Search Results (210)

Recent advances in intraoperative nociception monitoring, such as the Surgical pleth index (SPI, GE Healthcare, Helsinki, Finland), may help optimize opioid use. Obese patients are particularly susceptible to opioid-related side effects, making this approach of interest in bariatric surgery. In this randomized pilot study, we investigated whether SPI-guided fentanyl administration would influence intraoperative opioid use and postoperative pain. We enrolled 49 patients undergoing laparoscopic gastric sleeve surgery under sevoflurane-based general anesthesia with multimodal perioperative analgesia, randomized to conventional fentanyl dosing at the anesthetist’s discretion (n = 25) or SPI-guided dosing (n = 24). The primary endpoint was intraoperative fentanyl consumption. Secondary outcomes included time to extubation, hemodynamic events, pain scores in the first 90 min postoperatively and rescue analgesia. Fentanyl use did not differ significantly between groups (SPI: 400 ± 101 mcg vs. control: 450 ± 56 mcg, p = 0.100). Extubation was faster with SPI guidance (8.1 ± 1.6 vs. 9.6 ± 1.3 min, p < 0.001). Hemodynamic events and rescue analgesia were less frequent in the SPI group, though not statistically significant. Pain scores were comparable, and no opioid-related adverse effects occurred. In our study, SPI-guided opioid administration did not reduce overall intraoperative fentanyl requirements compared with conventional practice but was associated with a modestly shorter time to extubation. Full article

Indoor air pollution has become a significant concern, contributing to the decline in air quality through the presence of gaseous pollutants and particulate matter, especially under poor ventilation. Hospitals, functioning as non-industrial microenvironments, particularly in Thailand, face challenges due to insufficient and incomplete databases for effective air quality management. Within these environments, patients with heightened sensitivity, along with hospital staff who are predominantly exposed indoors, face increased risk of exposure to indoor air pollutants. This study aimed to review current evidence on VOCs in hospital settings in Thailand, identifying their sources, concentrations, and health impacts. It also aimed to provide recommendations for improved air quality monitoring and management. The review included studies published between 2008 and 2023 in English or Thai. Studies were selected based on relevance to VOCs in hospital environments, while excluding those lacking sufficient data or methodological rigor. Literature searches were conducted using Google Scholar, ScienceDirect, Scopus, and PubMed. Results from international studies were also considered to address gaps. Data extraction focused on VOC sources, concentrations, measurement methods, and associated health impacts. Results were synthesized into six thematic categories: characterization, health effects, control measures, etiological studies, monitoring systems, and comparative studies. The review identified 87 relevant studies. VOC exposure was associated with several adverse health impacts resulting from short- and long-term exposures, leading to an increased risk of cancer. Identified sources of VOC emissions within hospitals encompass anesthetic gases, sterilization processes, pharmaceuticals, laboratory chemicals, patient care, and household products, as well as building materials and furnishings. Commonly encountered VOCs include alcohols (e.g., ethanol, 2-methyl-2-propanol, isopropanol), ether, isoflurane, nitrous oxide, sevoflurane, chlorine, formaldehyde, aromatic hydrocarbons, limonene, and glutaraldehyde, among those commonly detected in hospital environments. Yet, limited knowledge exists regarding their source contributions, emissions, and concentrations associated with health impacts in Thai hospitals. Full article

Background: There is little data available in infants on the extent to which inhalational anesthetics prolong the effects of neuromuscular blocking agents compared with intravenous agents. Here, we assessed the differences between the neuromuscular blocking effects (duration and recovery time) of a single dose of rocuronium during propofol vs. sevoflurane anesthesia. Methods: The prospective study enrolled 20 infants (4–12 months of age) scheduled for craniosynostosis surgery, randomly assigned to receive general anesthesia maintenance with sevoflurane or propofol. All patients received 0.6 mg/kg rocuronium as a single bolus dose to facilitate tracheal intubation and surgery. Primary study endpoint was the clinical duration of rocuronium, from administration until spontaneous recovery to a train-of-four ratio (TOFR) > 0.90. Secondary endpoints were times for reappearance of the first, second, third, and fourth twitches of the TOF (T1, T2, T3 and T4, respectively) in the two patient groups. Results: There were no differences in the infants’ age (sevoflurane maintenance: 5.8 ± 2.4 months; propofol maintenance: 6.7 ± 3.1 months, p = 0.47) or weight (sevoflurane: 7722 ± 1644 g; propofol: 7433 ± 1782 g, p = 0.71). Rocuronium onset time was 101.0 ± 55.0 s in the sevoflurane group and 83.4 ± 47.9 s in the propofol group (p = 0.46). Total duration of anesthesia was comparable in the sevoflurane (122.0 ± 23.8 min) and propofol (107.7 ± 25.2 min, p = 0.18) groups. Rocuronium recovery to TOFR > 0.9 required 136 min (CI: 123.7–149.5 min) in the sevoflurane group and 61.5 min (CI: 58.0–101.0 min) in the propofol group (p < 0.001). Conclusions: In infants, sevoflurane maintenance enhances the neuromuscular blocking effect of a single, 0.6 mg/kg BW dose of rocuronium as compared to propofol maintenance. After discontinuation of sevoflurane, additional time is necessary to reach the acceptable TOFR >0.9 needed before tracheal extubation. The present study further underscores the importance of objective (quantitative) neuromuscular monitoring in infants to guide intraoperative management and prevent residual neuromuscular block. Full article

Sedation and analgesia are crucial elements in managing discomfort and facilitating critical care interventions in children. Our choice of sedative agents has a significant impact on the physiological and psychological outcomes of our patients. Oversedation and undersedation are associated with adverse events, including increased risk of Pediatric Intensive Care Unit (PICU) readmission, mortality, and longer duration of mechanical ventilation. Studies have shown significant variation in sedation and analgesia practices across different regions and specialties. Consensus clinical guidelines have been developed to standardize sedation and analgesia practices; commonly used intravenous agents include opioids (fentanyl, morphine, and remifentanil), α-2 agonists (clonidine and dexmedetomidine), benzodiazepines (particularly midazolam), ketamine, and volatile anesthetic agents (isoflurane and sevoflurane). Our goal should be to administer the smallest possible number of sedative and analgesic agents, in the lowest possible doses, for the shortest amount of time, whilst adequately controlling the pain and agitation of our patients. Aside from drug management, non-pharmacological interventions, such as family presence, music, and virtual reality, can also play a significant role in maintaining comfort in critically ill children. Validated clinical tools are available to measure sedation and to assess iatrogenic withdrawal syndrome and delirium. Daily interruption of sedatives and protocolized sedation management has been associated with a reduction in the duration of mechanical ventilation and length of PICU admission in some studies, but their effectiveness is still debated. Further research is needed to optimize sedation and analgesia practices in critically ill children. By adopting evidence-based guidelines and incorporating non-pharmacological interventions, clinicians may be able to improve patient outcomes and also reduce the incidence of adverse events. Full article

Background: Dopamine (DA) is a critical neurotransmitter that regulates many physiological and behavioral processes. The central dopaminergic system plays a pivotal role in modulating general anesthesia (GA). DA release in the brain is mainly concentrated in the nucleus accumbens (NAc), prefrontal cortex, hypothalamus, and dorsal striatum. Several NAc neuron subtypes are essential for modulating states of consciousness during GA. However, whether NAc DA signal dynamics correlate with different states of consciousness under sevoflurane anesthesia remains to be elucidated. In this study, we measured the dynamic fluctuations of NAc DA levels throughout sevoflurane anesthesia to verify its role. Methods: An intensity-based genetically encoded DA indicator, dLight1.1, was employed to track DA release in the NAc. Fiber photometry combined with electroencephalogram/electromyogram recordings was employed to synchronously track NAc DA signal dynamics across different states of consciousness under sevoflurane anesthesia. Results: Under 2.5% sevoflurane exposure, DA release in the NAc significantly increased during the initial 100 s of sevoflurane induction, which was designated as sevo on-1 (mean ± standard error of the mean [SEM]; baseline vs. sevo on-1, p = 0.0261), and continued to decrease in the subsequent anesthesia maintenance phases (sevo on-1 vs. sevo on-4, p = 0.0070). Following the cessation of sevoflurane administration (with intervals denoted as sevooff), NAc DA gradually returned to baseline levels (sevo on-1 vs. sevo off-1, p = 0.0096; sevo on-1 vs. sevo off-3, p = 0.0490; sevo on-1 vs. sevo off-4, p = 0.0059; sevo on-4 vs. sevo off-4, p = 0.0340; sevo off-1 vs. sevo off-4, p = 0.0451). During the induction phase, NAc DA signal dynamics markedly increased during the pre-loss of consciousness (LOC) period (pre-anesthesia baseline vs. pre-LOC, p = 0.0329) and significantly declined after LOC (pre-LOC vs. post-LOC, p = 0.0094). For the emergence period, NAc DA release exhibited a noticeable increase during the initial period after recovery of consciousness (ROC) (anesthesia baseline vs. post-ROC, p = 0.0103; pre-ROC vs. post-ROC, p = 0.0086). Furthermore, the DA signals peaked rapidly upon the initiation of the burst wave and then gradually attenuated, indicating a positive correlation with the burst wave onset during burst suppression events. Conclusions: Our findings revealed that NAc DA neurotransmitter signal dynamics correlate with different states of consciousness throughout sevoflurane anesthesia. Full article

Background: Optimizing critical care sedation is an important and complex task. Although intravenous sedatives are widely used, they do have limitations compared to volatile sedatives, such as faster awakening and minimal accumulation. However, volatiles are still rarely used due to technical barriers and costs. We intended to conduct an economic evaluation on the workload and efficiency of short-term volatile sedation. Methods: Retrospective secondary data analysis of the cost of 60 min sedation after cardiac valve surgery performed at a tertiary center (n = 94), including assessment of material turnover, substance consumption and personnel expenses combined on a monetary basis. Results: The time required for bedside preparation was extended from almost 18 min (i.v. sedation) to an additional 9–10 min when applying volatile sedatives. We calculated a median sevoflurane consumption of 23 mL using MIRUS^TM and 14 mL using Sedaconda, resulting in an average price of EUR 38.43 for propofol, EUR 13.24 for sevoflurane under Sedaconda, and EUR 15.03 using MIRUS^TM for application in the monetary evaluation. The total prices were calculated based on an additionally optimized scenario of weekly use of a MIRUS^TM reflection device system, at EUR 128.99 versus EUR 119.73 (Sedaconda) versus EUR 48.44 for conventional propofol-based sedation. Conclusions: The use of volatile sedation in intensive care has a higher price in short-term use due to the cost of the single-use reflector of the anesthetic conserving device, which is difficult to offset financially against the pharmacological benefits in terms of faster recovery. However, the additional setup times are relatively short. Clinical benefits such as faster recovery were not included in the cost analysis. Full article

Volatile anesthetics, while increasingly utilized in intensive care medicine, are associated with significant renal adverse effects. A critical safety concern—particularly with sevoflurane—involves its potential impact on renal function. Pathophysiologically, inorganic fluoride levels exceeding 50 µmol/L are recognized as a threshold for nephrogenic diabetes insipidus, a condition generally considered reversible. Additionally, the sevoflurane degradation product “compound A” has been implicated in direct renal tubular and glomerular toxicity. Specifically, exposure has been correlated with glomerular damage, evidenced by albuminuria, as well as injury to both proximal and distal tubules, indicated by elevated levels of α-glutathione-S-transferase. Postprandial glycosuria may also be observed. Unlike nephrogenic diabetes insipidus, the structural damage induced by compound A may result in irreversible renal impairment. Full article

Endotoxemia often leads to microcirculatory derangement. In six sevoflurane anaesthetized Beagle dogs, we investigated the effects of 1 mg/kg of Escherichia coli lipopolysaccharide endotoxin intravenous and blood pressure (mean arterial pressure of 65 mmHg versus 85 mmHg) on microcirculation assessed on buccal mucosa using side stream dark field microscopy. Dogs were afterwards resuscitated with fluids and noradrenaline. We investigated dose requirements of noradrenaline with or without dexmedetomidine. Microcirculatory parameters, and markers of sepsis (cardiac output, mixed venous oxygen saturation, carbon dioxide gap, and lactate) were analysed before endotoxemia, after endotoxemia, after a 30 mL/kg of Ringer’s acetate fluid bolus, and during noradrenaline +/− dexmedetomidine infusion, after a second fluid bolus, and a second time after vasopressor treatment in a cross-over fashion. Endotoxemia and mean arterial pressure had no statistically significant effect on microcirculation; however, endotoxemia resulted in a decrease in cardiac output. Dexmedetomidine neither improved microcirculation nor reduced noradrenaline requirements. Full article

Surgical trauma elicits a complex inflammatory stress response, contributing to postoperative morbidity and recovery variability. This response is influenced by patient-specific factors and surgical and anesthetic techniques. To isolate the impact of anesthesia on the acute phase response, we investigated plasma proteomic changes in a uniquely homogeneous cohort of healthy, living kidney donors (n = 36; propofol = 19; sevoflurane = 17) undergoing laparoscopic donor nephrectomy. Proteomic profiling of plasma samples collected preoperatively and at 2 and 24 h postoperatively revealed 633 quantifiable proteins, of which 22 showed significant perioperative expression changes. Eight proteins exhibited over two-fold increases, primarily related to the acute phase response (CRP, SAA1, SAA2, LBP), tissue repair (FGL1, A2GL), and anti-inflammatory regulation (AACT). These changes were largely independent of anesthetic type, though SAA2 and MAN1A1 showed anesthetic-specific expression. The upregulation of these proteins implicates the activation of immune pathways involved in host defense, tissue remodeling, and inflammation resolution. Our findings provide a molecular reference for the surgical stress response in healthy individuals and highlight candidate biomarkers for predicting and managing postoperative outcomes. Understanding these pathways may support the development of strategies to mitigate surgical stress and enhance recovery, particularly in vulnerable patient populations. Full article

Background and Objectives: The aim of this study was to compare the effects of sevoflurane-based anesthesia and propofol-based total intravenous anesthesia (TIVA) on intraocular pressure (IOP) during coronary artery bypass graft surgery (CABG) with cardiopulmonary bypass (CPB). Materials and Methods: This prospective observational monocentric study included 68 patients scheduled for CABG with CPB, divided into two groups of propofol-based TIVA (Group P) and sevoflurane-based anesthesia (Group S). Intraocular pressure was measured and recorded at eight predefined time points using a tonometer: before anesthesia induction (T1), 10 min after induction (T2), immediately before the beginning of CPB (T3), 3 min after the beginning of CPB (T4), 3 min after cross-clamping (T5), 3 min after cross-clamp removal (T6), immediately before the weaning of CPB (T7), and at the end of the surgery (immediately after skin closure) (T8). The primary endpoint was to examine the effects of propofol-based TIVA and sevoflurane-based anesthesia methods on IOP during CABG operation. The secondary endpoints included a comparison of hemodynamic variables, blood gas values, and intensive care unit (ICU) and hospital stays. Results: Intraocular pressure values were similar for both groups at all time points. A statistically significant decrease was found in IOP in all measurements after induction compared to pre-induction values in both Group P and Group S (p < 0.05). Compared to IOP measured at 10 min after induction, no statistically significant difference was found at all subsequent time points in both groups. When the right and left IOP values were compared, no statistically significant difference was detected at all time points in both Group P and Group S. Conclusions: The results of the study indicated that propofol-based TIVA and sevoflurane-based anesthesia had similar effects on IOP in patients undergoing CABG with CPB. Full article

(1) Background: The aim of this bibliometric study is to analyze global research trends, citation impact, and scientific collaborations in the field of neuromuscular blockers (NMBAs) and their antagonists between 2000 and 2024. (2) Methods: Data were retrieved from the Web of Science Core Collection (WoSCC) using Boolean search strategies. Bibliometric analyses were conducted using R bibliometrix, VOSviewer, and CiteSpace software to visualize collaboration networks, keyword trends, and citation bursts. (3) Results: A total of 499 articles were analyzed, with the United States of America (USA), China, and South Korea leading in productivity, while France had the highest citation impact. Influential authors included Mertes PM and Fuchs-Buder T. Emerging topics such as sugammadex, sevoflurane, and neuromuscular monitoring were identified, reflecting a shift from pharmacokinetic studies to safety and monitoring strategies. (4) Conclusions: The findings indicate a marked increase in studies on neuromuscular monitoring and reversal agents, such as sugammadex, over the past two decades. The USA, France, and China emerged as the most contributory countries in NMBAs research, with their extensive international collaborations playing a pivotal role in shaping scientific progress. Highly influential studies have predominantly focused on NMBA pharmacokinetics, safety, anaphylaxis risks, and the clinical benefits of sugammadex, underscoring its critical role in reducing residual neuromuscular blockade (rNMB) and enhancing patient safety. Full article

Background and Objectives: Metabolic-flow (<0.35 L/min) anesthesia is practiced more often as manufacturers provide newer technologies, yet the benefits of metabolic-flow anesthesia have not been fully investigated. This study aimed to investigate the feasibility and safety of automated gas control (AGC^®) mode, which provides metabolic-flow anesthesia, in a pediatric population. Materials and Methods: Pediatric surgery patients between 1 and 10 years of age were included in this prospective observational trial. After intravenous induction and safe orotracheal intubation, AGC^® was initiated, and total sevoflurane consumption (mL) and wash-in speed-based sevoflurane consumption data were collected to measure feasibility. For safety, inspired (F_iO₂), alveolar (F_AO₂), and expired (F_EO₂) oxygen concentration data, and inspired and alveolar sevoflurane (F_iSevo and F_ASevo, respectively) concentration data, were recorded. Changes in fresh gas flow (FGF) throughout the procedure and postoperative recovery data were also compared. Results: A total of 130 patients were eligible for this study, and 121 patients were included in the analyses; 30 patients had a wash-in speed of 4 (WI4) and 91 patients had a wash-in speed of 8 (WI8) at follow-up. The total mean sevoflurane consumption was 9.35 ± 4.93 mL for a median surgery duration of 100 min. WI8 patients consumed more sevoflurane (9.92 ± 5.08 mL vs. 7.79 ± 4.19 mL, p = 0.04). At the 15th and 30th minutes, the FGF dropped under minimal flow and metabolic flow limits, respectively (p < 0.001). The times to extubation and obeying commands were shorter in WI8 patients (8 (5–10) vs. 11 (5–15) p = 0.03, and 9.5 (5–10.5) vs. 13 (9–17) p < 0.01). Conclusions: Maintenance with AGC^® may offer up to 40 h of anesthesia, considering that the volume of a sevoflurane bottle is 250 mL, reflecting exceptional savings compared to conventional anesthesia management. Metabolic flow anesthesia driven by AGC^® is feasible and safe in pediatric anesthesia practice. Full article

Various electron impact scattering cross sections of Sevoflurane are reported up to 5 keV. The elastic cross sections (differential and integral) are computed using the single-centre-expansion formalism within a molecular framework. The ground state target wavefunction is determined at the Hartree–Fock (HF) level. Post-HF corrections are incorporated to make a scattering realistic model. The total interacting potential is defined as the sum of static, correlation–polarization and exchange potentials. These potentials are numerically computed using their local forms. The long-range effects affecting the scattering due to the polar nature of the molecule are incorporated using the Born Top-up approach. The ionization cross sections are obtained from the semi-empirical binary-encounter-Bethe model. The total cross sections are estimated from the incoherent sum of Born-corrected elastic integral and ionization cross sections. The computed results show fairly good agreement with the experimental reported cross sections. Full article

Background/objectives: Common carotid artery occlusion can cause oxidant and inflammatory damage to the optic nerve. In this study, the effect of sunitinib was investigated, the antioxidant and anti-inflammatory properties of which have been previously reported and shown to be protective in I/R injury and in preventing bilateral optic nerve ischemia–reperfusion (I/R) injuries after unilateral common carotid artery ligation in rats. Methods: In this study, 18 Albino Wistar male rats were divided into SG (sham-operated), CCU (clamping and unclamping), and SCCU (sunitinib + clamping and unclamping) groups. One hour before the surgical procedures, sunitinib (25 mg/kg, oral) was given to SCCU rats. Anesthesia was induced with ketamine (60 mg/kg, ip) and sevoflurane. The right common carotid arteries of all rats were accessed under anesthesia. While the skin opened in SG rats was closed with sutures, the right common carotid arteries of CCU and SCCU rats were clipped, and an ischemia period was created for 10 min. Then, reperfusion (6 h) was achieved by unclipping. After euthanasia with ketamine (120 mg/kg, intraperitoneally), the right and left optic nerves of the rats were removed and examined biochemically and histopathologically. Results: Malondialdehyde, tumor necrosis factor α, interleukin-1β, and interleukin-6 were increased, and total glutathione levels had decreased in both ipsilateral and contralateral optic nerves (p < 0.05). These changes were more prominent on the ipsilateral side. Similarly, histopathological damage was observed to be more on the ipsilateral side (p < 0.05). Biochemical and histopathological changes were significantly suppressed in rats receiving sunitinib treatment (p < 0.05). Conclusions: Sunitinib may protect optic nerve tissue against I/R injury by reducing oxidative stress and inflammation. Full article

This study evaluated electroencephalogram [EEG] and cardiovascular correlation of sevoflurane anesthesia in healthy beagle dogs at varying minimum alveolar concentration (MAC) multiples. Processed EEG indices (Patient State Index [PSI], burst suppression ratio [SR], and Spectral Edge Frequency [SEF95], cardiovascular parameters (mean blood pressure [MBP], heart rate [HR]), and responses to noxious (electrical) stimuli were recorded. Deep anesthesia (2.5x MAC) resulted in the lowest PSI and MBP values (13.5 ± 9.9, 42.2 ± 7.4 mmHg, respectively), the highest SR (52.7 ± 35.4%), and dominant burst suppression. Surgical anesthesia (1.5x MAC) was characterized by alpha/low beta waves and the absence of response to noxious stimuli. At 1x MAC (2.1%), PSI and MBP increased (41.9 ± 12.6, 119.9 ± 17.7, respectively) while SR decreased (7.1 ± 13%). A moderate PSI-MBP correlation (ρ = 0.48, p = 0.002) was observed. Recovery was acceptable or smooth in most dogs. These findings suggest that sevoflurane disrupts cortical communication, inducing anesthesia and antinociception and that real-time EEG monitoring may aid in titrating sevoflurane delivery in conjunction with MBP. Full article