scholarly journals Intravenous versus Volatile Anesthetic Effects on Postoperative Cognition in Elderly Patients Undergoing Laparoscopic Abdominal Surgery

2021 ◽  
Vol 134 (3) ◽  
pp. 381-394
Author(s):  
Yujuan Li ◽  
Dongtai Chen ◽  
Hanbing Wang ◽  
Zhi Wang ◽  
Furong Song ◽  
...  
Keyword(s):  
Abdominal Surgery ◽  
Elderly Patients ◽  
General Anesthesia ◽  
Interleukin 6 ◽  
Odds Ratio ◽  
Volatile Anesthetic ◽  
Skin Incision ◽  
Controlled Study ◽  
Double Blind ◽  
Sevoflurane Group

Background Delayed neurocognitive recovery after surgery is associated with poor outcome. Most surgeries require general anesthesia, of which sevoflurane and propofol are the most commonly used inhalational and intravenous anesthetics. The authors tested the primary hypothesis that patients with laparoscopic abdominal surgery under propofol-based anesthesia have a lower incidence of delayed neurocognitive recovery than patients under sevoflurane-based anesthesia. A second hypothesis is that there were blood biomarkers for predicting delayed neurocognitive recovery to occur. Methods A randomized, double-blind, parallel, controlled study was performed at four hospitals in China. Elderly patients (60 yr and older) undergoing laparoscopic abdominal surgery that was likely longer than 2 h were randomized to a propofol- or sevoflurane-based regimen to maintain general anesthesia. A minimum of 221 patients was planned for each group to detect a one-third decrease in delayed neurocognitive recovery incidence in propofol group compared with sevoflurane group. The primary outcome was delayed neurocognitive recovery incidence 5 to 7 days after surgery. Results A total of 544 patients were enrolled, with 272 patients in each group. Of these patients, 226 in the propofol group and 221 in the sevoflurane group completed the needed neuropsychological tests for diagnosing delayed neurocognitive recovery, and 46 (20.8%) in the sevoflurane group and 38 (16.8%) in the propofol group met the criteria for delayed neurocognitive recovery (odds ratio, 0.77; 95% CI, 0.48 to 1.24; P = 0.279). A high blood interleukin-6 concentration at 1 h after skin incision was associated with an increased likelihood of delayed neurocognitive recovery (odds ratio, 1.04; 95% CI, 1.01 to 1.07; P = 0.007). Adverse event incidences were similar in both groups. Conclusions Anesthetic choice between propofol and sevoflurane did not appear to affect the incidence of delayed neurocognitive recovery 5 to 7 days after laparoscopic abdominal surgery. A high blood interleukin-6 concentration after surgical incision may be an independent risk factor for delayed neurocognitive recovery. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New

scholarly journals Advantageous usage combined spinal, epidural and general anesthesia versus general anesthesia in abdominal surgery

2003 ◽  
Vol 131 (5-6) ◽  
pp. 232-237 ◽  
Author(s):  
Vesna Malenkovic ◽  
Sava Zoric ◽  
Tomislav Randjelovic
Keyword(s):  
Intensive Care ◽  
Side Effects ◽  
Abdominal Surgery ◽  
General Anesthesia ◽  
Controlled Study ◽  
General Anesthetics ◽  
Subjective Effect ◽  
Combined Spinal Epidural ◽  
Spinal Epidural

Type and technique of anesthesia have an important effect on per operative surgical course. The aim of the study was prospective analyses of advantages of combined spinal, epidural and general anesthesia (CSEGA) versus general anesthesia (GA) in abdominal surgery according to: 1. operative course (haemodynamic stability of patients, quality of analgesia, undesirables effects), 2. postoperative course (quality of analgesia, unfavorable effects, temporary abode of patients in intensive care). Using prospective randomized double blind controlled study, we evaluated two groups of patients whom the same type of abdominal surgical intervention was planed and the only difference was the type of technique of anesthesia. First group of patients (n=34), was treated with CSEGA and second group of patients (n=33), was treated only with standard (GA). Both groups had intraoperative and 24-hour-long postoperative continued monitoring of blood pressure central venous pressure, and dieresis. In the 24 hours postoperative period the following parameters were analyzed: vigilance conditions, motor block level, pain intensity in rest and movement, necessity for a complementary analgesia, side effects and final subjective effect of analgesia. There was important difference in waking up the patients after a general anesthesia in the first group this period was shorter. In the first 24 hours, patients from the first group didn't get any systemic analgesic, while the patients from the second group needed fractionary application of parenteral analgesics in the period of 4-6 hours. Patients from the first group were also physically faster and easier recovered and they had less respiratory complications and there was not any example of thromboembolysm and the intestine motility was faster re-established. First group of patients spent less time in intensive care (three days) than second group (six days). Final subjective effect of analgesia, according to verbal descriptive scale (VDS) of pain was satisfying with 75% of patients of the first group and 15% of patients of the second group. According to results investigation advantages of CSEDGA versus GA in abdominal surgery manifold: better hemodynamic stability and perfusion of operative region, decrease of single doses of opioid analgesics, local and general anesthetics followed by the decrease of their side effects, better intensity and longer duration of analgesia, improved total functional capability of patients.

scholarly journals Reliable and rapid smooth extubation after Ketofol for induction of general anesthesia in Laparoscopic Drilling of polycystic ovary: A randomized controlled trial

2020 ◽  
Author(s):  
Atef Mohamed Sayed Mahmoud ◽  
Joseph Makram Botros ◽  
Safaa Gaber Ragab
Keyword(s):  
General Anesthesia ◽  
Polycystic Ovary ◽  
Controlled Trial ◽  
Controlled Study ◽  
Double Blind ◽  
Randomized Controlled ◽  
Airway Response ◽  
American Society ◽  
American Society Of Anesthesiologists ◽  
Better Than

Abstract Background the outcome of ketofol on the hemodynamics and the airway response during induction of general anesthesia has been studied before. Its effect on smoothness of extubation has not been studied before. So, we aimed to assess the effect of ketofol on the smoothness of extubation and compare it with propofol only for induction of general anesthesia. Methods This double-blind, randomized, and controlled study was conducted on one hundred and six American Society of Anesthesiologists Physical status ''ASA PS'' class I and II female patients aged 18–40 years old and scheduled for laparoscopic drilling for polycystic ovary disease under general anesthesia. The patients were assigned into one of two groups (53) patients each; group KP = ketofol and group P = propofol. Results There was good sedation score during suction and extubation in the ketofol group. Airway response and smoothness of extubation were better in the ketofol group better than the propofol group. Conclusion Ketofol as an induction anesthetic agent was effective in attenuating the airway response during extubation more than profofol only. Trial registration: This trial was retrospectively registered at the Clinical Trial.gov with the Identification Number: NCT04365686.

Aspirin, but not propranolol, attenuates the acute stress-induced increase in circulating levels of interleukin-6: A randomized, double-blind, placebo-controlled study

2008 ◽  
Vol 22 (2) ◽  
pp. 150-157 ◽  
Author(s):  
Roland von Känel ◽  
Brigitte M. Kudielka ◽  
Petra Metzenthin ◽  
Susanne Helfricht ◽  
Daniel Preckel ◽  
...  
Keyword(s):  
Interleukin 6 ◽  
Acute Stress ◽  
Controlled Study ◽  
Double Blind ◽  
Double Blind Placebo ◽  
Circulating Levels

scholarly journals Safety assessment of prucalopride in elderly patients with constipation: a double-blind, placebo-controlled study

2009 ◽  
Vol 21 (12) ◽  
pp. 1256-e117 ◽  
Author(s):  
m. camilleri ◽  
g. beyens ◽  
r. kerstens ◽  
p. robinson ◽  
l. vandeplassche
Keyword(s):  
Elderly Patients ◽  
Safety Assessment ◽  
Controlled Study ◽  
Double Blind ◽  
Double Blind Placebo

scholarly journals Remifentanil at induction of general anesthesia for cesarean section: Double blind, randomized clinical trial

2013 ◽  
pp. 87-91 ◽  
Author(s):  
Shokoufeh Behdad ◽  
Vida Ayatollahi ◽  
Hamid Harrazi ◽  
Naderali Nazemian ◽  
Najemh Heiranizadeh ◽  
...  
Keyword(s):  
Cesarean Section ◽  
General Anesthesia ◽  
Obstetric Anesthesia ◽  
Skin Incision ◽  
Assisted Ventilation ◽  
Elective Cesarean Section ◽  
Control Group ◽  
Double Blind ◽  
Duration Of Action ◽  
Hemodynamic Variables

Introduction: Remifentanil, with its rapid activity onset and short duration of action, may be more effective than other opioids for providing hemodynamic stability during obstetric anesthesia. However, there is some evidence of adverse effects on neonatal respiratory function. We investigated maternal and fetal effects of remifentanil during cesarean section surgery. Methods: Eighteen women with singleton term pregnancies, and physical class status of I or II as defined by the American Society of Anesthesia (ASA), who were undergoing general anesthesia for semi-elective cesarean section were randomized into two groups (40 in each group) that received either and intravenous bolus of 0.5 µg/kg remifentanil or the same dose of saline as a placebo. Maternal hemodynamic variables and neonatal umbilical artery pH and Apgar score at first and fifth min were evaluated in both groups. Results: Systolic and diastolic blood pressure were significantly lower after tracheal intubation and skin incision in the remifentanil group as compared with the control group (p<0.05). There were no significant differences regarding heart rate between groups at any time (p>0.05). Apgar scores at first and fifth min were not significantly different among groups (p>0.05). No neonate required assisted ventilation or naloxan administration. Conclusion: Remifentanil may be a safe and effective drug for the induction of general anesthesia and surgical stimulation without subsequent neonatal depression.

scholarly journals Effectiveness of Intravenous Ibuprofen On Emergence Agitation in Children Undergoing Tonsillectomy With Propofol Anesthesia: A Double-Blind, Placebo-Controlled, Randomized Study

2021 ◽  
Author(s):  
Zhengzheng Gao ◽  
Jianmin Zhang ◽  
Xiaolu Nie ◽  
Xiaohuan Cui
Keyword(s):  
General Anesthesia ◽  
Protective Factor ◽  
Pediatric Anesthesia ◽  
Controlled Study ◽  
Control Group ◽  
Emergence Agitation ◽  
Double Blind ◽  
Double Blind Placebo ◽  
High Pain Score ◽  
Intravenous Ibuprofen

Abstract Background: Emergence agitation (EA) has a negative effect on recovery from general anesthesia in children. Objectives: This study aimed to evaluate the effectiveness of intravenous ibuprofen in reducing the incidence of EA in children.Methods: This randomized, double-blind, placebo-controlled study analyzed data from patients aged 3–9 years undergoing tonsillectomy with propofol general anesthesia. These patients were randomly assigned to receive either the ibuprofen or the placebo intraoperatively. The primary endpoint was between-group difference in the incidence of EA after surgery. EA was defined as Pediatric Anesthesia Emergence Delirium score ≥ 10. The secondary endpoint included the associated factors of EA.Results: Eighty-nine patients were included in the study. Ibuprofen decreased the incidence of EA (8.9% in the treatment group vs. 34.1% in the control group; odds ratio [OR], 0.261; 95% confidence interval [CI], 0.094–0.724; P = 0.004). After the logistic regression analysis, anxiety behavior pre-anesthesia and high pain score after surgery were the risk factors related to EA (OR, 8.07; 95% CI, 1.12–58.07, P = 0.038 and OR, 2.78; 95% CI, 1.60–4.82, P < 0.001, respectively). Ibuprofen administration was the protective factor related to EA (OR, 0.05; 95% CI, 0.01–0.67, P = 0.023).Conclusions: In our studied cohort, intraoperatively infusing ibuprofen and relieving preoperative anxiety and postoperative pain can significantly reduce the incidence and severity of EA after propofol general anesthesia.Trial registration: ChiCTR2100045128 (07/04/2021)

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