lesions of the left dorsal pathway and the associated perisylvian regions can induce the interhemispheric transfer of language functions to right homolog regions. This study provides combined evidence of structural and functional brain reorganization of language networks after early stroke with strong implications for neurobiological models of language development.
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15
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Memtsoudis SG, Cozowicz C, Nagappa M, Wong J, Joshi GP, Wong DT, Doufas AG, Yilmaz M, Stein MH, Krajewski ML, Singh M, Pichler L, Ramachandran SK, Chung F. Society of Anesthesia and Sleep Medicine Guideline on Intraoperative Management of Adult Patients With Obstructive Sleep Apnea. Anesth Analg 2019; 127:967-987. [PMID: 29944522 PMCID: PMC6135479 DOI: 10.1213/ane.0000000000003434] [Citation(s) in RCA: 88] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
The purpose of the Society of Anesthesia and Sleep Medicine Guideline on Intraoperative Management of Adult Patients With Obstructive Sleep Apnea (OSA) is to present recommendations based on current scientific evidence. This guideline seeks to address questions regarding the intraoperative care of patients with OSA, including airway management, anesthetic drug and agent effects, and choice of anesthesia type. Given the paucity of high-quality studies with regard to study design and execution in this perioperative field, recommendations were to a large part developed by subject-matter experts through consensus processes, taking into account the current scientific knowledge base and quality of evidence. This guideline may not be suitable for all clinical settings and patients and is not intended to define standards of care or absolute requirements for patient care; thus, assessment of appropriateness should be made on an individualized basis. Adherence to this guideline cannot guarantee successful outcomes, but recommendations should rather aid health care professionals and institutions to formulate plans and develop protocols for the improvement of the perioperative care of patients with OSA, considering patient-related factors, interventions, and resource availability. Given the groundwork of a comprehensive systematic literature review, these recommendations reflect the current state of knowledge and its interpretation by a group of experts at the time of publication. While periodic reevaluations of literature are needed, novel scientific evidence between updates should be taken into account. Deviations in practice from the guideline may be justifiable and should not be interpreted as a basis for claims of negligence.
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Affiliation(s)
- Stavros G Memtsoudis
- From the Department of Anesthesiology, Critical Care & Pain Management, Weill Cornell Medical College and Hospital for Special Surgery, New York, New York.,Department of Anesthesiology, Perioperative Medicine and Intensive Care Medicine, Paracelsus Medical University, Salzburg, Austria
| | - Crispiana Cozowicz
- From the Department of Anesthesiology, Critical Care & Pain Management, Weill Cornell Medical College and Hospital for Special Surgery, New York, New York.,Department of Anesthesiology, Perioperative Medicine and Intensive Care Medicine, Paracelsus Medical University, Salzburg, Austria
| | - Mahesh Nagappa
- Department of Anesthesia and Perioperative Medicine, London Health Sciences Centre and St Joseph's Health Care, Western University, London, Ontario, Canada
| | - Jean Wong
- Department of Anesthesia and Pain Medicine, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Girish P Joshi
- Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical School, Dallas, Texas
| | - David T Wong
- Department of Anesthesia and Pain Medicine, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Anthony G Doufas
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University Medical Center, Palo Alto, California
| | - Meltem Yilmaz
- Department of Anesthesiology, Northwestern University, Chicago, Illinois
| | - Mark H Stein
- Department of Anesthesiology, Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Megan L Krajewski
- Department of Anesthesia, Critical Care, and Pain Management, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Mandeep Singh
- Department of Anesthesia, University of Toronto, Toronto, Ontario, Canada.,Toronto Sleep and Pulmonary Centre, Toronto, Canada.,Department of Anesthesia and Pain Management, Women's College Hospital, Toronto, Canada.,Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - Lukas Pichler
- From the Department of Anesthesiology, Critical Care & Pain Management, Weill Cornell Medical College and Hospital for Special Surgery, New York, New York.,Department of Anesthesiology, Perioperative Medicine and Intensive Care Medicine, Paracelsus Medical University, Salzburg, Austria
| | - Satya Krishna Ramachandran
- Department of Anesthesiology, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Frances Chung
- Department of Anesthesia and Pain Medicine, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
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16
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Pharmacokinetic–pharmacodynamic population modelling in paediatric anaesthesia and its clinical translation. Curr Opin Anaesthesiol 2019; 32:353-362. [DOI: 10.1097/aco.0000000000000725] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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17
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Levitt DG. PKQuest: PBPK modeling of highly lipid soluble and extracellular solutes. ADMET AND DMPK 2018; 7:60-75. [PMID: 35350744 PMCID: PMC8957251 DOI: 10.5599/admet.579] [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: 08/12/2018] [Revised: 11/16/2018] [Indexed: 11/18/2022] Open
Abstract
One of the primary objectives of physiologically based pharmacokinetics (PBPK) is the prediction of a drug’s pharmacokinetics just from knowledge of its physicochemical structure. Unfortunately, at present, the accuracy of this prediction is limited for most drugs because of uncertainty about the drug’s organ/blood partition coefficient (K). However, there are two classes of solutes which are exceptions to this: 1) the highly lipid soluble (HLS) solutes, and 2) the extracellular (ECS) solutes. Since the HLS drugs (eg, volatile anesthetics, propofol, cannabinol) have lipid/water partition coefficients (PL/W) of 100 or greater, their K is dominated by the tissue fat fraction and one can accurately predict K just from in vitro measurements of PL/W along with prior anatomic measurements of the fat fraction of the organs in the PBPK model. Since the ECS drugs, such as most antibiotics, cannot penetrate cells, they are not subject to the intracellular binding that complicates the prediction of K for the weak bases and acids. The ECS K is determined primarily by plasma and interstitial albumin binding and can be predicted from in vitro measurements of plasma albumin binding along with prior measurements of interstitial tissue volume and albumin concentrations. This review provides an in depth discussion of the PBPK modeling of these two drug classes along with many specific clinical examples illustrating the good PBPK predictions possible with just zero (volatile anesthetics) or 1 (the clearance) adjustable parameter. The PBPK analysis uses PKQuest, a freely distributed, general purpose pharmacokinetic program. PKQuest is designed so that application to the HLS and ECS solute classes is especially easy. The user only needs to enter the specific parameters that are required to characterize the drug (eg, PL/W for HLS or plasma albumin binding for ECS) with all the other PBPK parameters (organ blood flow, fat fraction, extracellular volumes, etc.) are set by default.
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Affiliation(s)
- David G Levitt
- Department of Integrative Biology and Physiology, University of Minnesota, 6-125 Jackson Hall, 321 Church St. S. E., Minneapolis, MN 55455, USA
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18
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Cortínez LI, Anderson BJ. Modeling the pharmacokinetics and pharmacodynamics of sevoflurane using compartment models in children and adults. Paediatr Anaesth 2018; 28:834-840. [PMID: 30117213 DOI: 10.1111/pan.13465] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Revised: 07/10/2018] [Accepted: 07/23/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND Sevoflurane pharmacokinetics have been traditionally described using physiological models, while pharmacodynamics employed the use of minimal alveolar concentration. AIMS The integrated pharmacokinetic-pharmacodynamic relationship of sevoflurane in both adults and children was reviewed using compartment models. We wished to delineate age-related changes in both pharmacokinetics and pharmacodynamics. METHODS The bispectral index and sevoflurane endtidal concentration were continuously measured in 50 patients, aged 3-71 years, scheduled for minor surgery. During maintenance of anesthesia and after stable bispectral index values of 60-65 were obtained, the inspired concentration of sevoflurane was increased to 5 vol % for 5 minutes or until BIS 40 and then decreased. Data were analyzed using mammillary compartments with nonlinear mixed effects population modeling. The covariate effects of age and size were investigated. RESULTS A three-compartment PK model adequately described sevoflurane pharmacokinetics. Size standardization using allometry explained clearance and volume changes with age. The equilibration half-time (1.48 minutes) increased with age, but could be predicted using allometry in those under 40 years. The effect site concentration eliciting half the maximum response at age 40 years was 1.3% (95%CI 1.22, 1.42) decreased with age from 1.6% at 3 years to 1.1% at 70 years. CONCLUSION Pharmacokinetic compartment models offer an alternative method to describe inhalation anesthetic drug disposition and effects.
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Affiliation(s)
- Luis Ignacio Cortínez
- Division Anestesiologia, Escuela de Medicina, Pontificia Universidad Catolica de Chile, Santiago, de Chile
| | - Brian J Anderson
- Department of Anesthesiology, University of Auckland, Auckland, New Zealand
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19
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Neisi A, Albooghobeish M, Geravandi S, Adeli Behrooz HR, Mahboubi M, Omidi Khaniabad Y, Valipour A, Karimyan A, Mohammadi MJ, Farhadi M, Yari AR, Ghomeishi A. Investigation of health risk assessment sevoflurane on indoor air quality in the operation room in Ahvaz city, Iran. TOXIN REV 2018. [DOI: 10.1080/15569543.2018.1434796] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Affiliation(s)
- Abdolkazem Neisi
- Department of Environmental Health Engineering, School of Public Health and Environmental Technologies Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Masoumeh Albooghobeish
- Department of Anesthesiology, Paramedical School, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | | | | | | | - Yusef Omidi Khaniabad
- Health Care System of Karoon, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | | | | | - Mohammad Javad Mohammadi
- Department of Environmental Health Engineering, School of Public Health and Environmental Technologies Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Majid Farhadi
- Nutrition Health Research Center, Department of Environmental Health, School of Health and Nutrition, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Ahmad Reza Yari
- Research Center for Environmental Pollutants, Qom University of Medical Sciences, Qom, Iran
| | - Ali Ghomeishi
- Department of Anesthesiology, Faculty of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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20
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Ng KT, Alston RP, Just G, McKenzie C. Coronary Sinus Isoflurane Concentration in Cardiac Surgery. J Cardiothorac Vasc Anesth 2017; 31:2035-2041. [PMID: 28506542 DOI: 10.1053/j.jvca.2017.03.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Volatile anesthetic agents such as isoflurane may be associated with fewer adverse myocardial events compared with total intravenous anesthesia in cardiac surgery. The authors aimed to determine whether reasonable isoflurane concentrations at tissue level were being achieved to protect the myocardium using this agent. The isoflurane concentration in myocardium has never been measured. The primary aim was to sample coronary sinus (CS) blood and measure its isoflurane concentration. Secondary aims were to determine whether the CS blood concentration would equilibrate with the arterial blood concentration and the relationship of CS blood concentration with oxygenator exhaust isoflurane concentrations during cardiopulmonary bypass (CPB). DESIGN Prospective, observational study. SETTING Single-center university hospital. PARTICIPANTS The study comprised 23 patients undergoing cardiac surgery using CPB and isoflurane. MEASUREMENTS AND MAIN RESULTS Shortly after initiation of CPB and insertion of a CS retrograde cardioplegia catheter but before aortic cross-clamping, CS blood was aspirated, followed by radial artery blood, which then were analyzed for isoflurane with gas chromatography and mass spectrometry. The oxygenator exhaust isoflurane level was measured with an anesthetic gas analyzer. The mean arterial and CS isoflurane concentrations were 87.7 ± 50.1 and 73.0 ± 42.9 μg/mL, respectively. There was a significant mean difference of 14.7 μg/mL (95% confidence interval 6.7-22.8) between CS and arterial isoflurane concentrations. Oxygenator exhaust isoflurane levels were correlated positively with those in the CS blood (r = 0.68, p < 0.001) and arterial blood (r = 0.72, p < 0.001). CONCLUSIONS This was the first study in which CS blood was sampled and measured for isoflurane concentration. The CS isoflurane concentration could be estimated from the isoflurane concentration in the oxygenator exhaust gas. However, the value of this relationship is limited because the CS isoflurane concentration does not accurately represent its myocardial levels during CPB.
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Affiliation(s)
- Ka Ting Ng
- University of Edinburgh, Edinburgh, United Kingdom.
| | - R Peter Alston
- Department of Anaesthesia, Critical Care and Pain Medicine, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
| | - George Just
- Clinical Research Facility Mass Spectrometry Core Centre for Cardiovascular Research, Queens Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Chris McKenzie
- Department of Anaesthesia, Critical Care and Pain Medicine, University of Edinburgh, Edinburgh, United Kingdom
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Meroni R, Gianni S, Guarnieri M, Saglietti F, Gemma M, Zangrillo A, Bignami E. Feasibility of Anesthesia Maintenance With Sevoflurane During Cardiopulmonary Bypass: A Pilot Pharmacokinetics Study. J Cardiothorac Vasc Anesth 2016; 31:1210-1217. [PMID: 28283250 DOI: 10.1053/j.jvca.2016.12.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Adequate maintenance of hypnosis during anesthesia throughout surgery using sevoflurane alone was investigated. In addition, sevoflurane pharmacokinetics during cardiopulmonary bypass were analyzed. DESIGN This was a pilot pharmacokinetic study. SETTING Tertiary care university hospital. PARTICIPANTS The study comprised 10 patients aged between 18 and 75 years who underwent elective mitral valve surgery. INTERVENTIONS The end-tidal and sevoflurane plasma concentrations were measured throughout cardiac surgery procedures involving cardiopulmonary bypass. The sevoflurane plasma concentration was measured using gas chromatography. In addition, the ratio between sevoflurane alveolar concentration and inspired concentration over time (FA/FI) was analyzed to describe wash-in and wash-out curves. MEASUREMENTS AND MAIN RESULTS Hypnosis was maintained adequately throughout surgery using sevoflurane alone. The bispectral index was maintained between 40 and 60 during cardiopulmonary bypass. The end-tidal sevoflurane was significantly different before and during cardiopulmonary bypass (1.86%±0.54% v 1.30%±0.58%, respectively; p<0.001). However, the sevoflurane plasma concentration was not significantly different before and after cardiopulmonary bypass start-up (40.55 µg/mL [76.62-125.33] before cardiopulmonary bypass and 36.24 µg/mL [56.49-81-42] during cardiopulmonary bypass). This mismatch possibly can be explained by changes that occured after cardiopulmonary bypass start-up, such as reductions of body temperature (36.33°C±0.46°C v 32.98°C±2.38°C, respectively; p<0.001) and hematocrit (35.62%±3.98% v 25.5%±3.08%, respectively; p<0.001). The sevoflurane alveolar concentration varied according to sevoflurane plasma concentration and bispectral index values. No adverse events regarding sevoflurane administration during cardiopulmonary bypass were observed. CONCLUSIONS Sevoflurane end-tidal values were reliable indicators of adequate anesthesia during all cardiac surgery procedures involving cardiopulmonary bypass.
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Affiliation(s)
- Roberta Meroni
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Stefano Gianni
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Marcello Guarnieri
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Francesco Saglietti
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Marco Gemma
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Alberto Zangrillo
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Elena Bignami
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy.
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Freiermuth D, Mets B, Bolliger D, Reuthebuch O, Doebele T, Scholz M, Gregor M, Haschke M, Seeberger MD, Fassl J. Sevoflurane and Isoflurane—Pharmacokinetics, Hemodynamic Stability, and Cardioprotective Effects During Cardiopulmonary Bypass. J Cardiothorac Vasc Anesth 2016; 30:1494-1501. [DOI: 10.1053/j.jvca.2016.07.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Indexed: 11/11/2022]
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23
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Fernández Del Río R, O'Hara ME, Pemberton P, Whitehouse T, Mayhew CA. Elimination characteristics of post-operative isoflurane levels in alveolar exhaled breath via PTR-MS analysis. J Breath Res 2016; 10:046006. [PMID: 27732571 PMCID: PMC6050519 DOI: 10.1088/1752-7155/10/4/046006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Isoflurane (1-chloro-2,2,2-trifluoroethyl difluoromethyl ether), C3H2ClF5O, is a commonly used inhalation anaesthetic. Using a proton transfer reaction mass spectrometer (PTR-MS) we have detected isoflurane in the breath of patients several weeks following major surgery. That isoflurane is detected in the breath of patients so long after being anaesthetised raises questions about when cognitive function has fully returned to a patient. Temporal profiles of isoflurane concentrations in breath are presented for five patients (F/M 3/2, mean age 50 years, min-max 36-58 years) who had undergone liver transplant surgery. In addition, results from a headspace analysis of isoflurane are presented so that the product ions resulting from the reactions of H3O+ with isoflurane in PTR-MS could be easily identified in the absence of the complex chemical environment of breath. Six product ions were identified. In order of increasing m/z (using the 35Cl isotope where appropriate) these are [Formula: see text] (m/z 51), CHFCl+ (m/z 67), CF3CHCl+ (m/z 117), C3F4OCl+ (m/z 163), C3H2F4OCl+ (m/z 165), and C3F4OCl+ H2O (m/z 183). No protonated parent was detected. For the headspace study both clean air and CO2 enriched clean air (4% CO2) were used as buffer gases in the drift tube of the PTR-MS. The CO2 enriched air was used to determine if exhaled breath would affect the product ion branching ratios. Importantly no significant differences were observed, and therefore for isoflurane the product ion distributions determined in a normal air mixture can be used for breath analysis. Given that PTR-MS can be operated under different reduced electric fields (E/N), the dependence of the product ion branching percentages for isoflurane on E/N (96-138 Td) are reported.
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Affiliation(s)
- R Fernández Del Río
- Molecular Physics Group, School of Physics and Astronomy, University of Birmingham, Birmingham B15 2TT, UK
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Chatrath V, Khetarpal R, Bansal D, Kaur H. Sevoflurane in low-flow anesthesia using "equilibration point". Anesth Essays Res 2016; 10:284-90. [PMID: 27212762 PMCID: PMC4864709 DOI: 10.4103/0259-1162.172343] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
CONTEXT While giving low-flow anesthesia, it is a routine practice to give fixed duration of initial high-flow. This study was conducted to show the use of equilibration point as changeover point from initial high-flow to low-flow. AIMS It was to compare the use of equilibration point, hemodynamics, end-tidal agent concentration, recovery time, and recovery score between isoflurane and sevoflurane. SETTINGS AND DESIGN It was a prospective randomized study conducted on 100 patients who were admitted for elective surgery expected to be < 2 h duration. MATERIALS AND METHODS Patients were randomly assigned to one of the two groups of 50 each. Group I received isoflurane and Group S sevoflurane as an inhalational agent. STATISTICAL ANALYSIS The observations obtained in both the groups were recorded and compared. Analysis was done using unpaired t-test and Chi-square test. RESULTS Hemodynamic parameters were comparable in both the groups. The mean equilibration times obtained for sevoflurane and isoflurane were 8.22 ± 1.060 min and 17.24 ± 10.2 min, respectively. The drift in end-tidal agent concentration over time was less in sevoflurane group. Mean recovery time was 7.92 ± 1.56 min in the sevoflurane group and 12.89 ± 3.45 min in the isoflurane group (P = 0.001). There was no significant difference between intraoperative and postoperative complications. CONCLUSION Use of equilibration time of the volatile anesthetic agent as a changeover point, from high-flow to low-flow, can help us to use circle system with low-flow anesthesia in a more efficient way, especially with newer anesthetics such as sevoflurane.
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Affiliation(s)
- Veena Chatrath
- Department of Anaesthesia and Critical Care, Government Medical College, Amritsar, Punjab, India
| | - Ranjana Khetarpal
- Department of Anaesthesia and Critical Care, Government Medical College, Amritsar, Punjab, India
| | - Divya Bansal
- Department of Anaesthesia and Critical Care, Government Medical College, Amritsar, Punjab, India
| | - Harjinder Kaur
- Department of Anaesthesia and Critical Care, Government Medical College, Amritsar, Punjab, India
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Diaz LK, Gaynor JW, Koh SJ, Ittenbach RF, Gerdes M, Bernbaum JC, Zackai EH, Clancy RR, Rehman MA, Pennington JW, Burnham N, Spray TL, Nicolson SC. Increasing cumulative exposure to volatile anesthetic agents is associated with poorer neurodevelopmental outcomes in children with hypoplastic left heart syndrome. J Thorac Cardiovasc Surg 2016; 152:482-9. [PMID: 27183886 DOI: 10.1016/j.jtcvs.2016.03.095] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Revised: 03/03/2016] [Accepted: 03/17/2016] [Indexed: 12/30/2022]
Abstract
OBJECTIVES Despite improved survival in children with hypoplastic left heart syndrome (HLHS), significant concern persists regarding their neurodevelopmental (ND) outcomes. Previous studies have identified patient factors, such as prematurity and genetic syndromes, to be associated with worse ND outcomes. However, no consistent relationships have been identified among modifiable management factors, including cardiopulmonary bypass strategies, and ND outcomes after cardiac surgery in infancy. Studies in immature animals, including primates, have demonstrated neurodegeneration and apoptosis in the brain after certain levels and extended durations of anesthetic exposure. Retrospective human studies have also suggested relationships between adverse ND effects and anesthetic exposure. METHODS Cumulative minimum alveolar concentration hours (MAC-hrs) of exposure to volatile anesthetic agents (VAA) (desflurane, halothane, isoflurane, and sevoflurane) were collected from an anesthetic database and medical record review for 96 patients with HLHS or variants. ND testing was performed between ages 4 and 5 years, including full-scale IQ, verbal IQ, performance IQ, and processing speed. Four generalized linear modes were hypothesized a priori and tested using a Gaussian (normal) distribution with an identity link. RESULTS Cumulative VAA exposure ranged from 0 to 35.3 MAC-hrs (median 7.5 hours). Using specified covariates identified previously as significant predictors of ND outcomes, statistically significant relationships were identified between total MAC-hrs exposure and worse full-scale IQ and verbal IQ scores (P's < .05) alone and after adjusting for relevant covariates. CONCLUSIONS Increased cumulative MAC-hrs exposure to VAA is associated with worse ND outcomes in certain domains in children with HLHS and variants.
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Affiliation(s)
- Laura K Diaz
- Department of Anesthesia and Critical Care Medicine, The Children's Hospital of Philadelphia, Perelman School of Medicine at The University of Pennsylvania, Philadelphia, Pa
| | - J William Gaynor
- Division of Pediatric Cardiothoracic Surgery, The Children's Hospital of Philadelphia, Perelman School of Medicine at The University of Pennsylvania, Philadelphia, Pa.
| | - Shannon J Koh
- Division of Pediatric Cardiothoracic Surgery, The Children's Hospital of Philadelphia, Perelman School of Medicine at The University of Pennsylvania, Philadelphia, Pa
| | - Richard F Ittenbach
- Division of Biostatistics and Epidemiology, Cincinnati Children's Medical Center, University of Cincinnati School of Medicine, Cincinnati, Ohio
| | - Marsha Gerdes
- Department of Pediatrics, The Children's Hospital of Philadelphia, Perelman School of Medicine at The University of Pennsylvania, Philadelphia, Pa
| | - Judy C Bernbaum
- Department of Pediatrics, The Children's Hospital of Philadelphia, Perelman School of Medicine at The University of Pennsylvania, Philadelphia, Pa
| | - Elaine H Zackai
- Department of Pediatrics, The Children's Hospital of Philadelphia, Perelman School of Medicine at The University of Pennsylvania, Philadelphia, Pa
| | - Robert R Clancy
- Department of Pediatrics, The Children's Hospital of Philadelphia, Perelman School of Medicine at The University of Pennsylvania, Philadelphia, Pa
| | - Mohamed A Rehman
- Department of Anesthesia and Critical Care Medicine, The Children's Hospital of Philadelphia, Perelman School of Medicine at The University of Pennsylvania, Philadelphia, Pa
| | - Jeffrey W Pennington
- Center for Biomedical Informatics, The Children's Hospital of Philadelphia, Perelman School of Medicine at The University of Pennsylvania, Philadelphia, Pa
| | - Nancy Burnham
- Division of Pediatric Cardiothoracic Surgery, The Children's Hospital of Philadelphia, Perelman School of Medicine at The University of Pennsylvania, Philadelphia, Pa
| | - Thomas L Spray
- Division of Pediatric Cardiothoracic Surgery, The Children's Hospital of Philadelphia, Perelman School of Medicine at The University of Pennsylvania, Philadelphia, Pa
| | - Susan C Nicolson
- Department of Anesthesia and Critical Care Medicine, The Children's Hospital of Philadelphia, Perelman School of Medicine at The University of Pennsylvania, Philadelphia, Pa
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Language learning and brain reorganization in a 3.5-year-old child with left perinatal stroke revealed using structural and functional connectivity. Cortex 2016; 77:95-118. [DOI: 10.1016/j.cortex.2016.01.010] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Revised: 08/09/2015] [Accepted: 01/18/2016] [Indexed: 11/20/2022]
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Xu F, Armstrong R, Urrego D, Qazzaz M, Pehar M, Armstrong JN, Shutt T, Syed N. The mitochondrial division inhibitor Mdivi-1 rescues mammalian neurons from anesthetic-induced cytotoxicity. Mol Brain 2016; 9:35. [PMID: 27009068 PMCID: PMC4806411 DOI: 10.1186/s13041-016-0210-x] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Accepted: 03/12/2016] [Indexed: 12/11/2022] Open
Abstract
Background Concerns have risen regarding the potential side effects of clinical exposure of the pediatric population to inhalational anesthetics, and how they might impact cognitive, learning, and memory functions. However, neither the mechanisms of anesthetic cytotoxicity, nor potential protective strategies, have yet been fully explored. In this study, we examined whether two of the most commonly used inhalational anesthetics, sevoflurane and desflurane, affect neuronal viability and synaptic network assembly between cultured rat cortical neurons. Results Primary rat cortical neuron cultures were exposed to equipotent sevoflurane or desflurane for 1 hour. Neuron viability, synaptic protein expression, mitochondrial morphology, and neurite growth were assayed with immunostaining and confocal microscopy techniques. The effects of anesthetics on the functional development of neural networks were evaluated with whole-cell patch clamp recordings of spontaneous synaptic currents. Our results demonstrate that an acute exposure to sevoflurane and desflurane inhibits the development of neurite processes, impacts the mitochondria, and compromises synaptic proteins - concomitant with a reduction in synaptic function in mature networks. Interestingly, pretreatment of neurons with a mitochondrial division inhibitor (Mdivi-1) not only protected mitochondria integrity but also played a protective role against anesthetic-induced structural and functional neurotoxicity. Conclusions We show that Mdivi-1 likely plays a protective role against certain harmful effects of general anesthetics on primary rat neuronal cultures. In addition, Mdivi-1 alone plays a direct role in enhancing growth and modulating synaptic activity. This study highlights the importance of further study into possible protective agents against anesthetic neurotoxicity.
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Affiliation(s)
- Fenglian Xu
- Hotchkiss Brain Institute and the Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, T2N 2T9, Canada. .,The Department of Biology, College of Arts and Sciences, Saint Louis University, Saint Louis, MO, 63103-2010, USA.
| | - Ryden Armstrong
- Hotchkiss Brain Institute and the Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, T2N 2T9, Canada
| | - Daniela Urrego
- Hotchkiss Brain Institute and the Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, T2N 2T9, Canada
| | - Munir Qazzaz
- Hotchkiss Brain Institute and the Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, T2N 2T9, Canada
| | - Mario Pehar
- The Department of Anesthesiology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, T2N 2T9, Canada
| | - J N Armstrong
- The Department of Anesthesiology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, T2N 2T9, Canada
| | - Tim Shutt
- The Departments of Medical Genetics and Biochemistry & Molecular Biology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, T2N 2T9, Canada
| | - Naweed Syed
- Hotchkiss Brain Institute and the Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, T2N 2T9, Canada. .,The Department of Cell Biology & Anatomy and the Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, T2N 4Z6, Canada.
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Gambús PL, Trocóniz IF. Pharmacokinetic-pharmacodynamic modelling in anaesthesia. Br J Clin Pharmacol 2015; 79:72-84. [PMID: 24251846 DOI: 10.1111/bcp.12286] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2013] [Accepted: 10/31/2013] [Indexed: 11/29/2022] Open
Abstract
Anaesthesiologists adjust drug dosing, administration system and kind of drug to the characteristics of the patient. They then observe the expected response and adjust dosing to the specific requirements according to the difference between observed response, expected response and the context of the surgery and the patient. The approach above can be achieved because on one hand quantification technology has made significant advances allowing the anaesthesiologist to measure almost any effect by using noninvasive, continuous measuring systems. On the other the knowledge on the relations between dosing, concentration, biophase dynamics and effect as well as detection of variability sources has been achieved as being the benchmark specialty for pharmacokinetic-pharmacodynamic (PKPD) modelling. The aim of the review is to revisit the most common PKPD models applied in the field of anaesthesia (i.e. effect compartmental, turnover, drug-receptor binding and drug interaction models) through representative examples. The effect compartmental model has been widely used in this field and there are multiple applications and examples. The use of turnover models has been limited mainly to describe respiratory effects. Similarly, cases in which the dissociation process of the drug-receptor complex is slow compared with other processes relevant to the time course of the anaesthetic effect are not frequent in anaesthesia, where in addition to a rapid onset, a fast offset of the response is required. With respect to the characterization of PD drug interactions different response surface models are discussed. Relevant applications that have changed the way modern anaesthesia is practiced are also provided.
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Affiliation(s)
- Pedro L Gambús
- Systems Pharmacology Effect Control & Modeling (SPEC-M) Research Group, Anesthesiology Department, Hospital CLINIC, Barcelona; Institut d'Investigacions Biomèdiques August Pi Sunyer (IDIBAPS) Villarroel 170, Barcelona, 08036, Spain; Department of Anesthesia and Perioperative Care, University of California San Francisco (UCSF), San Francisco, CA, USA
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Abstract
Sevoflurane has been available for clinical practice for about 20 years. Nowadays, its pharmacodynamic and pharmacokinetic properties together with its absence of major adverse side effects on the different organ systems have made this drug accepted worldwide as a safe and reliable anesthetic agent for clinical practice in various settings.
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Affiliation(s)
- Stefan De Hert
- Department of Anesthesiology, Ghent University Hospital, De Pintelaan 185, Ghent, B-9000, Belgium
| | - Anneliese Moerman
- Department of Anesthesiology, Ghent University Hospital, De Pintelaan 185, Ghent, B-9000, Belgium
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Kim JH, Lee IO. Perioperative management of elderly surgical patients under general anesthesia. JOURNAL OF THE KOREAN MEDICAL ASSOCIATION 2015. [DOI: 10.5124/jkma.2015.58.8.729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Jae-Hwan Kim
- Department of Anesthesiology and Pain Medicine, Korea University College of Medicine, Seoul, Korea
| | - Il-Ok Lee
- Department of Anesthesiology and Pain Medicine, Korea University College of Medicine, Seoul, Korea
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Lu CC, Tso-Chou L, Hsu CH, Tsai CS, Sheen MJ, Hu OYP, Ho ST. Pharmacokinetics of sevoflurane elimination from respiratory gas and blood after coronary artery bypass grafting surgery. J Anesth 2014; 28:873-9. [PMID: 24801478 DOI: 10.1007/s00540-014-1841-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2013] [Accepted: 04/19/2014] [Indexed: 11/28/2022]
Abstract
PURPOSE Sevoflurane, with a relative low blood-gas partition coefficient, is an ideal anesthetic to achieve rapid offset and recovery from general anesthesia. This study will determine the profiles of four concentration-time curves to characterize the pharmacokinetics of sevoflurane elimination. METHODS Eight patients (aged 54-76 years) undergoing coronary arterial bypass grafting surgery were enrolled in this study. At the end of surgery, anesthetic gas and blood were sampled 20 min before and after stopping sevoflurane administration, with prior maintenance of a fixed 5% inspired sevoflurane (CIsev) in 6 L/min oxygen flow for 60 min before the cessation of sevoflurane administration for the subsequent 20 min elimination. An infrared analyzer was used to determine both CIsev and end-tidal sevoflurane (CEsev). The sevoflurane concentrations in the internal jugular-bulb (Jsev), arterial (Asev) and pulmonary arterial blood (PAsev) were analyzed by gas chromatography, and cardiac output was measured using an Opti-Q pulmonary artery catheter. RESULTS A bi-exponential decay function was the best fit for the CEsev,Jsev, Asev, and PAsev time curves. There were two distinct components, the initial 5-min fast or distribution phase and the subsequent 15-min slow or elimination phase. Before cessation of the sevoflurane supplement, the step-down concentration of sevoflurane was listed in the following order: CIsev > CEsev > Asev ≧ Jsev > PAsev. During the elimination phase, the fastest decay occurred in CEsev, followed by Jsev, Asev and PAsev. Therefore, a reverse step-down pattern was observed (PAsev > Asev ≧ Jsev > CEsev) after 20 min. The ratio of Asev to CEsev was 89% at baseline before stopping sevoflurane administration, but the ratio of Asev to CEsev increased to 128% at the twentieth min of the sevoflurane elimination phase. CONCLUSIONS During elimination, the initial washout of sevoflurane from the functional residual capacity of the lungs was reflected in the fast component of the CEsev, Jsev, Asev, and PAsev time curves. In contrast, the slow component was dominated by the tangible effects of the physiological membrane barriers, such as the alveoli-pulmonary capillary and blood-brain barriers.
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Affiliation(s)
- Chih-Cherng Lu
- Department of Anesthesiology, Taipei Veterans General Hospital/National Defense Medical Center, 4 F, Chung-Cheng Building, No. 201, Sec. 2, Shipai Rd, Beitou District, Taipei, Taiwan
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Fang M, Tao Y, Wang Y. An enriched simulation environment for evaluation of closed-loop anesthesia. J Clin Monit Comput 2013; 28:13-26. [PMID: 23748601 DOI: 10.1007/s10877-013-9483-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2012] [Accepted: 05/29/2013] [Indexed: 11/26/2022]
Abstract
To simulate and evaluate the administration of anesthetic agents in the clinical setting, many pharmacology models have been proposed and validated, which play important roles for in silico testing of closed-loop control methods. However, to the authors' best knowledge, there is no anesthesia simulator incorporating closed-loop feedback control of anesthetic agent administration freely available and accessible to the public. Consequently, many necessary but time consuming procedures, such as selecting models from the available literatures and establishing new simulator algorithms, will be repeated by different researchers who intend to explore a novel control algorithm for closed-loop anesthesia. To address this issue, an enriched anesthesia simulator was devised in our laboratory and made freely available to the anesthesia community. This simulator was built by using MATLAB(®) (The MathWorks, Natick, MA). The GUI technology embedded in MATLAB was chosen as the tool to develop a human-machine interface. This simulator includes four types of anesthetic models, and all have been wildly used in closed-loop anesthesia studies. For each type of model, 24 virtual patients were created with significant diversity. In addition, the platform also provides a model identification module and a control method library. For the model identification module, the least square method and particle swarm optimization were presented. In the control method library, a proportional-integral-derivative control and a model predictive control were provided. Both the model identification module and the control method library are extensive and readily accessible for users to add user-defined functions. This simulator could be a benchmark-testing platform for closed-loop control of anesthesia, which is of great value and has significant development potential. For convenience, this simulator is termed as Wang's Simulator, which can be downloaded from http://www.AutomMed.org .
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Affiliation(s)
- Mengqi Fang
- College of Information Science and Technology, Beijing University of Chemical Technology, Mail Box 4, 15# Beisanhuan East Road, Beijing, 100029, China
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Ghimenti S, Di Francesco F, Onor M, Stiegel MA, Trivella MG, Comite C, Catania N, Fuoco R, Pleil JD. Post-operative elimination of sevoflurane anesthetic and hexafluoroisopropanol metabolite in exhaled breath: pharmacokinetic models for assessing liver function. J Breath Res 2013; 7:036001. [PMID: 23735676 DOI: 10.1088/1752-7155/7/3/036001] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Sevoflurane (SEV), a commonly used anesthetic agent for invasive surgery, is directly eliminated via exhaled breath and indirectly by metabolic conversion to inorganic fluoride and hexafluoroisopropanol (HFIP), which is also eliminated in the breath. We studied the post-operative elimination of SEV and HFIP of six patients that had undergone a variety of surgeries lasting between 2.5 to 8.5 h using exhaled breath analysis. A classical three compartments pharmacokinetic model developed for the study of environmental contaminants was fitted to the breath data. We found that SEV kinetic behavior following surgery (for up to six days) is consistent across all subjects whereas the production and elimination of HFIP varies to some extent. We developed subject specific parameters for HFIP metabolism and interpreted the differences in the context of timing and dose of anesthesia, type of surgery, and specific host factors. We propose methods for assessing individual patient liver function using SEV as a probe molecule for assessing efficiency of liver metabolism to HFIP. This work is valuable not only for the clinical study of metabolism recovery, but potentially also for the study of the interaction of other manufactured and environmental compounds with human systems biology in controlled exposure and observational studies.
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Affiliation(s)
- S Ghimenti
- Dipartimento di Chimica e Chimica Industriale, Università di Pisa, Via del Risorgimento, 35 56126 Pisa, Italy
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Pleil JD, Stiegel MA, Risby TH. Clinical breath analysis: discriminating between human endogenous compounds and exogenous (environmental) chemical confounders. J Breath Res 2013; 7:017107. [PMID: 23445880 DOI: 10.1088/1752-7155/7/1/017107] [Citation(s) in RCA: 70] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Volatile organic compounds (VOCs) in exhaled breath originate from current or previous environmental exposures (exogenous compounds) and internal metabolic (anabolic and catabolic) production (endogenous compounds). The origins of certain VOCs in breath presumed to be endogenous have been proposed to be useful as preclinical biomarkers of various undiagnosed diseases including lung cancer, breast cancer, and cardio-pulmonary disease. The usual approach is to develop difference algorithms comparing VOC profiles from nominally healthy controls to cohorts of patients presenting with a documented disease, and then to apply the resulting rules to breath profiles of subjects with unknown disease status. This approach to diagnosis has a progression of sophistication; at the most rudimentary level, all measurable VOCs are included in the model. The next level corrects exhaled VOC concentrations for current inspired air concentrations. At the highest level, VOCs exhibiting discriminatory value also require a plausible biochemical pathway for their production before inclusion. Although these approaches have all shown some level of success, there is concern that pattern recognition is prone to error from environmental contamination and between-subject variance. In this paper, we explore the underlying assumptions for the interpretation and assignment of endogenous compounds with probative value for assessing changes. Specifically, we investigate the influence of previous exposures, elimination mechanisms and partitioning of exogenous compounds as confounders of true endogenous compounds. We provide specific examples based on a simple classical pharmacokinetic approach to identify potential misinterpretations of breath data and propose some remedies.
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Affiliation(s)
- Joachim D Pleil
- Human Exposure and Atmospheric Sciences Division, NERL/ORD, US Environmental Protection Agency, Research Triangle Park, NC, USA.
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Pharmacokinetics of intravenous emulsified isoflurane in beagle dogs. Br J Anaesth 2013; 110:128-36. [DOI: 10.1093/bja/aes311] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
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Kim YS, Chae YK, Choi YS, Min JH, Ahn SW, Yoon JW, Lee SE, Lee YK. A comparative study of emergence agitation between sevoflurane and propofol anesthesia in adults after closed reduction of nasal bone fracture. Korean J Anesthesiol 2012; 63:48-53. [PMID: 22870365 PMCID: PMC3408515 DOI: 10.4097/kjae.2012.63.1.48] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2012] [Revised: 02/20/2012] [Accepted: 02/22/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Emergence agitation is associated with increased morbidity and hospital costs. However, there have been few reports in the medical literature on the occurrence of emergence agitation in adults. The aim of this study was to compare emergence agitation between sevoflurane and propofol anesthesia in adults after closed reduction of nasal bone fracture. METHODS Forty adults (ASA I-II, 20-60 yr) undergoing closed reduction of nasal bone fracture were randomly assigned to either sevoflurane or propofol group and anesthesia was maintained with sevoflurane or propofol. The bispectral index (BIS) was monitored and maintained within 40-60. At the end of surgery, patients were transported to the post anesthetic care unit (PACU) and agitation state scale was checked by Aono's four-point scale (AFPS). Emergence agitation was defined as and AFPS score of 3 or 4. Pain score were measured by numeric rating scale (NRS) on arrival and peak value at PACU. RESULTS Nine (45.0%) patients in the sevoflurane group and 2 (10.0%) patients in the propofol group developed emergence agitation in the PACU (P = 0.031). There was no correlation between peak NRS and Aono's four-point scale. CONCLUSIONS Propofol may decrease incidence of emergence agitation compared to sevoflurane in adults undergoing closed reduction of nasal bone fracture.
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Affiliation(s)
- Young-Shin Kim
- Department of Anesthesiology and Pain Medicine, Myongji Hospital, Kwandong University Medical School, Goyang, Korea
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Brosnan RJ, Steffey EP, Escobar A. Effects of hypercapnic hyperpnea on recovery from isoflurane or sevoflurane anesthesia in horses. Vet Anaesth Analg 2012; 39:335-44. [PMID: 22574839 DOI: 10.1111/j.1467-2995.2012.00727.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To test the hypothesis that hypercapnic hyperpnea produced using endotracheal insufflation with 5-10% CO(2) in oxygen could be used to shorten anesthetic recovery time in horses, and that recovery from sevoflurane would be faster than from isoflurane. STUDY DESIGN Randomized crossover study design. ANIMALS Eight healthy adult horses. METHODS After 2 hours' administration of constant 1.2 times MAC isoflurane or sevoflurane, horses were disconnected from the anesthetic circuit and administered 0, 5, or 10% CO(2) in balance O(2) via endotracheal tube insufflation. End-tidal gas samples were collected to measure anesthetic washout kinetics, and arterial and venous blood samples were collected to measure respiratory gas partial pressures. Horses recovered in padded stalls without assistance, and each recovery was videotaped and evaluated by reviewers who were blinded to the anesthetic agent and insufflation treatment used. RESULTS Compared to isoflurane, sevoflurane caused greater hypoventilation and was associated with longer times until standing recovery. CO(2) insufflation significantly decreased anesthetic recovery time compared to insufflation with O(2) alone without significantly increasing PaCO(2) . Pharmacokinetic parameters during recovery from isoflurane with CO(2) insufflation were statistically indistinguishable from sevoflurane recovery without CO(2). Neither anesthetic agent nor insufflation treatment affected recovery quality from anesthesia. CONCLUSIONS AND CLINICAL RELEVANCE Hypercapnic hyperpnea decreases time to standing without influencing anesthetic recovery quality. Although the lower blood gas solubility of sevoflurane should favor a shorter recovery time compared to isoflurane, this advantage is negated by the greater respiratory depression from sevoflurane in horses.
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Affiliation(s)
- Robert J Brosnan
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California, Davis, CA, USA.
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Lockwood G. Theoretical context-sensitive elimination times for inhalation anaesthetics. Br J Anaesth 2010; 104:648-55. [DOI: 10.1093/bja/aeq051] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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41
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Modelling and multi-parametric control for delivery of anaesthetic agents. Med Biol Eng Comput 2010; 48:543-53. [DOI: 10.1007/s11517-010-0604-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2009] [Accepted: 03/05/2010] [Indexed: 10/19/2022]
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Ko JS, Gwak MS, Choi SJ, Yang M, Kim MJ, Lee JY, Kim GS, Kwon CHD, Joh JW. The effects of desflurane and sevoflurane on hepatic and renal functions after right hepatectomy in living donors*. Transpl Int 2010; 23:736-44. [PMID: 20102552 DOI: 10.1111/j.1432-2277.2009.01050.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
We compared postoperative hepatic and renal functions between the two inhalational anesthetics, desflurane and sevoflurane in living donors undergoing right hepatectomy. Seventy-four adult donors were randomly allocated into Des group (n = 37) and sevo group (n = 37). Before the induction of anesthesia, morphine sulfate 400 microg was injected intrathecally. Anesthesia was maintained with one minimum alveolar concentration (MAC) of deflurane or sevoflurane plus continuous intravenous remifentanil. Liver and renal function tests were performed and analysed at preoperative period, immediately after operation, and on 1st, 2nd, 3rd, 5th, 7th, and 30th postoperative days (PODs). Aspartate aminotransferase (AST) showed significant elevations from the day of surgery to POD 3 and alanine aminotransferase (ALT) was significantly elevated on POD 1 and POD 3 in the sevo group. Albumin level was significantly lower on POD 2 in the sevo group. Creatinine was significantly higher on POD 3 and POD 30 and estimated glomerular filtration ratio was significantly lower on POD 3 and POD 30 in the sevo group. No patient developed hepatic or renal failures. The results of our study showed better postoperative hepatic and renal function test with desflurane than sevoflurane at equivalent dose of 1 MAC in living donors undergoing right hepatectomy, but further study is required to evaluate clinical importance.
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Affiliation(s)
- Justin S Ko
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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McKay RE, Malhotra A, Cakmakkaya OS, Hall KT, McKay WR, Apfel CC. Effect of increased body mass index and anaesthetic duration on recovery of protective airway reflexes after sevoflurane vs desflurane. Br J Anaesth 2009; 104:175-82. [PMID: 20037150 DOI: 10.1093/bja/aep374] [Citation(s) in RCA: 82] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Increased BMI may increase the body's capacity to store potent inhaled anaesthetics, more so with more soluble agents. Accordingly, we asked whether increased BMI and longer anaesthesia prolonged airway reflex recovery. METHODS We measured time from anaesthetic discontinuation until first response to command (T1); from response to command until ability to swallow (T2); and from anaesthetic discontinuation to recovery of ability to swallow (T3) in 120 patients within three BMI ranges (18-24, 25-29, and >or=30 kg m(-2)). All received sevoflurane or desflurane, delivered via an LMA. RESULTS T1 and T3 after sevoflurane exceeded T1 and T3 after desflurane: 6.6 (sd 4.2) vs 4.0 (1.9) min (P<0.001), and 14.1 (sd 8.3) vs 6.1 (2.0) min (P<0.0001). T3 correlated more strongly with BMI after sevoflurane (28 s per kg m(-2), P=0.02) than desflurane (7 s per kg m(-2), P=0.03). Regarding T2, patients receiving sevoflurane with BMI >or=30 kg m(-2) were less often able to swallow 2 min after response to command than were those with BMI 18-24 or 25-29 kg m(-2) (3/20 vs 10/20 or 9/20, P<0.05). Each sevoflurane MAC-hour delayed T3 by 4.5 min (268 s) (R=0.46, P<0.001) whereas each desflurane MAC-hour delayed T3 by 0.2 min (16 s) (R=0.10, P=0.44). CONCLUSIONS Prolonged sevoflurane administration and greater BMI delay airway reflex recovery. The contribution of BMI to this delay is more pronounced after sevoflurane than desflurane.
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Affiliation(s)
- R E McKay
- Department of Anaesthesia and Perioperative Care, C-450, University of California San Francisco, San Francisco, CA 94143-0648, USA.
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Abstract
BACKGROUND Sevoflurane is often presented as a near-perfect anaesthetic. After 10 years in the operating room, new uses are emerging outside. OBJECTIVE To remind readers of the principal characteristics of sevoflurane, to affirm its usefulness for day-case anaesthesia and to consider the recent new uses. METHODS The discussion of the physical properties, pharmacokinetics, metabolism, mechanisms of action and clinical effects is based on classic, essential papers. Recent literature concerning emerging utilizations of sevoflurane was analysed. RESULTS Sevoflurane presents many benefits with minimum inconvenience. It allows rapid inhalation induction, maintenance and rapid recovery. It has little toxicity and its haemodynamic and respiratory depressive effects are moderate and well tolerated. It is already widely use for sedation for magnetic resonance imaging in children. Its use in paediatric or adult intensive care could improve the management of pain and sedation.
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Affiliation(s)
- Fabrice Michel
- Faculty of Medicine, Paediatric and Neonatal Intensive Care Unit, University of the Mediterranean, North University Hospital, Marseille Cedex 20, France.
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Kreuer S, Bruhn J, Wilhelm W, Grundmann U, Rensing H, Ziegeler S. Comparative pharmacodynamic modeling of desflurane, sevoflurane and isoflurane. J Clin Monit Comput 2009; 23:299-305. [PMID: 19711188 DOI: 10.1007/s10877-009-9196-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2009] [Accepted: 08/07/2009] [Indexed: 11/28/2022]
Abstract
BACKGROUND We compared dose-response curves of the hypnotic effects of desflurane, sevoflurane and isoflurane. In addition, we analyzed the k(e0) values of the different anesthetics. The EEG parameters Bispectral index (BIS, Aspect Medical Systems, Natick, MA, version XP) and Narcotrend index (MonitorTechnik, Bad Bramstedt, Germany, version 4.0) were used as measures of the pharmacodynamic effect. METHODS With IRB approval and informed consent we analyzed the data of three studies including 61 adult patients scheduled for radical prostatectomies. At least 45 min after induction of general anesthesia, end-tidal concentrations of desflurane, sevoflurane or isoflurane were varied between 0.5 and 2 MAC. We transferred the end-tidal concentrations into age-related MAC values. The relationship between MAC effect compartment concentrations and EEG was modeled with a variation of the classical fractional sigmoid E(max) model with two linked sigmoidal curves. All parameters were calculated as a population fit by NONMEM V (GloboMax, Hanover, USA) by minimizing log likelihood. RESULTS The k(e0) values of the population fit derived from BIS data were 0.54 min(-1) for desflurane, 0.24 min(-1) for sevoflurane and 0.16 min(-1) for isoflurane, from the Narcotrend index 0.43 min(-1) for desflurane, 0.26 min(-1) for sevoflurane and 0.18 min(-1) for isoflurane. The change between the first and the second sigmoidal curve was positioned at nearly the same Narcotrend- and BIS index values between 41 and 44. CONCLUSIONS The first order rate constant (k(e0) value) determining the equilibration between age-related MAC values and MAC effect site concentration is substantially higher for desflurane than for sevoflurane or isoflurane.
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Affiliation(s)
- Sascha Kreuer
- Department of Anaesthesiology and Intensive Care Medicine, University of Saarland, Homburg/Saar, Saarland, Germany.
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A Single Dose of Esmolol Blunts the Increase in Bispectral Index to Tracheal Intubation During Sevoflurane but not Desflurane Anesthesia. J Neurosurg Anesthesiol 2009; 21:214-7. [DOI: 10.1097/ana.0b013e3181a41e69] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Grossherr M, Hengstenberg A, Dibbelt L, Igl BW, Noel R, Knesebeck AVD, Schmucker P, Gehring H. Blood gas partition coefficient and pulmonary extraction ratio for propofol in goats and pigs. Xenobiotica 2009; 39:782-7. [PMID: 19548775 DOI: 10.1080/00498250903056109] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The interpretation of continuously measured propofol concentration in respiratory gas demands knowledge about the blood gas partition coefficient and pulmonary extraction ratio for propofol. In the present investigation we compared both variables for propofol between goats and pigs during a propofol anaesthesia. In ten goats and ten pigs, expired alveolar gas and arterial and mixed venous blood samples were simultaneously drawn during total intravenous anaesthesia with propofol. The blood gas partition coefficient and pulmonary extraction ratio were calculated for both species. Non-parametric methods were used for statistical inference. The blood gas partition coefficient ranged between 7000 and 646,000 for goats and between 17,000 and 267,000 for pigs. The pulmonary extraction ratio ranged between 32.9% and 98.1% for goats and was higher for pigs, which ranged between -106.0% and 39.0%. The blood gas partition coefficient for propofol exceeded those for other known anaesthetic compounds so that it takes longer to develop a steady-state. The different pulmonary extraction rates in two species suggest that there are different ways to distribute propofol during the lung passage on its way from the blood to breathing gas. This species-specific difference has to be considered for methods using the alveolar gas for monitoring the propofol concentration in plasma.
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Affiliation(s)
- M Grossherr
- Anaesthesiology, University of Luebeck, Luebeck, Germany.
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Sreenivas Y, Yeng TW, Rangaiah GP, Lakshminarayanan S. A Comprehensive Evaluation of PID, Cascade, Model-Predictive, and RTDA Controllers for Regulation of Hypnosis. Ind Eng Chem Res 2009. [DOI: 10.1021/ie800927u] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Yelneedi Sreenivas
- Department of Chemical & Biomolecular Engineering, National University of Singapore, Singapore 117576
| | - Tian Woon Yeng
- Department of Chemical & Biomolecular Engineering, National University of Singapore, Singapore 117576
| | - G. P. Rangaiah
- Department of Chemical & Biomolecular Engineering, National University of Singapore, Singapore 117576
| | - S. Lakshminarayanan
- Department of Chemical & Biomolecular Engineering, National University of Singapore, Singapore 117576
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Optimisation de l’administration des agents anesthésiques inhalés : débit de gaz frais ou fraction délivrée ? ACTA ACUST UNITED AC 2008; 27:900-8. [DOI: 10.1016/j.annfar.2008.07.097] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2008] [Accepted: 07/23/2008] [Indexed: 11/22/2022]
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Connor CW, Philip JH. The Severinghaus square root of time relationship for anesthetic uptake and its implications for the stability of compartmental pharmacokinetics. Physiol Meas 2008; 29:685-701. [DOI: 10.1088/0967-3334/29/5/012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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