Effects of sevoflurane on left ventricular function by speckletracking echocardiography in coronary bypass patients: A randomized trial

The present study aimed to dynamically observe the segmental and global myocardial movements of the left ventricle during coronary artery bypass grafting by transesophageal speckle-tracking echocardiography,and to assess the effect of sevoflurane on cardiac function.Sixty-four patients scheduled for the off-pump coronary artery bypass grafting were randomly divided into a sevoflurane-based anesthesia(AS)group and a propofolbased total intravenous anesthesia(AA)group.The AS group demonstrated a higher absolute value of left ventricular global longitudinal strain than that of the AA group at both T1(after harvesting all grafts and before coronary anastomosis)and T_(2)(30 min after completing all coronary anastomoses)(P<0.05).Moreover,strain improvement in the segment with the highest preoperative strain was significantly reduced in the AS group,compared with the AA group at both T1 and T_(2)(P<0.01).The flow of the left internal mammary artery-left anterior descending artery graft was superior,and the postoperative concentration of troponin T decreased rapidly in the AS group,compared with the AA group(P<0.05).Compared with total intravenous anesthesia,sevoflurane resulted in a significantly higher global longitudinal strain,stroke volume,and cardiac output.Sevoflurane also led to an amelioration in the condition of the arterial graft.Furthermore,sevoflurane significantly reduced strain improvement in the segmental myocardium with a high preoperative strain value.The findings need to be replicated in larger studies.

Impact of propofol and sevoflurane anesthesia on cognition and emotion in gastric cancer patients undergoing radical resection

BACKGROUND Propofol and sevoflurane are commonly used anesthetic agents for maintenance anesthesia during radical resection of gastric cancer.However,there is a debate concerning their differential effects on cognitive function,anxiety,and depression in patients undergoing this procedure.AIM To compare the effects of propofol and sevoflurane anesthesia on postoperative cognitive function,anxiety,depression,and organ function in patients undergoing radical resection of gastric cancer.METHODS A total of 80 patients were involved in this research.The subjects were divided into two groups:Propofol group and sevoflurane group.The evaluation scale for cognitive function was the Loewenstein occupational therapy cognitive assessment(LOTCA),and anxiety and depression were assessed with the aid of the self-rating anxiety scale(SAS)and self-rating depression scale(SDS).Hemodynamic indicators,oxidative stress levels,and pulmonary function were also measured.RESULTS The LOTCA score at 1 d after surgery was significantly lower in the propofol group than in the sevoflurane group.Additionally,the SAS and SDS scores of the sevoflurane group were significantly lower than those of the propofol group.The sevoflurane group showed greater stability in heart rate as well as the mean arterial pressure compared to the propofol group.Moreover,the sevoflurane group displayed better pulmonary function and less lung injury than the propofol group.CONCLUSION Both propofol and sevoflurane could be utilized as maintenance anesthesia during radical resection of gastric cancer.Propofol anesthesia has a minimal effect on patients'pulmonary function,consequently enhancing their postoperative recovery.Sevoflurane anesthesia causes less impairment on patients'cognitive function and mitigates negative emotions,leading to an improved postoperative mental state.Therefore,the selection of anesthetic agents should be based on the individual patient's specific circumstances.

Effects of Sevoflurane and Propofol on Neurological Recovery of Traumatic Brain Injury Patients in the Early Postoperative Stage: A Retrospective Cohort Study

Objective To investigate the effects of propofol and sevoflurane on neurological recovery of traumatic brain injury(TBI)patients in the early postoperative stage.Methods We retrospectively analyzed the clinical data of TBI patients who underwent craniotomy or decompressive craniectomy.Generalized additive mixed model(GAMM)was used to analyze effects of propofol and sevoflurane on Glasgow Coma Scale(GCS)on postoperative days 1,3,and 7.Multivariate regression analysis was used to analyze effects of the two anesthetics on Glasgow Outcome Scale(GOS)at discharge.Results A total of 340 TBI patients were enrolled in this study.There were 110 TBI patients who underwent craniotomy including 75 in the propofol group and 35 in the sevoflurane group,and 134 patients who underwent decompressive craniectomy including 63 in the propofol group and 71 in the sevoflurane group.It showed no significant difference in GCS at admission between the propofol and the sevoflurane groups among craniotomy patients(β=0.75,95%CI:-0.55 to 2.05,P=0.260).However,elevation in GCS from baseline was 1.73 points(95%CI:-2.81 to-0.66,P=0.002)less in the sevoflurane group than that in the propofol group on postoperative day 1,2.03 points(95%CI:-3.14 to-0.91,P 0.001)less on day 3,and 1.31 points(95%CI:-2.43 to-0.19,P=0.022)less on day 7.The risk of unfavorable GOS(GOS 1,2,and 3)at discharge was higher in the sevoflurane group(OR=4.93,95%CI:1.05 to 23.03,P=0.043).No significant difference was observed among two-group decompressive craniectomy patients in GCS and GOS.Conclusions Compared to propofol,sevoflurane was associated with worse neurological recovery during the hospital stay in TBI patients undergoing craniotomy.This difference was not detected in TBI patients undergoing decompressive craniectomy.

Sevoflurane Preconditioning and Total Knee Arthroplasty Bleeding: Randomized Controlled Trial

Background: Total knee arthroplasty (TKA) is a highly complex and effective surgery even though its perioperative bleeding may increase the need for blood transfusion and its associated infection risk, cardiovascular overload, increased costs, and mortality. As the tourniquet reduces intraoperative bleeding, it may be associated with postoperative bleeding, venous thrombosis, and distal ischemia. The reperfusion may trigger a local and systemic inflammatory response. Anesthetic preconditioning (APC) with sevoflurane minimizes ischemia-reperfusion syndrome (IRS). This study evaluated the effects of APC with sevoflurane on perioperative bleeding in TKA. Methods: We allocated 30 patients into two groups: a sevo group (sevoflurane 2% for 15 minutes before the tourniquet) and a control group (propofol infusion). Laboratory tests were collected right before the tourniquet (LAB PRE, in the operating room) and after its release at four moments: LAB POST (immediately after), LAB 2 (two hours after), LAB 12 (12 hours after), and LAB 24 (24 hours after). The volume of the suction drain was measured at one, two, 12, and 24 hours after the end of the surgery. Antifibrinolytics were not administered. Results: There was no statistically significant difference in bleeding-related variables, such as drained volume and hemoglobin and hematocrit measurements. Drainage volume was higher in the first two hours after the procedure, while hematocrit decreased pre- to postoperatively and between two and 12 hours post-procedure. Conclusion: Sevoflurane as an anesthetic preconditioning did not reduce postoperative bleeding in TKA surgery.

Does sevoflurane sedation in pediatric patients lead to“pseudo”leptomeningeal enhancement in the brain on 3 Tesla magnetic resonance imaging?

BACKGROUND Prominent leptomeningeal contrast enhancement(LMCE)in the brain is observed in some pediatric patients during sedation for imaging.However,based on clinical history and cerebrospinal fluid analysis,the patients are not acutely ill and do not exhibit meningeal signs.Our study determined whether sevoflurane inhalation in pediatric patients led to this pattern of‘pseudo’LMCE(pLMCE)on 3 Tesla magnetic resonance imaging(MRI).AIM To highlight the significance of pLMCE in pediatric patients undergoing enhanced brain MRI under sedation to avoid misinterpretation in reports.METHODS A retrospective cross-sectional evaluation of pediatric patients between 0-8 years of age was conducted.The patients underwent enhanced brain MRI under inhaled sevoflurane.The LMCE grade was determined by two radiologists,and interobserver variability of the grade was calculated using Cohen’s kappa.The LMCE grade was correlated with duration of sedation,age and weight using the Spearman rho rank correlation.RESULTS A total of 63 patients were included.Fourteen(22.2%)cases showed mild LMCE,48(76.1%)cases showed moderate LMCE,and 1 case(1.6%)showed severe LMCE.We found substantial agreement between the two radiologists in detection of pLMCE on post-contrast T1 imaging(kappa value=0.61;P<0.001).Additionally,we found statistically significant inverse and moderate correlations between patient weight and age.There was no correlation between duration of sedation and pLMCE.CONCLUSION pLMCE is relatively common on post-contrast spin echo T1-weighted MRI of pediatric patients sedated by sevoflurane due to their fragile and immature vasculature.It should not be misinterpreted for meningeal pathology.Knowing pertinent clinical history of the child is an essential prerequisite to avoid radiological overcalling and the subsequent burden of additional investigations.

Protective effect of sevoflurane on lung function of elderly chronic obstructive pulmonary disease patients undergoing total hip arthroplasty

BACKGROUND Chronic obstructive pulmonary disease(COPD)is a common respiratory disorder that affects the elderly population and increases the risk of postoperative pulmonary complications(PPCs)after major surgeries.Sevoflurane is a volatile anesthetic that has been shown to have anti-inflammatory and antioxidant properties and attenuate lung injury in animal models.AIM To evaluate the protective effect of sevoflurane on the lung function of elderly COPD patients undergoing total hip arthroplasty(THA).METHODS In this randomized controlled trial,we randomly assigned 120 elderly patients with COPD,who were scheduled for THA,to receive either sevoflurane(sevoflurane group)or propofol(propofol group)as the maintenance anesthetic.The primary outcome was the incidence of PPCs within seven days after surgery.The secondary outcomes were changes in the lung function parameters,inflammatory markers,oxidative stress markers,and postoperative pain scores.RESULTS The results showed that the incidence of PPCs was significantly lower in the sevoflurane group than in the propofol group(10%vs 25%,P=0.02).Furthermore,the decline in the forced expiratory volume in 1 s,forced vital capacity,and peak expiratory flow was significantly lesser in the sevoflurane group than in the propofol group at 24 h and 48 h after surgery(P<0.05).The interleukin-6,tumor necrosis factor-alpha,malondialdehyde,and 8-hydroxy-2α-deoxyguanosine levels were significantly lower in the sevoflurane group than in the propofol group at 24 h after surgery(P<0.05).The sevoflurane group showed significantly lower postoperative pain scores than the propofol group at 6 h,12 h,and 24 h after surgery(P<0.05).CONCLUSION Sevoflurane protects the lung function of elderly COPD patients undergoing THA under general anesthesia by reducing the incidence of PPCs,attenuating inflammatory and oxidative stress responses,and alleviating postoperative pain.

Effect of sevoflurane preconditioning on astrocytic dynamics and neural network formation after cerebral ischemia and reperfusion in rats

Astrocytes, the major component of blood-brain barriers, have presented paradoxical profiles after cerebral ischemia and reperfusion in vivo and in vitro. Our previous study showed that sevoflurane preconditioning improved the integrity of blood-brain barriers after ischemia and reperfusion injury in rats. This led us to investigate the effects of sevoflurane preconditioning on the astrocytic dynamics in ischemia and reperfusion rats, in order to explore astrocytic cell-based mechanisms of sevoflurane preconditioning. In the present study, 2,3,5-triphenyltetrazolium chloride staining and Garcia behavioral scores were utilized to evaluate cerebral infarction and neurological outcome from day 1 to day 3 after transient middle cerebral artery occlusion surgery. Using immunofluorescent staining, we found that sevoflurane preconditioning substantially promoted the astrocytic activation and migration from the penumbra to the infarct with microglial activation from day 3 after middle cerebral artery occlusion. The formation of astrocytic scaffolds facilitated neuroblasts migrating from the subventricular zone to the lesion sites on day 14 after injury. Neural networks increased in the infarct of sevoflurane preconditioned rats, consistent with decreased infarct volume and improved neurological scores after ischemia and reperfusion injury. These findings demonstrate that sevoflurane preconditioning confers neuroprotection, not only by accelerating astrocytic spatial and temporal dynamics, but also providing astrocytic scaffolds for neuroblasts migration to ischemic regions, which facilitates neural reconstruction after brain ischemia.

Sevoflurane plays a reduced role in cognitive impairment compared with isoflurane: limited effect on fear memory retention

Isoflurane and sevoflurane are both inhalation anesthetics,but in clinical application,sevoflurane has been considered to be less suitable for long-term anesthesia because of its catabolic compounds and potential nephrotoxicity.Nevertheless,recent studies have shown that these two inhalation anesthetics are similar in hepatorenal toxicity,cost,and long-term anesthetic effect.Moreover,sevoflurane possibly has less cognitive impact on young mice.In this study,C57BL/6 mice aged 8–10 weeks were exposed to 1.2%isoflurane or 2.4%sevoflurane for 6 hours.Cognitive function and memory were examined in young mice using the novel object recognition,contextual fear conditioning,and cued-fear extinction tests.Western blot assay was performed to detect expression levels of D1 dopamine receptor,catechol-O-methyltransferase,phospho-glycogen synthase kinase-3β,and total glycogen synthase kinase-3βin the hippocampus.Our results show that impaired performance was not detected in mice exposed to sevoflurane during the novel object recognition test.Contextual memory impairment in the fear conditioning test was shorter in the sevoflurane group than the isoflurane group.Long-term sevoflurane exposure did not affect memory consolidation,while isoflurane led to memory consolidation and reduced retention.Downregulation of hippocampal D1 dopamine receptors and phosphorylated glycogen synthase kinase-3β/total glycogen synthase kinase-3βand upregulation of catechol-O-methyltransferase may be associated with differing memory performance after exposure to isoflurane or sevoflurane.These results confirm that sevoflurane has less effect on cognitive impairment than isoflurane,which may be related to expression of D1 dopamine receptors and catechol-O-methyltransferase and phosphorylation of glycogen synthase kinase-3βin the hippocampus.This study was approved by the Institutional Animal Care and Use Committee,Nanjing University,China on November 20,2017(approval No.20171102).

Effect of sevoflurane on tissue permeability of lung ischemia-reperfusion injury in rats

Objective:To investigate the effect of sevoflurane on tissue permeability of lung ischemiareperfusion injury(LIRI)in rats.Methods:A total of 45 wistar rats were randomly divided into3 groupsⅠ,Ⅱ,Ⅲ.Modified Eppinger method was adopted to establish the rat lung ischemiareperfusion injury model.GroupⅠserved as the control group,groupⅡas ischemia reperfusion group,groupⅢas sevoflurane ischemia-reperfusion group.Blood gas index,lung permeability index(LPI)change,lung tissue pathology change and lung water content were observed and compared between groups of rats at different time points.Results:During ischemia reperfusion,all rats kept balance of the MAP during different time points,SPO_2 of groupⅡandⅢdecreased significantly thanⅠgroup(P<0.05);after reperfusion lung permeability index in GroupⅡandⅢwas higher than the control group significantly(P<0.05),120 min after reperfusion LPI change and iujury of groupⅢwas significantly lower thanⅡgroup(P<0.05);interstitial and alveolar cavity effusion in of groupⅢwere lower than that of groupⅡ.Conclusions:Sevoflurane pretreatment can reduce the lung tissue permeability,and LIRI plays a protective role in LIRI.

Preventive effects of sevoflurane treatment on lung inflammation in rats

Objective:To observe the effects of sevoflurane treatment on lung inflammation in rats with lipopolysaccharide-induced acute lung injury(ALI).Methods:The rat model of ALI was established by intratracheal instillation of lipopolysaccharide(LPS).45 infantile SD rats[body weight(272±15) g]were randomly divided into 3 groups(n=15):control group,LPS group, sevoflurane group.NS(1 mL/kg) was instillated in rats’airways of control group;LPS(5 mg/ kg) was instillated in rats’airways of LPS group.Sevoflurane group rats received sevoflurane (2.4%) inhalation for a hour after LPS was instillated in rats’airways.Six hours after NS or LPS instillation,all rats were exsanguinated.Lung tissues were examined by HE staining.Expressions of TNF-αand ICAM1 mRNA were detected by semiquantitative RT-PCR techniques.The protein level of TNF-αand ICAM1 were assessed by western blot techniques.Results:In LPS group the permeability of lung tissues increased,organizational structure severely damaged and the alveolar wall turned thick,with interstitial edema and Europhiles infiltrated increasingly.The LPS group had higher mRNA expressions of TNF-αand ICAM1 than control group and sevoflurane group (P【0.05),and LPS group had higher protein level of TNF-αand ICAMI than control group and sevoflurane group(P【0.05).Conclusions:Sevoflurane treatment can attenuate lung inflammation in rats with lipopolysaccharide-induced acute lung injury.

Sevoflurane pretreatment inhibits the myocardial apoptosis caused by hypoxia reoxygenation through AMPK pathway:An experimental study

Objective:To study whether sevoflurane pretreatment inhibits the myocardial apoptosis caused by hypoxia reoxygenation through AMPK pathway.Methods:H9c2 myocardial cell lines were cultured and divided into control group(C group),hypoxia reoxygenation group(H/R group),sevoflurane pretreatment+hypoxia reoxygenation group(SP group) and sevoflurane combined with Compound C pretreatment+hypoxia reoxygenation group(ComC group),and the cell proliferation activity and apoptosis rate,myocardial enzyme levels in culture medium as well as the expression of apoptosis genes and p-AMPK in cells were determined.Results:p-AMPK expression in cells of H/R group was significantly lower than that of C group,SP group was significantly higher than that of H/R group;cell proliferation activity value and Bcl-2 expression in cells of H/R group were significantly lower than those of C group,SP group were significantly higher than those of H/R group,Com C group were significantly lower than those of SP group;apoptosis rate,LDH,CK and AST levels as well as the Bax and Caspase-3 expression in cells of H/R group were significantly higher than those of C group,SP group were significantly lower than those of H/R group,ComC group were significantly higher than those of SP group.Conclusions:Sevoflurane pretreatment can activate AMPK signaling pathway to inhibit the myocardial apoptosis caused by hypoxia reoxygenation.

Enriched environment for offspring improves learning and memory impairments induced by sevoflurane exposure during the second trimester of pregnancy

Studies in animals indicate that sevoflurane exposure in the second trimester of pregnancy has harmful effects on the learning and memory of offspring.Whether an enriched environment can reverse the damage of sevoflurane exposure in the second trimester of pregnancy on the learning and memory of rat offspring remains unclear.In this study,rats at 14 days of pregnancy were exposed to 3.5%sevoflurane for 2 hours and their offspring were treated with an enriched environment for 20 successive days.We found that the enriched environment for offspring increased nestin and Ki67 levels in hippocampal tissue,increased hippocampal neurogenesis,inhibited glycogen synthase kinase 3βactivity,and increased the expression of cell proliferation-relatedβ-catenin and apoptosis-related Bcl-2,indicating that an enriched environment reduces sevoflurane-induced damage by increasing the proliferation of stem cells in the hippocampus.These findings suggest that an enriched environment can reverse the effects of sevoflurane inhaled by rats during the second trimester of pregnancy on learning and memory of offspring.This study was approved by the Animal Ethics Committee of Shengjing Hospital of China Medical University(approval No.2018PS07K)on January 2,2018.

Combined sevoflurane-dexmedetomidine and nerve blockade on post-surgical serum oxidative stress biomarker levels in thyroid cancer patients

BACKGROUND The incidence of thyroid cancer is increasing annually.Clinical routine thyroid surgery can be performed under a cervical plexus block,but cannot mediate the stress response during the surgery.If thyroid surgery is performed under nerve block,an inappropriate level of blockade may occur.Similarly,the stress response caused by surgery is more serious than that caused by conventional anesthesia.Therefore,it is important to combine blockade with more effective anesthesia methods.AIM To investigate the effects of combining sevoflurane-dexmedetomidine inhalation general anesthesia with the cervical plexus nerve block on the post-surgical levels of the serum oxidative stress biomarkers levels in thyroid cancer patients.METHODS We enrolled 96 thyroid cancer patients admitted to the hospital between January 2019 and December 2020.Participants were divided into a control group(n=47)and an experimental group(n=49).The experimental group received a combination of inhaled sevoflurane-dexmedetomidine and cervical plexus block,while the control group received conventional general anesthesia.The groups were compared for serum levels of monocyte chemotactic protein-1(MCP-1)and glutathione peroxidase(GSH-Px)before and after surgery,and the adrenocorticotropic hormone(ACTH)and norepinephrine(NE)levels at 1 and 12 h postsurgery.The Bispectral index(BIS)and the incidence of anesthesia side effects were also compared.RESULTS Following surgery,MCP-1 was significantly lower in the experimental group compared to the control group,whereas GSH-Px was significantly higher than that in the control group(P<0.001).The serum ACTH and NE levels were significantly lower in the experimental group than those the control group at 1 and 12 h post-surgery(P<0.001).BIS was significantly lower in the experimental group than that in the control group at 20 minutes into the operation,but the direction of the difference was reversed at eye opening(P<0.001).The incidence of side effects was 10.20%(5/49)and 12.76%(6/47)in the experimental and control groups,respectively,the difference being non-significant.CONCLUSION Sevoflurane-dexmedetomidine inhalation general anesthesia combined with cervical plexus nerve block can reduce the postoperative stress and inflammatory responses in thyroid cancer patients,while maintaining high anesthesia effectiveness and safety.

Application value of sevoflurane light general anesthesia via laryngeal mask airway combined with brachial plexus block for children with upper limb fractures

Objective:To study the application value of sevoflurane light general anesthesia via laryngeal mask airway combined with brachial plexus block for children with upper limb fractures. Methods:Children who underwent upper limb fracture surgery in the First Women and Children's Hospital of Huizhou between June 2014 and April 2017 were selected as the research subjects and randomly divided into the combined group who accepted sevoflurane light general anesthesia via laryngeal mask airway combined with brachial plexus block and the control group who accepted sevoflurane light general anesthesia via laryngeal mask airway. The contents of inflammatory cytokines IL-1β, TNF-α, CRP, IL-10 and TGF-β as well as stress hormones FC, Ins, NE and E in serum were determined the same day and 3 days after operation.Results: The same day and 3 days after operation, the contents of IL-1β, TNF-α, CRP, IL-10, TGF-β, FC, Ins, NE and E in serum of combined group were significantly lower than those of control group.Conclusion: Sevoflurane light general anesthesia via laryngeal mask airway combined with brachial plexus block is more effective than sevoflurane light general anesthesia via laryngeal mask airway to suppress the inflammatory stress response in children with upper limb fracture surgery.

Continuous Rocuronium Administration Method Based on Pharmacokinetic/Pharmacodynamics Model during Propofol, Sevoflurane, and Desflurane Anesthesia

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.

Prospective, Randomized Comparisons of Induction of Anesthesia with Ketamine, Propofol and Sevoflurane for Quality of Recovery from Short Sevoflurane Anesthesia in Pediatric Patients

Background: Emergence agitation (EA) after sevoflurane anesthesia is common in children. When rapid intravenous induction of general anesthesia is indicated in a brief procedure, the induction agent can reduce the incidence of EA after sevoflurane anesthesia. The aim of this study was to compare the efficacy of intravenous induction with ketamine and propofol for reducing EA in children after short sevoflurane anesthesia. Methods: Children aged 2 to 6 years who were scheduled to undergo inguinal hernia repair were randomly divided into 3 groups to receive 2 mg/kg ketamine iv, 3 mg/kg propofol iv, or inspired concentration of 8% sevoflurane for induction of anesthesia. After a laryngeal mask airway (LMA) insertion, a caudal block was performed in all children. Anesthesia was maintained with 1.5% sevoflurane and 65% nitrous oxide in oxygen with spontaneous ventilation. The recovery characteristics were recorded and EA were evaluated by using the Pediatric Anesthesia Emergence Delirium (PAED) scale. Results: One hundred and twenty children were enrolled and randomized to treatment. Children who received ketamine induction had higher incidence of EA than those who received propofol (42% vs 16%, P < 0.05) and showed delayed recovery (32 ± 9 min) as compared with those who received propofol or sevoflurane (22 ± 8 min and 20 ± 7 min, respectively, P < 0.05). The mean peak PAED score was significantly lower in children who received propofol induction (6.8 ± 4.0, P < 0.05) than ketamine (11.8 ± 4.1) or sevoflurane (11.6 ± 3.8). Conclusions: Intravenous induction with ketamine does not prevent the incidence of EA and delays recovery. Induction with propofol improves the quality of recovery by reducing the incidence of EA and provides a safe and early recovery.

Sevoflurane pretconditioning has similar effects as sevoflurane postconditioning to attenuate transient outward potassium channel current suppression after ischemia reperfusion injury

Objective To investigate the effects of sevoflurane preconditioning and postconditioning on electrophysiological characteristics of transient outward potassium channel(Ito)in rat ventricular myocytes.Methods Isolated rat hearts were harvested and balanced with Langendorff perfusion system,then they were randomly assigned to one of the following 4 groups(n=10):(1)Time Control group(perfused with KH solution for 75 min);(2)Ischemia/reperfusion(I/R)group(perfused with KH solution for 20 min and then subjected to 25 min of global ischemia followed by 30 min of reperfusion with KH solution).

Sevoflurane preconditioning and postconditioning attenuate apoptosis induced by ischemia-reperfusion in rat lung

Objective To investigate the effect of sevoflurane preconditioning and postconditioning on lung ischemia-reperfusion(IR) injury and apoptosis in rat.Methods Wistar rats were randomly assigned to four groups:sham group(n =6):no ischaemia-reperfusion;IR group(n =6):left lung ischemia was achieved by clamping the hilum for 90 min,followed by 120 min reperfusion;sev+pre group(n =6):1 minimum alveolar concentration(MAC) sevoflurane was admi-nistered for 30 min prior to ischemia;sev+post group(n =6):ischemia was followed by 1 MAC sevoflurane postconditioning at the first 30 min reperfusion.PaO2 was measured after reperfusion.The number of apoptotic cells was estimated using the terminal deoxynucleotidyl transferase-mediated dUTP-biotin nick-end labeling(TUNEL) technique.Results After ischemia-reperfusion,a significant deterioration of PaO2 was noticed and the number of apoptotic cells remarkably increased compared with that of sham group.In sev+pre group and sev+post group,PaO2 was(85.7±14.4) mmHg and(88.6±12.5) mmHg respectively,which was apparently increased compared with that in IR group [(63.9±11.3) mmHg,P <0.05].The number of apoptotic cells in sev+pre group [(6.94 ± 1.49)%] and sev+post group [(7.69 ± 1.61)%] was significantly lower than that in IR group [(12.12 ± 2.77)%,P <0.05].But all parameters showed no significant difference between sev+pre group and sev+post group.Conclusions Both sevoflurane preconditioning and postconditioning could prevent lung ischemia-reperfusion injury and attenuate apoptosis in rat.

Effect of sevoflurane inhalation and general anesthesia on serum IL-6 and S100β levels and coagulation function in elderly patients undergoing total hip replacement

Objective:To investigate the effects of sevoflurane inhalation general anesthesia on serum IL-6,brain injury protein S100βand coagulation function in elderly patients undergoing total hip arthroplasty.Method:From May 2017 to May 2019,84 patients,age 60-75 underwent total hip arthroplasty in our hospital.were randomly divided into two groups:group A(n=42)and group B(n=42).Group A was maintained with sevoflurane inhalation by general anesthesia and group B with propofol by intravenous anesthesia.The surgical related indexes and postoperative complications in the two groups were compared.The level of serum IL-6,S100β,Coagulation function index[platelet count(PLT),Fibrinogen(FIB),plasma D-dimer(D-D),activated partial enzyme activity time(APTT),prothrombin time(PT)],MMSE score and MoCA score were compared between two groups before and after operation.Results:There was no significant difference in anesthesia time,operation time,intraoperative bleeding and postoperative drainage(P>0.05).1h,1d and 7d after operation,the level of PLT,D-D and FIB in group A were significantly lower than that in group B(P<0.05),PT and APTT were significantly higher than that in group B(P<0.05).1h,1d and 7d after operation,the level of IL-6,S100βin group A were significantly lower than that in group B(P<0.05).1d after operation,the MMSE and MoCA scores in group B were significantly lower than those in group A(P<0.05).The incidence of lower extremity deep venous thrombosis(2.38%)and cognitive impairment(2.38%)in group A was lower than that in group B(14.29%,16.67%)(t1=3.896,P1=0.048;t2=4.974,P2=0.026).Conclusion:sevoflurane anesthesia can reduce the incidence of deep venous thrombosis and cognitive impairment of the lower extremity after operation in elderly patients with thr,stabilize the coagulation index of patients,and downregulate the expression of il-6 and S100β.

Differences of Heart Rate Variability during Sevoflurane Anesthesia in Children by Age

Background: The child’s central nervous system develops with aging, and heart rate variability (HRV), which is con-trolled by the brain, differs from that of adults. We investigated changes in HRV during sevoflurane anesthesia in children. Methods: One 138 children aged from 2 - 12 years without major underlying problems were enrolled. During maintenance with 2 - 2.5 vol% sevoflurane anesthesia, electrocardiographic data were obtained and power spectral analysis, approximate entropy (ApEn) or Hurst exponent were analyzed and compared in three groups (age 2 - 5 years, 6 - 9 and 10 - 12 years of age). Results: The RR interval increased with aging, but low-frequency powers did not. High- frequency power was greater in the oldest children (P < 0.05), while ApEn and Hurst exponents were lower (P < 0.05). Conclusion: Change in HRV is one of the characteristics of development in children.