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Sevoflurane
Terms modified by Sevoflurane Selected AbstractsDifferential effects of sevoflurane and propofol anesthesia on left ventricular,arterial coupling in dogsACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 8 2010Y. L. J. M. DERYCK Background: General anesthetics interfere with arterial and ventricular mechanical properties, often altering left ventricular,arterial (LVA) coupling. We hypothesized that sevoflurane and propofol alter LVA coupling by different effects on arterial and ventricular properties. Methods: Experiments were conducted in six anesthetized open-chest dogs for the measurement of left ventricular pressure and aortic pressure and flow. Measurements were performed during anesthesia with 0.5, 1.0 and 1.5 minimum alveolar concentration sevoflurane and 12, 24 and 36 mg/kg/h propofol. LVA coupling was assessed as the ratio of ventricular end-systolic elastance (Ees, measuring ventricular contractility) to effective arterial elastance (Ea, measuring ventricular afterload). The steady component of afterload, arterial tone, was assessed by systemic vascular resistance and arterial pressure,flow curves. The pulsatile component of afterload was assessed by aortic impedance and compliance. Results: Sevoflurane decreased aortic pressure and cardiac output more than propofol. Sevoflurane reduced arterial tone, increased arterial stiffness and did not affect wave reflections. It increased Ea, decreased Ees and reduced LVA coupling. Propofol reduced arterial tone, did not affect arterial stiffness and decreased wave reflections. It did not affect Ea, Ees or LVA coupling. Conclusions: Sevoflurane increased ventricular afterload and decreased ventricular performance, thereby altering LVA coupling. Propofol did not affect ventricular afterload or ventricular performance, thereby preserving LVA coupling. Thus, propofol preserves LVA coupling in dogs better, and might be a better choice for patients with compromised left ventricular function. [source] Exposure to anaesthetic trace gases during general anaesthesia: CobraPLA vs.ACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 7 2010LMA classic Background: To prospectively investigate the performance, sealing capacity and operating room (OR) staff exposure to waste anaesthetic gases during the use of the Cobra perilaryngeal airway (CobraPLA) compared with the laryngeal mask airway classic (LMA). Methods: Sixty patients were randomly assigned to the CobraPLA or the LMA group. Insertion time, number of insertion attempts and airway leak pressures were assessed after induction of anaesthesia. Occupational exposure to nitrous oxide (N2O) and Sevoflurane (SEV) was measured at the anaesthetists' breathing zone and the patients' mouth using a photoacoustic infrared spectrometer. Results: N2O waste gas concentrations differed significantly in the anaesthetist's breathing zone (11.7±7.2 p.p.m. in CobraPLA vs. 4.1±4.3 p.p.m. in LMA, P=0.03), whereas no difference could be shown in SEV concentrations. Correct CobraPLA positioning was possible in 28 out of 30 patients (more than one attempt necessary in five patients). Correct positioning of the LMA classic was possible in all 30 patients (more than one attempt in three patients). Peak airway pressure was higher in the CobraPLA group (16±3 vs. 14±2 cmH2O, P=0.01). The average leak pressure of the CobraPLA was 24±4 cmH2O, compared with 20±4 cmH2O of the LMA classic (P<0.001; all values means±SD). Conclusion: Despite higher airway seal pressures, the CobraPLA caused higher intraoperative N2O trace concentrations in the anaesthetists' breathing zone. [source] Effects of sevoflurane on collagen production and growth factor expression in rats with an excision woundACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 7 2010H.-J. LEE Background: Sevoflurane is a widely used inhalation anesthetic, but there are no studies on its effect on the wound-healing process. This study was undertaken to evaluate the effect of exposure time to sevoflurane on wound healing. Method: Male Sprague,Dawley rats were used. Two circular full-thickness skin defects 8 mm in diameter were made on the dorsum of the rats. The animals were divided into six groups according to exposed gas type and time: S1 (sevoflurane, 1 h), S4 (sevoflurane, 4 h), S8 (sevoflurane, 8 h), O1 (oxygen, 1 h), O4 (oxygen, 4 h), and O8 (oxygen, 8 h). The surface area of the wounds was measured 0, 1, 3, and 7 days after surgery. Separately, the mean blood pressures (MBP) and arterial oxygen pressures (PaO2) were monitored during the sevoflurane exposure. Collagen type I production and transforming growth factor-,1 (TGF-,1) and basic fibroblast growth factor (bFGF) expression on the wound surface were analyzed. Routine histological analysis was also performed. Result: Exposure duration to sevoflurane had no influence on MBP and PaO2. The reduction in wound size and collagen type I production was delayed in S8. The expression of TGF-,1 and bFGF on the wound surface in S8 was significantly attenuated in S8. The histology of the S8 demonstrated a delayed healing status. Conclusions: Prolonged exposure to sevoflurane might alter the inflammatory phase of the wound-healing process by attenuation of growth factor expression such as TGF-,1 and bFGF and subsequently by reduced collagen production. [source] Regional cerebral glucose metabolism during sevoflurane anaesthesia in healthy subjects studied with positron emission tomographyACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 5 2010L. 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] Sevoflurane-induced post-conditioning has no beneficial effects on neuroprotection after incomplete cerebral ischemia in ratsACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 3 2010H.-M. LEE Background: The aim of this study was to investigate whether sevoflurane-induced post-conditioning has a neuroprotective effect against incomplete cerebral ischemia in rats. Methods: After cerebral ischemia by right common carotid artery occlusion in combination with hemorrhagic hypotension (35 mmHg) for 30 min, 1.0 minimum alveolar concentration of sevoflurane was administered for 15 min (Post-C 15, n=8), 30 min (Post-C 30, n=8), or 60 min (Post-C 60, n=8) in rats. Sevoflurane was not administered in control (n=8) and sham control rats (n=8). Neurologic evaluations were performed at 24, 48, and 72 h after ischemia. Degrees of neuronal damage in ischemic hippocampal CA1 and the cortex were assessed by counting eosinophilic neurons, and detection of DNA fragmentation was performed by terminal deoxynucleotidyl transferase-mediated dUTP nick end-labeling (TUNEL) staining. Results: Neurologic deficit scores in the Post-C 60 group were higher than in the control group at 48 and 72 h post-ischemia (P<0.05). No differences were observed in the percentages of eosinophilic neurons among the control (CA1: 37.3 ± 25.4, cortex: 26.0 ± 8.9), Post-C 15 (CA1: 54.0 ± 21.4, cortex: 30.8 ± 19.9), or Post-C 30 (CA1: 68.4 ± 17.5, cortex: 38.0 ± 11.0) groups in ischemic CA1 and cortices. However, in the Post-C 60 group, the percentages of eosinophilic neurons were higher than in the control group in CA1 and cortices (P<0.05). The percentages of TUNEL-positive cell were similar in the control group and the post-conditioned groups. Conclusion: These findings show that sevoflurane administration after ischemia does not provide neuroprotection in rats subjected to incomplete cerebral ischemia. [source] Sevoflurane and propofol depolarize mitochondria in rat and human cerebrocortical synaptosomes by different mechanismsACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 10 2009R. BAINS Background and objectives: The mitochondrial membrane potential drives the main functions of the mitochondria. Sevoflurane depolarizes neural mitochondria. There is still, however, limited information concerning the effect of anaesthetics on neural mitochondria in humans. The effect of sevoflurane and propofol on the intracellular Ca2+ concentration [Ca2+]i and the mitochondrial membrane potential (,,m) was therefore compared in rat and human synaptosomes, and the changes were related to interventions in the electron transport chain. Methods: Synaptosomes from rat and human cerebral cortex were loaded with the fluorescent probes fura-2 ([Ca2+]i) and JC-1 (,,m) before exposure to sevoflurane 1 and 2 minimum alveolar concentration (MAC), and propofol 30 and 100 ,M. The effect on the electron transport chain was investigated by blocking complex V. Results: Sevoflurane and propofol decreased ,,m in rat synaptosomes in a dose-dependent manner, and to the same extent by equipotent doses. Inhibition of complex V enhanced the depolarizing effect of sevoflurane 2 MAC, but not of propofol 100 ,M. Neither sevoflurane nor propofol affected [Ca2+]i significantly. Sevoflurane and propofol decreased ,,m in human synaptosomes to the same extent as in the rat experiments. Conclusions: Sevoflurane and propofol at equipotent doses depolarize the mitochondria in rat and human nerve terminals to the same extent. The depolarizing effect of propofol on ,m was more rapid in onset than that of sevoflurane. Whereas sevoflurane inhibits the respiratory chain sufficiently to cause ATP synthase reversal, the depolarizing effect of propofol seems to be related to inhibition of the respiratory chain from complex I to V. [source] Sevoflurane- and Desflurane-induced human myocardial post-conditioning through Phosphatidylinositol-3-kinase/Akt signallingACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 7 2009L. ZHU Background: The role of phosphatidylinositol-3-kinase (PI3K) in sevoflurane- and desflurane-induced myocardial post-conditioning remains unknown. Methods: We recorded isometric contraction of isolated human right atrial trabeculae (oxygenated Tyrode's at 34 °C, stimulation frequency 1 Hz). In all groups, a 30-min hypoxic period was followed by a 60-min reoxygenation period. At the onset of reoxygenation, muscles were exposed to 5 min of sevoflurane 1%, 2%, and 3%, and desflurane 3%, 6%, and 9%. In separate groups, sevoflurane 2% and desflurane 6% were administered in the presence of 100 nM wortmannin, a PI3K inhibitor. Recovery of force after the 60-min reoxygenation period was compared between groups (mean ± SD). Result: As compared with the Control group (49 ± 7% of baseline) PostC by sevoflurane 1%, 2%, and 3% (78 ± 4%, 79 ± 5%, and 85 ± 4% of baseline, respectively) and desflurane 3%, 6%, and 9% (74 ± 5%, 84 ± 4%, and 86 ± 11% of baseline, respectively) enhanced the recovery of force. This effect was abolished in the presence of wortmannin (56 ± 5% of baseline for sevoflurane 2%+wortmannin; 56 ± 3% of baseline for desflurane 6%+wortmannin). Wortmannin alone had no effect on the recovery of force (57 ± 7% of baseline). Conclusion: In vitro, sevoflurane and desflurane post-conditioned human myocardium against hypoxia through activation of phosphatidylinositol-3-kinase. [source] Hypertrophied hearts: what of sevoflurane cardioprotection?ACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 4 2009J. R. LARSEN Background: Recent studies have demonstrated that inhalation anaesthetics, like sevoflurane, confer cardioprotection both experimentally and clinically. However, coexisting cardiac disease might diminish anaesthetic cardioprotection and could partly explain why the clinical results of cardioprotection with anaesthetics remain controversial , in contrast to solid experimental evidence. Concomitant left ventricular hypertrophy is found in some cardiac surgery patients and could change cardioprotection efficacy. Hypertrophy could potentially render the heart less susceptible to sevoflurane cardioprotection and more susceptible to ischaemic injury. We investigated whether hypertrophy blocks sevoflurane cardioprotection, and whether tolerance to ischaemia is altered by left ventricular hypertrophy, in an established experimental animal model of ischaemia,reperfusion. Methods: Anaesthetized juvenile pigs (n=7,12/group) were subjected to 45 min distal coronary artery balloon occlusion, followed by 120 min of reperfusion. Controls were given pentobarbital, while sevoflurane cardioprotection was achieved by 3.2% inhalation throughout the experiment. Chronic banding of the ascending aorta resulted in left ventricular hypertrophy development in two further groups and these animals underwent identical ischaemia,reperfusion protocols, with or without sevoflurane cardioprotection. Myocardial infarct sizes were compared post-mortem. Results: The mean myocardial infarct size (% of area-at-risk) was reduced from mean 55.0 (13.6%) (±SD) in controls to 17.5 (13.2%) by sevoflurane (P=0.001). Sevoflurane reduced the infarct size in hypertrophied hearts to 14.6 (10.4%) (P=0.001); however, in hypertrophic controls, infarcts were reduced to 34.2 (10.2%) (P=0.001). Conclusion: Sevoflurane abrogated ischaemic injury to similar levels in both normal and left ventricular hypertrophied hearts. [source] Mask induction of anaesthesia with isoflurane or sevoflurane in premedicated catsJOURNAL OF SMALL ANIMAL PRACTICE, Issue 1 2002P. Lerche A comparison was made of the time to and quality of induction of anaesthesia when sevoflurane (n=14) or isoflurane (n=14) was delivered by mask in premedicated healthy adult cats presented for elective surgery. Times to induction and intubation were significantly shorter with sevoflurane (210 ±57 seconds and 236 ±60 seconds, respectively) than with isoflurane (264 ±75 seconds and 292 ±73 seconds). The quality of induction was similar for both agents. Two cats in each group developed opisthotonus of less than 45 seconds'duration. Both sevoflurane and isoflurane produced mask induction of anaesthesia of a similar quality in this species. Sevoflurane provided more rapid induction of anaesthesia and establishment of a controlled airway than isoflurane. [source] Does the pre-ischaemic administration of sevoflurane reduce myocardial stunning?ACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 5 2007A porcine experimental model Background:, In a porcine model, the cardioprotective effect of sevoflurane was studied with regard to the preservation of myocardial contractility (myocardial stunning) after a myocardial ischaemic insult. Methods:, Twenty-seven pigs were randomized to receive either a dual 4% sevoflurane inhalation period as a supplement to pentobarbital anaesthesia or pentobarbital anaesthesia only before a 15-min ischaemic insult on the left anterior descending coronary artery. The ischaemic period was followed by 180 min of reperfusion. Myocardial contractility was assessed by myocardial sonomicrometry. Results:, A significant difference was found between the sevoflurane group and the control group at 5 min of reperfusion. However, subsequently, there was no overall difference between the two groups. Conclusion:, Sevoflurane administered as a pre-ischaemic bolus does not provide long-term improvement of the myocardial contractility. However, it can be speculated that sevoflurane may induce an early improvement in contractility. [source] Sevoflurane and CBF: There is much more out there than you might expectACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 8 2005I.H. Lorenz No abstract is available for this article. [source] Similar excitation after sevoflurane anaesthesia in young children given rectal morphine or midazolam as premedicationACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 10 2004W. 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: an ideal agent for adult day-case anesthesia?ACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 8 2003S. Ghatge Sevoflurane has several properties which make it potentially useful as a day case anaesthetic. Following induction of anaesthesia with propofol, awakening from sevoflurane is faster compared to isoflurane, faster or similar compared to propofol and comparable (in the majority of studies) to desflurane. Subsequent recovery and discharge is generally similar following all agents. Sevoflurane may also be used to induce anaesthesia, which is generally well-received and causes less hypotension and apnoea compared to propofol. When used as a maintenance anaesthetic, the incidence of postoperative nausea and vomiting after sevoflurane is comparable to other inhaled anaesthetics, but this complication appears more common after inhaled inductions. The tolerability and low solubility of sevoflurane facilitate titration of anaesthesia and may reduce the need for opioid analgesia, which in turn may limit the occurrence of nausea and vomiting. [source] Sevoflurane versus isoflurane , anaesthesia for lower abdominal surgery.ACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 2 2003Effects 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] The effect of sevoflurane on glutamate release and uptake in rat cerebrocortical presynaptic terminalsACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 1 2002M. L. Vinje Background: Volatile anaesthetics exert their effect in the brain mainly by reducing synaptic excitability. Isoflurane abates excitation by reducing the release and increasing the uptake of transmitter glutamate into the presynaptic terminal. The exact molecular mechanisms exerting these effects, however, are not clear. Voltage-gated calcium channels have been proposed as the pharmacological target. The present study examines the effect of sevoflurane on synaptic glutamate release and free cytosolic calcium and the effect on high- and low-affinity uptake of L-glutamate using isolated presynaptic terminals prepared from rat cerebral cortex. Methods: Released glutamate was measured fluorometrically in a spectrophotometer as the fluorescence of NADPH and calcium as the fluorescence of fura-2. 4-aminopyridine was used to induce membrane depolarization. Glutamate uptake was measured in a series of different concentrations of L-glutamate corresponding to the high- and the low- affinity uptake systems adding a fixed concentration og radiolabelled glutamate. The labelling was measured by counting disintegrations per min in a ,-scintillation counter. Results: Sevoflurane reduced the calcium-dependent glutamate release in a dose-dependent manner as sevoflurane 1.5, 2.5 and 4.0% reduced the release by 58, 69 and 94%, respectively (P<0.05). Membrane depolarization induced an increase in free cytosolic calcium by 25%. Sevoflurane did not affect this increase. Neither the high- nor the low-affinity uptake transporter systems are affected by the anaesthetic. Conclusion: These results indicate that different volatile anaesthetics may act differently on the presynaptic terminal. The exact modes of action have to be further investigated. [source] Comparison of plasma , glutathione S-transferase concentrations during and after low-flow sevoflurane or isoflurane anaesthesiaACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 10 2001H. 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] Halogenated volatile anesthetics inhibit carbon monoxide-stimulated soluble guanylyl cyclase activity in rat brainACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 3 2000E. Masaki Background: Because of halogen contents, halogenated volatile anesthetics (HVA) have a similarity to nitric oxide (NO) in terms of great affinity for the ferrous ion. Interactions between HVA and NO at the ferrous ion of soluble guanylyl cyclase (sGC) have been reported in different tissues. Carbon monoxide (CO), a more stable gas than NO, activates sGC by the same mechanism as NO. This study was undertaken to examine the effect of HVA on CO-stimulated sGC activity in rat brain. Methods: Sprague-Dawley rat brain was homogenized and ultracentrifuged. The resulting supernatant was used as sGC fraction. The fraction was incubated with CO and HVA, and the activity of sGC was determined by measuring cyclic guanosine monophosphate (cGMP) production using an enzyme immunoassay in aliquots of the supernatant. Results: CO clearly increased cGMP production in a dose-dependent manner. Sevoflurane and isoflurane produced significant and dose-dependent inhibition of CO-stimulated sGC activity. There was no difference in the inhibitory effect between the two anesthetics. GTP dose-dependently increased CO-stimulated cGMP production. Both anesthetics decreased GTP production, but the inhibition by the anesthetics was not significant at higher GTP concentrations. Conclusions: These results suggest that HVA can compete with CO at the ferrous ion of sGC and inhibit the activity of this enzyme. [source] Sevoflurane and epileptiform EEG changesPEDIATRIC ANESTHESIA, Issue 4 2005ISABELLE CONSTANT MD Summary Sevoflurane has become the volatile agent of choice for inhalation induction of anesthesia. Hemodynamic stability and lack of respiratory irritation have justified its rapid extension to pediatric inhalation induction. The epileptogenic potential of sevoflurane has been suspected since the first case reports of abnormal movements in children without a history of epilepsy. The objectives of this short review are to: (i) analyze clinical and electroencephalographic (EEG) features supporting epileptogenic activity of sevoflurane, (ii) identify factors which may modulate that activity, and (iii) suggest guidelines of clinical practice to limit expression of this epileptiform phenomenon, which has thus far unknown morbidity. The use of sevoflurane may be associated with cortical epileptiform EEG signs, usually without clinical manifestation. No lasting neurological or EEG sequelae have been described thus far, and the potential morbidity of this epileptogenic effect is unknown. The use of sevoflurane in children, with its remarkable cardiovascular profile, should include a number of precautions. Among them, the limitation of the depth of anesthesia is essential. The wide use of cerebral function monitoring (the most simple being the EEG), may permit optimization of sevoflurane dose and avoidance of burst suppression and major epileptiform signs in fragile subjects, notably the very young and the very old. [source] Postoperative behavioral changes following anesthesia with sevofluranePEDIATRIC ANESTHESIA, Issue 10 2004Aideen Keaney MB FRCA Summary Background :,Behavioral disturbance following hospitalization is a relatively frequent event, some children still having negative behavioral changes (NBC) 1 month following their operation. Sevoflurane has a propensity to induce ,excitement' during induction of anaesthesia, and delirium in the immediate postoperative phase. The aim of this study was to evaluate whether this translates into prolonged behavioral change. Methods :,A total of 120 children presenting for daycase surgical procedures under anesthesia were included in the study. Children were randomized to induction and maintenance of anesthesia with sevoflurane or halothane. No additional sedative drugs were administered. Postoperative behavioral change was assessed using the Post-Hospital Behavior Questionnaire (PHBQ) on postoperative days 1, 7 and 30. Results :,The Sevoflurane group (n = 63) were more distressed on emergence of anesthesia than the Halothane group (n = 57) (P < 0.05). About 58.3, 46.8 and 38.3% of all children exhibited NBC on postoperative days 1, 7 and 30, respectively. There was no association between anesthetic agent and behavior. There was a significant relationship between decreasing age and NBC (P < 0.005). Conclusions :,Children anesthetized with sevoflurane exhibit more immediate postoperative distress than those anesthetized with halothane. This difference is not carried over into the longer posthospital period. Negative behavioral changes occur more frequently with decreasing age. [source] Effects of sevoflurane on QT parameters in children with congenital sensorineural hearing lossANAESTHESIA, Issue 1 2009H. S. Kim Summary Sevoflurane prolongs the QT interval (QTI). Patients with congenital sensorineural hearing loss (SNHL) often have a prolonged QTI. This study was to investigate the effects of sevoflurane on the QTI in SNHL and control children. Thirty patients with SNHL and 30 controls were studied. The corrected QT interval (QTc), interval from peak to end of T wave (Tp-e) and QT variability index (QTVI) were analysed. QTc and Tp-e were estimated by the average QTc and Tp-e measured beat-by-beat for 15 min. Heart rate power spectral analysis was performed. In both groups, QTc and QTVI increased during anaesthesia, but Tp-e did not change. There were no differences in QTc, QTVI, Tp-e, low- and high-frequency power between the two groups. In both groups, sevoflurane lengthened the QTc and QTVI intervals but not Tp-e. [source] Speed of induction of anaesthesia in dogs administered halothane, isoflurane, sevoflurane or propofol in a clinical settingAUSTRALIAN VETERINARY JOURNAL, Issue 1-2 2008RG Pottie Objective To compare the speed and quality of induction of general anaesthesia using three different inhalant agents and one intravenous agent, in healthy dogs undergoing desexing surgery. Materials and methods Less excitable dogs were not premedicated; others were premedicated with intramuscular acepromazine and morphine. Anaesthesia induction protocol was randomly assigned, with halothane, isoflurane or sevoflurane delivered by mask, or propofol delivered intravenously. Maximum vaporiser settings were used for inhalant inductions. Induction of anaesthesia was considered complete at the time of endotracheal intubation. Quality of induction was scored by the administering veterinarian. Results Seventy-one dogs were enrolled. Twenty-four received no premedication and 47 received premedication. Isoflurane inductions were significantly faster than halothane inductions (2.86 ± 0.25 vs 3.71 ± 0.22 min; mean ± SE, P = 0.013). Sevoflurane inductions (3.29 ± 0.24 min) were not significantly different from either halothane (3.71 ± 0.22 min, P = 0.202) or isoflurane inductions (2.86 ± 0.25 min, P = 0.217). Induction with propofol (1.43 ± 0.13 min) was significantly faster than inhalant induction (P < 0.001 in each case). Premedication decreased the dose requirement and time to induction for dogs induced with propofol, but did not significantly change the time to intubation for inhalant inductions. Dogs administered propofol and/or premedication were significantly more likely to have an excellent quality of induction, but there was no difference between inhalant agents in terms of induction quality. Conclusion Sevoflurane possesses chemical properties that should produce a more rapid induction of anaesthesia in comparison to halothane or isoflurane. However, in clinical practice patient related factors outweigh this improvement. [source] Absolute configuration and conformational analysis of a degradation product of inhalation anesthetic Sevoflurane: A vibrational circular dichroism studyCHIRALITY, Issue 8 2002Feng Wang Abstract 1,1,1,3,3-pentafluoro-2-(fluoromethoxy)-3-methoxypropane, compound B, is a product obtained in the degradation of the anesthetic Sevoflurane. Enantiopure (+)- B was investigated using vibrational circular dichroism (VCD). Experimental absorption and VCD spectra of (+)- B in CDCl3 solution in the 2,000,900 cm,1 region are compared with the ab initio predictions of absorption and VCD spectra obtained from density functional theory using B3LYP/6-31G* basis set for different conformers of (S)-1,1,1,3,3-pentafluoro-2-(fluoromethoxy)-3-methoxypropane. This comparison indicates that (+)- B is of the (S)-configuration in CDCl3 solution, in agreement with previous literature results. Our results also indicate that this compound adopts six predominant conformations in CDCl3 solution. Chirality 14:618,624, 2002. © 2002 Wiley-Liss, Inc. [source] Larger tidal volume increases sevoflurane uptake in blood: a randomized clinical studyACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 9 2010B. ENEKVIST Background: The rate of uptake of volatile anesthetics is dependent on alveolar concentration and ventilation, blood solubility and cardiac output. We wanted to determine whether increased tidal volume (VT), with unchanged end-tidal carbon dioxide partial pressure (PETCO2), could affect the arterial concentration of sevoflurane. Methods: Prospective, randomized, clinical study. ASA physical status 2 and II patients scheduled for elective surgery of the lower abdomen were randomly assigned to one of the two groups with 10 patients in each: one group with normal VT (NVT) and one group with increased VT (IVT) achieved by increasing the inspired plateau pressure 0.04 cmH2O/kg above the initial plateau pressure. A corrugated tube added extra apparatus dead space to maintain PETCO2 at 4.5 kPa. The respiratory rate was set at 15 min,1, and sevoflurane was delivered to the fresh gas by a vaporizer set at 3%. Arterial sevoflurane tensions (Pasevo), Fisevo, PETsevo, PETCO2, PaCO2, VT and airway pressure were measured. Results: The two groups of patients were similar with regard to gender, age, weight, height and body mass index. The mean PETsevo did not differ between the groups. Throughout the observation time, arterial sevoflurane tension (mean±SE) was significantly higher in the IVT group compared with the NVT group, e.g. 1.9±0.23 vs. 1.6±0.25 kPa after 60 min of anesthesia (P<0.05). Conclusion: Ventilation with larger tidal volumes with isocapnia maintained with added dead-space volume increases the tension of sevoflurane in arterial blood. [source] Personnel breathing zone sevoflurane concentration adherence to occupational exposure limits in conjunction with filling of vaporisersACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 9 2010H. HEIJBEL Background: Work place pollution during filling of anaesthetic vaporisers has been a matter of concern. We studied personnel breathing zone ambient air sevoflurane concentrations during filling of sevoflurane with three different filling systems: Quik-FilÔ for Abbott and Dräger FillÔ resp. Easy-FilÔ adapters for Baxter sevoflurane bottles, referred to as ,Abbott and Baxter filling systems'. Method: Sequential filling of three vaporisers was performed for a 15-min period, once with each of Abbott and Baxter filling systems, by four nurses. Ambient-air sevoflurane p.p.m. concentration in the breathing zone was continuously measured using a Miran 1a device during filling, and the mean 15 min sevoflurane concentration was calculated. Results: All eight measured (4 × 2 sequences) 15-min mean breathing zone sevoflurane concentrations covering filling of three vaporisers were well below the recommended short-term value (STV) provided by the Swedish Work Environment Authority (STV 20 p.p.m.). Conclusion: The breathing zone sevoflurane concentration during filling of sevoflurane with Baxter or Abbott filling systems, in an ordinary operating theatre, was found to be reassuringly below the Swedish recommended STV (20 p.p.m. average for a 15-min period). [source] Transillumination by light-emitting diode facilitates peripheral venous cannulations in infants and small childrenACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 8 2010K. HOSOKAWA Background: Transillumination facilitates the visualization of peripheral veins in infants and children. The clinical usefulness of light-emitting diode (LED)-powered devices has not been thoroughly studied. Methods: We randomly assigned 136 infants and children weighing <15 kg, undergoing general anesthesia, to red LED-powered transillumination (TM group, n=67) vs. the usual method (UM group, n=69) of peripheral venous cannulations. Venous puncture was performed following anesthesia induction with sevoflurane and nitrous oxide. The primary and secondary study endpoints were the rate of successful cannulations at initial attempt, and the duration of insertion attempts, respectively. Results: The median score of the estimated cannulation difficulty before attempted puncture was similar in both groups. The success rates at first attempt were 75% and 61% (NS) and mean±SD times to successful venous access were 47±34 and 68±66 s (NS) in the TM and UM groups, respectively. The cannulation procedures were completed significantly earlier in the TM group than in the UM group (hazard ratio, 1.59; 95% confidence interval, 1.03,2.47; P=0.03). In the subgroup of infants and children <2 years old, venous cannulation was successful at first attempt in 73% and 49% in the TM group (n=44) and in the UM group (n=47), respectively (P=0.03). Conclusions: LED-powered transillumination devices facilitated peripheral venous cannulations in small infants and children. [source] Differential effects of sevoflurane and propofol anesthesia on left ventricular,arterial coupling in dogsACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 8 2010Y. L. J. M. DERYCK Background: General anesthetics interfere with arterial and ventricular mechanical properties, often altering left ventricular,arterial (LVA) coupling. We hypothesized that sevoflurane and propofol alter LVA coupling by different effects on arterial and ventricular properties. Methods: Experiments were conducted in six anesthetized open-chest dogs for the measurement of left ventricular pressure and aortic pressure and flow. Measurements were performed during anesthesia with 0.5, 1.0 and 1.5 minimum alveolar concentration sevoflurane and 12, 24 and 36 mg/kg/h propofol. LVA coupling was assessed as the ratio of ventricular end-systolic elastance (Ees, measuring ventricular contractility) to effective arterial elastance (Ea, measuring ventricular afterload). The steady component of afterload, arterial tone, was assessed by systemic vascular resistance and arterial pressure,flow curves. The pulsatile component of afterload was assessed by aortic impedance and compliance. Results: Sevoflurane decreased aortic pressure and cardiac output more than propofol. Sevoflurane reduced arterial tone, increased arterial stiffness and did not affect wave reflections. It increased Ea, decreased Ees and reduced LVA coupling. Propofol reduced arterial tone, did not affect arterial stiffness and decreased wave reflections. It did not affect Ea, Ees or LVA coupling. Conclusions: Sevoflurane increased ventricular afterload and decreased ventricular performance, thereby altering LVA coupling. Propofol did not affect ventricular afterload or ventricular performance, thereby preserving LVA coupling. Thus, propofol preserves LVA coupling in dogs better, and might be a better choice for patients with compromised left ventricular function. [source] Cuffed endotracheal tubes in children reduce sevoflurane and medical gas consumption and related costsACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 7 2010S. ESCHERTZHUBER Background: This study aims to evaluate sevoflurane and anaesthetic gas consumption using uncuffed vs. cuffed endotracheal tubes (ETT) in paediatric surgical patients. Methods: Uncuffed or cuffed ETT were used in paediatric patients (newborn to 5 years) undergoing elective surgery in a randomized order. Duration of assessment, lowest possible fresh gas flow (minimal allowed FGF: 0.5 l/min) and sevoflurane concentrations used were recorded. Consumption and costs for sevoflurane and medical gases were calculated. Results: Seventy children (35 uncuffed ETT/35 cuffed ETT), aged 1.73 (0.01,4.80) years, were enrolled. No significant differences in patient characteristics, study period and sevoflurane concentrations used were found between the two groups. Lowest possible FGF was significantly lower in the cuffed ETT group [1.0 (0.5,1.0) l/min] than in the uncuffed ETT group [2.0 (0.5,4.3) l/min], P<0.001. Sevoflurane consumption per patient was 16.1 (6.4,82.8) ml in the uncuffed ETT group and 6.2 (1.1,14.9) ml in the cuffed ETT group, P=0.003. Medical gas consumption was 129 (53,552) l in the uncuffed ETT group vs. 46 (9,149) l in the cuffed ETT group, P<0.001. The total costs for sevoflurane and medical gases were 13.4 (6.0,67.3),/patient in the uncuffed ETT group and 5.2 (1.0,12.5),/patient in the cuffed ETT group, P<0.001. Conclusions: The use of cuffed ETT in children significantly reduced the costs of sevoflurane and medical gas consumption during anaesthesia. Increased costs for cuffed compared with uncuffed ETT were completely compensated by a reduction in sevoflurane and medical gas consumption. [source] Spectral entropy monitoring allowed lower sevoflurane concentration and faster recovery in childrenACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 7 2010S. R. CHOI Background: Anesthetic titration using spectral entropy monitoring reduces anesthetic requirements and shortens recovery in adult surgical patients. This study was performed to evaluate the effect of entropy monitoring on end-tidal sevoflurane concentration and recovery characteristics in pediatric patients undergoing sevoflurane anesthesia. Methods: Seventy-eight children (aged 3,12 years) scheduled for a tonsillectomy and/or an adenoidectomy were randomly divided into one of two groups: standard practice (Standard) or entropy-guided (Entropy). In the Standard group, sevoflurane was adjusted to maintain the heart rate and systolic blood pressure (BP) within 20% of the baseline values. In the Entropy group, sevoflurane was adjusted to achieve a state entropy of 40,50. We compared the entropy values, end-tidal sevoflurane concentration and recovery times between groups. Results: During maintenance of anesthesia, the entropy and BP values were higher in the Entropy group (P<0.05). The end-tidal sevoflurane concentration during maintenance was lower in the Entropy group (2.2 (0.3) vol%) compared with the Standard group (2.6 (0.4) vol%) (P<0.05). Recovery times were faster in the Entropy group (P<0.05). Conclusions: Compared with standard practice, we found that entropy-guided anesthetic administration was associated with a reduced sevoflurane concentration and a slightly faster emergence and recovery in 3,12-year-old children. [source] Effects of sevoflurane on collagen production and growth factor expression in rats with an excision woundACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 7 2010H.-J. LEE Background: Sevoflurane is a widely used inhalation anesthetic, but there are no studies on its effect on the wound-healing process. This study was undertaken to evaluate the effect of exposure time to sevoflurane on wound healing. Method: Male Sprague,Dawley rats were used. Two circular full-thickness skin defects 8 mm in diameter were made on the dorsum of the rats. The animals were divided into six groups according to exposed gas type and time: S1 (sevoflurane, 1 h), S4 (sevoflurane, 4 h), S8 (sevoflurane, 8 h), O1 (oxygen, 1 h), O4 (oxygen, 4 h), and O8 (oxygen, 8 h). The surface area of the wounds was measured 0, 1, 3, and 7 days after surgery. Separately, the mean blood pressures (MBP) and arterial oxygen pressures (PaO2) were monitored during the sevoflurane exposure. Collagen type I production and transforming growth factor-,1 (TGF-,1) and basic fibroblast growth factor (bFGF) expression on the wound surface were analyzed. Routine histological analysis was also performed. Result: Exposure duration to sevoflurane had no influence on MBP and PaO2. The reduction in wound size and collagen type I production was delayed in S8. The expression of TGF-,1 and bFGF on the wound surface in S8 was significantly attenuated in S8. The histology of the S8 demonstrated a delayed healing status. Conclusions: Prolonged exposure to sevoflurane might alter the inflammatory phase of the wound-healing process by attenuation of growth factor expression such as TGF-,1 and bFGF and subsequently by reduced collagen production. [source] Regional cerebral glucose metabolism during sevoflurane anaesthesia in healthy subjects studied with positron emission tomographyACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 5 2010L. 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] | ||||||||||