BACKGROUND Hepatectomy with inflow occlusion results in ischemia-reperfusion injury;however,pharmacological preconditioning can prevent such injury and optimize the postoperative recovery of hepatectomized patients.Th...BACKGROUND Hepatectomy with inflow occlusion results in ischemia-reperfusion injury;however,pharmacological preconditioning can prevent such injury and optimize the postoperative recovery of hepatectomized patients.The normal inflammatory response after a hepatectomy involves increased expression of metalloproteinases,which may signal pathologic hepatic tissue reformation.AIM To investigate the effect of desflurane preconditioning on these inflammatory indices in patients with inflow occlusion undergoing hepatectomy.METHODS This is a single-center,prospective,randomized controlled trial conducted at the 4th Department of Surgery of the Medical School of Aristotle University of Thessaloniki,between August 2016 and December 2017.Forty-six patients were randomized to either the desflurane treatment group for pharmacological preconditioning(by replacement of propofol with desflurane,administered 30 min before induction of ischemia)or the control group for standard intravenous propofol.The primary endpoint of expression levels of matrix metalloproteinases and their inhibitors was determined preoperatively and at 30 min posthepatic reperfusion.The secondary endpoints of neutrophil infiltration,coagulation profile,activity of antithrombin III(AT III),protein C(PC),protein S and biochemical markers of liver function were determined for 5 d postoperatively and compared between the groups.RESULTS The desflurane treatment group showed significantly increased levels of tissue inhibitor of metalloproteinases 1 and 2,significantly decreased levels of matrix metalloproteinases 2 and 9,decreased neutrophil infiltration,and less profound changes in the coagulation profile.During the 5-d postoperative period,all patients showed significantly decreased activity of AT III,PC and protein S(vs baseline values,P<0.05).The activity of AT III and PC differed significantly between the two groups from postoperative day 1 to postoperative day 5(P<0.05),showing a moderate drop in activity of AT III and PC in the desflurane treatment group and a dramatic drop in the control group.Compared to the control group,the desflurane treatment group also had significantly lower international normalized ratio values on all postoperative days(P<0.005)and lower serum glutamic oxaloacetic transaminase and serum glutamic pyruvic transaminase values on postoperative days 2 and 3(P<0.05).Total length of stay was significantly less in the desflurane group(P=0.009).CONCLUSION Desflurane preconditioning can lessen the inflammatory response related to ischemia-reperfusion injury and may shorten length of hospitalization.展开更多
Mass-spectrometric interface for the measurement of anaesthetic agent concentration in biological fluids (blood plasma and cerebrospinal fluid) is described. Sampling of biological fluids was performed during balanced...Mass-spectrometric interface for the measurement of anaesthetic agent concentration in biological fluids (blood plasma and cerebrospinal fluid) is described. Sampling of biological fluids was performed during balanced inhalational (desflurane, fentanyl) anaesthesia and total intravenous (propofol, fentanyl) anaesthesia. The described method for drug concentration measurement in biologic fluids does not require long-term sample processing before injecting the sample into mass-spectrometer interface, in contrast to chromatographic methods. A hydrophobic membrane was used in the interface to separate anaesthetic agents from biological fluids: inhalational anaesthetic desflurane, hypnotic propofol, analgesic fentanyl. A possibility to use the interface for measurement of desflurane and propofol absolute concentration in blood plasma and cerebrospinal fluid was demonstrated for the study of blood-brain barrier (BBB) properties.展开更多
Purpose: Although rocuronium bromide (Rb) is suitable for continuous administration use, determination of optimal continuous doses is difficult due to individual differences. This study examines the efficacy of a cont...Purpose: Although rocuronium bromide (Rb) is suitable for continuous administration use, determination of optimal continuous doses is difficult due to individual differences. This study examines the efficacy of a continuous Rb administration method based on effect-site concentrations calculated by a pharmacokinetic/pharmacodynamics model during propofol, sevoflurane, and desflurane anesthesia. Methods: The 36 enrolled patients were equally divided into three groups (P;propofol, S;sevoflurane, and D;desflurane groups). After induction and administration of Rb 0.6 mg/kg, we calculated the simulated effect-site concentration at the point which the first twitch (%T1) recovered to > 0% and defined this as the Rb recovery concentration (Rbr.c.) level appropriate for continuous rocuronium administration. The continuous administration doses of Rb were adjusted to maintain Rbr.c. during surgery. The Rbr.c. and the recovery time at %T1 > 25% were recorded for each type of anesthesia. Results: Rbr.c. (μg/mL) for the P, S, and D groups were 1.54 ± 0.2, 1.24 ± 0.2, and 1.09 ± 0.2, respectively. Continuous administration doses (μg/kg/min) in the P, S, and D group were 6.7 ± 0.9, 5.2 ± 1.0, and 4.5 ± 0.8, respectively. Rbr.c. and continuous doses in the S and D groups were lower than the P group. Neuromuscular relaxations during surgery in the S and D groups were more strongly maintained than for the P group. There was also a significantly prolonged recovery duration for the %T1 > 25% in the D versus the other two groups (P < 0.05). Conclusion: Results showed that our continuous administration method was effective for maintaining sufficient muscle relaxation without excessively prolonged recovery effects for both sevoflurane and desflurane as well as propofol anesthesia.展开更多
AIM: To investigate CYP2E1 IgG4 autoantibody levels and liver biochemical markers in adult patients after anesthesia with desflurane. METHODS: Forty patients who were > 18 years old and undergoing elective surgery ...AIM: To investigate CYP2E1 IgG4 autoantibody levels and liver biochemical markers in adult patients after anesthesia with desflurane. METHODS: Forty patients who were > 18 years old and undergoing elective surgery under general anes-thesia with desflurane were studied. Alpha-glutathione-S-transferase(aGST) and IgG4 antibodies againstCYP2E1 were measured preoperatively and 96 h post-operatively, as well as complete blood count, prothrom-bin time(PT), activated partial thromboplastin time(aPTT), international normalized ratio(INR), aspartate aminotransferase(SGOT), alanine aminotransferase(SGPT), g-glutamyl-transpeptidase(gGT), alkaline phosphatase, total serum proteins, albumin and bili-rubin. A separate group of 8 patients who received re-gional anesthesia was also studied for calibration of the methodology used for CYP2E1 IgG4 and aGST measure-ments. Student's t-test and the Mann-Whitney U test were used for comparison of the continuous variables, and Fisher's exact test was used for the categorical variables. All tests were two-tailed, with statistical sig-nificance set as P < 0.05.RESULTS: None of the patients developed postopera-tive liver dysfunction, and all patients were successfully discharged from the hospital. No statistically significant difference was observed regarding liver function tests(SGOT, SGPT, γGT, bilirubin, INR), aGST and CYP2E1 IgG4, before and after exposure to desflurane. After dividing patients into two subgroups based on whether or not they had received general anesthesia in the past, no significant difference in the levels of CYP2E1 IgG4 was observed at baseline or 96 h after desflurane administration(P = 0.099 and P = 0.051, respectively). Alpha-GST baseline levels and levels after the interven-tion also did not differ significantly between these two subgroups(P > 0.1). The mean aGST differences were statistically elevated in men by 2.15 ng/mL compared to women when adjusted for BMI, duration of anesthe-sia, number of times anesthesia was administered pre-viously and length of hospital stay. No significant dif-ference was observed between patients who received desflurane and those who received regional anesthesia at any time point.CONCLUSION: There was no difference in CYP2E1 IgG4 or aGST levels after desflurane exposure; furtherresearch is required to investigate their role in desflu-rane-induced liver injury.展开更多
Background: Emergence Delirium (ED) is considered a usual complication in pediatric anesthesia. Aim: Analyze the quantitative and qualitative differences in ED in children receiving general anesthesia with sevoflurane...Background: Emergence Delirium (ED) is considered a usual complication in pediatric anesthesia. Aim: Analyze the quantitative and qualitative differences in ED in children receiving general anesthesia with sevoflurane or desflurane in day case surgery. Materials and Methods: Two hundred and two children, ASA I-II, who required outpatient elective day case surgery, were assigned to receive anesthesia with sevoflurane or desflurane. ED was assessed by a masked investigator using the Pediatric Anesthesia Emergence Delirium (PAED) scale at 5 and 15 minutes (min). Results: Mean time to wake up was shorter with desflurane compared with sevoflurane (6.0 versus 8.3 min, p = 0.0001). The overall incidence of ED was 21.3% and Postoperative Maladaptive Behavior Changes (POMBC) incidence was 22%;however, these were not related. Main factors found to be associated with ED were younger age, postoperative pain and preoperative anxiety. Although there were not statistically significant differences in ED incidence between sevoflurane (26.4%, 95% CI 17.3% - 35.4%) and desflurane anesthesia (16.3%, 95% CI 8.8% - 23.8%) (p = 0.18), scores of items 1 and 2 from PAED scale (eye contact and purposeful actions, items related to the patients’ connection with their surroundings) were significantly higher in sevoflurane than in desflurane group (p = 0.034 and p = 0.021 respectively). Conclusion: Recovery after anesthetic maintenance with desflurane is faster and as safe as sevoflurane, including postoperative behavioral disorders. Although desflurane did not statistically decrease ED incidence as compared with sevoflurane, patients who were agitated with desflurane were qualitatively less disoriented and disconnected from their surroundings.展开更多
Background:Ophthalmic ambulatory surgery is preferred to be performed under general anesthesia either by total intravenous anesthesia(TIVA)or by inhalational anesthesia to increase the patient comfort.However,anesthes...Background:Ophthalmic ambulatory surgery is preferred to be performed under general anesthesia either by total intravenous anesthesia(TIVA)or by inhalational anesthesia to increase the patient comfort.However,anesthesia-controlled time(ACT)can cause increased non-operative operating room(OR)time which may adversely affect the ORs efficiency.This study was aimed to compare the ACT of desflurane with that of propofol-remifentanil in strabismus ambulatory surgery.Methods:From November 2016 to December 2017,a total of 200 strabismus patients(aged 18-60 years old,and scheduled for elective ambulatory surgery at Zhongshan Ophthalmic Center)were randomly assigned to receive either propofol-based TIVA(group TIVA)or desflurane anesthesia(group DES)for maintenance of anesthesia.The primary outcome was the extubation time.Secondary outcomes included surgical time,anesthetic time,OR exit time,and Phase I and II recovery time.The intraoperative incidences of hypotension,bradycardia and oculocardiac reflex(OCR),and the incidences of any post-operative complications were recorded.Mann-Whitney U test and Chi-square or Fisher exact tests were used to compare the two groups.Results:We found that the extubation time(5.5[3.9-7.0]vs.9.7[8.5-11.4]min,P<0.001)and the incidence of prolonged time to extubation(0 vs.6%,P=0.029)in the DES group were significantly decreased compared with those in the TIVA group.The patients in the DES group displayed shorter OR exit time as compared with that in the TIVA group(7.3[5.5-8.7]vs.10.8[9.3-12.3]min,P<0.001).The patients using desflurane exhibited more stable hemodynamics during surgery than the patients using propofol-based TIVA,as demonstrated by lower incidences of hypotension(1%vs.22%,P<0.001),bradycardia(2%vs.13%,P=0.002),and OCR(17%vs.44%,P<0.001).Conclusion:DES enhanced the ophthalmic OR efficiency by reducing the extubation time and OR exit time,and provided more stable hemodynamics intra-operatively than TIVA in patients undergoing strabismus ambulatory surgery.Trial registration:ClinicalTrials.gov,No.NCT02922660;https://clinicaltrials.gov/ct2/show/NCT02922660?id=NCT02922660&draw=2&rank=1.展开更多
Objective To investigate the effects of desflurane on ischemia-reperfusion induced myocardium injury in patients undergoing mitral valve replacement. Methods Thirty patients scheduled for mitral valve replacement with...Objective To investigate the effects of desflurane on ischemia-reperfusion induced myocardium injury in patients undergoing mitral valve replacement. Methods Thirty patients scheduled for mitral valve replacement with cardiopulmonary bypass (CPB) were randomly assigned to receive either infusion of propofol or inhalational anesthetic of desflurane as part of a fentanyl-based anesthetic regimen. Systemic hemodynamic variables and cardiac function were measured perioperatively using pulse-induced contour cardiac output (PiCCO) technique. For assessing myocardial injury, cardiac troponin I (cTnI) and myocardial fraction of creatine kinase (CK-MB) were determined during the first 48 postoperative hours. Results After CPB, the cardiac index and stroke volume index in desflurane group were recovered earlier than the propofol group. And they were significantly higher in desflurane group than in propofol group during the first 6 postoperative hours. Concentration of cTnI and CK-MB increased significantly in propofol group as compared with those in desflurane group. Conclusion Desflurane has protective effects on ischemia-reperfusion induced myocardium injury in patients undergoing mitral valve replacement.展开更多
文摘BACKGROUND Hepatectomy with inflow occlusion results in ischemia-reperfusion injury;however,pharmacological preconditioning can prevent such injury and optimize the postoperative recovery of hepatectomized patients.The normal inflammatory response after a hepatectomy involves increased expression of metalloproteinases,which may signal pathologic hepatic tissue reformation.AIM To investigate the effect of desflurane preconditioning on these inflammatory indices in patients with inflow occlusion undergoing hepatectomy.METHODS This is a single-center,prospective,randomized controlled trial conducted at the 4th Department of Surgery of the Medical School of Aristotle University of Thessaloniki,between August 2016 and December 2017.Forty-six patients were randomized to either the desflurane treatment group for pharmacological preconditioning(by replacement of propofol with desflurane,administered 30 min before induction of ischemia)or the control group for standard intravenous propofol.The primary endpoint of expression levels of matrix metalloproteinases and their inhibitors was determined preoperatively and at 30 min posthepatic reperfusion.The secondary endpoints of neutrophil infiltration,coagulation profile,activity of antithrombin III(AT III),protein C(PC),protein S and biochemical markers of liver function were determined for 5 d postoperatively and compared between the groups.RESULTS The desflurane treatment group showed significantly increased levels of tissue inhibitor of metalloproteinases 1 and 2,significantly decreased levels of matrix metalloproteinases 2 and 9,decreased neutrophil infiltration,and less profound changes in the coagulation profile.During the 5-d postoperative period,all patients showed significantly decreased activity of AT III,PC and protein S(vs baseline values,P<0.05).The activity of AT III and PC differed significantly between the two groups from postoperative day 1 to postoperative day 5(P<0.05),showing a moderate drop in activity of AT III and PC in the desflurane treatment group and a dramatic drop in the control group.Compared to the control group,the desflurane treatment group also had significantly lower international normalized ratio values on all postoperative days(P<0.005)and lower serum glutamic oxaloacetic transaminase and serum glutamic pyruvic transaminase values on postoperative days 2 and 3(P<0.05).Total length of stay was significantly less in the desflurane group(P=0.009).CONCLUSION Desflurane preconditioning can lessen the inflammatory response related to ischemia-reperfusion injury and may shorten length of hospitalization.
文摘Mass-spectrometric interface for the measurement of anaesthetic agent concentration in biological fluids (blood plasma and cerebrospinal fluid) is described. Sampling of biological fluids was performed during balanced inhalational (desflurane, fentanyl) anaesthesia and total intravenous (propofol, fentanyl) anaesthesia. The described method for drug concentration measurement in biologic fluids does not require long-term sample processing before injecting the sample into mass-spectrometer interface, in contrast to chromatographic methods. A hydrophobic membrane was used in the interface to separate anaesthetic agents from biological fluids: inhalational anaesthetic desflurane, hypnotic propofol, analgesic fentanyl. A possibility to use the interface for measurement of desflurane and propofol absolute concentration in blood plasma and cerebrospinal fluid was demonstrated for the study of blood-brain barrier (BBB) properties.
文摘Purpose: Although rocuronium bromide (Rb) is suitable for continuous administration use, determination of optimal continuous doses is difficult due to individual differences. This study examines the efficacy of a continuous Rb administration method based on effect-site concentrations calculated by a pharmacokinetic/pharmacodynamics model during propofol, sevoflurane, and desflurane anesthesia. Methods: The 36 enrolled patients were equally divided into three groups (P;propofol, S;sevoflurane, and D;desflurane groups). After induction and administration of Rb 0.6 mg/kg, we calculated the simulated effect-site concentration at the point which the first twitch (%T1) recovered to > 0% and defined this as the Rb recovery concentration (Rbr.c.) level appropriate for continuous rocuronium administration. The continuous administration doses of Rb were adjusted to maintain Rbr.c. during surgery. The Rbr.c. and the recovery time at %T1 > 25% were recorded for each type of anesthesia. Results: Rbr.c. (μg/mL) for the P, S, and D groups were 1.54 ± 0.2, 1.24 ± 0.2, and 1.09 ± 0.2, respectively. Continuous administration doses (μg/kg/min) in the P, S, and D group were 6.7 ± 0.9, 5.2 ± 1.0, and 4.5 ± 0.8, respectively. Rbr.c. and continuous doses in the S and D groups were lower than the P group. Neuromuscular relaxations during surgery in the S and D groups were more strongly maintained than for the P group. There was also a significantly prolonged recovery duration for the %T1 > 25% in the D versus the other two groups (P < 0.05). Conclusion: Results showed that our continuous administration method was effective for maintaining sufficient muscle relaxation without excessively prolonged recovery effects for both sevoflurane and desflurane as well as propofol anesthesia.
文摘AIM: To investigate CYP2E1 IgG4 autoantibody levels and liver biochemical markers in adult patients after anesthesia with desflurane. METHODS: Forty patients who were > 18 years old and undergoing elective surgery under general anes-thesia with desflurane were studied. Alpha-glutathione-S-transferase(aGST) and IgG4 antibodies againstCYP2E1 were measured preoperatively and 96 h post-operatively, as well as complete blood count, prothrom-bin time(PT), activated partial thromboplastin time(aPTT), international normalized ratio(INR), aspartate aminotransferase(SGOT), alanine aminotransferase(SGPT), g-glutamyl-transpeptidase(gGT), alkaline phosphatase, total serum proteins, albumin and bili-rubin. A separate group of 8 patients who received re-gional anesthesia was also studied for calibration of the methodology used for CYP2E1 IgG4 and aGST measure-ments. Student's t-test and the Mann-Whitney U test were used for comparison of the continuous variables, and Fisher's exact test was used for the categorical variables. All tests were two-tailed, with statistical sig-nificance set as P < 0.05.RESULTS: None of the patients developed postopera-tive liver dysfunction, and all patients were successfully discharged from the hospital. No statistically significant difference was observed regarding liver function tests(SGOT, SGPT, γGT, bilirubin, INR), aGST and CYP2E1 IgG4, before and after exposure to desflurane. After dividing patients into two subgroups based on whether or not they had received general anesthesia in the past, no significant difference in the levels of CYP2E1 IgG4 was observed at baseline or 96 h after desflurane administration(P = 0.099 and P = 0.051, respectively). Alpha-GST baseline levels and levels after the interven-tion also did not differ significantly between these two subgroups(P > 0.1). The mean aGST differences were statistically elevated in men by 2.15 ng/mL compared to women when adjusted for BMI, duration of anesthe-sia, number of times anesthesia was administered pre-viously and length of hospital stay. No significant dif-ference was observed between patients who received desflurane and those who received regional anesthesia at any time point.CONCLUSION: There was no difference in CYP2E1 IgG4 or aGST levels after desflurane exposure; furtherresearch is required to investigate their role in desflu-rane-induced liver injury.
文摘Background: Emergence Delirium (ED) is considered a usual complication in pediatric anesthesia. Aim: Analyze the quantitative and qualitative differences in ED in children receiving general anesthesia with sevoflurane or desflurane in day case surgery. Materials and Methods: Two hundred and two children, ASA I-II, who required outpatient elective day case surgery, were assigned to receive anesthesia with sevoflurane or desflurane. ED was assessed by a masked investigator using the Pediatric Anesthesia Emergence Delirium (PAED) scale at 5 and 15 minutes (min). Results: Mean time to wake up was shorter with desflurane compared with sevoflurane (6.0 versus 8.3 min, p = 0.0001). The overall incidence of ED was 21.3% and Postoperative Maladaptive Behavior Changes (POMBC) incidence was 22%;however, these were not related. Main factors found to be associated with ED were younger age, postoperative pain and preoperative anxiety. Although there were not statistically significant differences in ED incidence between sevoflurane (26.4%, 95% CI 17.3% - 35.4%) and desflurane anesthesia (16.3%, 95% CI 8.8% - 23.8%) (p = 0.18), scores of items 1 and 2 from PAED scale (eye contact and purposeful actions, items related to the patients’ connection with their surroundings) were significantly higher in sevoflurane than in desflurane group (p = 0.034 and p = 0.021 respectively). Conclusion: Recovery after anesthetic maintenance with desflurane is faster and as safe as sevoflurane, including postoperative behavioral disorders. Although desflurane did not statistically decrease ED incidence as compared with sevoflurane, patients who were agitated with desflurane were qualitatively less disoriented and disconnected from their surroundings.
基金supported by a grant of Clinical Research Project of the Zhongshan Ophthalmic Center of Sun Yat-sen University(No.3030901010073).
文摘Background:Ophthalmic ambulatory surgery is preferred to be performed under general anesthesia either by total intravenous anesthesia(TIVA)or by inhalational anesthesia to increase the patient comfort.However,anesthesia-controlled time(ACT)can cause increased non-operative operating room(OR)time which may adversely affect the ORs efficiency.This study was aimed to compare the ACT of desflurane with that of propofol-remifentanil in strabismus ambulatory surgery.Methods:From November 2016 to December 2017,a total of 200 strabismus patients(aged 18-60 years old,and scheduled for elective ambulatory surgery at Zhongshan Ophthalmic Center)were randomly assigned to receive either propofol-based TIVA(group TIVA)or desflurane anesthesia(group DES)for maintenance of anesthesia.The primary outcome was the extubation time.Secondary outcomes included surgical time,anesthetic time,OR exit time,and Phase I and II recovery time.The intraoperative incidences of hypotension,bradycardia and oculocardiac reflex(OCR),and the incidences of any post-operative complications were recorded.Mann-Whitney U test and Chi-square or Fisher exact tests were used to compare the two groups.Results:We found that the extubation time(5.5[3.9-7.0]vs.9.7[8.5-11.4]min,P<0.001)and the incidence of prolonged time to extubation(0 vs.6%,P=0.029)in the DES group were significantly decreased compared with those in the TIVA group.The patients in the DES group displayed shorter OR exit time as compared with that in the TIVA group(7.3[5.5-8.7]vs.10.8[9.3-12.3]min,P<0.001).The patients using desflurane exhibited more stable hemodynamics during surgery than the patients using propofol-based TIVA,as demonstrated by lower incidences of hypotension(1%vs.22%,P<0.001),bradycardia(2%vs.13%,P=0.002),and OCR(17%vs.44%,P<0.001).Conclusion:DES enhanced the ophthalmic OR efficiency by reducing the extubation time and OR exit time,and provided more stable hemodynamics intra-operatively than TIVA in patients undergoing strabismus ambulatory surgery.Trial registration:ClinicalTrials.gov,No.NCT02922660;https://clinicaltrials.gov/ct2/show/NCT02922660?id=NCT02922660&draw=2&rank=1.
文摘Objective To investigate the effects of desflurane on ischemia-reperfusion induced myocardium injury in patients undergoing mitral valve replacement. Methods Thirty patients scheduled for mitral valve replacement with cardiopulmonary bypass (CPB) were randomly assigned to receive either infusion of propofol or inhalational anesthetic of desflurane as part of a fentanyl-based anesthetic regimen. Systemic hemodynamic variables and cardiac function were measured perioperatively using pulse-induced contour cardiac output (PiCCO) technique. For assessing myocardial injury, cardiac troponin I (cTnI) and myocardial fraction of creatine kinase (CK-MB) were determined during the first 48 postoperative hours. Results After CPB, the cardiac index and stroke volume index in desflurane group were recovered earlier than the propofol group. And they were significantly higher in desflurane group than in propofol group during the first 6 postoperative hours. Concentration of cTnI and CK-MB increased significantly in propofol group as compared with those in desflurane group. Conclusion Desflurane has protective effects on ischemia-reperfusion induced myocardium injury in patients undergoing mitral valve replacement.
