Search

Objective: The authors aimed to compare the anti-inflammatory and antioxidant effects of propofol and sevoflurane in children with cyanotic congenital heart disease (CCHD) undergoing cardiac surgery with cardiopulmonary bypass., Design: Prospective, randomized, double-blind study., Setting: Single center, university hospital., Participants: Children ages 1-10 years with CCHD undergoing elective cardiac surgery with cardiopulmonary bypass., Interventions: Children were randomized to receive general anesthesia with either sevoflurane (group S) or propofol (group P). Systemic inflammatory response syndrome (SIRS) occurrence was assessed at the end of the surgery and at the sixth, 12th, and 24th postoperative hours. Blood samples were obtained at 4 times: after anesthesia induction (T0), after release of the aortic cross-clamp (T1), at the end of the surgery (T2), and at the postoperative 24th hour (T3). The serum levels of interleukin 6 and tumor necrosis factor alpha, and the total antioxidant status (TAS) and total oxidant status, were analyzed., Results: SIRS was more common in group S than in group P at all times (p = 0.020, p = 0.036, p = 0.004, p = 0.008). There were no significant differences between the groups in the mean tumor necrosis factor alpha and interleukin 6 levels at any time. The TAS level at T2 was higher in group P than group S (p = 0.036). The serum TAS level increased at T2 compared with T0 in group P, but it decreased in group S (p = 0.041)., Conclusion: The results showed that propofol provided a greater antioxidant effect and reduced SIRS postoperatively more than sevoflurane in children with CCHD undergoing cardiac surgery., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Objective: To determine the blood sevoflurane and desflurane concentrations during one-lung ventilation (OLV)., Design: Randomized, single-blind study., Setting: Single university hospital., Participants: The study comprised 24 patients, 35 to 70 years old who were scheduled for either a major abdominal surgery or thoracotomy., Interventions: The patients were divided into the following 4 groups: sevoflurane two-lung ventilation (TLV), sevoflurane OLV, desflurane TLV, and desflurane OLV. Vaporizers were set at 1.5% sevoflurane or 6% desflurane., Measurements and Main Results: In the TLV groups, blood samples were taken in 10-minute intervals starting 40 minutes after the start of TLV (T 1 -T 9 ) for blood gas analysis and gas chromatography. In the OLV groups, the first sample was collected at 40 minutes of TLV (T 1 ), and other samples were collected in 10-minute intervals from the start of OLV (T 2 -T 9 ). Saturation of peripheral oxygen (SpO 2 ), hemodynamic variables, and inspired and end-tidal volatiles were recorded. The fraction uptake of the volatile agents (F) was calculated for each patient at the same time points. The mean arterial sevoflurane concentration in the sevoflurane OLV group at T 1 decreased from 40.7 ± 4.4 to 30.2 ± 2.5 µg/mL at T 3 (p = 0.014, 26% decrease). In the OLV desflurane group, the mean arterial desflurane concentration at T 1 declined from 224.6 ± 44.8 to 159.8 ± 32 µg/mL at T 3 (p=0.018, 29% decrease). However, the reduction of sevoflurane concentration compared with that of desflurane at T 3 was not statistically significant (p = 0.31). In addition, the fraction uptake of the volatile agents values significantly increased at the start of OLV (p = 0.001)., Conclusion: An OLV procedure causes a decrease in the both arterial and venous blood concentrations of sevoflurane and desflurane. This reduction is believed to be due to ventilation-perfusion mismatch., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Background/aim: Myocardial protection is an important factor of open heart surgery and biological biomarkers (lactate, CKMB, cardiac troponin I, and pyruvate) are used to assess myocardial damage. This study compares the effects of dexmedetomidine and remifentanil on myocardial protection during coronary artery bypass grafting (CABG) surgery. Materials and methods: Patients scheduled for elective CABG surgery (n = 60) were included in this study. Anesthesia induction was introduced with propofol, fentanyl, and vecuronium bromide. Anesthesia was maintained with remifentanil infusion and sevoflurane in the remifentanil group (Group R) and with dexmedetomidine infusion and sevoflurane in the dexmedetomidine group (Group D). Blood samples for biochemical markers were taken from the coronary sinus catheter before cardiopulmonary bypass (T1), 20 min after aortic cross-clamping (T2), 20 min after removal of the aortic cross-clamping (T3), and 10 min after separation from cardiopulmonary bypass (T4). Results: Demographic data were similar between the groups. Lactate level at the T2 period and CKMB levels during the study period were lower in Group D than in Group R. In both groups, all values except pyruvate significantly increased over time. Conclusion: The dexmedetomidine-sevoflurane combination may improve the cardioprotective effect in comparison with remifentanilsevoflurane in CABG surgery. [ABSTRACT FROM AUTHOR]

The aim of this study was to compare the effects of 3 inhalation agents that combined with dexmedetomidine infusion on hemodynamic stability and postoperative recovery in patients undergoing supratentorial tumor surgery. After the institute's ethics committee approved this study and written informed consent was obtained from each participant, 90 patients with ASA I and III, who were scheduled for supratentorial tumor surgery, were recruited for this prospective, randomized controlled study. Routine monitoring was applied for unpremedicated patients on arrival in the operating room. All the patients received IV dexmedetomidine 0.5 μg/kg over 10 minutes, followed by 0.9 μg/kg/h infusion during maintenance. Patients were randomly divided into 3 groups. Anesthesia was maintained by sevoflurane in group 1, desflurane in group 2, and isoflurane in group 3. Hemodynamic variables, brain relaxation scores, intraoperative anesthetics requirement, and recovery characteristics were recorded. Demographic values, hemodynamic variables, and brain relaxation scores were similar among the groups. Mean arterial pressure was higher after intubation at the first minute in all groups than at baseline values. Hypertension was reported in 4 of 30 patients in group 1, 8 of 30 patients in group 2, and 5 of 30 patients in group 3, intraoperatively. Eye opening, following the verbal commands, was significantly lesser in patients receiving desflurane-dexmedetomidine than the other groups (P=0.001). We conclude that dexmedetomidine infusion is not sufficient for suppressing hemodynamic responses, decreasing the requirement of inhalation agents, and providing adequate brain relaxation in patients undergoing supratentorial craniotomy. Desflurane-dexmedetomidine anesthesia offers lesser eye opening and a slower response to verbal commands postoperatively. [ABSTRACT FROM AUTHOR]