scholarly journals Effects of different sufentanil target concentrations on the MACBAR of sevoflurane in patients with carbon dioxide pneumoperitoneum stimulus

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Yanxia Guo ◽  
Dan Wang ◽  
Xiaolin Yang ◽  
Pingping Jiang ◽  
Juan Xu ◽  
...  
Keyword(s):  
Carbon Dioxide ◽  
Laparoscopic Cholecystectomy ◽  
Target Concentration ◽  
Sevoflurane Concentration ◽  
Link Type ◽  
Carbon Dioxide Pneumoperitoneum ◽  
Adrenergic Response ◽  
Plasma Target ◽  
Before And After ◽  
End Tidal

Abstract Background This study aims to observe the effects of different target controlled plasma sufentanil concentrations on the minimum alveolar concentration (MAC) of sevoflurane for blocking adrenergic response (BAR) in patients undergoing laparoscopic cholecystectomy with carbon dioxide pneumoperitoneum stimulation. Methods Eighty-five patients undergoing laparoscopic cholecystectomy, aged 30–65 years, with American Society of Anesthesiologists physical status I-II, were enrolled in this study. All the patients were randomly divided into 5 groups (S0, S1, S2, S3, S4) with different sufentanil plasma target concentration (0.0, 0.1, 0.3, 0.5, 0.7 ng ml− 1). Anesthesia was induced by inhalation of 8% sevoflurane in 100% oxygen, and 0.6 mg kg− 1 of rocuronium was intravenously injected to facilitate the insertion of a laryngeal mask airway. The end-tidal sevoflurane concentration and sufentanil plasma target concentration were adjusted according to respective preset value in each group. The hemodynamic response to pneumoperitoneum stimulus was observed after the end-tidal sevoflurane concentration had been maintained stable at least for 15 min. The MACBAR of sevoflurane was measured by a sequential method. Meanwhile, epinephrine (E) and norepinephrine (NE) concentrations in the blood were also determined before and after pneumoperitoneum stimulus in each group. Results When the method of independent paired reversals was used, the MACBAR of sevoflurane in groups S0, S1, S2, S3, S4 was 5.333% (confidence interval [CI] 95%: 5.197–5.469%), 4.533% (95% CI: 4.451–4.616%), 2.861% (95% CI: 2.752–2.981%), 2.233% (95% CI: 2.142–2.324%) and 2.139% (95% CI: 2.057–2.219%), respectively. Meanwhile, when the isotonic regression analysis was used, the MACBAR of sevoflurane in groups S0, S1, S2, S3, S4 was 5.329% (95% CI: 5.321–5.343%), 4.557% (95% CI: 4.552–4.568%), 2.900% (95% CI: 2.894–2.911%), 2.216% (95% CI: 2.173–2.223%) and 2.171% (95% CI: 2.165–2.183%), respectively. The MACBAR was not significantly different between groups S3 and S4 when using 0.5 and 0.7 ng ml− 1 of sufentanil plasma target concentrations. No significant difference was found in the change of E or NE concentration between before and after pneumoperitoneum stimulation in each group. Conclusions The MACBAR of sevoflurane can be decreased with increasing sufentanil plasma target concentrations. A ceiling effect of the decrease occurred at a sufentanil plasma target concentration of 0.5 ng ml− 1. When the sympathetic adrenergic response was inhibited in half of the patients to pneumoperitoneum stimulation in each group, the changes of E and NE concentrations showed no significant differences. Trial registration The study was registered at http://www.chictr.org.cn (ChiCTR1800015819, 23, April, 2018).

scholarly journals Effects of different sufentanil target concentrations on the MACBAR of sevoflurane in patients with carbon dioxide pneumoperitoneum stimulus

2020 ◽  
Author(s):  
Yanxia Guo ◽  
Dan Wang ◽  
Xiao-lin Yang ◽  
Pingping Jiang ◽  
Juan Xu ◽  
...  
Keyword(s):  
Carbon Dioxide ◽  
Laparoscopic Cholecystectomy ◽  
Target Concentration ◽  
Sevoflurane Concentration ◽  
Carbon Dioxide Pneumoperitoneum ◽  
Adrenergic Response ◽  
Significant Difference ◽  
Plasma Target ◽  
Before And After ◽  
End Tidal

Abstract Background:The objective of this study is to observe the effects of different target controlled plasma sufentanil concentrations on the minimum alveolar concentration (MAC) of sevoflurane for blocking adrenergic response (BAR) in patients undergoing laparoscopic cholecystectomy with carbon dioxide pneumoperitoneum stimulation.Methods: Eighty-five patients undergoing laparoscopic cholecystectomy, aged 18-65 years, with American Society of Anaesthesiologists physical status Ⅰ-Ⅱ, were enrolled in this study. All the patients were randomly divided into 5 groups (S0, S1, S2, S3, S4) with different sufentanil plasma target concentration (0.0, 0.1, 0.3, 0.5, 0.7 ng ml-1). Anaesthesia was induced by inhalation of 8% sevoflurane in 100% oxygen, and 0.6 mg kg-1 of rocuronium was intravenously injected to facilitate the insertion of laryngeal mask airway. The end-tidal sevoflurane concentration and sufentanil plasma target concentration were adjusted according to respective preset value in each group. The hemodynamic response to pneumoperitoneum stimulus was observed after the end-tidal sevoflurane concentration had been maintained stable at least for 15 min. The MACBAR of sevoflurane was measured by a sequential method. Meanwhile, epinephrine and norepinephrine concentrations in the blood were also determined before and after pneumoperitoneum stimulus in each group.Results:The basic MACBAR of sevoflurane in group S0 was 5.33% (confidence interval[CI] 95%: 5.19-5.47%), which was decreased 15%, 46%, 58% and 60% by the infusion of sufentanil with 0.1, 0.3, 0.5 and 0.7 ng ml-1 plasma target concentration, respectively. But the decreased degree had no significant difference between 0.5 and 0.7 ng ml-1 of sufentanil plasma target concentrations. No significant difference was found in the change of epinephrine or norepinephrine concentration between before and after pneumoperitoneum stimulation in each group.Conclusions: The MACBAR of sevoflurane can be decreased with increasing sufentanil plasma target concentrations. A capping effect of the decrease occurred at a sufentanil plasma target concentration of 0.5 ng ml-1. When the sympathetic adrenergic response was inhibited in half patients to pneumoperitoneum stimulation in each group, the changes of epinephrine and norepinephrine concentrations showed no significant differences.Trial registration: The study was registered at http://www.chictr.org.cn (ChiCTR1800015819, 23, April, 2018) .

scholarly journals Effects of different sufentanil target concentrations on the MACBAR of sevoflurane in patients with carbon dioxide pneumoperitoneum stimulus

2020 ◽  
Author(s):  
Yanxia Guo ◽  
Dan Wang ◽  
Xiao-lin Yang ◽  
Pingping Jiang ◽  
Juan Xu ◽  
...  
Keyword(s):  
Carbon Dioxide ◽  
Laparoscopic Cholecystectomy ◽  
Target Concentration ◽  
Sevoflurane Concentration ◽  
Carbon Dioxide Pneumoperitoneum ◽  
Adrenergic Response ◽  
Significant Difference ◽  
Plasma Target ◽  
Before And After ◽  
End Tidal

Abstract Background: This study aims to observe the effects of different target controlled plasma sufentanil concentrations on the minimum alveolar concentration (MAC) of sevoflurane for blocking adrenergic response (BAR) in patients undergoing laparoscopic cholecystectomy with carbon dioxide pneumoperitoneum stimulation.Methods: Eighty-five patients undergoing laparoscopic cholecystectomy, aged 30-65 years, with American Society of Anesthesiologists physical status Ⅰ-Ⅱ, were enrolled in this study. All the patients were randomly divided into 5 groups (S0, S1, S2, S3, S4) with different sufentanil plasma target concentration (0.0, 0.1, 0.3, 0.5, 0.7 ng ml-1). Anesthesia was induced by inhalation of 8% sevoflurane in 100% oxygen, and 0.6 mg kg-1 of rocuronium was intravenously injected to facilitate the insertion of a laryngeal mask airway. The end-tidal sevoflurane concentration and sufentanil plasma target concentration were adjusted according to respective preset value in each group. The hemodynamic response to pneumoperitoneum stimulus was observed after the end-tidal sevoflurane concentration had been maintained stable at least for 15 min. The MACBAR of sevoflurane was measured by a sequential method. Meanwhile, epinephrine (E) and norepinephrine (NE) concentrations in the blood were also determined before and after pneumoperitoneum stimulus in each group.Results: When the method of independent paired reversals was used, the MACBAR of sevoflurane in groups S0, S1, S2, S3, S4 was 5.333% (confidence interval [CI] 95%: 5.197-5.469%), 4.533% (95% CI: 4.451-4.616%), 2.861% (95% CI: 2.752-2.981%), 2.233% (95% CI: 2.142-2.324%) and 2.139% (95% CI: 2.057-2.219%), respectively. Meanwhile, when the isotonic regression analysis was used, the MACBAR of sevoflurane in groups S0, S1, S2, S3, S4 was 5.329% (95% CI: 5.321-5.343%), 4.557% (95% CI: 4.552-4.568%), 2.900% (95% CI: 2.894-2.911%), 2.216% (95% CI: 2.173-2.223%) and 2.171% (95% CI: 2.165-2.183%), respectively. The MACBAR was not significantly different between groups S3 and S4 when using 0.5 and 0.7 ng ml-1 of sufentanil plasma target concentrations. No significant difference was found in the change of E or NE concentration between before and after pneumoperitoneum stimulation in each group.Conclusions: The MACBAR of sevoflurane can be decreased with increasing sufentanil plasma target concentrations. A ceiling effect of the decrease occurred at a sufentanil plasma target concentration of 0.5 ng ml-1. When the sympathetic adrenergic response was inhibited in half of the patients to pneumoperitoneum stimulation in each group, the changes of E and NE concentrations showed no significant differences.Trial registration: The study was registered at http://www.chictr.org.cn (ChiCTR1800015819, 23, April, 2018).

scholarly journals Effects of different sufentanil target concentrations on the MACBAR of sevoflurane in patients with carbon dioxide pneumoperitoneum stimulus

2020 ◽  
Author(s):  
Yanxia Guo ◽  
Dan Wang ◽  
Xiao-lin Yang ◽  
Pingping Jiang ◽  
Juan Xu ◽  
...  
Keyword(s):  
Carbon Dioxide ◽  
Laparoscopic Cholecystectomy ◽  
Target Concentration ◽  
Sevoflurane Concentration ◽  
Carbon Dioxide Pneumoperitoneum ◽  
Adrenergic Response ◽  
Significant Difference ◽  
Plasma Target ◽  
Before And After ◽  
End Tidal

Abstract Background: This study aims to observe the effects of different target controlled plasma sufentanil concentrations on the minimum alveolar concentration (MAC) of sevoflurane for blocking adrenergic response (BAR) in patients undergoing laparoscopic cholecystectomy with carbon dioxide pneumoperitoneum stimulation.Methods: Eighty-five patients undergoing laparoscopic cholecystectomy, aged 30-65 years, with American Society of Anesthesiologists physical status Ⅰ-Ⅱ, were enrolled in this study. All the patients were randomly divided into 5 groups (S0, S1, S2, S3, S4) with different sufentanil plasma target concentration (0.0, 0.1, 0.3, 0.5, 0.7 ng ml-1). Anesthesia was induced by inhalation of 8% sevoflurane in 100% oxygen, and 0.6 mg kg-1 of rocuronium was intravenously injected to facilitate the insertion of laryngeal mask airway. The end-tidal sevoflurane concentration and sufentanil plasma target concentration were adjusted according to respective preset value in each group. The hemodynamic response to pneumoperitoneum stimulus was observed after the end-tidal sevoflurane concentration had been maintained stable at least for 15 min. The MACBAR of sevoflurane was measured by a sequential method. Meanwhile, epinephrine (E) and norepinephrine (NE) concentrations in the blood were also determined before and after pneumoperitoneum stimulus in each group.Results: When the method of independent paired reversals was used, the MACBAR of sevoflurane in groups S0, S1, S2, S3, S4 was 5.333% (confidence interval [CI] 95%: 5.197-5.469%), 4.533% (95% CI:4.451-4.616%), 2.861% (95% CI:2.752-2.981%), 2.233% (95% CI:2.142-2.324%) and 2.139% (95% CI:2.057-2.219%), respectively. Meanwhile, when the isotonic regression analysis was used, the MACBAR of sevoflurane in groups S0, S1, S2, S3, S4 was 5.329% (95% CI:5.321-5.343%), 4.557% (95% CI:4.552-4.568%), 2.900% (95% CI:2.894-2.911%), 2.216% (95% CI:2.173-2.223%) and 2.171% (95%CI:2.165-2.183%), respectively. The MACBAR had no significant difference between group S3 and group S4 when using 0.5 and 0.7 ng ml-1 of sufentanil plasma target concentrations. No significant difference was found in the change of E or NE concentration between before and after pneumoperitoneum stimulation in each group.Conclusions: The MACBAR of sevoflurane can be decreased with increasing sufentanil plasma target concentrations. A capping effect of the decrease occurred at a sufentanil plasma target concentration of 0.5 ng ml-1. When the sympathetic adrenergic response was inhibited in half patients to pneumoperitoneum stimulation in each group, the changes of E and NE concentrations showed no significant differences.Trial registration: The study was registered at http://www.chictr.org.cn (ChiCTR1800015819, 23, April, 2018).

scholarly journals Effects of different plasma target concentrations of remifentanil on the MACBAR of sevoflurane in children with laparoscopic surgery

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Dan Wang ◽  
Juan Xu ◽  
Xiao-Lin Yang ◽  
Yan-Xia Guo ◽  
Ping-Ping Jiang ◽  
...  
Keyword(s):  
Laparoscopic Surgery ◽  
Laparoscopic Herniorrhaphy ◽  
Sequential Method ◽  
Link Type ◽  
Carbon Dioxide Pneumoperitoneum ◽  
Adrenergic Response ◽  
Significant Difference ◽  
Child Patients ◽  
Plasma Target ◽  
Before And After

Abstract Background To investigate the effects of different plasma target concentrations of remifentanil on the minimum alveolar concentration (MAC) for blocking adrenergic response (BAR) of sevoflurane in children with laparoscopic herniorrhaphy. Methods Seventy-five children with 3-7 years old scheduled for laparoscopic herniorrhaphy were randomly divided into group R0, group R1, and group R2 according to different remifentanil plasma target concentration (0, 1, and 2 ngml-1), respectively. The MACBAR of sevoflurane was determined by the up-and-down and sequential method in each group. The concentrations of epinephrine and noradrenaline were also determined at corresponding time points. Results A total of 52 child patients were used among the anticipated 75 patients. In groups R0, R1, and R2, the MACBAR of sevoflurane was (3.29 ± 0.17) %, (2.12 ± 0.10) % and (1.29 ± 0.11) %, respectively, and a significant difference was found among the three groups (P<0.05). The changes of epinephrine and noradrenaline concentrations in each group before and after insufflation of carbon dioxide pneumoperitoneum showed no significant differences. Conclusion Remifentanil by target-controlled infusion can effectively reduce the MACBAR of sevoflurane during laparoscopic surgery in children. At a similar effect of MACBAR, both the changes of epinephrine and noradrenaline concentrations are not affected by the infusion of different remifentanil target concentrations. Trial registration The trial was registered at http://www.chictr.org.cn(ChiCTR1800019393, 8, Nov, 2018).

scholarly journals Effects of different plasma target concentrations of remifentanil on the MACBAR of sevoflurane in children with laparoscopic surgery

2021 ◽  
Author(s):  
Xiao-lin Yang ◽  
Dan Wang ◽  
Juan Xu ◽  
YanXia Guy ◽  
Ping-Ping Jiang ◽  
...  
Keyword(s):  
Laparoscopic Surgery ◽  
Minimum Alveolar Concentration ◽  
Laparoscopic Herniorrhaphy ◽  
Target Concentration ◽  
Sequential Method ◽  
Carbon Dioxide Pneumoperitoneum ◽  
Adrenergic Response ◽  
Significant Difference ◽  
Plasma Target ◽  
Before And After

Abstract BackgroundTo investigate the effects of different plasma target concentrations of remifentanil on the minimum alveolar concentration (MAC) for blocking adrenergic response (BAR) of sevoflurane in children with laparoscopic herniorrhaphy.MethodsSeventy five children with 3–7 years old scheduled for laparoscopic herniorrhaphy were randomly divided into group R0, group R1, and group R2 according to different remifentanil plasma target concentration (0, 1, and 2 ng/ml), respectively. The MACBAR of sevoflurane was determined by the up-and-down and sequential method in each group. The concentrations of epinephrine and noradrenaline were also determined at corresponding time points.ResultsIn groups R0, R1, and R2, the MACBAR of sevoflurane was (3.29 ± 0.17)%, (2.12 ± 0.10)% and (1.29 ± 0.11)%, respectively, and a significant difference was found among the three groups (P < 0.05). The changes of epinephrine and noradrenaline concentrations in each group before and after insufflation of carbon dioxide pneumoperitoneum showed no significant differences.ConclusionRemifentanil by target-controlled infusion can effectively reduce the MACBAR of sevoflurane during laparoscopic surgery in children. At a similar effect of MACBAR, both the changes of epinephrine and noradrenaline concentrations are not affected by the infusion of different remifentanil target concentrations.Trial registrationThe trial was registered in the China Clinical Trial Center(http://www.chictr.org.cn) in advance (the registry number is ChiCTR1800019393.).

Ventilatory responses to carbon dioxide at low and high levels of oxygen are elevated after episodic hypoxia in men compared with women

2004 ◽  
Vol 97 (5) ◽  
pp. 1673-1680 ◽  
Author(s):  
Chris Morelli ◽  
M. Safwan Badr ◽  
Jason H. Mateika
Keyword(s):  
Carbon Dioxide ◽  
Ventilatory Response ◽  
Minute Ventilation ◽  
High Oxygen ◽  
Set Point ◽  
Ventilatory Responses ◽  
Episodic Hypoxia ◽  
Before And After ◽  
Oxygen Gas ◽  
End Tidal

We hypothesized that the acute ventilatory response to carbon dioxide in the presence of low and high levels of oxygen would increase to a greater extent in men compared with women after exposure to episodic hypoxia. Eleven healthy men and women of similar race, age, and body mass index completed a series of rebreathing trials before and after exposure to eight 4-min episodes of hypoxia. During the rebreathing trials, subjects initially hyperventilated to reduce the end-tidal partial pressure of carbon dioxide (PetCO2) below 25 Torr. Subjects then rebreathed from a bag containing a normocapnic (42 Torr), low (50 Torr), or high oxygen gas mixture (150 Torr). During the trials, PetCO2 increased while the selected level of oxygen was maintained. The point at which minute ventilation began to rise in a linear fashion as PetCO2 increased was considered to be the carbon dioxide set point. The ventilatory response below and above this point was determined. The results showed that the ventilatory response to carbon dioxide above the set point was increased in men compared with women before exposure to episodic hypoxia, independent of the oxygen level that was maintained during the rebreathing trials (50 Torr: men, 5.19 ± 0.82 vs. women, 4.70 ± 0.77 l·min−1·Torr−1; 150 Torr: men, 4.33 ± 1.15 vs. women, 3.21 ± 0.58 l·min−1·Torr−1). Moreover, relative to baseline measures, the ventilatory response to carbon dioxide in the presence of low and high oxygen levels increased to a greater extent in men compared with women after exposure to episodic hypoxia (50 Torr: men, 9.52 ± 1.40 vs. women, 5.97 ± 0.71 l·min−1·Torr−1; 150 Torr: men, 5.73 ± 0.81 vs. women, 3.83 ± 0.56 l·min−1·Torr−1). Thus we conclude that enhancement of the acute ventilatory response to carbon dioxide after episodic hypoxia is sex dependent.

scholarly journals Comparison of end-tidal carbon dioxide and point-of-care echocardiography for fluid response at the bedside

2019 ◽  
pp. 102490791987092 ◽  
Author(s):  
Semih Korkut ◽  
Erden Erol Ünlüer ◽  
Arif Karagöz ◽  
Karama Bouchaala Mnif ◽  
Emine Kadioğlu
Keyword(s):  
Carbon Dioxide ◽  
Cardiac Output ◽  
Point Of Care ◽  
Passive Leg Raising ◽  
Velocity Time Integral ◽  
Time Integral ◽  
End Tidal Carbon Dioxide ◽  
Before And After ◽  
End Tidal ◽  
Bedside Method

Purpose: In this study, we aimed to compare cardiac output, echocardiographic pulmonary velocity-time integral, and end-tidal carbon dioxide values before and after the passive leg raising maneuver in healthy volunteers. Methods: The Ethical Commission approved the study. A total of 36 volunteers were included after signed informed consent in our study. After 12 h of fasting, vital signs, cardiac output, pulmonary velocity-time integral, and end-tidal carbon dioxide were measured when the participants were lying supine. Then, participants’ legs were elevated to 45° passively, and all measurements were repeated. Pulmonary velocity-time integral was obtained in parasternal short-axis view with the aid of pulse Doppler. Pulmonary root measurements were recorded. Echocardiographic stroke volume and cardiac output were calculated. The differences between values of cardiac output, pulmonary velocity-time integral, and end-tidal carbon dioxide before and after passive leg raising were statistically compared. The level of significance was accepted as p < 0.05. Results: Significant differences were found between pre- and post-passive leg raising values of these three measurements. The effect of passive leg raising on pulmonary velocity-time integral measurements was greater. The change in end-tidal carbon dioxide was not correlated with either cardiac output or pulmonary velocity-time integral alteration. Conclusion: Our results showed that measurement of pulmonary velocity-time integral changes after passive leg raising is a more useful bedside method to predict fluid responsiveness than measurement of end-tidal carbon dioxide and cardiac output alteration.

Intraabdominal Carbon Dioxide Insufflation in the Pregnant Ewe

1996 ◽  
Vol 85 (6) ◽  
pp. 1395-1402. ◽  
Author(s):  
Antonio M. Cruz ◽  
Lucy C. Southerland ◽  
Tanya Duke ◽  
Hugh G. G. Townsend ◽  
James G. Ferguson ◽  
...  
Keyword(s):  
Carbon Dioxide ◽  
Blood Flow ◽  
Intraabdominal Pressure ◽  
Control Group ◽  
Uterine Blood Flow ◽  
Carbon Dioxide Insufflation ◽  
Carbon Dioxide Pneumoperitoneum ◽  
Arterial Blood ◽  
End Tidal Carbon Dioxide ◽  
End Tidal

Background Laparoscopic surgical procedures are being performed in pregnant women with increasing frequency. Maternal-fetal physiologic changes occurring during intraabdominal carbon dioxide insufflation are poorly understood, and maternal-fetal safety is of concern during carbon dioxide pneumoperitoneum. A previous pilot study using end-tidal carbon dioxide-guided ventilation resulted in maternal and fetal acidosis and tachycardia during carbon dioxide pneumoperitoneum. Using serial arterial PCO2 to guide ventilation, this study was designed to evaluate maternal-fetal cardiopulmonary status, uterine blood flow, and the intraamniotic pressure effects of intraabdominal carbon dioxide insufflation in singleton pregnant ewes between 120 and 135 days of gestation. Methods In a prospective randomized cross-over study, nine ewes were to receive either abdominal insufflation with carbon dioxide to an intraabdominal pressure of 15 mmHg (n = 9; insufflation group) or receive no insufflation (n = 9; control group). Anesthesia was induced with thiopental and maintained with end-tidal halothane (1 to 1.5 minimum alveolar concentration/100% oxygen). Mechanical ventilation was guided by serial maternal arterial blood gas analysis to maintain PaCO2 between 35 and 40 mmHg. Data from insufflated animals were collected during insufflation (60 min) and after desufflation (30 min). Control group data were collected and matched to similar time intervals for 90 min. Ewes were allowed to recover, and after a rest period (48 h) they were entered in the cross-over study. Results During insufflation there was a significant increase (P &lt; 0.05) in maternal PaCO2 to end-tidal carbon dioxide gradient and minute ventilation, with concomitant decreases in maternal end-tidal carbon dioxide and PaO2. Intraamniotic pressure increased significantly during insufflation. No significant changes were observed in maternal hemodynamic variables, fetal variables, or in uterine blood flow during the study. There were no fetal deaths or preterm labor in any of the animals during the experiment. Conclusions During the 1-h insufflation, a marked increase in PaCO2-to-end-tidal carbon dioxide gradient was observed, suggesting that capnography may be an inadequate guide to ventilation during carbon dioxide pneumoperitoneum in the pregnant patient. No other significant circulatory changes were observed.

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