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[PMID]:29444393
[Au] Autor:Hallet C; Venneman I; Hans G; Bonhomme V
[Ti] Título:Two different techniques of facial mask induction of anesthesia in children provide identical intubation conditions despite different anesthetic depth.
[So] Source:Acta Anaesthesiol Belg;67(2):81-85, 2016.
[Is] ISSN:0001-5164
[Cp] País de publicação:Belgium
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Sevoflurane induction in chil- dren is performed using different techniques. Constricted, centered, and symmetrical pupils (CCSP) are classically the endpoint to be achieved before laryngoscopy is performed. OBJECTIVES: We investigated whether two different inhalation induction techniques with the same clinical end- point provided similar intubating conditions and comparable depth of anesthesia as assessed by the Bispectral Index (BIS). METHODS: Following IRB approval, and informed parental consent, 20 children were recruited. They were sched- uled for general anesthesia with tracheal intubation, and randomly assigned to Group 1, where the practitioner used 6% inspired sevoflurane in 50% 02/N20, and no manually assisted ventilation, or Group 2, where inspired sevoflurane was 8% in 50% 02/N20, and ventilation was manually supported upon loss of consciousness. BIS values were blinded. Laryngoscopy was performed after CCSP. Intubation conditions scoring was based on jaw relaxation (mobile = 1, partially mobile = 2, fixed = 3), position of vocal cords (open = 1, half-closed = 2, closed = 3), and cough (no cough = 1, 1 or 2 coughing efforts = 2, persistent coughing = 3). A total score > 3 corresponded to non-optimal conditions. RESULTS: Upon CCSP, BIS values were significantly lower in Group 1 [mean (SD) : 30 (8) - 48 (18), p <0.001], despite significantly higher end-tidal sevoflurane concentration in Group 2 [mean (SD) : 5.0 (0.7) - 6.2 (0.5) ; p <0.001]. Time to CCSP was slightly shorter in Group 2. Intubation conditions were always optimal except for one patient of Group 1. DISCUSSION: Both induction techniques achieve good intubating conditions. Possible explanations for the between-group BIS difference include variable appreciation of the CCSP endpoint, different induction lengths or sevoflurane equilibration times, or sevoflurane-induced increase in electroencephalogram power. A better indicator of the best time to intubate is needed to avoid too deep anesthesia in children.
[Mh] Termos MeSH primário: Anestesia por Inalação/métodos
Intubação Intratraqueal/métodos
Máscaras
[Mh] Termos MeSH secundário: Criança
Pré-Escolar
Monitores de Consciência
Método Duplo-Cego
Eletroencefalografia
Seres Humanos
Éteres Metílicos/farmacologia
[Pt] Tipo de publicação:JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
[Nm] Nome de substância:
0 (Methyl Ethers); 38LVP0K73A (sevoflurane)
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180306
[Lr] Data última revisão:
180306
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180215
[St] Status:MEDLINE


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[PMID]:29390298
[Au] Autor:Han D; Liu YG; Pan S; Luo Y; Li J; Ou-Yang C
[Ad] Endereço:Anesthesia Department, Capital Institute of Pediatrics affiliated Children's Hospital.
[Ti] Título:Comparison of hemodynamic effects of sevoflurane and ketamine as basal anesthesia by a new and direct monitoring during induction in children with ventricular septal defect: A prospective, randomized research.
[So] Source:Medicine (Baltimore);96(50):e9039, 2017 Dec.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Sevoflurane and ketamine are commonly used to obtain sedation and facilitate intravenous anesthetic induction in children undergoing cardiac surgery who are uncooperative. We used a new and direct systemic hemodynamic monitoring technique pressure recording analytical method and compared the hemodynamic effects of sevoflurane and ketamine to facilitate intravenous anesthetic induction. METHODS: Forty-four children with ventricular septal defect (2.2 ±â€Š1.2 years) were enrolled and randomized to receive sevoflurane (Group S) or intramuscular ketamine (Group K) for sedation, followed by intravenous midazolam-sufentanil induction and tracheal intubation. Recorded parameters included heart rate (HR), arterial pressures, stroke volume index (SVI), cardiac index (CI), systemic vascular resistance index (SVRI), the maximal slope of systolic upstroke (dp/dtmax) after sedation obtained with sevoflurane or ketamine, 1, 2, 5 minutes after midazolam-sufentanil, 1, 2, 5, and 10 minutes after tracheal intubation. Rate-pressure product (RPP) and cardiac power output (CPO) were calculated. RESULTS: As compared with Group S, Group K had faster decreases during intravenous anesthetic induction in arterial pressures (P < .01 for all), higher HR, arterial pressures, SVRI, dp/dtmax, RPP, lower SVI, CI, CPO (P < .05 for all) during the study period. CONCLUSION: As compared with sevoflurane, ketamine facilitated intravenous anesthetic induction exerts unfavorable effects on systemic hemodynamic and myocardial energetic in children with ventricular septal defect.
[Mh] Termos MeSH primário: Anestésicos Dissociativos/administração & dosagem
Anestésicos Inalatórios/administração & dosagem
Comunicação Interventricular/cirurgia
Hemodinâmica/efeitos dos fármacos
Ketamina/administração & dosagem
Éteres Metílicos/administração & dosagem
[Mh] Termos MeSH secundário: Pré-Escolar
Feminino
Seres Humanos
Lactente
Intubação Intratraqueal
Masculino
Estudos Prospectivos
Resultado do Tratamento
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE; OBSERVATIONAL STUDY; RANDOMIZED CONTROLLED TRIAL
[Nm] Nome de substância:
0 (Anesthetics, Dissociative); 0 (Anesthetics, Inhalation); 0 (Methyl Ethers); 38LVP0K73A (sevoflurane); 690G0D6V8H (Ketamine)
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180301
[Lr] Data última revisão:
180301
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180203
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000009039


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[PMID]:29173362
[Au] Autor:Liu W; Zhu H; Fang H
[Ad] Endereço:Department of Anesthesiology, Jinshan Hospital Affiliated to Fudan University, Shanghai, China.
[Ti] Título:Propofol Potentiates Sevoflurane-Induced Inhibition of Nuclear Factor--κB-Mediated Inflammatory Responses and Regulation of Mitogen-Activated Protein Kinases Pathways via Toll-like Receptor 4 Signaling in Lipopolysaccharide-Induced Acute Lung Injury in Mice.
[So] Source:Am J Med Sci;354(5):493-505, 2017 11.
[Is] ISSN:1538-2990
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Toll-like receptor 4 (TLR4)-induced initiation of mitogen-activated protein kinases and the nuclear factor-kappa B signaling cascade is reportedly involved in inflammatory responses during lung injury. Studies have found that volatile anesthetics, such as isoflurane and sevoflurane, inhibit inflammation. This investigation explored the protective effects of propofol and whether propofol potentiates the protective effects of sevoflurane against lipopolysaccharide (LPS)-induced acute lung injury. MATERIALS AND METHODS: Male BALB/c mice were treated with LPS (10µg/mouse; intranasal instillation) to induce acute lung injury. Mice were exposed to sevoflurane (3%; 6 hours) alone or combined with propofol (10 or 20mg/kg body weight; subcutaneously) followed by sevoflurane for 1 hour before the LPS challenge. RESULTS: Sevoflurane with or without propofol attenuated pulmonary edema, restored altered lung architecture and reduced influx of inflammatory cells into bronchoalveolar lavage fluid after the LPS challenge. LPS-mediated overproduction of the proinflammatory cytokines tumor necrosis factor-α, interleukin-1ß, and interleukin-6 as well as nitric oxide, were reduced. Sevoflurane either alone or with propofol downregulated TLR4 and TLR4-mediated mitogen-activated protein kinase and nuclear factor-kappa B signaling. CONCLUSIONS: Combined exposure to propofol and sevoflurane was more effective than sevoflurane administered alone, suggesting the positive effects of propofol on sevoflurane-mediated anti-inflammatory effects.
[Mh] Termos MeSH primário: Lesão Pulmonar Aguda/induzido quimicamente
Lipopolissacarídeos
Éteres Metílicos/farmacologia
Propofol/farmacologia
Transdução de Sinais/efeitos dos fármacos
[Mh] Termos MeSH secundário: Lesão Pulmonar Aguda/tratamento farmacológico
Lesão Pulmonar Aguda/imunologia
Anestésicos Inalatórios/farmacologia
Anestésicos Intravenosos/farmacologia
Animais
Sinergismo Farmacológico
Masculino
Camundongos
Camundongos Endogâmicos BALB C
NF-kappa B/metabolismo
Substâncias Protetoras/farmacologia
Receptor 4 Toll-Like/metabolismo
[Pt] Tipo de publicação:JOURNAL ARTICLE; RESEARCH SUPPORT, NON-U.S. GOV'T
[Nm] Nome de substância:
0 (Anesthetics, Inhalation); 0 (Anesthetics, Intravenous); 0 (Lipopolysaccharides); 0 (Methyl Ethers); 0 (NF-kappa B); 0 (Protective Agents); 0 (Tlr4 protein, mouse); 0 (Toll-Like Receptor 4); 38LVP0K73A (sevoflurane); YI7VU623SF (Propofol)
[Em] Mês de entrada:1711
[Cu] Atualização por classe:180223
[Lr] Data última revisão:
180223
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:171128
[St] Status:MEDLINE


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[PMID]:29382022
[Au] Autor:Wang HX; Miao HH; Gao X; Wei W; Ding GN; Zhang Y; Tian M
[Ad] Endereço:Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China.
[Ti] Título:Optimum end-tidal concentration of sevoflurane to facilitate supraglottic airway device insertion with propofol at induction allowing spontaneous respiration in obese patients: A prospective observational study.
[So] Source:Medicine (Baltimore);96(47):e8902, 2017 Nov.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Obese patients are more likely to encounter with difficult airway management, and supraglottic airway device has been adopted to facilitate tracheal intubation. The optimum anesthetic concentration for obese patients to insert a supraglottic airway device with spontaneous respiration has not been investigated. This study was designed to determine the end-tidal concentration of sevoflurane that would provide acceptable condition for supraglottic airway device insertion with propofol at induction in obese patients without using neuromuscular blockade.Thirty elective obese patients [body mass index (BMI) 30-50 kg/m] scheduled for bariatric surgery were enrolled in this study. Sevoflurane was inhaled at a concentration of 5% after infusion of 1 mg/kg propofol (within 1 minute) according to lean body weight. The target concentration of sevoflurane was initiated at 2.5% with 0.5% as a step size using a modified Dixon up-and-down method. Five minutes after target concentration achieved, the insertion of supraglottic airway device was attempted.The minimum alveolar concentration of sevoflurane for successful insertion of supraglottic airway device calculated using up-and-down method were 2.25 (0.53) % for obese patients. The values of the effective concentration of sevoflurane for successful supraglottic airway device insertion in 50% (EC50) and 95% (EC95) of the obese patients obtained by probit regression analysis were 2.09% (95% confidence interval 1.48-2.68) and 3.31% (95% confidence interval 2.70-8.12), respectively.We conclude that sevoflurane at a minimum alveolar concentration of 2.25% can provide optimal conditions for insertion of supraglottic airway device with spontaneous respiration in obese patients with 1 mg/kg propofol at induction.
[Mh] Termos MeSH primário: Manuseio das Vias Aéreas/métodos
Anestésicos Inalatórios/administração & dosagem
Intubação Intratraqueal/métodos
Éteres Metílicos/administração & dosagem
Obesidade/cirurgia
[Mh] Termos MeSH secundário: Adulto
Anestésicos Inalatórios/análise
Anestésicos Intravenosos/administração & dosagem
Cirurgia Bariátrica
Relação Dose-Resposta a Droga
Feminino
Seres Humanos
Masculino
Éteres Metílicos/análise
Propofol/administração & dosagem
Estudos Prospectivos
Alvéolos Pulmonares/metabolismo
[Pt] Tipo de publicação:JOURNAL ARTICLE; OBSERVATIONAL STUDY
[Nm] Nome de substância:
0 (Anesthetics, Inhalation); 0 (Anesthetics, Intravenous); 0 (Methyl Ethers); 38LVP0K73A (sevoflurane); YI7VU623SF (Propofol)
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180207
[Lr] Data última revisão:
180207
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180201
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000008902


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[PMID]:29315308
[Au] Autor:Duffee L; Columbano N; Scanu A; Melosu V; Careddu GM; Sotgiu G; Driessen B
[Ad] Endereço:Department of Clinical Studies-New Bolton Center, University of Pennsylvania, School of Veterinary Medicine, Kennett Square, Pennsylvania, United States of America.
[Ti] Título:MAC-sparing effect of nitrous oxide in sevoflurane anesthetized sheep and its reversal with systemic atipamezole administration.
[So] Source:PLoS One;13(1):e0190167, 2018.
[Is] ISSN:1932-6203
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:INTRODUCTION: Nitrous oxide (N2O) is an anesthetic gas with antinociceptive properties and reduces the minimum alveolar concentration (MAC) for volatile anesthetic agents, potentially through mechanisms involving central alpha2-adrenoceptors. We hypothesized that 70% N2O in the inspired gas will significantly reduce the MAC of sevoflurane (MACSEVO) in sheep, and that this effect can be reversed by systemic atipamezole. MATERIALS AND METHODS: Animals were initially anesthetized with SEVO in oxygen (O2) and exposed to an electrical current as supramaximal noxious stimulus in order to determine MACSEVO (in duplicates). Thereafter, 70% N2O was added to the inspired gas and the MAC re-determined in the presence of N2O (MACSN). A subgroup of sheep were anesthetized a second time with SEVO/N2O for re-determination of MACSN, after which atipamezole (0.2 mg kg-1, IV) was administered for MACSNA determinations. Sheep were anesthetized a third time, initially with only SEVO/O2 to re-determine MACSEVO, after which atipamezole (0.2 mg kg-1, IV) was administered for determination of MACSA. RESULTS: MACSEVO was 2.7 (0.3)% [mean (standard deviation)]. Addition of N2O resulted in a 37% reduction of MACSEVO to MACSN of 1.7 (0.2)% (p <0.0001). Atipamezole reversed this effect, producing a MACSNA of 3.1 (0.7)%, which did not differ from MACSEVO (p = 0.12). MACSEVO did not differ from MACSA (p = 0.69). Cardiorespiratory variables were not different among experimental groups except a lower ETCO2 in animals exposed to SEVO/N2O. CONCLUSIONS: N2O produces significant MACSEVO-reduction in sheep; this effect is completely reversed by IV atipamezole confirming the involvement of alpha2-adrenoreceptors in the MAC-sparing action of N2O.
[Mh] Termos MeSH primário: Anestésicos Inalatórios/administração & dosagem
Imidazóis/administração & dosagem
Éteres Metílicos/administração & dosagem
Óxido Nitroso/efeitos adversos
[Mh] Termos MeSH secundário: Animais
Ovinos
[Pt] Tipo de publicação:JOURNAL ARTICLE; RESEARCH SUPPORT, NON-U.S. GOV'T
[Nm] Nome de substância:
0 (Anesthetics, Inhalation); 0 (Imidazoles); 0 (Methyl Ethers); 03N9U5JAF6 (atipamezole); 38LVP0K73A (sevoflurane); K50XQU1029 (Nitrous Oxide)
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180129
[Lr] Data última revisão:
180129
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180110
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pone.0190167


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[PMID]:29287876
[Au] Autor:Zhong Q; Qu X; Xu C
[Ad] Endereço:Department of Anesthesiology, Xiamen Changgung Hospital, Xiamen, Fujian 361028, PR China.
[Ti] Título:Effect of preoperative visiting operation room on emergence agitation in preschool children under sevoflurane anesthesia.
[So] Source:Int J Pediatr Otorhinolaryngol;104:32-35, 2018 Jan.
[Is] ISSN:1872-8464
[Cp] País de publicação:Ireland
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Emergence agitation (EA) is a common complication in children during recovery from sevoflurane anesthesia with an high incidence. The main objective of this study was to compare the effects of preoperative visiting operation room (PVOR) to administration of propofol at the end of anesthesia on EA in preschool children under sevoflurane anesthesia. METHODS: Sixty-nine preschool children aged from 3 to 6 years scheduled for tonsillectomy under sevoflurane anesthesia were randomly allocated to one of the three groups to receive either PVOR (Group PV), routine preoperative visit (Group RV) or routine preoperative visit plus propofol (Group RP), 23 patients were included in each group. General anesthesia was induced and maintained with sevoflurane. Parental separation status score, mask acceptance score, Aono's four point score and pediatric anesthesia emergence delirium (PAED) score and incidence of EA were recorded. PAED score >10 were regarded as EA. Recovery profile and adverse events were also recorded. RESULT: Parental separation status score and mask acceptance score in group PV was significantly lower than that in group RV and group RP (P < 0.05); Aono's four point score, PAED score and incidence of EA in group PV and group RP was significantly lower than that in group RV (P < 0.05); Time to extubation and time to interaction in group PV and group RV was significantly shorter than that in group RP (P < 0.05); POV and rescue by fentanyl in group PV and group RP was significantly lower than that in group RV(P < 0.05). CONCLUSION: PVOR can effectively reduce the incidence of EA as well as administration of propofol without additional medical expenses and other adverse effects.
[Mh] Termos MeSH primário: Anestésicos Inalatórios/efeitos adversos
Éteres Metílicos/efeitos adversos
Salas Cirúrgicas/estatística & dados numéricos
Cuidados Pré-Operatórios/métodos
Propofol/efeitos adversos
Agitação Psicomotora/etiologia
[Mh] Termos MeSH secundário: Período de Recuperação da Anestesia
Anestesia Geral/efeitos adversos
Anestésicos Inalatórios/uso terapêutico
Criança
Pré-Escolar
Delírio do Despertar
Feminino
Fentanila/uso terapêutico
Seres Humanos
Masculino
Éteres Metílicos/uso terapêutico
Propofol/uso terapêutico
Tonsilectomia/efeitos adversos
[Pt] Tipo de publicação:JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
[Nm] Nome de substância:
0 (Anesthetics, Inhalation); 0 (Methyl Ethers); 38LVP0K73A (sevoflurane); UF599785JZ (Fentanyl); YI7VU623SF (Propofol)
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180116
[Lr] Data última revisão:
180116
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171231
[St] Status:MEDLINE


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[PMID]:29252484
[Au] Autor:Lerman J
[Ad] Endereço:Department of Anesthesia, Women and Children's Hospital of Buffalo, Jacob's School of Medicine, Buffalo, New York, jerrold.lerman@gmail.com.
[Ti] Título:Does the Risk Scale Predict Emergence Agitation in Children?
[So] Source:Anesth Analg;126(1):365, 2018 01.
[Is] ISSN:1526-7598
[Cp] País de publicação:United States
[La] Idioma:eng
[Mh] Termos MeSH primário: Período de Recuperação da Anestesia
Delírio do Despertar
[Mh] Termos MeSH secundário: Anestésicos Inalatórios
Criança
Seres Humanos
Éteres Metílicos
[Pt] Tipo de publicação:LETTER; COMMENT
[Nm] Nome de substância:
0 (Anesthetics, Inhalation); 0 (Methyl Ethers)
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180111
[Lr] Data última revisão:
180111
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:171219
[St] Status:MEDLINE
[do] DOI:10.1213/ANE.0000000000002587


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[PMID]:28456451
[Au] Autor:Bussy U; Chung-Davidson YW; Buchinger TJ; Li K; Li W
[Ad] Endereço:Department of Fisheries and Wildlife, Michigan State University, Room 13 Natural Resources Building, 480 Wilson Road, East Lansing, MI 48824, USA.
[Ti] Título:High-sensitivity determination of estrogens in fish plasma using chemical derivatization upstream UHPLC-MSMS.
[So] Source:Steroids;123:13-19, 2017 Jul.
[Is] ISSN:1878-5867
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:This article describes the development and validation of a sensitive LC-MSMS method for determination of estrogen in fish plasma. Dansyl chloride derivatization of the phenol functional group in estrogen was used to enhance the response to atmospheric pressure ionization leading to improve the sensitivity. Individual C internal standards were selected after comparison with deuterated standards. Liquid-liquid extraction (ethyl acetate or methyl tert-butyl ether) and protein precipitation (acetonitrile, methanol or acetone) were compared for the extraction and clean-up of estrogens from fish plasma. Ethyl acetate was selected as the best alternative with recovery ranging from 61 to 96% and matrix effect ranging from 88 to 106%. Limits of quantification ranged from 0.5 to 1pg/mL showing a gain in sensitivity of 10,000 times over electrospray ionization of underivatized estrogens. Accuracy and precision were validated over three consecutive days and the method was applied to measure estrogen in sea lamprey (Petromyzon marinus) and lake trout (Salvelinus namaycush) plasma. Estrone and estriol were detected in fish below 1ng/mL in plasma, justifying the need of a highly sensitive LC-MSMS quantification method.
[Mh] Termos MeSH primário: Análise Química do Sangue/métodos
Cromatografia Líquida de Alta Pressão/métodos
Estrogênios/sangue
Estrogênios/química
Petromyzon/sangue
Espectrometria de Massas em Tandem/métodos
Truta/sangue
[Mh] Termos MeSH secundário: Acetatos/química
Animais
Estrogênios/isolamento & purificação
Limite de Detecção
Éteres Metílicos/química
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Acetates); 0 (Estrogens); 0 (Methyl Ethers); 29I4YB3S89 (methyl tert-butyl ether); 76845O8NMZ (ethyl acetate)
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180108
[Lr] Data última revisão:
180108
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170501
[St] Status:MEDLINE


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[PMID]:29194447
[Au] Autor:Kimura S; Nakao S; Kitaura A; Iwamoto T; Houri K; Matsushima M; Hamasaki S
[Ad] Endereço:Department of Anesthesiology, Kindai University Faculty of Medicine, OsakaSayama, Osaka, Japan.
[Ti] Título:Sevoflurane causes greater QTc interval prolongation in chronically hyperglycemic patients than in normoglycemic patients.
[So] Source:PLoS One;12(12):e0188555, 2017.
[Is] ISSN:1932-6203
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:QTc interval prolongation is a serious diabetic complication and increases mortality rate. Hyperglycemia inhibits the rapid component of delayed rectifier potassium channel currents (Ikr) and prolongs the QTc interval on electrocardiograms. Sevoflurane also inhibits the Ikr and causes QTc interval prolongation. In fact, torsade de pointes occurred in a patient with poorly controlled diabetes mellitus during sevoflurane anesthesia. We enrolled 74 patients, including 37 normoglycemic patients (glycated hemoglobin [HbA1c]: <6.5%) (NG group) and 37 chronically hyperglycemic patients (HbA1c: ≥6.5%) (HG group). Anesthesia was induced with 2 mg/kg propofol and 0.3 µg/kg/min remifentanil, and maintained with 2% sevoflurane in 40% O2 and 0.2-0.3 µg/kg/min remifentanil. The QT interval and Tp-e interval (from the peak to the end of the T wave) were measured before and at 5, 10, 30, 60, 90, and 120 min after the administration of sevoflurane and adjusted for the patient's heart rate (QTc and Tp-ec, respectively). P-values of <0.05 were considered statistically significant. The QTc and the Tp-ec intervals of the two groups did not differ significantly before the administration of sevoflurane. The QTc interval gradually increased with time in both groups and was significantly longer than the baseline value at 10 min after the administration of sevoflurane in both groups. The QTc interval of the HG group was significantly longer than that of the NG group at 90 min and 120 min after the administration of sevoflurane. The Tp-ec interval was not affected by sevoflurane in either group.We have demonstrated that sevoflurane significantly prolongs the QTc interval, and that the extent of the prolongation is significantly greater in chronically hyperglycemic patients than in normoglycemic patients. Although Tp-ec is not affected by sevoflurane, it should be noted that the simultaneous blockade of potassium channels would increase the risk of arrhythmias.
[Mh] Termos MeSH primário: Glicemia/análise
Eletrocardiografia/métodos
Coração/efeitos dos fármacos
Hiperglicemia/fisiopatologia
Éteres Metílicos/farmacologia
[Mh] Termos MeSH secundário: Idoso
Estudos de Casos e Controles
Feminino
Coração/fisiopatologia
Seres Humanos
Masculino
Meia-Idade
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Blood Glucose); 0 (Methyl Ethers); 38LVP0K73A (sevoflurane)
[Em] Mês de entrada:1712
[Cu] Atualização por classe:171226
[Lr] Data última revisão:
171226
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171202
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pone.0188555


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[PMID]:29245269
[Au] Autor:Kim HY; Lee JE; Kim HY; Kim J
[Ad] Endereço:aDepartment of Anesthesiology and Pain Medicine, Sungkyunkwan University School of MedicinebBiostatistics Collaboration UnitcDepartment of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea.
[Ti] Título:Volatile sedation in the intensive care unit: A systematic review and meta-analysis.
[So] Source:Medicine (Baltimore);96(49):e8976, 2017 Dec.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Volatile sedation in the intensive care unit (ICU) may reduce the number of adverse events and improve patient outcomes compared with intravenous (IV) sedation. We performed a systematic review and meta-analysis comparing the effects of volatile and IV sedation in adult ICU patients. METHODS: We searched the PubMed, Embase, Cochrane Central Register, and Web of Science databases for all randomized trials comparing volatile sedation using an anesthetic-conserving device (ACD) with IV sedation in terms of awakening and extubation times, lengths of ICU and hospital stay, and pharmacologic end-organ effects. RESULTS: Thirteen trials with a total of 1027 patients were included. Volatile sedation (sevoflurane or isoflurane) administered through an ACD shortened the awakening time [mean difference (MD), -80.0 minutes; 95% confidence intervals (95% CIs), -134.5 to -25.6; P = .004] and extubation time (MD, -196.0 minutes; 95% CIs, -305.2 to -86.8; P < .001) compared with IV sedation (midazolam or propofol). No differences in the lengths of ICU and hospital stay were noted between the 2 groups. In the analysis of cardiac effects of sedation from 5 studies, patients who received volatile sedation showed lower serum troponin levels 6 hours after ICU admission than patients who received IV sedation (P < .05). The effect size of troponin was largest between 12 and 24 hours after ICU admission (MD, -0.27 µg/L; 95% CIs, -0.44 to -0.09; P = .003). CONCLUSION: Compared with IV sedation, volatile sedation administered through an ACD in the ICU shortened the awakening and extubation times. Considering the difference in serum troponin levels between both arms, volatile anesthetics might have a myocardial protective effect after cardiac surgery even at a subanesthetic dose. Because the included studies used small sample sizes with high heterogeneity, further large, high-quality prospective clinical trials are needed to confirm our findings.
[Mh] Termos MeSH primário: Anestésicos Inalatórios/administração & dosagem
Unidades de Terapia Intensiva
Isoflurano/administração & dosagem
Éteres Metílicos/administração & dosagem
[Mh] Termos MeSH secundário: Extubação
Seres Humanos
Tempo de Internação
Ensaios Clínicos Controlados Aleatórios como Assunto
[Pt] Tipo de publicação:JOURNAL ARTICLE; META-ANALYSIS; REVIEW
[Nm] Nome de substância:
0 (Anesthetics, Inhalation); 0 (Methyl Ethers); 38LVP0K73A (sevoflurane); CYS9AKD70P (Isoflurane)
[Em] Mês de entrada:1712
[Cu] Atualização por classe:171225
[Lr] Data última revisão:
171225
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:171217
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000008976



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