Comparison of postoperative pain in children after maintenance anaesthesia with propofol or sevoflurane: a systematic review and meta-analysis.
British journal of anaesthesia
BACKGROUND:Propofol and sevoflurane are two of the most commonly used anaesthetics for paediatric surgery. Data from some clinical trials suggest that postoperative pain incidence is lower when propofol is used for maintenance of anaesthesia compared with sevoflurane, although this is not clear. METHODS:This meta-analysis compared postoperative pain following maintenance of anaesthesia with propofol or sevoflurane in paediatric surgeries. PubMed Medline, Embase, Scopus, Web of Science and Cochrane Library were searched for randomised controlled trials (RCTs) that compared postoperative pain between sevoflurane and propofol anaesthesia in children. After quality assessment, a meta-analysis was carried out using bias-adjusted inverse heterogeneity methods, heterogeneity using I and publication bias using Doi plots. RESULTS:In total, 13 RCTs with 1174 children were included. The overall synthesis suggested nearly two-fold higher odds of overall postoperative pain in the sevoflurane group compared with the propofol group (odds ratio [OR] 1.88, 95% confidence interval [CI] 1.12-3.15, I=58.2%). Further, children in the sevoflurane group had higher odds of having higher pain scores (OR 3.18, 95% CI 1.83-5.53, I=20.9%), and a 60% increase in the odds of requiring postoperative rescue analgesia compared with propofol (OR 1.60, 95% CI 0.89-2.88, I=58.2%). CONCLUSIONS:Children maintained on inhalational sevoflurane had higher odds of postoperative pain compared with those maintained on propofol. The results also suggest that sevoflurane is associated with higher odds of needing postoperative rescue analgesia compared with propofol. REGISTRATION:The protocol for this systematic review and meta-analysis was registered on the International Prospective Register of Systematic Reviews (PROSPERO) with registration ID CRD42023445913.
10.1016/j.bja.2024.03.022
Effect of Sevoflurane on the Deep Neuromuscular Blockade in Obese Patients Undergoing Laparoscopic Sleeve Gastrectomy: A Single Center Prospective Randomized Controlled Study.
Drug design, development and therapy
Objective:Our study aimed to demonstrate that the combination of sevoflurane inhalation with continuous intravenous anesthesia can effectively reduce the dosage of muscle relaxants, shorten extubation time under anesthesia while meeting the requirements of laparoscopic deep neuromuscular block (dNMB) in obese patients. Additionally, we sought to assess the potential reduction in postoperative residual muscle relaxants. Methods:Fifty-nine patients were randomly assigned. Anesthesia-related variables, such as anesthetics dosages, muscle relaxant effective time, clinical muscle relaxant time, muscle relaxant in vivo action time, muscle relaxant recovery time, body movement times, and extubation duration were recorded. Surgery-related variables (the Leiden-Surgical Rating Scale (L-SRS), duration of the procedure) were recorded. Pain was measured using the visual analog scale (VAS) score before leaving the PACU. The duration of the PACU stay and patients' satisfaction levels in the PACU were also recorded. Results:Patients who inhaled sevoflurane during the operation required a lower dosage of muscle relaxant to achieve the same deep neuromuscular block (dNMB) effect. The time from stopping the rocuronium pump to T1 recovery of 90% was shorter, and the time for T1 to recover from 25% to 75% was faster among patients who inhaled sevoflurane during the operation. Furthermore, the sevoflurane combined with continuous intravenous anesthesia group exhibited a shorter extubation time for obese patients undergoing laparoscopic bariatric surgery, along with a reduced risk of experiencing hypoxemia and a shorter observation time in the PACU. Conclusion:Inhaling sevoflurane combined with continuous intravenous anesthesia during the operation effectively reduces the dosage of muscle relaxant required to achieve the same deep neuromuscular block (dNMB) effect. Additionally, this approach significantly shortens the extubation time for obese patients undergoing laparoscopic bariatric surgery and reduces the risk of experiencing hypoxemia, along with reducing the observation time in the PACU.
10.2147/DDDT.S413535
Consciousness and General Anesthesia: Challenges for Measuring the Depth of Anesthesia.
Anesthesiology
The optimal consciousness level required for general anesthesia with surgery is unclear, but in existing practice, anesthetic oblivion, may be incomplete. This article discusses the concept of consciousness, how it is altered by anesthetics, the challenges for assessing consciousness, currently used technologies for assessing anesthesia levels, and future research directions. Wakefulness is marked by a subjective experience of existence (consciousness), perception of input from the body or the environment (connectedness), the ability for volitional responsiveness, and a sense of continuity in time. Anesthetic drugs may selectively impair some of these components without complete extinction of the subjective experience of existence. In agreement with Sanders et al. (2012), the authors propose that a state of disconnected consciousness is the optimal level of anesthesia, as it likely avoids both awareness and the possible dangers of oversedation. However, at present, there are no reliably tested indices that can discriminate between connected consciousness, disconnected consciousness, and complete unconsciousness.
10.1097/ALN.0000000000004830
The influence of moderate or deep neuromuscular block status on anesthetic depth monitoring system during total intravenous anesthesia using propofol and remifentanil: A randomized trial.
Science progress
The neuromuscular block state may affect the electroencephalogram-derived index representing the anesthetic depth. We applied an Anesthetic Depth Monitoring for Sedation (ADMS) to patients undergoing laparoscopic cholecystectomy under total intravenous anesthesia, and evaluated the requirement of propofol according to the different neuromuscular block state. Adult patients scheduled to undergo laparoscopic cholecystectomy were enrolled and randomly assigned to either the moderate (MB) or deep neuromuscular block (DB) group. The UniCon sensor of ADMS was applied to monitor anesthetic depth and the unicon value was maintained between 40 and 50 during the operation. According to the group assignment, intraoperative rocuronium was administered to maintain proper neuromuscular block state, moderate or deep block state. The unicon value, electromyography (EMG) index, and total dose of propofol and rocuronium were analyzed. At similar anesthetic depth, less propofol was used in the DB group compared to the MB group (6.19 ± 1.36 in the MB mg/kg/h group vs 4.93 ± 3.02 mg/kg/h in the DM group, = 0.042). As expected, more rocuronium were used in the DB group than in the MB group (0.8 ± 0.2 mg/kg in the MB group vs 1.2 ± 0.2 mg/kg in the DB group, = 0.023) and the EMG indices were lower in the DB group than in the MB group, at several time points as follows: at starting operation ( < 0.001); at 15 ( = 0.019), 45 ( = 0.011), and 60 min ( < 0.001) after the initiation of the operation; at the end of operation ( = 0.003); and at 5 min after the administration of sugammadex ( < 0.001). At similar anesthetic depth, patients under the deep neuromuscular block state required less propofol with lower intraoperative EMG indices compared to those under the moderate neuromuscular block state during general anesthesia.
10.1177/00368504211010629
[Slowing down of the EEG during hypoventilation in emergence from anesthesia].
Schultz B,Schultz A,Plein S,Eckert O,Pichlmayr I
Der Anaesthesist
Electroencephalographic (EEG) recordings were made using a "Narkograph", which performs an automatic on-line interpretation of electroencephalographic data obtained during anesthesia. The EEG was classified into one of 13 stages from A (awake) to F (very deep narcosis). In 20 of roughly 600 patients EEG changes were observed that could not be explained by the effects of anesthetics. Slowing of the EEG occurred during the transition from controlled to spontaneous ventilation and disappeared after minute ventilation increased. The alterations seen during hypoventilation were similar to the effects of hypoxia described in the literature. During the slowing in the rough EEG, waves appeared that were very regularly formed and corresponded to sharp peaks in the power spectrum. These features are rather atypical of the effects of anesthetics such as thiopental, propofol, halothane, isoflurane, and enflurane and were not observed when patients went back to sleep after extubation. If depth of anesthesia is monitored by EEG recording, clinical circumstances should be taken into account because conditions such as hypoxia may cause alterations of the EEG that bear a resemblance to the effects of anesthetics.
Impact of depth of propofol anaesthesia on functional residual capacity and ventilation distribution in healthy preschool children.
von Ungern-Sternberg B S,Frei F J,Hammer J,Schibler A,Doerig R,Erb T O
British journal of anaesthesia
BACKGROUND:Propofol is commonly used in children undergoing diagnostic interventions under anaesthesia or deep sedation. Because hypoxaemia is the most common cause of critical deterioration during anaesthesia and sedation, improved understanding of the effects of anaesthetics on pulmonary function is essential. The aim of this study was to determine the effect of different levels of propofol anaesthesia on functional residual capacity (FRC) and ventilation distribution. METHODS:In 20 children without cardiopulmonary disease mean age (SD) 49.75 (13.3) months and mean weight (SD) 17.5 (3.9) kg, anaesthesia was induced by a bolus of i.v. propofol 2 mg kg(-1) followed by an infusion of propofol 120 microg kg(-1) min(-1) (level I). Then, a bolus of propofol 1 mg kg(-1) was given followed by a propofol infusion at 240 microg kg(-1) min(-1) (level II). FRC and lung clearance index (LCI) were calculated at each level of anaesthesia using multibreath analysis. RESULTS:The FRC mean (SD) decreased from 20.7 (3.3) ml kg(-1) at anaesthesia level I to 17.7 (3.9) ml kg(-1) at level II (P < 0.0001). At the same time, mean (SD) LCI increased from 10.4 (1.1) to 11.9 (2.2) (P = 0.0038), whereas bispectral index score values decreased from mean (SD) 57.5 (7.2) to 35.5 (5.9) (P < 0.0001). CONCLUSIONS:Propofol elicited a deeper level of anaesthesia that led to a significant decrease of the FRC whereas at the same time the LCI, an index for ventilation distribution, increased indicating an increased vulnerability to hypoxaemia.
10.1093/bja/aem002
Effects of propofol on cancer development and chemotherapy: Potential mechanisms.
Jiang Sufang,Liu Ya,Huang Lining,Zhang Fuzhen,Kang Rongtian
European journal of pharmacology
Propofol (2, 6-diisopropylphenol) is the commonly used intravenous sedative-hypnotic agent. Accumulating evidence shows that propofol affects cancer development by direct and indirect ways. In this review, we will provide an overview of the effects of propofol on cancer development and chemotherapy, with a special focus on the underlying molecular mechanisms involved. Propofol regulates both microRNAs (miRNAs) and long non-coding RNAs (lncRNAs), and serves as a regulator of different signaling pathways including hypoxia-inducible factor-1α (HIF-1α), mitogen-activated protein kinase (MAPK), nuclear factor-kappaB (NF-κB), and nuclear factor E2-related factor-2 (Nrf2) pathways. In addition, propofol modulates host immune function. Possible correlation between propofol and cancer should be verified in further studies, including animal trials and prospective clinical studies.
10.1016/j.ejphar.2018.04.009
The Influences and Mechanisms of High-altitude Hypoxia Exposure on Drug Metabolism.
Current drug metabolism
BACKGROUND:The special environment of high-altitude hypoxia not only changes the physiological state of the body but also affects the metabolic process of many drugs, which may affect the safety and efficacy of these drugs. The number of drugs is huge, so it is not wise to blindly repeat the pharmacokinetic studies of all of them on the plateau. Mastering the law of drug metabolism on the plateau is conducive to the comprehensive development of rational drug use on the plateau. Therefore, it is very important to determine the impacts and elucidate the mechanism of drug metabolism in hypobaric hypoxia conditions. METHODS:In this review, we searched published studies on changes in drug metabolism in hypoxia conditions to summarize and analyze the mechanisms by which hypoxia alters drug metabolism. RESULTS:Although the reported effects of high-altitude hypoxia on drug metabolism are sometimes controversial, metabolism kinetics for most of the tested drugs are found to be affected. Mechanism studies showed that the major reasons causing metabolism changes are: regulated drug-metabolizing enzymes expression and activity mediated by HIF-1, nuclear receptors and inflammatory cytokines, and change in direct or indirect effects of intestinal microflora on drug metabolism by itself or the host mediated by microflora-derived drug-metabolizing enzymes, metabolites, and immunoregulation. CONCLUSION:Altered enzyme expression and activity in the liver and altered intestinal microflora are the two major reasons to cause altered drug metabolism in hypoxia conditions.
10.2174/1389200224666221228115526
Oxygen saturation profile in traumatic brain injury animal model after propofol administration.
Narra J
Traumatic brain injury (TBI) is a traumatic that often leads to death due to untreatable cerebral hypoxia, indicated by oxygen saturation of <90%. Cerebral hypoxia is rarely monitored and thereby often overlooked as a cause of mortality and monitoring oxygen saturation is an accurate method to detect the condition. Propofol, an anesthetic agent, is commonly used in the management of TBI; however, its effect on brain tissue and cerebral hypoxia in TBI cases is not well understood. The aim of this study was to evaluate the profile of oxygen saturation in TBI animal model after propofol administration. A laboratory experimental study was conducted, involving 18 male rats (aged 4-8 weeks with weight between 150-200 grams) divided into three different treatment groups (non-TBI, TBI without propofol, and TBI with propofol). Oxygen saturation was measured regularly from day 1 to day 8 using pulse oximetry. The oxygen saturation percentages were compared between the TBI rats with and without propofol administration using independent Student t-rest. The results revealed significant reductions of oxygen saturation levels of animals within propofol-treated TBI group compared to that of the untreated-TBI group (<0.05), with the average oxygen saturation ranging from 80.8%±6.96% vs 86.8%±5.48%. This finding suggests a reducing effect of propofol administration on oxygen saturation levels in rats with TBI and this potentially causes cerebral hypoxia.
10.52225/narra.v3i2.189
Altitude effect on Propofol Pharmacokinetics in Rats.
Current drug metabolism
BACKGROUND:Propofol is an intravenous agent for clinical anesthesia. As the influence of the hypobaric-hypoxic environment (Qinghai-Tibetan region, altitude: 2800-4300 m, PaO2: 15.1-12.4 kPa) on the metabolism of Propofol is complex, the research results on the metabolic characteristics of Propofol in high-altitude areas remain unclear. This study aimed to investigate the pharmacokinetic characteristics of Propofol in a high-altitude hypoxic environment using animal experiments. METHODS:Rats were randomly divided into three groups: high-altitude, medium-altitude, and plain groups. The time of disappearance and recovery of the rat righting reflex was recorded as the time of anesthesia induction and awakening, respectively. The plasma concentration of Propofol was determined by gas chromatography-mass spectrometry. A pharmacokinetic analysis software was used to analyze the blood-drug concentrations and obtain the pharmacokinetic parameters. RESULTS:We observed that when Propofol anesthetizes rats, the anesthesia induction time was shortened, andthe recovery time was prolonged with increased altitude. Compared with the plain group, the clearance ofPropofol decreased, whereas the half-life, area under the concentration-time curve, peak plasma concentration,and average residence time extension increased. CONCLUSION:The pharmacokinetic characteristics of Propofol are significantly altered in high-altitude hypoxic environments.
10.2174/0113892002285571240220131547