scholarly journals Combined inhalational and intravenous anesthesia at surgeries in patients with gastrointestinal cancers

2012 ◽  
Vol 93 (5) ◽  
pp. 728-731
Author(s):  
M I Neimark ◽  
S Z Tanatarov ◽  
T A Adylkhanov
Keyword(s):  
Serum Cortisol ◽  
Gastrointestinal Cancers ◽  
Inhalational Anesthesia ◽  
Intravenous Anesthesia ◽  
Glucose Levels ◽  
Significant Difference ◽  
Circulation Parameters ◽  
Head Of The Pancreas ◽  
Combined Anesthesia ◽  
Central Circulation

Aim. To define efficiency and safety of the combined inhalational and intravenous anesthesia (isoflurane + propofol) in patients operated due to gastrointestinal cancer. Methods. 163 patients who were operated due to gastric cancer (119 patients), cancer of the head of the pancreas (24 patients) and colon cancer (20 patients) were examined. Central circulation parameters, autonomic nervous system status, serum cortisol and glucose levels, bispectral index in patients who underwent inhalational or combined inhalational and intravenous anesthesia were compared. Results. There was no significant difference of the examined parameters in patients who underwent combined inhalational and intravenous anesthesia (isoflurane + propofol) compared to patients in whom only inhalational anesthesia with isoflurane was used. Combination was characterized by less change of the examined parameters compared to baseline levels and prolonged emergence from anesthesia. Conclusion. Combined anesthesia is quite safe and effective if used in oncosurgery.

scholarly journals Does a combined intravenous-volatile anesthesia offer advantages compared to an intravenous or volatile anesthesia alone: a systematic review and meta-analysis

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Alexander Wolf ◽  
Helene Selpien ◽  
Helge Haberl ◽  
Matthias Unterberg
Keyword(s):  
Pain Perception ◽  
Meta Analysis ◽  
Intravenous Anesthesia ◽  
Significant Difference ◽  
Balanced Anesthesia ◽  
Volatile Anesthesia ◽  
Single Use ◽  
Combined Anesthesia ◽  
Early Occurrence ◽  
Dose Dependent

Abstract Background In anesthesia, additive drug interactions are used for reducing dose and dose-dependent side-effects. The combination of propofol with volatile anesthetics is rather unusual but might have advantages compared to the single use regarding PONV, time to extubation, movement during surgery and postoperative pain perception. Methods We searched PubMed, Scopus, Web of Science, and CENTRAL for relevant studies comparing combined intravenous volatile anesthesia with total intravenous or balanced anesthesia. The studies identified were summarized in a meta-analysis with the standardized mean difference or risk ratio as the effect size. Results Ten studies provided data. The risk for PONV in the recovery room was significantly reduced for a combined anesthesia compared to a balanced anesthesia (RR 0.657, CI 0.502–0.860, p-value 0.002). There was no significant difference detected either in the time to extubation or in pain perception. Movement during surgery was significantly reduced for a combined compared to a total intravenous anesthesia (RR 0.241, CI 0.135–0.428, p-value 0.000). Conclusions The combination of propofol and volatiles may have some advantages in the early occurrence of PONV compared to a balanced anesthesia. To sufficiently evaluate potential advantages of a combination of volatiles and propofol further high-quality trials are needed. Trial registration PROSPERO CRD42019126627.

Effects of Total Intravenous Anesthesia with Propofol Versus Inhalational Anesthesia with Sevoflurane on Postoperative Quality of Life and Postoperative Delirium in Patients Undergoing Total Knee Arthroplasty: A Randomized, Controlled, Double-Blinded Clinical Trial

2020 ◽  
Author(s):  
Han Su ◽  
Yuxin Fang ◽  
Guanghong Xu ◽  
Xuesheng Liu
Keyword(s):  
Quality Of Life ◽  
Postoperative Delirium ◽  
Total Intravenous Anesthesia ◽  
Inhalational Anesthesia ◽  
Intravenous Anesthesia ◽  
Significant Difference ◽  
Total Knee ◽  
Anxiety Depression ◽  
Postoperative Quality

Abstract Background: The widespread use of total knee arthroplasty(TKA) to treat patients who suffer knee osteoarthritis(KOA) has led to a number of postoperative problems, including the recovery of postoperative quality of life and postoperative delirium(POD). Both problems could cause profound damages to patients and their families. This study assessed and compared the effects of total intravenous anesthesia with propofol versus inhalational anesthesia (sevoflurane) on postoperative quality of life and POD in patients who underwent TKA.Methods: One hundred and fifty patients American Society of Anesthesiologists(ASA) I-III were assessed for inclusion in this study, and randomly divided into inhalational anesthesia with sevoflurane group(group S), and total intravenous anesthesia with propofol group(group P). The primary outcome was postoperative quality of life and secondary outcome was POD.Results: The quality of life at the first month after surgery in group S was better than that in group P(P=0.02). However, there was no significant difference in quality of life between the two groups at 1 day before surgery, 1 day after surgery, 3 days after surgery, 7 days after surgery and 3 months after surgery. In group P, 19 patients (31.1%) had no anxiety/depression problems, 40 patients (65.6%) had moderate problems, and 2 patients (3.3%) had severe problems.In group S, 37 patients (60.6%) had no problems in anxiety/depression, 23 patients (37.7%) had moderate problems, and 1 patient had severe problems (1.7%). These two outcomes had significant differences (P=0.005) .The incidence of POD within 3 days after surgery was 24.6% (15/61) in group P and 36.1% (22/61) in group S. There was no significant difference in the incidence of POD between the two groups (P=0.17).Conclusions: Group S patients have a better quality of life at the first month after surgery in comparison with those in group P regarding anxiety/depression. However, there were no significant differences in the quality of lives between the two groups at 1 day before surgery, 1 day after surgery, 3 days after surgery, 7 days after surgery, and 3 months after surgery. There was also no significant difference in POD. Thus, we concluded that both anesthetic technologies could be extensively used for TKA.Trial registration: This trial was registered at the Chinese Clinical Trial Registry (ChiCRT-IOR-17012428). Date of Registration: 21 Aug. 2017.

scholarly journals Postoperative Nausea and Vomiting and Postoperative Pain in Patients Undergoing Elective Laparoscopy; Comparison of Total Intravenous Anesthesia versus Inhalational Anesthesia; A Randomized Clinical Trial

2020 ◽  
Author(s):  
Ali Ahmadzadeh Amiri ◽  
Kasra Karvandian ◽  
Mojgan Rahimi ◽  
Mohammad Ashouri ◽  
Amir Ahmadzadeh Amiri
Keyword(s):  
Clinical Trial ◽  
Postoperative Pain ◽  
Postoperative Nausea ◽  
Postoperative Nausea And Vomiting ◽  
Postoperative Recovery ◽  
Nausea And Vomiting ◽  
Total Intravenous Anesthesia ◽  
Inhalational Anesthesia ◽  
Intravenous Anesthesia ◽  
Significant Difference

Background: Two major complications of surgeries are postoperative nausea and vomiting (PONV) and also postoperative pain (POP). Several studies have compared total intravenous anesthesia (TIVA) with inhalational anesthesia regarding these two complications. Some results have shown a better postoperative recovery conditions, but other contradictory results can also be found. This study was performed to evaluate and compare the effect of inhalational and intravenous anesthesia in patients undergoing elective laparoscopic surgery, on the incidence and the severity of PONV and POP. Methods: This study was performed as a single-blinded prospective clinical trial. All patients aged 18-65, with ASA class I and II who underwent elective laparoscopy were included. Patients were divided into two groups of intravenous anesthesia and inhalational anesthesia. The incidence and the severity of PONV and POP were examined in 5 separated times after the surgery. The use of a rescue antiemetic and analgesic medication were also evaluated. Results: Overall, 67 patients received inhalational anesthesia and 55 patients received intravenous anesthesia. It was revealed that 47.8% of the patients in the inhalation group and 18.2% of the patients in the intravenous group developed PONV (P<0.001). The severity of PONV was significantly lower in the TIVA group (P<0.001), however, no statistically significant difference was found regarding the severity of abdominal pain (P=0.62). Conclusion: The incidence of PONV and the need for administration of an antiemetic rescue drug are significantly lower in the TIVA group.

Carbohydrate metabolism of mice exposed to simulated changes in gravity

1964 ◽  
Vol 207 (2) ◽  
pp. 411-414 ◽  
Author(s):  
Jiro Oyama ◽  
William T. Platt
Keyword(s):  
Blood Glucose ◽  
Carbohydrate Metabolism ◽  
Exposure Time ◽  
Liver Glycogen ◽  
Critical Function ◽  
Glucose Levels ◽  
Blood Glucose Levels ◽  
Significant Difference ◽  
Glycogen Deposition ◽  
Adrenal Corticosterone

Unrestrained mice were centrifuged for varying periods ranging from 0.5 to 10 hr at 2.5, 5, and 10 x gravity. Liver glycogen and blood glucose levels increased significantly depending on the g load and exposure time. Adrenalectomy completely abolished the glycogen deposition response. The glycogen response was a critical function of the age of mice; unweaned mice did not respond. Blood corticosterone increased significantly prior to the deposition of glycogen. Centrifuged fed mice deposited three times the amount of glycogen of fasted mice. There was no significant difference in the amount of glycogen deposited in centrifuged mice previously starved for 1, 2, or 3 days. It is concluded that the increased glycogen deposited following centrifugation is effected by an increased elaboration of adrenal corticosterone.

Additive Interactions between Propofol and Ketamine When Used for Anesthesia Induction in Female Patients 

1995 ◽  
Vol 82 (3) ◽  
pp. 641-648 ◽  
Author(s):  
T. W. Hui ◽  
T. G. Short ◽  
W. Hong ◽  
T. Suen ◽  
T. Gin ◽  
...  
Keyword(s):  
Heart Rate ◽  
Arterial Pressure ◽  
Additional Term ◽  
Anesthesia Induction ◽  
Response Curves ◽  
Intravenous Anesthesia ◽  
Verbal Command ◽  
Female Patients ◽  
Loss Of Response ◽  
Significant Difference

Background Propofol and ketamine may be paired for anesthesia induction and for total intravenous anesthesia. The nature of any sedative interactions occurring between propofol and ketamine are unknown. The combination when used for anesthesia induction in female patients was studied. Methods Quantal dose-response curves were determined in 180 female patients to whom the drugs were administered individually and in combination. Two minutes after administering the drugs, two endpoints were assessed. First, loss of response to verbal command (hypnosis) and then, in those who failed to respond to this endpoint, loss of response to a 5-s transcutaneous tetanus (anesthesia). Interactions were analyzed by fitting the data to a mathematical model in which response was analyzed in terms of the doses of the two drugs and an additional term included to describe nonadditive interactions. The incidences of apnea, arterial pressure, and heart rate changes during the first 5 min were recorded. Results At the hypnotic endpoint, the ED50s were 1.10 mg/kg propofol (95% CIs 0.93-1.27), 0.39 mg/kg ketamine (95% CIs 0.27-0.46), and the combination of 0.63 mg/kg propofol and 0.21 mg/kg ketamine (95% CIs 0.53/0.18-0.73/0.24). At the anesthetic endpoint, the ED50s were 1.85 mg/kg propofol (95% CIs 1.58-2.36) 0.66 mg/kg ketamine (95% CIs 0.58-0.77), and the combination of 1.05 mg/kg propofol and 0.35 mg/kg ketamine (95% CIs 0.88/0.29-1.27/0.42). The effects were additive at both endpoints; there was no evidence of an interaction. The ED50s for apnea were 1.61 mg/kg propofol (95% CIs 1.39-1.94), greater than 0.85 mg/kg ketamine and for the combination 1.50 mg/kg propofol and 0.50 mg/kg ketamine (95% CIs 1.15/0.38-3.09/1.03). The addition of ketamine did not significantly alter the ED50 for apnea of propofol. There was a significant difference in the arterial pressures among the three groups (P &lt; 0.001). Using the combination, the cardiostimulant effects of ketamine balanced the cardiodepressant effects of propofol. There was no change in arterial pressure or heart rate after the noxious stimulus. Conclusions When using the combination, doses were additive at hypnotic and anesthetic endpoints. Ketamine had no influence on the incidence of apnea after propofol, and the net hemodynamic effects were minimal.

Abstract P315: Vascular AT1 Angiotensin Receptors Do Not Contribute to Albuminuria or Hyperfiltration in Diabetes

Hypertension ◽  
2016 ◽  
Vol 68 (suppl_1) ◽  
Author(s):  
Matthew A Sparks ◽  
Stacy Johnson ◽  
Rishav Adhikari ◽  
Edward Diaz ◽  
Aaron Kupin ◽  
...  
Keyword(s):  
Kidney Injury ◽  
Renin Angiotensin System ◽  
Diabetic Control ◽  
Angiotensin Receptors ◽  
Mrna Levels ◽  
Glucose Levels ◽  
Blood Glucose Levels ◽  
Significant Difference ◽  
Akita Mice ◽  
The Impact

Blockade of the renin angiotensin system (RAS) reduces albuminuria, attenuates hyperfiltration, and slows the progression of diabetic nephropathy (DN) by preventing vasoconstriction and subsequent increases in glomerular hydrostatic pressure. Since RAS blockade disrupts Ang II signaling in all tissues, the specific contribution of vascular actions of AT1 receptors in DN has been difficult to delineate. Therefore, we generated 129 SvEv mice with cell-specific loss of AT1A from VSMCs (SMKOs) using Cre-loxp . To eliminate AT1R from VSMCs, we crossed the SMKO mice with AT1BR -/- mice, lacking the minor AT1B isoform. To study the impact of vascular AT1R in DN, we crossed the AT1B- null SMKOs with mice having the Ins2 C96Y AKITA mutation, which develop DM1 early. To enhance kidney injury, mice underwent uninephrectomy (UNX) at 11wks. Blood glucose levels were elevated (~500mg/dL) and similar at 10, 16 and 24wks between the two groups. Prior to UNX, albuminuria was similar between Control AKITA and AT1B- null SMKO AKITA (62±10 Control AKITA versus 107±27 μg/24hrs SMKO AKITA, P=NS). Albuminuria increased with age in both Control Akita and AT1B- null SMKO AKITA but without significant differences between the groups at 16wks (307±106 vs 313±117 μg/24hrs; P=NS) or 24wks (494±236 versus 730±217 μg/24hrs; P=NS), despite a trend toward higher albuminuria in AT1B- null SMKO AKITAs. There was no significant difference in GFR (using FITC-inulin) between non-diabetic Control and AT1B- null SMKO (15.6±1.2 vs 14.8±0.8 μl/min/g BW), and hyperfiltration was observed in both Control AKITA (23.7±2.4 μl/min/g BW; P=0.003) and AT1B- null SMKO AKITA mice (20.7±1.7 μl/min/g BW; P=0.01) relative to their non-diabetic comparators. However, there was no significant difference in GFR between ControlAKITA and AT1B- null SMKO AKITA (P=NS). Finally we measured mRNA levels of putative kidney injury markers by RTqPCR and found no differences in levels of Col1A1 , NGAL , or TGFB1 mRNA between Control AKITA and AT1B null SMKO AKITA. Our studies indicate that the absence of vascular AT1R responses is not sufficient to reduce albuminuria and prevent hyperfiltration in a mouse model of DN. This suggests that blockade of AT1R in other cell lineages may contribute to beneficial actions of ARBs in DN.

Solumedrol Treatment for Severe Sepsis in Humans with a Blunted Adrenocorticotropic Hormone-Cortisol Response: A Prospective Randomized Double-Blind Placebo-Controlled Pilot Clinical Trial

2021 ◽  
pp. 088506662110388
Author(s):  
Divya Birudaraju ◽  
Sajad Hamal ◽  
John A. Tayek
Keyword(s):  
Blood Pressure ◽  
Clinical Trial ◽  
Adrenocorticotropic Hormone ◽  
Serum Cortisol ◽  
High Dose ◽  
Cortisol Response ◽  
Acth Stimulation ◽  
Double Blind ◽  
Significant Difference ◽  
To Receive

Purpose To test the benefits of Solumedrol treatment in sepsis patients with a blunted adrenocorticotropic hormone (ACTH)-cortisol response (delta <13 µg/dL) with regard to the number of days on ventilator, days on intravenous blood pressure support, length of time in an intensive care unit (ICU), 14-day mortality, and 28-day mortality. The trial was prospective, randomized, and double-blind. As part of a larger sepsis trial, 54 patients with sepsis had an intravenous ACTH stimulation test using 250 µg of ACTH, and serum cortisol was measured at times 0, 30, and 60 min. Eleven patients failed to increase their cortisol concentration above 19.9 µg/dL and were excluded from the clinical trial as they were considered to have adrenal insufficiency. The remaining 43 patients had a baseline cortisol of 32 ± 1 µg/dL increased to 38 ± 3 µg/dL at 30 min and 40 ± 3 at 60 min. All cortisol responses were <12.9 µg/dL between time 0 and time 60, which is defined as a blunted cortisol response to intravenous ACTH administration. Twenty-one were randomized to receive 20 mg of intravenous Solumedrol and 22 were randomized to receive a matching placebo every 8 h for 7-days. There was no significant difference between the two randomized groups. Data analysis was carried out bya two-tailed test and P < .05 as significant. Results Results: The mean age was 51 ± 2 (mean ± SEM) with 61% female. Groups were well matched with regard to APACHE III score in Solumedrol versus placebo (59 ± 6 vs 59 ± 6), white blood cell count (18.8 ± 2.2 vs 18.6 ± 2.6), and incidence of bacteremia (29 vs 39%). The 28-day mortality rate was reduced in the Solumedrol treated arm (43 ± 11 vs 73 ± 10%; P < .05). There was no change in days in ICU, days on blood pressure agents, or days on ventilator. Seven days of high-dose intravenous Solumedrol treatment (20 mg every 8 h) in patients with a blunted cortisol response to ACTH was associated with an improved 28-day survival. This small study suggests that an inability to increase endogenous cortisol production in patients with sepsis who are then provided steroid treatment could improve survival.

The Effect of Yacon Leaf Powder (Smallanthus Sonchifolius) on White Rats (Rattus norvegicus) Blood Glucose Levels with High Sugar Diet

2021 ◽  
Vol 8 (2) ◽  
pp. 217-220
Author(s):  
Thatit Nurmawati ◽  
Sandi Alfa Wiga Arsa ◽  
Nawang Wulandari ◽  
Agus Saparudin
Keyword(s):  
Blood Glucose ◽  
Treatment Group ◽  
Carbohydrate Diet ◽  
Glucose Levels ◽  
Smallanthus Sonchifolius ◽  
High Carbohydrate ◽  
White Rats ◽  
Blood Glucose Levels ◽  
Treatment Dose ◽  
Significant Difference

Maintaining a lifestyle can reduce the incidence of DM (diabetes mellitus). DM occurs due to insulin disorders so that blood glucose levels increase, which can lead to various complications. The management of blood glucose levels by activating the insulin function can be done by using natural ingredients such as the Yakon (Smallanthus sonchifolius) plant. Yakon leaves contain phenol which can reduce blood glucose. The design of this study was experimental with a pre-posttest approach with control-group design, using male and healthy white rats (Rattus norvegicus). Rats were divided into 3 groups, treatment dose 1, treatment dose 2 and control. The rats were given a high carbohydrate diet during 9 weeks to make the rats hyperglycemic. In the treatment group, dose 1 was 150 mg/kg BW, dose 2 was 300 mg kg BW, and was given for 3 days. The results showed that the rats in the treatment group dose 1 had decreased in the average blood sugar level of 114.10 mg / dl (p 0.002) and dose 2 was 105.27 mg / dl (p 0.005). This showed that there was an effect of treatments on blood sugar levels. The comparison results showed that there was a significant difference between the dose 1, the dose 2 group and the control (Sig. (2-tailed) = 0.001 (α) = 0.05). There was no significant difference in the treatment group dose 1 and treatment dose 2 (Sig. (2-tailed) = 0.693, (α) = 0.05). Yakon leaves can be used alternative to lower to control blood glucose levels in rats receiving a high-carbohydrate diet

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