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Nogi T, Uranishi K, Suzuki A, Hirasaki M, Nakamura T, Kazama T, Nagasaka H, Okuda A, Mieda T. Similarity and dissimilarity in alterations of the gene expression profile associated with inhalational anesthesia between sevoflurane and desflurane. PLoS One 2024; 19:e0298264. [PMID: 38547201 PMCID: PMC10977671 DOI: 10.1371/journal.pone.0298264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Accepted: 01/22/2024] [Indexed: 04/02/2024] Open
Abstract
Although sevoflurane is one of the most commonly used inhalational anesthetic agents, the popularity of desflurane is increasing to a level similar to that of sevoflurane. Inhalational anesthesia generally activates and represses the expression of genes related to xenobiotic metabolism and immune response, respectively. However, there has been no comprehensive comparison of the effects of sevoflurane and desflurane on the expression of these genes. Thus, we used a next-generation sequencing method to compare alterations in the global gene expression profiles in the livers of rats subjected to inhalational anesthesia by sevoflurane or desflurane. Our bioinformatics analyses revealed that sevoflurane and, to a greater extent, desflurane significantly activated genes related to xenobiotic metabolism. Our analyses also revealed that both anesthetic agents, especially sevoflurane, downregulated many genes related to immune response.
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Affiliation(s)
- Takehiro Nogi
- Department of Anesthesiology, Saitama Medical University Hospital, Morohongo, Moroyama, Iruma-gun, Saitama, Japan
| | - Kousuke Uranishi
- Division of Biomedical Sciences, Research Center for Genomic Medicine, Saitama Medical University, Yamane, Hidaka Saitama, Japan
| | - Ayumu Suzuki
- Division of Biomedical Sciences, Research Center for Genomic Medicine, Saitama Medical University, Yamane, Hidaka Saitama, Japan
| | - Masataka Hirasaki
- Department of Clinical Cancer Genomics, Saitama Medical University International Medical Center, Yamane, Hidaka, Saitama, Japan
| | - Tina Nakamura
- Department of Anesthesiology, Saitama Medical University Hospital, Morohongo, Moroyama, Iruma-gun, Saitama, Japan
| | - Tomiei Kazama
- Department of Anesthesiology, Saitama Medical University Hospital, Morohongo, Moroyama, Iruma-gun, Saitama, Japan
| | - Hiroshi Nagasaka
- Department of Anesthesiology, Saitama Medical University Hospital, Morohongo, Moroyama, Iruma-gun, Saitama, Japan
| | - Akihiko Okuda
- Division of Biomedical Sciences, Research Center for Genomic Medicine, Saitama Medical University, Yamane, Hidaka Saitama, Japan
| | - Tsutomu Mieda
- Department of Anesthesiology, Saitama Medical University Hospital, Morohongo, Moroyama, Iruma-gun, Saitama, Japan
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Truglia B, Carbone N, Ghadre I, Vallero S, Zito M, Zizzi EA, Deriu MA, Tuszynski JA. An In Silico Investigation of the Molecular Interactions between Volatile Anesthetics and Actin. Pharmaceuticals (Basel) 2023; 17:37. [PMID: 38256871 PMCID: PMC10819646 DOI: 10.3390/ph17010037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Revised: 12/15/2023] [Accepted: 12/21/2023] [Indexed: 01/24/2024] Open
Abstract
Volatile anesthetics (VAs) are medicinal chemistry compounds commonly used to enable surgical procedures for patients who undergo painful treatments and can be partially or fully sedated, remaining in an unconscious state during the operation. The specific molecular mechanism of anesthesia is still an open issue, but scientific evidence supports the hypothesis of the involvement of both putative hydrophobic cavities in membrane receptors as binding pockets and interactions between anesthetics and cytoplasmic proteins. Previous studies demonstrated the binding of VAs to tubulin. Since actin is the other major component of the cytoskeleton, this study involves an investigation of its interactions with four major anesthetics: halothane, isoflurane, sevoflurane, and desflurane. Molecular docking was implemented using the Molecular Operating Environment (MOE) software (version 2022.02) and applied to a G-actin monomer, extrapolating the relative binding affinities and root-mean-square deviation (RMSD) values. A comparison with the F-actin was also made to assess if the generally accepted idea about the enhanced F-to-G-actin transformation during anesthesia is warranted. Overall, our results confirm the solvent-like behavior of anesthetics, as evidenced by Van der Waals interactions as well as the relevant hydrogen bonds formed in the case of isoflurane and sevoflurane. Also, a comparison of the interactions of anesthetics with tubulin was made. Finally, the short- and long-term effects of anesthetics are discussed for their possible impact on the occurrence of mental disorders.
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Affiliation(s)
| | | | | | - Sara Vallero
- DIMEAS, Politecnico di Torino, 10129 Turin, Italy
| | | | | | | | - J. A. Tuszynski
- DIMEAS, Politecnico di Torino, 10129 Turin, Italy
- Department of Data Science and Engineering, The Silesian University of Technology, 44-100 Gliwice, Poland
- Department of Physics, University of Alberta, Edmonton, AB T6G 2E1, Canada
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Hutt A, Hudetz AG. Arousal system stimulation and anesthetic state alter visuoparietal connectivity. Front Syst Neurosci 2023; 17:1157488. [PMID: 37139471 PMCID: PMC10150228 DOI: 10.3389/fnsys.2023.1157488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 03/27/2023] [Indexed: 05/05/2023] Open
Abstract
Cortical information processing is under the precise control of the ascending arousal system (AAS). Anesthesia suppresses cortical arousal that can be mitigated by exogenous stimulation of the AAS. The question remains to what extent cortical information processing is regained by AAS stimulation. We investigate the effect of electrical stimulation of the nucleus Pontis Oralis (PnO), a distinct source of ascending AAS projections, on cortical functional connectivity (FC) and information storage at mild, moderate, and deep anesthesia. Local field potentials (LFPs) recorded previously in the secondary visual cortex (V2) and the adjacent parietal association cortex (PtA) in chronically instrumented unrestrained rats. We hypothesized that PnO stimulation would induce electrocortical arousal accompanied by enhanced FC and active information storage (AIS) implying improved information processing. In fact, stimulation reduced FC in slow oscillations (0.3-2.5 Hz) at low anesthetic level and increased FC at high anesthetic level. These effects were augmented following stimulation suggesting stimulus-induced plasticity. The observed opposite stimulation-anesthetic impact was less clear in the γ-band activity (30-70 Hz). In addition, FC in slow oscillations was more sensitive to stimulation and anesthetic level than FC in γ-band activity which exhibited a rather constant spatial FC structure that was symmetric between specific, topographically related sites in V2 and PtA. Invariant networks were defined as a set of strongly connected electrode channels, which were invariant to experimental conditions. In invariant networks, stimulation decreased AIS and increasing anesthetic level increased AIS. Conversely, in non-invariant (complement) networks, stimulation did not affect AIS at low anesthetic level but increased it at high anesthetic level. The results suggest that arousal stimulation alters cortical FC and information storage as a function of anesthetic level with a prolonged effect beyond the duration of stimulation. The findings help better understand how the arousal system may influence information processing in cortical networks at different levels of anesthesia.
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Affiliation(s)
- Axel Hutt
- MLMS, MIMESIS, Université de Strasbourg, CNRS, lnria, ICube, Strasbourg, France
- *Correspondence: Axel Hutt,
| | - Anthony G. Hudetz
- Department of Anesthesiology, Center for Consciousness Science, University of Michigan, Ann Arbor, MI, United States
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Jiang J, Jiao Y, Gao P, Yin W, Zhou W, Zhang Y, Liu Y, Wen D, Wang Y, Zhou L, Yu T, Yu W. Propofol differentially induces unconsciousness and respiratory depression through distinct interactions between GABAA receptor and GABAergic neuron in corresponding nuclei. Acta Biochim Biophys Sin (Shanghai) 2021; 53:1076-1087. [PMID: 34137445 DOI: 10.1093/abbs/gmab084] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Indexed: 11/13/2022] Open
Abstract
Propofol is the most commonly used intravenous anesthetic worldwide. It can induce loss of consciousness prior to the occurrence of severe respiratory suppression, which is also a pharmacodynamic feature of all general anesthetics. However, the neural mechanisms underlying this natural phenomenon are controversial and highly related to patient safety. In the present study, we demonstrated that the pharmacodynamic effects of propofol (50 and 100 μM) on suppression of consciousness-related excitatory postsynaptic currents in the medial prefrontal cortex (mPFC) and centromedian nucleus of the thalamus (CMT) were lower than those in the kernel respiratory rhythmogenesis nucleus pre-Bötzinger complex (PrBo). Furthermore, we unexpectedly found that the GABAA receptor β3 subunit is the key target for propofol's action and that it is mutually and exclusively expressed in GABAergic neurons. It is also more abundant in the mPFC and CMT, but mainly co-localized with GABAergic neurons in the PrBo. As a result, the differentiated expression pattern should mediate more neuron suppression through the activation of GABAergic neurons in the mPFC and CMT at low doses of propofol (50 μM). However, PrBo GABAergic neurons were only activated by propofol at a high dose (100 μM). These results highlight the detailed pharmacodynamic effects of propofol on consciousness-related and respiration-related nuclei and provide the distinct interaction mechanism between the β3 subunit and GABAergic neurons in mediating the suppression of consciousness compared to the inhibition of respiration.
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Affiliation(s)
- Junli Jiang
- Department of Anesthesiology, School of Medicine, Renji Hospital, Shanghai Jiao Tong University, Shanghai 200127, China
- Guizhou Key Laboratory of Anesthesia and Organ Protection, Affiliated Hospital of Zunyi Medical University, Guizhou 563000, China
| | - Yingfu Jiao
- Department of Anesthesiology, School of Medicine, Renji Hospital, Shanghai Jiao Tong University, Shanghai 200127, China
| | - Po Gao
- Department of Anesthesiology, School of Medicine, Renji Hospital, Shanghai Jiao Tong University, Shanghai 200127, China
| | - Wen Yin
- Department of Anesthesiology, School of Medicine, Renji Hospital, Shanghai Jiao Tong University, Shanghai 200127, China
| | - Wei Zhou
- Department of Anesthesiology, School of Medicine, Renji Hospital, Shanghai Jiao Tong University, Shanghai 200127, China
| | - Yunchun Zhang
- Department of Anesthesiology, School of Medicine, Renji Hospital, Shanghai Jiao Tong University, Shanghai 200127, China
| | - Yanjun Liu
- Department of Anesthesiology, Eye & ENT Hospital, Fudan University, Shanghai 200031, China
| | - Daxiang Wen
- Department of Anesthesiology, School of Medicine, Renji Hospital, Shanghai Jiao Tong University, Shanghai 200127, China
| | - Yuan Wang
- Guizhou Key Laboratory of Anesthesia and Organ Protection, Affiliated Hospital of Zunyi Medical University, Guizhou 563000, China
| | - Liang Zhou
- Guizhou Key Laboratory of Anesthesia and Organ Protection, Affiliated Hospital of Zunyi Medical University, Guizhou 563000, China
| | - Tian Yu
- Guizhou Key Laboratory of Anesthesia and Organ Protection, Affiliated Hospital of Zunyi Medical University, Guizhou 563000, China
- Guizhou Key Laboratory of Brain Science, Zunyi Medical University, Guizhou 563000, China
| | - Weifeng Yu
- Department of Anesthesiology, School of Medicine, Renji Hospital, Shanghai Jiao Tong University, Shanghai 200127, China
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Trivedi K, O'Brien VJ, Rochetto RP. Sugammadex-Associated Bronchospasm. Am J Ther 2021. [PMID: 34050049 DOI: 10.1097/MJT.0000000000001390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Wongtangman K, Wilartratsami S, Hemtanon N, Tiviraj S, Raksakietisak M. Goal-Directed Fluid Therapy Based on Pulse-Pressure Variation Compared with Standard Fluid Therapy in Patients Undergoing Complex Spine Surgery: A Randomized Controlled Trial. Asian Spine J 2021; 16:352-360. [PMID: 33966364 PMCID: PMC9260406 DOI: 10.31616/asj.2020.0597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 02/07/2021] [Indexed: 01/28/2023] Open
Abstract
Study Design Prospective, randomized, controlled study. Purpose To determine whether the use of goal-directed fluid therapy (GDT) guided by pulse-pressure variation (PPV) and fluid management protocol can reduce intraoperative hypotension, blood transfusion requirements, and postoperative complications in adults undergoing complex spine surgery. Overview of Literature Complex spine surgeries involve a significant risk of blood loss and intraoperative hypotension. Previous studies showed that GDT reduces intraoperative hypotension and postoperative complications in these surgery types; however, limited information exists about GDT guided by PPV. Methods Sixty adults (18–70 years) patients undergoing complex spine surgeries at Siriraj Hospital, Mahidol University, Thailand were enrolled. Patients were allocated to two groups (30 patients in each) using computer-generated randomization. Intraoperative fluid and vasopressor were administrated via either GDT or standard care. The GDT algorithm used PPV and fluid protocol as the primary tool to guide hemodynamic management. The incidences and episodes of perioperative hypotension were measured as the outcomes. Results Fifty-seven patients were analyzed (three patients in the GDT group were excluded). The baseline characteristics and surgical procedures of the two groups did not differ significantly. The prevalence of intraoperative hypotension was 80.0% for the control group and 66.7% for the GDT group (p=0.25). Two episodes (1–3) of intraoperative hypotension occurred in the control group, and one episode (0–3) occurred in the GDT group; the difference was not significantly different (p=0.57). The intraoperative blood transfusion requirements and postoperative complications were similar in both the groups. In the subgroup analysis, patients with intraoperative hypotension exhibited a higher incidence of postoperative bowel dysfunction. Conclusions PPV-guided GDT and fluid protocol, as compared with standard practice, did not show significant advantages with respect to intraoperative hypotension, blood transfusion, or postoperative complications in patients undergoing complex spine surgery in the prone position.
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Affiliation(s)
- Karuna Wongtangman
- Department of Anesthesiology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Sirichai Wilartratsami
- Department of Orthopaedic Surgery, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Nattachai Hemtanon
- Department of Anesthesiology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Supinya Tiviraj
- Department of Anesthesiology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Manee Raksakietisak
- Department of Anesthesiology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
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Ren J, Wang X, Wei G, Meng Y. Exposure to desflurane anesthesia confers colorectal cancer cells metastatic capacity through deregulation of miR-34a/LOXL3. Eur J Cancer Prev 2021; 30:143-53. [PMID: 32658033 DOI: 10.1097/CEJ.0000000000000608] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Due to high potency and low toxicity, desflurane has been widely used during surgery. Recent evidence that the use of desflurane was associated with colorectal cancer (CRC) tumor metastasis and poor prognosis raising concerns about the safety of desflurane. However, the mechanism was uncovered. CRC cells were exposed to desflurane, the changes in morphology and epithelial-mesenchymal transition (EMT)-related genes were evaluated. Transwell assay was used to study the migration and invasion effect. Xenograft was performed to study the tumor formation ability of desflurane-treated cells in vivo. Dual-luciferase reporter assay was conducted to verify the target of microRNA (miR)-34a. Knockdown or overexpression of LOXL3 was used to investigate the mechanism of desflurane-induced EMT. The association of LOXL3 with CRC molecular subtypes and clinical relevance was studied by analysis of public datasets. Exposure to desflurane induced EMT, migration, and invasion in CRC cells. Mice injected with desflurane-treated cells formed more tumors in the lungs. Downregulation of miR-34a and upregulation of LOXL3 were required for desflurane-induced EMT in CRC cells. LOXL3 was a direct target of miR-34a. Overexpression of LOXL3 rescued miR-34a-repressed EMT after exposure to desflurane. Elevated expression of LOXL3 was enriched in CMS4 and CRIS-B subtypes. Patients with high expression of LOXL3 showed more lymph node metastasis, as well as poor survival. Desflurane induced EMT and metastasis in CRC through deregulation of miR-34a/LOXL3 axis. Clinical miR-34a mimic or inhibitor targeting LOXL3 might have a potential protective role when patients with CRC anesthetized by desflurane.
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Silverman J. How to resolve a dilemma about desflurane? Lab Anim (NY) 2020; 49:55. [DOI: 10.1038/s41684-020-0482-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Thompson-Iritani S, Reyes N, Sullivan JM. The Department Chair could have done better…. Lab Anim (NY) 2020; 49:56. [DOI: 10.1038/s41684-020-0484-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Weber J, Schmidt J, Wirth S, Schumann S, Philip JH, Eberhart LHJ. Context-sensitive decrement times for inhaled anesthetics in obese patients explored with Gas Man®. J Clin Monit Comput 2020; 35:343-354. [PMID: 32067148 PMCID: PMC7943506 DOI: 10.1007/s10877-020-00477-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Accepted: 01/29/2020] [Indexed: 01/24/2023]
Abstract
Anesthesia care providers and anesthesia decision support tools use mathematical pharmacokinetic models to control delivery and especially removal of anesthetics from the patient’s body. However, these models are not able to reflect alterations in pharmacokinetics of volatile anesthetics caused by obesity. The primary aim of this study was to refine those models for obese patients. To investigate the effects of obesity on the elimination of desflurane, isoflurane and sevoflurane for various anesthesia durations, the Gas Man® computer simulation software was used. Four different models simulating patients with weights of 70 kg, 100 kg, 125 kg and 150 kg were constructed by increasing fat weight to the standard 70 kg model. For each modelled patient condition, the vaporizer was set to reach quickly and then maintain an alveolar concentration of 1.0 minimum alveolar concentration (MAC). Subsequently, the circuit was switched to an open (non-rebreathing) circuit model, the inspiratory anesthetic concentration was set to 0 and the time to the anesthetic decrements by 67% (awakening times), 90% (recovery times) and 95% (resolution times) in the vessel-rich tissue compartment including highly perfused tissue of the central nervous system were determined. Awakening times did not differ greatly between the simulation models. After volatile anesthesia with sevoflurane and isoflurane, awakening times were lower in the more obese simulation models. With increasing obesity, recovery and resolution times were higher. The additional adipose tissue in obese simulation models did not prolong awakening times and thus may act more like a sink for volatile anesthetics. The results of these simulations should be validated by comparing the elimination of volatile anesthetics in obese patients with data from our simulation models.
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Affiliation(s)
- Jonas Weber
- Department of Anesthesiology and Critical Care, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
| | - Johannes Schmidt
- Department of Anesthesiology and Critical Care, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Steffen Wirth
- Department of Anesthesiology and Critical Care, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Stefan Schumann
- Department of Anesthesiology and Critical Care, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - James H Philip
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA
| | - Leopold H J Eberhart
- Department of Anaesthesiology and Intensive Care, Philipps-Universität Marburg, Marburg, Germany
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Kapoor MC, Sashank A, Vats A, Garg S, Puri A. Minimal flow anesthesia can be initiated early with the use of higher fresh gas flow to facilitate desflurane "Wash-in". J Anaesthesiol Clin Pharmacol 2020; 35:487-492. [PMID: 31920232 PMCID: PMC6939559 DOI: 10.4103/joacp.joacp_188_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Background and Aims: More than 80% of delivered anesthetic gases get wasted at high fresh gas flows as they are vented out unused. Use of minimal flow anesthesia is associated with less waste anesthetic gas emission and environmental pollution. There is no approved or validated technique to initiate minimal flow anesthesia and simultaneously achieve denitrogenation of the breathing circuit. We studied the wash-in characteristics of desflurane, when delivered with 50% nitrous oxide, to reach a target end-tidal concentration at two different gas flow rates. Material and Methods: Patients were allocated randomly to two groups of 25 adults each. In Group A, with the vaporizer dial fixed at 4 vol %, after an initial fresh gas flow of 4 L/min was administered to wash-in of desflurane using the closed-circuit, with 50% N2O in O2, and in group B, 6 L/min was used. Minimal flow anesthesia, with 0.5 L/min, was initiated in both groups on attaining a target end-tidal desflurane concentration of 3.5 vol %. After initiation of desflurane delivery, the inspired/expired gas concentrations were noted every minute for 15 min. Results: In Group A, the target desflurane end-tidal concentration was reached in 499.2 ± 68.6 s±, and in the Group B (P < 0.001), it was reached significantly faster in 314.4 ± 69.89 s. Denitrogenation of the circuit was adequate in both groups. Conclusion: Minimal flow anesthesia can be initiated, without any gas-volume deficit, in about 5 min with an initial fresh gas flow rate of 6 L/min and the vaporizer set at 4 vol%.
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Affiliation(s)
- Mukul Chandra Kapoor
- Department of Anaesthesia, Max Smart Super-Specialty Hospital, Saket, Delhi, India
| | | | - Ashok Vats
- Department of Anaesthesia, Max Smart Super-Specialty Hospital, Saket, Delhi, India
| | - Shaloo Garg
- Department of Anaesthesia, Max Smart Super-Specialty Hospital, Saket, Delhi, India
| | - Archana Puri
- Department of Anaesthesia, Max Smart Super-Specialty Hospital, Saket, Delhi, India
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Öztürk MC, Demiroluk Ö, Abitagaoglu S, Ari DE. The Effect of sevoflurane, desflurane and propofol on respiratory mechanics and integrated pulmonary index scores in laparoscopic sleeve gastrectomy. A randomized trial. Saudi Med J 2019; 40:1235-1241. [PMID: 31828275 PMCID: PMC6969621 DOI: 10.15537/smj.2019.12.24693] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Objectives: To compare the effects of sevoflurane, desflurane, and propofol on respiratory mechanics, and integrated pulmonary index (IPI) scores in patients undergoing laparoscopic sleeve gastrectomy. Methods: A total of 60 patients with a body mass index of ≥40 kg/m2, who underwent laparoscopic sleeve gastrectomy between September 2015 and September 2016 at Fatih Sultan Mehmet Health Application and Research Center, Istanbul, Turkey were included in this randomized prospective study. After induction, anesthesia was maintained by sevoflurane in group S, desflurane in group D, and propofol in group P. Peak inspiratory pressure (PIP), plateau pressure (Pplateau), compliance (Cdyn), respiratory resistance (Rrs), and IPI values were recorded. Mann-Whitney U, Kruskal-Wallis, Dunn’s, Friedman, and Fisher-Freeman-Halton tests were performed for statistical analysis. A p value of <0.05 was considered statistically significant. Results: A significant increase was found in PIP in group S (T1: 25; T2: 27 cmH2O), and group D (T1: 25; T2: 29,5 cmH2O) during pneumoperitoneum. Dynamic compliance decreased in all groups during pneumoperitoneum. In group S, the decrease in Cdyn was also statistically significant after pneumoperitoneum (T1: 43.65; T5: 41.25 ml/cmH2O). Comparison between groups the values of PIP, Pplateau, Cdyn, Rrs, and IPI were similar. Conclusion: In morbidly obese patients, sevoflurane, desflurane, and propofol are similar in terms of the intraoperative respiratory mechanics, and perioperative respiratory parameters provided with IPI.
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Affiliation(s)
- Mehmet C Öztürk
- Intensive Care Unit, Dokuz Eylül University, Izmir, Turkey. E-mail.
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Toal P, Chiplonkar S, Panchal P. A randomised prospective comparison of equilibration point and changing gas composition during low-flow anaesthesia with sevoflurane vs desflurane. Indian J Anaesth 2019; 63:814-819. [PMID: 31649393 PMCID: PMC6798620 DOI: 10.4103/ija.ija_31_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 04/16/2019] [Accepted: 07/22/2019] [Indexed: 11/29/2022] Open
Abstract
Background and Aims: Safety and economy are the main concerns while using low- flow anaesthesia with newer inhalational agents. The main objective of this study was to use and compare 'equilibration time' of sevoflurane and desflurane after change-over from high-to-low flow anaesthesia. Methods: This prospective study included consenting adult patients between 18–70 years undergoing elective surgery under general anaesthesia. Patients were randomised initially to receive high-flow anaesthesia with 1.3 MAC of either desflurane or sevoflurane with nitrous oxide. After equilibration point, low-flow anaesthesia was initiated. Heart rate, non-invasive blood pressure, pulse oximeter, 5 electrode ECG and gas monitoring was done. Statistical analysis was done with the help of Med CalC version 12.5.0.0 (student version) and IBM SPSS Version 20.0. Results: Mean equilibration time in sevoflurane group was higher (4.59 ± 0.77 minutes) than desflurane group (3.78 ± 0.56 minutes, P < 0.001). Inspired concentrations of both inhalational agents varied from their vaporiser settings over 2 hours, more so with sevoflurane than desflurane. Inspired oxygen concentration (FiO2) remained above 30% during anaesthesia in both groups with stable haemodynamics. Conclusion: Change-over from high-to-low flow anaesthesia is faster in desflurane. With fresh gas flow (FGF) of 1 L with 50% oxygen and dial concentration of 1–1.5% of sevoflurane and 3.8–4.4% of desflurane, the risk of hypoxia is minimal. The disparity between the set and delivered concentrations is more (20%) in sevoflurane than desflurane (12%).
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Affiliation(s)
- Pratibha Toal
- Department of Anaesthesia, BARC Hospital, Anushakti Nagar, Mumbai, Maharashtra, India
| | - Sheetal Chiplonkar
- Department of Anaesthesia, BARC Hospital, Anushakti Nagar, Mumbai, Maharashtra, India
| | - Pratik Panchal
- Department of Anaesthesia, Spandan Multispeciality Hospital, Vadodara, Gujarat, India
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14
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Hopper CP, Wollborn J. Delivery of carbon monoxide via halogenated ether anesthetics. Nitric Oxide 2019; 89:93-95. [PMID: 31125687 DOI: 10.1016/j.niox.2019.05.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2019] [Revised: 04/04/2019] [Accepted: 05/21/2019] [Indexed: 01/31/2023]
Affiliation(s)
- Christopher P Hopper
- Department of Medicinal Chemistry, College of Pharmacy, The University of Florida, Gainesville, Florida, USA; Institute for Pharmacy and Food Chemistry, University of Wuerzburg, Germany; Institute for Experimental Biomedicine, University Hospital Wuerzburg, Germany.
| | - Jakob Wollborn
- Department of Anesthesiology and Critical Care, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
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15
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Abstract
Objectives The study aimed to test the effect of intraoperative intravenous (IV) lidocaine on the incidence of postextubation laryngospasm in adult patients. Methods The prospective randomized clinical trial was conducted at tertiary care hospital in Riyadh, between January and December 2012. Seventy-two patients undergoing laparoscopic cholecystectomy were randomly assigned to receive either placebo (n = 36) or IV lidocaine (n = 36), 1 mg/kg bolus after desflurane was discontinued. Laryngospasm was graded from 0 to 3 based on the absence or presence of signs and the severity of postextubation laryngospasm. Results The study was terminated early by the data monitoring committee because of safety concerns due to an increased incidence of postextubation laryngospasm. Patient demographics were similar for both groups. The incidence of postextubation laryngospasm was 19.5% in the placebo group and 0% in the treatment (lidocaine) group; this difference was statistically significant (P = 0.017; 95% confidence interval, 4.6% to 36.0%). Conclusions The cause of laryngospasm in our study was most likely the rapid increase in the concentration of inspired desflurane, which might have caused airway irritation. Therefore, we believe that pretreating patients at risk of developing laryngospasm with IV lidocaine could be effective.
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Affiliation(s)
- Khalid Ibrahim Aljonaieh
- Department of Anesthesia, College of Medicine, King Khalid University Hospital, King Saud University, Riyadh, Kingdom of Saudi Arabia
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16
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Leijonhufvud F, Jöneby F, Jakobsson JG. The impact of fresh gas flow on wash-in, wash-out time and gas consumption for sevoflurane and desflurane, comparing two anaesthesia machines, a test-lung study. F1000Res 2017; 6:1997. [PMID: 29333245 PMCID: PMC5754744 DOI: 10.12688/f1000research.13064.2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/19/2017] [Indexed: 11/20/2022] Open
Abstract
Low-flow anaesthesia is considered beneficial for the patient and the environment, and it is cost reducing due to reduced anaesthetic gas consumption. An initial high-flow to saturate the circle system (
wash-in) is desirable from a clinical point of view. We measured the wash-in and wash-out times (time to saturate and to eliminate the anaesthetic agent, AA), for sevoflurane and desflurane, in a test-lung with fixed 3 MAC vaporizer setting at different fresh gas flow (FGF) and calculated the consumption of AA. We tried to find an optimal flow rate for speed and gas consumption, comparing two anaesthesia machines (AMs): Aisys and Flow-i. Time to reach 1 minimal alveolar concentration (MAC) (wash-in) decreased (p<0.05) at higher flow rates (1 – 2 – 4) but plateaued at 4-4.8 l/min. The consumption of AA was at its lowest around 4-4.8 l/min (optimal flow) for all but the Aisys /desflurane group. Wash-out times decreased as FGF increased, until reaching plateau at FGF of 4-6 l/min. Aisys had generally shorter wash-in times at flow rates < 4 l/min as well as lower consumption of AA. At higher flow rates there were little difference between the AMs. The “optimal FGF” for wash-out, elimination of gas from the test-lung and circle system, plateaued with no increase in speed beyond 6 l/min. A fresh gas flow of 4 l/min. seems “optimal” taking speed to reach a 1 MAC ET and gas consumption into account during wash-in with a fixed 3 MAC vaporizer setting, and increasing fresh gas flow beyond 6 l/min does not seem to confirm major benefit during wash-out.
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Affiliation(s)
| | | | - Jan G Jakobsson
- Institution for Clinical Science, Karolinska Institutet, Danderyds University Hospital, Stockholm, Sweden
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17
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Kapoor MC, Radhakrishnan M, Ramesh VJ, Murthy HS, Sharma D, Gundappa P, Das T, Wankhede R, Bhaskaran K, Sengupta S, Patil R, Dey S, Singh K, Moharana AK. A prospective observational study of the use of desflurane anesthesia in Indian adult inpatients undergoing surgery: The Registry in India on Suprane Emergence registry. J Anaesthesiol Clin Pharmacol 2017; 33:164-171. [PMID: 28781440 PMCID: PMC5520587 DOI: 10.4103/joacp.joacp_350_16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Background and Aims: Limited registry studies are available on the use of anesthetic agents. This registry was conducted to evaluate emergence outcomes in Indian adult patients undergoing surgery with desflurane anesthesia. Material and Methods: This multicenter, prospective, non-interventional, observational study (Registry in India on Suprane Emergence [RISE] registry) included adult inpatients who received desflurane as general anesthetic for surgical procedure of ≥2 h. Patients were stratified by age into three groups: ≥18–40 years, ≥41–65 years, and >65 years. Data on patients’ demographics, practice, and usage pattern of medications were collected. The primary efficacy outcomes were time to extubation, time to response to verbal command, and time to orientation. Results: Of 236 patients screened, 201 (≥18–40 years, n = 70; ≥41–65 years, n = 65; >65 years, n = 66) were enrolled in the study. Mean time to extubation observed in ≥18–40 years group was 7.2 ± 4.1 min, ≥41–65 years was 11.6 ± 8.99 min, and >65 years was 12.0 ± 10.5 min. Mean time to response to verbal command was 7.4 ± 4.3 min for ≥18–40 years, 10.9 ± 8.5 min for ≥41–65 years, and 10.0 ± 5.4 min for >65 years. Mean time to orientation was 13.0 ± 7.0 min for ≥18–40 years, 16.1 ± 12.0 min for ≥41–65 years, and 17.0 ± 8.6 min for >65 years. Incidence of nausea and retching/vomiting was observed in 8% of patients each in the postoperative period, and these complications were seen more in the >65 years age group. Overall, desflurane treatment maintained hemodynamic stability and no major airway events were reported. Conclusions: The RISE registry data suggest that desflurane-based anesthesia provides early recovery with stable hemodynamics without any airway adverse events, in a wide variety of surgical procedures.
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Affiliation(s)
- Mukul Chandra Kapoor
- Department of Anaesthesia, Max Smart Super Specialty Hospital, Saket, Delhi, India
| | - M Radhakrishnan
- Department of Anaesthesia, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - V J Ramesh
- Department of Anaesthesia, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - H S Murthy
- Department of Anaesthesia, Manipal Hospital, Bengaluru, Karnataka, India
| | - Dhirja Sharma
- Department of Anaesthesia, Max Super Speciality Hospital, Shalimar Bagh, Delhi, India
| | | | - Tanmoy Das
- Department of Anaesthesia, Apollo Gleneagles Hospitals, Kolkata, West Bengal, India
| | - Ravi Wankhede
- Department of Anaesthesia, Apollo Gleneagles Hospitals, Kolkata, West Bengal, India
| | - K Bhaskaran
- Department of Anaesthesia, Apollo Hospitals, Chennai, Tamil Nadu, India
| | - Saiket Sengupta
- Department of Anaesthesia, Apollo Gleneagles Hospitals, Kolkata, West Bengal, India
| | | | - Sibasish Dey
- Medical Affairs, Baxter India Private Limited, Gurgaon, Haryana, India
| | - Kuljinder Singh
- Medical Affairs, Baxter India Private Limited, Gurgaon, Haryana, India
| | - Ashok K Moharana
- Medical Affairs, Baxter India Private Limited, Gurgaon, Haryana, India
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18
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Abstract
Objective To determine the effect-site concentration (Ce) of remifentanil target-controlled infusion required for a smooth inhalational induction without airway irritation using desflurane in a stepwise incremental manner for 50% of patients (EC50) and 95% of patients (EC95). Methods Patients with an American Society of Anesthesiologists physical status I and II, aged 19-60 years undergoing elective surgery were enrolled in this study. When target Ce of remifentanil was reached, desflurane was inhaled at 4 vol% initially and then it was increased to 8 and 12 vol% at intervals of 30 s. Smooth induction was regarded as an absence of airway irritation signs and excitatory movements. The EC50 and EC95 values for remifentanil were determined using a modified Dixon's up-and-down method as well as an isotonic regression method with a bootstrapping approach. Results The EC50 and EC95 of remifentanil for smooth induction during inhalation of desflurane were 3.40 ng/ml (95% confidence interval [CI] 2.42, 4.38 ng/ml) and 4.31 ng/ml (95% CI 2.15, 5.98 ng/ml), respectively. Conclusion Prior administration of remifentanil could provide smooth inhalational induction with desflurane in a stepwise increment.
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Affiliation(s)
- Ji Young Yoo
- Department of Anaesthesiology and Pain Medicine, School of Medicine, Ajou University, Suwon, Republic of Korea
| | - Sook Young Lee
- Department of Anaesthesiology and Pain Medicine, School of Medicine, Ajou University, Suwon, Republic of Korea
| | - Hae Won Jeong
- Department of Anaesthesiology and Pain Medicine, School of Medicine, Ajou University, Suwon, Republic of Korea
| | - Hyung Bae Park
- Department of Anaesthesiology and Pain Medicine, School of Medicine, Ajou University, Suwon, Republic of Korea
| | - Yun Jeong Chae
- Department of Anaesthesiology and Pain Medicine, School of Medicine, Ajou University, Suwon, Republic of Korea
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