ObjectiveTo evaluate the association of anesthesia regime (volatile or intravenous anesthetics) with the occurrence of postoperative pulmonary complications (PPCs) in adult patients undergoing elective cardiac surgery under cardiopulmonary bypass (CPB).MethodsThe electronic medical records of 194 patients undergoing elective cardiac surgery under CPB at West China Hospital, Sichuan University between September 2018 and February 2019 were reviewed, including 92 males and 102 females with an average age of 53 years. The patients were classified into a volatile group (n=94) or a total intravenous anesthesia (TIVA) group (n=100) according to anesthesia regimen during surgery (including CPB). The primary outcome was the incidence of PPCs within first 7 d after surgery. Secondary outcomes included incidence of reintubation, duration of mechanical ventilation, ICU stay and hospital stay.ResultsThere was no significant difference in the incidence of PPCs between the two groups (RR=1.020, 95%CI 0.763-1.363, P=0.896), with an incidence of 48.9% in the volatile group and 48.0% in the TIVA group. Secondary outcomes were also found no significant difference between the two groups (P>0.05).ConclusionNo association of anesthesia regimen with the incidence of PPCs is found in adult patients undergoing elective cardiac surgery under CPB.
ObjectiveTo systematically review the safety of propofol versus sevoflurane for pediatric surgery.
MethodsEMbase, PubMed, The Cochrane Library, CSCD, CNKI, WanFang Data were searched to collect randomized controlled trials (RCTs) about propofol versus sevoflurane for pediatric surgery from inception to January 2015. Two reviewers independently screened literature, extracted data, and assessed the risk of bias of included studies. Then metaanalysis was performed by using RevMan 5.3 software.
ResultsFifteen RCTs involving 1 065 children were included finally. Meta-analysis results showed that, compared with the sevoflurane group, the propofol group could reduce the incidence of emergence agitation (OR=0.23, 95%CI 0.16 to 0.34, P<0.000 01) and the incidence of postoperative vomiting (OR=0.32, 95%CI 0.20 to 0.51, P<0.000 01). There were no significant differences between the two groups in extubation time (MD=0.98, 95%CI -0.26 to 2.21, P=0.12), eye-opening time (MD=3.32, 95%CI -2.65 to 9.29, P=0.28) and postoperative analgesic requirements (OR=0.60, 95%CI 0.30 to 1.23, P=0.16).
ConclusionIn reducing the incidence of emergence agitation and postoperative vomiting, propofol is superior to sevoflurane, so propofol is safer than sevoflurane for children's surgery.
Objective To evaluate the association between anesthesia regimen (volatile or intravenous anesthetics) and postoperative infection in adult cardiac patients undergoing cardiac surgery. MethodsThe clinical data of 496 elective adults undergoing cardiac surgery under cardiopulmonary bypass from June 2019 to June 2020 in West China Hospital of Sichuan University were retrospectively analyzed, including 251 females and 245 males with an average age of 54.1±11.4 years. American Society of Anesthesiologists grade was Ⅰ-Ⅲ. There were 243 patients in a volatile group with sevoflurane or desflurane, and 253 patients in an intravenous anesthesia group with propofol. The primary outcome was the incidence of infection within 30 days after cardiac surgery, including pulmonary infection, surgical site infection, sepsis, and urinary tract infection. The secondary outcomes were duration of mechanical ventilation, incidence of reintubation, ICU stay, postoperative length of hospital stay and total hospitalization cost. Results A total of 155 (31.3%) patients developed postoperative infection within 30 days, with an incidence of 32.9% in the volatile group and 29.6% in the intravenous anesthesia group. There was no statistical difference in the incidence of infection (RR=1.111, 95%CI 0.855 to 1.442, P=0.431) or the secondary outcomes (P>0.05) between the two groups. Conclusion The anesthesia regimen (volatile or intravenous anesthetics) has no association with the risk of occurrence of postoperative infection in adult patients undergoing elective cardiac surgery with cardiopulmonary bypass.
ObjectiveTo determine whether there was a clinical relevant association between anesthetic regimen (propofol or inhalational anesthetics) and the occurrence of postoperative delirium (POD) in patients undergoing cardiac surgery.MethodsThis retrospective study was conducted on patients with elective cardiac surgery under cardiopulmonary bypass (CPB) at West China Hospital of Sichuan University between October 2018 and March 2019. The patients were divided into a propofol group or an inhalational anesthetics group according to anesthetic regimen (including CPB). The primary outcome was the occurrence of POD during first 3 days after surgery. Logistic regression analysis was used to determine the relationship between anesthetic regimen and the occurrence of POD.ResultsA total of 197 patients who met the inclusion criteria were included, with an average age of 53 years, and 51.8% (102/197) were females. POD occurred in 21.3% (42/197) patients. The incidence of POD was 21.4% in the propofol group and 21.2% in the inhalational anesthetics group; there was no significant difference between the two groups (RR=1.01, 95%CI 0.51-2.00, P=0.970). Logistic regression analysis did not find that anesthetic regimen was a risk factor for delirium after cardiac surgery after adjusting risk factors (OR=1.05, 95%CI 0.48-2.32, P=0.900).ConclusionAnesthetic regimen (propofol or inhalational anesthetics) is not associated with an increased risk for POD in adult patients undergoing elective cardiac surgery under CPB.
Abstract： Objective To observe myocardial protective effect of sevoflurane used in the whole process of cardiopulmonary bypass（CPB）. Methods A total of 150 patients older than 18 years who underwent cardiac surgery under CPB in Fu wai Hospital from January 2010 to November 2011 were enrolled in this double-blind and randomized controlled study. All the patients were randomly divided into three groups：Sevoflurane pretreatment group （Group A，n=50），whole-process Sevoflurane group （Group B，n=50），and whole-process intravenous anesthesia group （Group C，n=50）. Radial artery pressure and other hemodynamic parameters were continuously measured for all the patients. At following time points: CPB beginning （T1），aortic declamping （T2），3 hours after aortic declamping （T3），and 24 hours after aortic declamping （T4），serum concentrations of cardiac troponin I （cTnI） and other parameters were measured by enzyme-linked immunosorbent assay （ELISA）. Results There were 31 males and 19 females at age of 60.43±3.24 years in group A，28 males and 22 females at age of 59.88±4.12 years in group B，31 males and 19 females at age of 58.76±3.87 years. There was no statistical difference in mean arterial pressure （MAP），central venous pressure （CVP），pulmonary artery wedge pressure （PAWP） and heart rate （HR） at respective time points among the 3 groups （P＞0.05）. At T1 and T2，there was no statistical difference in cardiac index （CI） among the 3 groups （P＞0.05）. At T3，there was no statistical difference in CI between Group A and Group C（F=3.382，P=0.845），but CI of Group B was significantly higher than that of Group A and C（F=3.382，3.382； P=0.033，0.020）. At T4，CI of Group B was significantly higher than that of Group A and C （F=13.324，13.324； P=0.005，P=0.000），and CI of Group A was significantly higher than that of Group C （F=13.324，P=0.024）. At T1 and T2，there was no statistical difference in serum concentrations of creatinine kinase MB （CK-MB），cTnI，interleukin-6 （IL-6） and tumor necrosis factor alpha （TNF-α） among the 3 groups （P＞0.05）. At T3 and T4，serum concentrations of CK-MB，TNF-α，IL-6 and cTnI of Group C were significantly higher than those of Group A，and serum concentrations of CK-MB，TNF-α，IL-6 and cTnI of Group A were significantly higher than those of Group B （F=531.616，5.410，3.5813，3.160，1.126，4.702，7.819，5.424，all P=0.000）. Conclusion Sevoflurane used in the whole process of CPB has definite myocardial protective effect which is ber than that of Sevoflurane pretreatment.
ObjectiveTo explore the influence of propofol as well as sevoflurane on the histamine release induced by mivacurium chloride.
MethodsForty patients with American Sociaty of Anesthesiologists stage Ⅰ-Ⅱ scheduled to receive ear-nose-throat surgery between March and October 2012 were recruited and were randomly assigned into two groups:propofol group and sevoflurane group. Patients in the propofol group were induced with targeted intravenous infusion with propofol. Patients in the sevoflurane group was induced with sevoflurane. The blood specimen was prepared before mivacurium chloride (0.16 mg/kg) infusion (T0), 1 minute (T1), 3 minutes (T2), and 5 minutes (T3) after the infusion. Mean blood pressure (MBP) and heart rate (HR) were recorded at corresponding time points. In addition, we recorded the symptoms of anaphylactic reaction such as skin erythema or bronchospasm.
ResultsBoth MBP and HR decreased after anesthesia induction. However, there was no significant difference from that before the induction in both groups, and no difference was found between the two groups (P>0.05). The concentration of histamine in both groups at T1 and T2 was significantly higher than that at T0 (P<0.05). The concentration of histamine in both groups at T4 was significantly higher than that at T0 (P<0.05). The concentration of histamine in the propofol group was higher than that in the sevoflurane group. No skin erythema or bronchospasm was found in any of the two groups.
ConclusionMivacurium chloride at a dose of 0.16 mg/kg can be safely used in propofol anesthesia, as well as sevofluane anesthesia, with no clinically significant histamine release or adverse hemodynamic fluctuation.
ObjectiveTo explore the effects of different concentrations of sevoflurane on hyperoxia-induced lung injury in rat.MethodsThe 72 SD rats were randomly divided into control group C (n=12); sevoflurane inhalation group S, group S contains 5 subgroups (n=12) S0, S1.0, S1.5, S2.0, S2.5. Group C wasn’t given any treatment, rats in group S were inhaled 95% oxygen for 48 hours to establish a hyperoxia-induced lung injury model. then rats in each subgroup inhaled sevoflurane at different concentrations of 0%, 1.0%, 1.5%, 2.0% and 2.5% for 1 h respectively, rats in group C were breathe air freely. At the two time points which include inhaled 95% oxygen for 48 hours, and sevoflurane was inhaled for 1 h, blood was collected by the abdominal aorta, then arterial blood was used for blood gas analysis; using enzyme linked immunosorbent assay for the detection of serum tumor necrosis factor (TNF) -α and interleukin (IL) -8 and IL-6 concentration; HE staining was carried out in the right lung, and the pathological changes of lung tissue were observed under light microscope; Wet to dry ratio (W/D) of the left lung was taken.ResultsAfter inhalation of 95% oxygen for 48 hours (T1): compared with the group C, group S of arterial blood gas results suggested that the PaO2 value decreased, PaCO2 value increased. The degree of lung tissue injury and the pathological score, TNF-α, IL-8 and IL-6, W/D content increased significantly (P < 0.05), there was no significant difference between the S0 to S2.5 groups; After treatment with sevoflurane for 1 h (T2): compared with the group C, group S of arterial blood gas results suggested that the PaO2 value decreased, PaCO2 value increased. the degree of lung tissue injury and the pathological score, TNF-α, IL-8 and IL-6, W/D content increased significantly (P < 0.05); Compared with before sevoflurane treatment, the PaO2 value increased, PaCO2 value decreased, TNF-α, IL-8 and IL-6, W/D content decreased, pathological score decreased in group S1.0 to S2.5 (P <0.05), but there was no significant difference in group S0; After treatment with sevoflurane, compared with S2.0 group, the PaO2 value decreased, PaCO2 value increased, TNF-, IL-8 and IL-6, W/D content increased, pathological score increased in the group S1.0 and S1.5 (P < 0.05), but there was no significant difference in group S2.5.ConclusionSevoflurane can effectively reduce the degree of lung injury caused by hyperoxia in rats especially when the concentration is 2%.
