Sevoflurane Anaesthesia (sevoflurane + anaesthesia)

Distribution by Scientific Domains


Selected Abstracts


Different apoptosis ratios and gene expressions in two human cell lines after sevoflurane anaesthesia

ACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 9 2009
S. KVOLIK
Background: The aim of this study was to determine the effect of a single exposure of carcinoma cells (Caco-2 and HEp-2) to an anaesthetic gas mixture containing sevoflurane 3%, applied for a period of either 1 or 2 h, on the induction of apoptosis, propapototic gene expression and sphingomyelinase activity. Methods: Apoptosis was determined by flow cytometry. p53, caspase 3 and CYP2E1 gene expression was determined using reverse transcriptase polymerase chain reaction. Activities of acid (aSMase) and neutral sphingomyelinases (nSMase) were measured using methyl- 14C sphingomyeline, and for de novo ceramide and lipid synthesis [3H] palmitic acid was used. All results were compared with controls and analysed by Mann,Whitney and Kruskal,Wallis tests. Results: In the treated Caco-2 cells, the apoptotic ratio increased 24 h after anaesthesia (16.9%; P=0.04). The expression of both p53 and caspase-3 genes increased in Caco-2 and decreased in HEp-2 cells. The CYP2E1 gene expression was observed only in the Caco-2 cells. In control cells, the catalytic activity of aSMase was 2.3 times higher than that of nSMase activity. Decreased aSMase and nSMase activities were observed in Caco-2 cells 24 h after exposition. aSMase activity was halved (54.2%; P=0.06) in HEp-2 cells 24 h after anaesthesia. De novo ceramide synthesis correlated with SMase activity in Caco-2 cells. Conclusion: Sevoflurane anaesthesia induces late apoptosis in the colonic and laryngeal cancer cells investigated. Although the results obtained may indicate that an anaesthetic gas mixture containing sevoflurane induces p53-dependent apoptosis in the Caco-2 cells, the mechanism of apoptosis induction is unclear and remains to be elucidated. [source]


Regional cerebral glucose metabolism during sevoflurane anaesthesia in healthy subjects studied with positron emission tomography

ACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 5 2010
L. SCHLÜNZEN
Background: The precise mechanism by which sevoflurane exerts its effects in the human brain remains unknown. In the present study, we quantified the effects of sevoflurane on regional cerebral glucose metabolism (rGMR) in the human brain measured with positron emission tomography. Methods: Eight volunteers underwent two dynamic 18F-fluorodeoxyglucose positron emission tomography (PET) scans. One scan assessed conscious-baseline metabolism and the other scan assessed metabolism during 1 minimum alveolar concentration (MAC) sevoflurane anaesthesia. Cardiovascular and respiratory parameters were monitored and bispectral index responses were registered. Statistical parametric maps and conventional regions of interest analysis were used to determine rGMR differences. Results: All subjects were unconsciousness at 1.0 MAC sevoflurane. Cardiovascular and respiratory parameters were constant over time. In the awake state, rGMR ranged from 0.24 to 0.35 ,mol/g/min in the selected regions. Compared with the conscious state, total GMR decreased 56% in sevoflurane anaesthesia. In white and grey matter, GMR was averaged 42% and 58% of normal, respectively. Sevoflurane reduced the absolute rGMR in all selected areas by 48,71% of the baseline (P,0.01), with the most significant reductions in the lingual gyrus (71%), occipital lobe in general (68%) and thalamus (63%). No increases in rGMR were observed. Conclusions: Sevoflurane caused a global whole-brain metabolic reduction of GMR in all regions of the human brain, with the most marked metabolic suppression in the lingual gyrus, thalamus and occipital lobe. [source]


Regional cerebral blood flow responses to hyperventilation during sevoflurane anaesthesia studied with PET

ACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 5 2010
L. SCHLÜNZEN
Background: Arterial carbon dioxide tension (PaCO2) is an important factor controlling cerebral blood flow (CBF) in neurosurgical patients. It is still unclear whether the hypocapnia-induced decrease in CBF is a general effect on the brain or rather linked to specific brain regions. We evaluated the effects of hyperventilation on regional cerebral blood flow (rCBF) in healthy volunteers during sevoflurane anaesthesia measured with positron emission tomography (PET). Methods: Eight human volunteers were anaesthetized with sevoflurane 1 MAC, while exposed to hyperventilation. During 1 MAC sevoflurane at normocapnia and 1 MAC sevoflurane at hypocapnia, one H215O scan was performed. Statistical parametric maps and conventional regions of interest analysis were used for estimating rCBF differences. Results: Cardiovascular parameters were maintained constant over time. During hyperventilation, the mean PaCO2 was decreased from 5.5 ± 0.7 to 3.8 ± 0.9 kPa. Total CBF decreased during the hypocapnic state by 44%. PET revealed wide variations in CBF between regions. The greatest values of vascular responses during hypocapnia were observed in the thalamus, medial occipitotemporal gyrus, cerebellum, precuneus, putamen and insula regions. The lowest values were observed in the superior parietal lobe, middle and inferior frontal gyrus, middle and inferior temporal gyrus and precentral gyrus. No increases in rCBF were observed. Conclusions: This study reports highly localized and specific changes in rCBF during hyperventilation in sevoflurane anaesthesia, with the most pronounced decreases in the sub cortical grey matter. Such regional heterogeneity of the cerebral vascular response should be considered in the assessment of cerebral perfusion reserve during hypocapnia. [source]


Infusion requirements and reversibility of rocuronium at the corrugator supercilii and adductor pollicis muscles

ACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 10 2009
T. SUZUKI
Background: The aim of this study is to compare the infusion rates required to maintain a constant neuromuscular block and the reversibility of rocuronium at the corrugator supercilii muscle (CSM) and the adductor pollicis muscle (APM). Methods: We randomly allocated 30 female patients into two groups of 15 patients each to monitor neuromuscular block at either the CSM or the APM. After induction of anaesthesia and laryngeal mask insertion, contraction of the CSM to the facial nerve stimulation or that of the APM to the ulnar nerve stimulation was quantified using an acceleromyograph during 1.0,1.5% end-tidal sevoflurane anaesthesia. All the patients received a bolus of 1 mg/kg rocuronium. When the first twitch (T1) of train-of-four (TOF) recovered to 10% of the control, rocuronium infusion was commenced and maintained at T1 of 10% of the control at the CSM or APM for 120 min. Immediately after rocuronium infusion was discontinued, the time required for 0.04 mg/kg neostigmine-facilitated recovery to a TOF ratio of 0.9 was recorded. Results: Rocuronium infusion dose after a lapse of 120 min was significantly larger in the CSM than in the APM [7.1 (2.3) vs. 4.7 (2.6) ,g/kg/min; P=0.001]. The time for facilitated recovery was shorter in the CSM than in the APM [11.4 (3.8) vs. 16.2 (6.0) min; P=0.016]. Conclusion: A larger rocuronium infusion dose was required to maintain a constant neuromuscular block at the CSM. Neostigmine-mediated reversal was faster at the CSM. [source]


Different apoptosis ratios and gene expressions in two human cell lines after sevoflurane anaesthesia

ACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 9 2009
S. KVOLIK
Background: The aim of this study was to determine the effect of a single exposure of carcinoma cells (Caco-2 and HEp-2) to an anaesthetic gas mixture containing sevoflurane 3%, applied for a period of either 1 or 2 h, on the induction of apoptosis, propapototic gene expression and sphingomyelinase activity. Methods: Apoptosis was determined by flow cytometry. p53, caspase 3 and CYP2E1 gene expression was determined using reverse transcriptase polymerase chain reaction. Activities of acid (aSMase) and neutral sphingomyelinases (nSMase) were measured using methyl- 14C sphingomyeline, and for de novo ceramide and lipid synthesis [3H] palmitic acid was used. All results were compared with controls and analysed by Mann,Whitney and Kruskal,Wallis tests. Results: In the treated Caco-2 cells, the apoptotic ratio increased 24 h after anaesthesia (16.9%; P=0.04). The expression of both p53 and caspase-3 genes increased in Caco-2 and decreased in HEp-2 cells. The CYP2E1 gene expression was observed only in the Caco-2 cells. In control cells, the catalytic activity of aSMase was 2.3 times higher than that of nSMase activity. Decreased aSMase and nSMase activities were observed in Caco-2 cells 24 h after exposition. aSMase activity was halved (54.2%; P=0.06) in HEp-2 cells 24 h after anaesthesia. De novo ceramide synthesis correlated with SMase activity in Caco-2 cells. Conclusion: Sevoflurane anaesthesia induces late apoptosis in the colonic and laryngeal cancer cells investigated. Although the results obtained may indicate that an anaesthetic gas mixture containing sevoflurane induces p53-dependent apoptosis in the Caco-2 cells, the mechanism of apoptosis induction is unclear and remains to be elucidated. [source]


Similar excitation after sevoflurane anaesthesia in young children given rectal morphine or midazolam as premedication

ACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 10 2004
W. Malmgren
Background:, Sevoflurane is a rapid-acting volatile anaesthetic agent frequently used in paediatric anaesthesia despite transient postoperative symptoms of cerebral excitation, particularly in preschool children. This randomised and investigator-blinded study was designed to evaluate whether premedication with an opioid might reduce non-divertible postoperative excitation more than premedication with a benzodiazepine in preschool children anaesthetized with sevoflurane. Methods:, Ninety-two healthy two to six year-old children scheduled for nasal adenoidectomy were randomised to be given rectal atropine 0.02 mg kg,1 together with either morphine 0.15 mg kg,1 or midazolam 0.30 mg kg,1 approximately 30 min before induction and maintenance of sevoflurane anaesthesia. The patient groups were compared pre- and postoperatively by repeated clinical assessments of cerebral excitation according to a modified Objective Pain Discomfort Scale, OPDS. Results:, There were no statistically significant postoperative differences in incidence, extent or duration of excitation between children given morphine or midazolam for premedication, whereas morphine was associated with more preoperative excitation than was midazolam. The study groups did not differ significantly with respect to age, weight, duration of surgery and anaesthesia, and time from tracheal extubation to arrival in and discharge from the postoperative ward. Conclusion:, In this study morphine for premedication in young children anaesthetized with sevoflurane was associated with similar postoperative and higher preoperative OPDS scores compared with midazolam. These findings indicate that substitution of morphine for midazolam is no useful way of reducing clinical excitation after sevoflurane anaesthesia. [source]


Sevoflurane versus isoflurane , anaesthesia for lower abdominal surgery.

ACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 2 2003
Effects on perioperative glucose metabolism
Background: The aim of this study was to determine the impact of sevoflurane anaesthesia on metabolic and endocrine responses to lower abdominal surgery. Methods: A prospective randomized controlled study in 20 patients undergoing abdominal hysterectomy. Patients were randomly assigned to receive either sevoflurane (S) or isoflurane anaesthesia (I). Using a stable isotope dilution technique, endogenous glucose production (EGP) and plasma glucose clearance (GC) were determined pre- and postoperatively (6,6- 2H2 -glucose). Plasma concentrations of glucose, insulin, cortisol, epinephrine and norepinephrine were measured preoperatively, 5 min after induction of anaesthesia, during surgery and 2 h after the operation. Results: EGP increased in both groups with no intergroup differences (preop. S 12.2 ± 1.6, I 12.4 ± 1.6; postop. S 16.3 ± 1.9*, I 19.0 ± 3.1*µmol kg,1 min,1, all values are means ± SD, *P < 0.05 vs. preop.). Plasma glucose concentration increased and GC decreased in both groups. There were no differences between groups. (Glucose conc. mmol l,1 preop.: S 4.1 ± 0.3, I 3.9 ± 0.5; 5 AI S 5.1 ± 0.6*, I 5.1 ± 1.0*, postop. S 7.0 ± 1.0*, I 7.1 ± 1.4*; * = P < 0.05 vs. preop.; GC ml kg,1min,1 preop. S 3.0 ± 0.4, I 3.2 ± 0.4; postop. S 2.4 ± 0.3*, I 2.7 ± 0.3*; *=P < 0.05 vs. preop.) Insulin plasma concentrations were unchanged. Cortisol plasma concentrations increased intra- and postoperatively with no changes between the groups. Norepinephrine plasma concentration increased in the S group after induction of anaesthesia. I group norepinephrine was increased 2 h after operation and showed no intergroup differences. Conclusion: Sevoflurane, as well as isoflurane, does not prevent the metabolic endocrine responses to surgery. [source]


Comparison of plasma , glutathione S-transferase concentrations during and after low-flow sevoflurane or isoflurane anaesthesia

ACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 10 2001
H. Higuchi
Background: We evaluated the effect of low-flow sevoflurane anaesthesia, in which compound A is generated, and isoflurane anaesthesia, in which compound A is not generated (n=13 in each group), on hepatocellular integrity using , glutathione S-transferase (GST). , GST is a more sensitive and specific marker of hepatocellular damage than is aminotransferase activity and correlates better with hepatic histology. Methods: Sevoflurane or isoflurane were delivered without nitrous oxide with a fresh gas flow of 1 l/min. Concentrations of compound A in the circuit were measured hourly, and plasma , GST concentrations were measured perioperatively. Results: Mean duration of anaesthesia was 338±92 min in the sevoflurane group and 320±63 min in the isoflurane group. Mean compound A concentration in the sevoflurane group was 28.6±9.0 ppm. There was no significant difference in , GST concentrations between the sevoflurane and isoflurane groups during or after anaesthesia. Conclusion: These results indicate that low-flow sevoflurane and isoflurane anaesthesia have the same effect on hepatic function, as assessed by plasma , GST concentrations. [source]


Probability of acceptable intubation conditions with low dose rocuronium during light sevoflurane anaesthesia in children

ACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 8 2001
M. Eikermann
Background: To define the rocuronium doses which would provide 50%, 90%, and 95% probability of ,acceptable' intubation conditions during light sevoflurane anaesthesia, we studied 60 children aged 2,7 years in a prospective, randomised, assessor blinded study. Methods: After mask ventilation with 1 MAC sevoflurane/N2O for 17±1 (x̌±SD) min we administered rocuronium (either 0.15, 0.22, 0.3, 0.5, or 1.0 mg ,· ,kg,1) or placebo, and quantified the evoked force of the adductor pollicis muscle. Intubation conditions were assessed before and 2 min after injection of the test drug. Results: Intubation conditions were improved significantly with rocuronium and scored ,acceptable' in 70%, 90%, and 100% of the children after injection of rocuronium 0.15, 0.22, and 0.3 mg ,· ,kg,1, respectively. In parallel, twitch tension decreased to 53% (6,100), 26% (11,100), and 11% (0,19) of baseline (median (range)). Recovery of train-of-four ratio to 0.8 was achieved 13 (7,19), 16 (8,28), and 27 (23,44) min after injection of the respective rocuronium doses. Higher rocuronium doses did not further improve intubation conditions but only prolonged time of neuromuscular recovery. Logistic regression analysis revealed that rocuronium 0.11 (CI 0.05,0.16), 0.21 (0.14,0.28), and 0.25 (0.15,0.34) mg ,· ,kg,1 provides a 50%, 90%, and 95% probability of ,acceptable' intubation conditions in children during 1 MAC sevoflurane/N2O anaesthesia, respectively. Furthermore, we calculated that force depression of adductor pollicis muscle to 81% (CI 72,90), 58% (42,74), and 50% (29,71) of baseline is associated with 50%, 90%, and 95% probability of ,acceptable' intubation conditions. Conclusions: Submaximal depression of muscle force with low dose rocuronium improves intubation conditions in children during light sevoflurane anaesthesia while allowing rapid recovery of neuromuscular function. However, when using low dose rocuronium neuromuscular monitoring may be helpful to detect children with inadequate response to the relaxant so as to avoid an unsuccessful intubation attempt. [source]


Rapid emergence does not explain agitation following sevoflurane anaesthesia in infants and children: a comparison with propofol

PEDIATRIC ANESTHESIA, Issue 1 2003
Ira Todd Cohen MD
Summary Background: Emergence agitation in children is frequently associated with the use of the new highly insoluble volatile anaesthetics. Rapid emergence has been cited as one of the possible causes. Propofol also permits rapid emergence from general anaesthesia but is not associated with agitation. Methods: The emergence characteristics of children receiving sevoflurane and propofol anaesthesia were examined. After induction with sevoflurane, 53 children, aged 2,36 months, who were undergoing ambulatory surgery, were randomized to receive maintenance anaesthesia with either sevoflurane or propofol. Introperative analgesia with either 2 µg·kg,1 of intravenous fentanyl or a caudal block with 0.25% bupivacaine was supplied according to surgical procedure. An observer blinded to anaesthetic technique recorded the time to achieve extubation and recovery and assessed emergence behaviour. Data were analysed using Wilcoxon scores, Kruskal,Wallis test, chi-square and multiple regression analysis. Results: The results showed that the time to extubation and recovery were similar between the two study groups, but that emergence agitation was significantly higher in the sevoflurane group compared with the propofol group. No relationship between analgesic technique and agitation scores was found. Conclusions: Although both sevoflurane and propofol allow for rapid emergence from general anaesthesia, only sevoflurane is associated with a high incidence of emergence agitation in infants and young children. Rapid emergence does not fully explain this phenomena. [source]


The acute hypoxic ventilatory response under halothane, isoflurane, and sevoflurane anaesthesia in rats,

ANAESTHESIA, Issue 3 2010
N. Karanovic
Summary The relative order of potency of anaesthetic agents on the hypoxic ventilatory response has been tested in humans, but animal data are sparse. We examined the effects of 1.4, 1.6, 1.8, and 2.0 MAC halothane, isoflurane, and sevoflurane on phrenic nerve activity in euoxia (baseline) and during acute normocapnic hypoxia (inspired oxygen fraction 0.09) in adult male Sprague-Dawley rats. With halothane, all animals became apnoeic even in euoxia, and the hypoxic response was completely abolished at all anaesthetic levels. With isoflurane, 5 of 14 animals exhibited phrenic nerve activity in euoxia at 1.4 MAC and demonstrated a hypoxic response (302% of baseline activity), but all became apnoeic and lost the hypoxic response at higher doses. With sevoflurane, phrenic nerve activity and a hypoxic response was preserved in at least some animals at all doses (i.e. even the highest dose of 2.0 MAC). Similar to the rank order of potency previously observed in humans, the relative order of potency of depression of the hypoxic ventilatory response in rats was halothane (most depressive) > isoflurane > sevoflurane (p = 0.01 for differences between agents). [source]


Seizures on emergence from sevoflurane anaesthesia for Caesarean section in a healthy parturient

ANAESTHESIA, Issue 12 2002
Article first published online: 18 NOV 200
No abstract is available for this article. [source]


Effect of oral midazolam premedication on the awakening concentration of sevoflurane, recovery times and bispectral index in children

PEDIATRIC ANESTHESIA, Issue 5 2001
Keith K. Brosius MD
Background: We sought to determine the influence of preoperative oral midazolam on: (i) measures of anaesthetic emergence; (ii) recovery times and (iii) intraoperative bispectral index (BIS) measurements during sevoflurane/N2O anaesthesia in paediatric patients. Methods: Fifty-two patients, aged 1,10 years, ASA I,II, were enrolled in a prospective double-blinded study. Patients were randomized to receive either midazolam 0.5 mg·kg,1 (M) or midazolam vehicle (P) as premedication. After inhalation induction and intubation, expired sevoflurane was stabilized at 3% in 60% N2O and the corresponding BIS (BIS I) recorded. At the completion of surgery, sevoflurane was stabilized at 0.5% and the BIS (BIS E) again recorded. Awakening time, expired sevoflurane/N2O awakening concentrations and recovery times were recorded. Results: There were no significant differences between groups in awakening time, sevoflurane or N2O awakening concentrations, time to PACU discharge, time to hospital discharge or in BIS I and BIS E measurements. [source]