RESUMEN
This study compared genetic damage and immunological markers between surgical patients who underwent inhalational anesthesia with isoflurane or sevoflurane. Blood samples were collected from surgical patients (n = 18 in the isoflurane group and n = 17 in the sevoflurane group) at baseline (before the anesthesia procedure) and the day after anesthesia. DNA damage was detected using an alkaline comet assay; proinflammatory interleukin (IL)-6 was detected by flow cytometry, and white blood cells were detected via an automatic hematology analyzer. The characteristics of both groups were similar, and neither of the two anesthetics induced DNA damage. Similarly, mild neutrophilia was observed after anesthesia in both groups. Increased IL-6 levels were observed 1 day after anesthesia regardless of the type of anesthetic, but this increase was greater in the isoflurane group. Our study suggested that isoflurane and sevoflurane administration may contribute to changes in the immune parameters measured, though no genotoxic hazard was identified, in healthy adult patients who undergo low-stress surgery.
Asunto(s)
Anestésicos por Inhalación , Biomarcadores , Ensayo Cometa , Daño del ADN , Interleucina-6 , Isoflurano , Sevoflurano , Daño del ADN/efectos de los fármacos , Humanos , Anestésicos por Inhalación/efectos adversos , Sevoflurano/efectos adversos , Masculino , Femenino , Adulto , Isoflurano/efectos adversos , Persona de Mediana Edad , Ensayo Cometa/métodos , Biomarcadores/sangre , Interleucina-6/sangre , Éteres Metílicos/efectos adversos , Éteres Metílicos/toxicidadRESUMEN
This study assessed, for the first time, the expression of the genes hOGG1, TP53, and IL-6 in leukocytes by real-time quantitative polymerase chain reaction in surgical patients before (baseline), during (2 h of anesthesia) and 1 day after sevoflurane anesthesia. Additionally, DNA damage was detected by the comet assay, serum interleukin (IL)-6 was detected by flow cytometry, and differential leukocyte counting was also performed. TP53 and hOGG1 expression was downregulated on the day after anesthesia compared to before anesthesia. However, IL-6 expression did not change, and no DNA damage induction was observed during or after anesthesia. At the systemic level, mild neutrophilia and an increase in IL-6 levels occurred after anesthesia. Our findings suggest that sevoflurane anesthesia downregulates gene expression (hOGG1 and TP53) and contributes to an inflammatory status (increased systemic IL-6 and mild neutrophilia) but is not associated with DNA damage in patients without comorbidities who undergo minor elective surgery.
Asunto(s)
Anestesia , Anestésicos por Inhalación , Humanos , Sevoflurano/efectos adversos , Interleucina-6/genética , Anestésicos por Inhalación/efectos adversos , Inflamación/genética , Inflamación/inducido químicamente , Expresión GénicaRESUMEN
Abstract Background Compound A is generated by sevoflurane when it reacts with carbon dioxide absorbers with strong bases at minimal fresh gas flow (FGF) and is nephrotoxic in animals. No conclusive data has shown increased risk in humans. The aim of this study was to investigate if minimal FGF promotes an increase in the incidence of acute kidney injury (AKI) when compared to high FGF in patients undergoing on-pump cardiac surgery under sevoflurane anesthesia. Methods Two hundred and four adult patients scheduled for on-pump cardiac surgery under sevoflurane anesthesia were randomly allocated to two groups differentiated by FGF: minimal FGF (0.5 L.min−1) or high FGF (2.0 L.min−1). Baseline creatinine measured before surgery was compared daily to values assayed on the first five postoperative days, and 24-hour urinary output was monitored, according to the KDIGO (Kidney Disease Improving Global Outcomes) guideline to define postoperative cardiac surgery-associated acute kidney injury (CSA-AKI). Creatinine measurements were also obtained 20 and 120 days after hospital discharge. Results Postoperative AKI occurred in 55 patients, 26 patients (29.5%) in the minimal FGF group and 29 patients (31.5%) in the high FGF group (p= 0.774). Twenty days after discharge, 11 patients (6.1%) still had CSA-AKI and 120 days after discharge only 2 patients (1.6%) still had CSA-AKI. Conclusions When compared to high FGF, minimal FGF sevoflurane anesthesia during on-pump cardiac surgery is not associated with increased risk of postoperative AKI in this population at high risk for renal injury.
Asunto(s)
Humanos , Adulto , Lesión Renal Aguda/inducido químicamente , Lesión Renal Aguda/epidemiología , Procedimientos Quirúrgicos Cardíacos , Anestesia/efectos adversos , Complicaciones Posoperatorias/inducido químicamente , Complicaciones Posoperatorias/epidemiología , Creatinina , Sevoflurano/efectos adversosRESUMEN
BACKGROUND: Compound A is generated by sevoflurane when it reacts with carbon dioxide absorbers with strong bases at minimal fresh gas flow (FGF) and is nephrotoxic in animals. No conclusive data has shown increased risk in humans. The aim of this study was to investigate if minimal FGF promotes an increase in the incidence of acute kidney injury (AKI) when compared to high FGF in patients undergoing on-pump cardiac surgery under sevoflurane anesthesia. METHODS: Two hundred and four adult patients scheduled for on-pump cardiac surgery under sevoflurane anesthesia were randomly allocated to two groups differentiated by FGF: minimal FGF (0.5 L.min-1) or high FGF (2.0 L.min-1). Baseline creatinine measured before surgery was compared daily to values assayed on the first five postoperative days, and 24-hour urinary output was monitored, according to the KDIGO (Kidney Disease Improving Global Outcomes) guideline to define postoperative cardiac surgery-associated acute kidney injury (CSA-AKI). Creatinine measurements were also obtained 20 and 120 days after hospital discharge. RESULTS: Postoperative AKI occurred in 55 patients, 26 patients (29.5%) in the minimal FGF group and 29 patients (31.5%) in the high FGF group (p = 0.774). Twenty days after discharge, 11 patients (6.1%) still had CSA-AKI and 120 days after discharge only 2 patients (1.6%) still had CSA-AKI. CONCLUSIONS: When compared to high FGF, minimal FGF sevoflurane anesthesia during on-pump cardiac surgery is not associated with increased risk of postoperative AKI in this population at high risk for renal injury.
Asunto(s)
Lesión Renal Aguda , Anestesia , Procedimientos Quirúrgicos Cardíacos , Adulto , Humanos , Sevoflurano/efectos adversos , Creatinina , Lesión Renal Aguda/inducido químicamente , Lesión Renal Aguda/epidemiología , Anestesia/efectos adversos , Complicaciones Posoperatorias/inducido químicamente , Complicaciones Posoperatorias/epidemiologíaRESUMEN
In this study, the effects of exposure to isoflurane, sevoflurane and desflurane on the oxidative response and inflammation at different times was analyzed in the lungs of adult C57BL/6 mice. 120 animals were divided into 3 groups (n = 40): Isoflurane (ISO), Sevoflurane (SEV) and Desflurane (DES) and exposed to these anesthetics for 1 h (n = 10), 2 h (n = 10) and 3 h (n = 10), at a minimum alveolar concentration (MAC) equal to 1. The control group (CG) (n = 10) was exposed to ambient air. 24 h after the experimental protocol, the animals were euthanized and the bronchoalveolar lavage fluid (BALF), blood and lung tissue samples were collected. In the BALF, animals exposed to isoflurane for 2 h and 3 h showed a greater influx of leukocytes, especially macrophages compared to the CG. The ISO3h had lower leukocyte counts in the peripheral blood compared to CG, ISO1h and ISO2h. There was an increase in CCL-2 levels in the ISO3h compared to the CG. Superoxide dismutase activity was higher in ISO1h compared to CG. The activity of catalase was higher in the ISO1h and ISO2h compared to the CG. The lipid peroxidation, as well as carbonylated protein were higher in the ISO3h compared to the CG (p < 0.05). Similar results were observed in the exposure of SEV and DES compared to inflammation and redox imbalance in different periods. This study demonstrated that time is a determinant to promote a local and systemic inflammatory response to different inhalational anesthetics in a healthy murine model.
Asunto(s)
Anestésicos por Inhalación , Isoflurano , Éteres Metílicos , Ratones , Animales , Isoflurano/toxicidad , Sevoflurano/efectos adversos , Desflurano , Catalasa/metabolismo , Ratones Endogámicos C57BL , Anestésicos por Inhalación/toxicidad , Superóxido Dismutasa/metabolismo , Inflamación/inducido químicamente , Éteres Metílicos/farmacologíaAsunto(s)
Anestésicos por Inhalación , Delirio del Despertar , Éteres Metílicos , Propofol , Humanos , Niño , Sevoflurano/efectos adversos , Propofol/efectos adversos , Delirio del Despertar/epidemiología , Incidencia , Éteres Metílicos/efectos adversos , Anestesia General/efectos adversos , Periodo de Recuperación de la Anestesia , Anestésicos por Inhalación/efectos adversosRESUMEN
Background: Incoming anaesthesia created by the use of many drugs with different physicochemical properties is a sourceof stress and trauma for the body. This event increases the oxidative response and changes the balance between oxidant/antioxidant capacity in the organism in favor of oxidant capacity. This situation is defined as oxidative stress. For thesereasons, studies are conducted to determine the effects of general anaesthetic agents on oxidant and antioxidant systems inthe organism. In this study, it was aimed to determine the effects of isoflurane and sevoflurane used for general anaesthesiain humans and animals on lipid peroxidation and antioxidant defense system in calves.Materials, Methods & Results: The study included 14 calves of different breeds, ages, sexes, and weighing, average 2 weeksold. The cases randomly were divided into 2 groups, the isoflurane group (group I), and the sevoflurane group (group II),and each group included 7 animals. Before general anaesthesia, 0.04 mg/kg atropine was administered intramuscularly toall animals for premedication. At 15 min after atropine administration, isoflurane was administered at an inspiratory concentration of 3-5% in group I, and sevoflurane was administered at an inspiratory concentration of 5-7% in group II, via aface mask for 15 min for the induction of anaesthesia. Endotracheal intubation was performed in all cases at the 15 min ofthe induction period following the onset of general anaesthesia symptoms. After the induction, anaesthesia was continuedat an inspiratory concentration of 1.5-3% in the isoflurane group and inspiratory concentration of 2.5-4% in the sevofluranegroup. Blood samples were taken just before anaesthesia, just before skin incision, at the end of anaesthesia and surgery,and at the 24 h postoperatively. The malondialdehyde (MDA), superoxide dismutase (SOD), catalase (CAT), glutathione...(AU)
Asunto(s)
Animales , Bovinos , Bovinos , Peroxidación de Lípido , Anestesia/efectos adversos , Anestesia/veterinaria , Estrés Oxidativo , Isoflurano/efectos adversos , Sevoflurano/efectos adversosRESUMEN
BACKGROUND: Recent experimental evidence shows that sevoflurane can reduce the inflammatory response during cardiac surgery with cardiopulmonary bypass. However, this observation so far has not been assessed in an adequately powered randomized controlled trial. METHODS: We plan to include one hundred patients undergoing elective coronary artery bypass graft with cardiopulmonary bypass who will be randomized to receive either volatile anesthetics during cardiopulmonary bypass or total intravenous anesthesia. The primary endpoint of the study is to assess the inflammatory response during cardiopulmonary bypass by measuring PMN-elastase serum levels. Secondary endpoints include serum levels of other pro-inflammatory markers (IL-1ß, IL-6, IL-8, TNFα), anti-inflammatory cytokines (TGFß and IL-10), and microRNA expression in peripheral blood to achieve possible epigenetic mechanisms in this process. In addition clinical endpoints such as presence of major complications in the postoperative period and length of hospital and intensive care unit stay will be assessed. DISCUSSION: The trial may determine whether adding volatile anesthetic during cardiopulmonary bypass will attenuate the inflammatory response. TRIAL REGISTRATION: ClinicalTrials.gov NCT02672345 . Registered on February 2016 and updated on June 2020.
Asunto(s)
Anestésicos por Inhalación , Procedimientos Quirúrgicos Cardíacos , Anestésicos por Inhalación/efectos adversos , Procedimientos Quirúrgicos Cardíacos/efectos adversos , Puente Cardiopulmonar/efectos adversos , Puente de Arteria Coronaria/efectos adversos , Humanos , Ensayos Clínicos Controlados Aleatorios como Asunto , Sevoflurano/efectos adversosRESUMEN
Considering the importance and lack of data of toxicogenomic approaches on occupational exposure to anesthetics, we evaluated possible associations between waste anesthetic gases (WAGs) exposure and biological effects including oxidative stress, DNA damage, inflammation, and transcriptional modulation. The exposed group was constituted by anesthesia providers who were mainly exposed to the anesthetics sevoflurane and isoflurane (10 ppm) and to a lesser degree to nitrous oxide (150 ppm), and the control group was constituted by physicians who had no exposure to WAGs. The oxidative stress markers included oxidized DNA bases (comet assay), malondialdehyde (high-performance liquid chromatography [HPLC]), nitric oxide metabolites (ozone-chemiluminescence), and antioxidative markers, including individual antioxidants (HPLC) and antioxidant defense marker (ferric reducing antioxidant power by spectrophotometry). The inflammatory markers included high-sensitivity C-reactive protein (chemiluminescent immunoassay) and the proinflammatory interleukins IL-6, IL-8 and IL-17A (flow cytometry). Telomere length and gene expression related to DNA repair (hOGG1 and XRCC1), antioxidant defense (NRF2) and inflammation (IL6, IL8 and IL17A) were evaluated by real-time quantitative polymerase chain reaction. No significant differences (p > .0025) between the groups were observed for any parameter evaluated. Thus, under the conditions of the study, the findings suggest that occupational exposure to WAGs is not associated with oxidative stress or inflammation when evaluated in serum/plasma, with DNA damage evaluated in lymphocytes and leucocytes or with molecular modulation assessed in peripheral blood cells in university anesthesia providers. However, it is prudent to reduce WAGs exposure and to increase biomonitoring of all occupationally exposed professionals.
Asunto(s)
Anestesia/efectos adversos , Anestésicos por Inhalación/efectos adversos , Daño del ADN/efectos de los fármacos , Expresión Génica/efectos de los fármacos , Inflamación/inducido químicamente , Exposición Profesional/efectos adversos , Estrés Oxidativo/efectos de los fármacos , Adulto , Anciano , Contaminantes Ocupacionales del Aire/efectos adversos , Antioxidantes/metabolismo , Reparación del ADN/efectos de los fármacos , Femenino , Hospitales , Humanos , Inflamación/metabolismo , Isoflurano/efectos adversos , Masculino , Persona de Mediana Edad , Óxido Nitroso/efectos adversos , Sevoflurano/efectos adversosRESUMEN
Background: Incoming anaesthesia created by the use of many drugs with different physicochemical properties is a sourceof stress and trauma for the body. This event increases the oxidative response and changes the balance between oxidant/antioxidant capacity in the organism in favor of oxidant capacity. This situation is defined as oxidative stress. For thesereasons, studies are conducted to determine the effects of general anaesthetic agents on oxidant and antioxidant systems inthe organism. In this study, it was aimed to determine the effects of isoflurane and sevoflurane used for general anaesthesiain humans and animals on lipid peroxidation and antioxidant defense system in calves.Materials, Methods & Results: The study included 14 calves of different breeds, ages, sexes, and weighing, average 2 weeksold. The cases randomly were divided into 2 groups, the isoflurane group (group I), and the sevoflurane group (group II),and each group included 7 animals. Before general anaesthesia, 0.04 mg/kg atropine was administered intramuscularly toall animals for premedication. At 15 min after atropine administration, isoflurane was administered at an inspiratory concentration of 3-5% in group I, and sevoflurane was administered at an inspiratory concentration of 5-7% in group II, via aface mask for 15 min for the induction of anaesthesia. Endotracheal intubation was performed in all cases at the 15 min ofthe induction period following the onset of general anaesthesia symptoms. After the induction, anaesthesia was continuedat an inspiratory concentration of 1.5-3% in the isoflurane group and inspiratory concentration of 2.5-4% in the sevofluranegroup. Blood samples were taken just before anaesthesia, just before skin incision, at the end of anaesthesia and surgery,and at the 24 h postoperatively. The malondialdehyde (MDA), superoxide dismutase (SOD), catalase (CAT), glutathione...
Asunto(s)
Animales , Bovinos , Anestesia/efectos adversos , Anestesia/veterinaria , Bovinos , Estrés Oxidativo , Peroxidación de Lípido , Isoflurano/efectos adversos , Sevoflurano/efectos adversosRESUMEN
Resumen Introducción: El síndrome de hipertermia maligna es un trastorno farmacogenético del músculo esquelético de carácter hereditario, que se caracteriza por un estado hipermetabólico relacionado con la exposición a anestésicos inhalatorios o relajantes musculares despolarizantes. Se trata de una afección infrecuente en individuos genéticamente predispuestos, con una incidencia muy baja en pediatría (1 de cada 10,000-15,000 procedimientos anestésicos). Caso clínico: Se presenta un caso de hipertermia maligna relacionado con la exposición a sevoflurano durante una cirugía de adenoidectomía en un paciente de sexo femenino de 6 años de edad. La paciente presentó taquicardia, hipercapnia e hipertermia, que precisaron la administración de dos dosis sucesivas de dantroleno sódico. La evolución posterior fue buena. Conclusiones: El síndrome de hipertermia maligna es un cuadro poco frecuente en la edad pediátrica. Se debe sospechar de forma precoz, ya que es fundamental su detección temprana para iniciar el tratamiento.
Abstract Background: Malignant hyperthermia syndrome is a hereditary pharmacogenetic disorder of skeletal muscle characterized by hypermetabolic state related to the exposure of volatile anesthetic gases or depolarizing muscle relaxants. It is an infrequent entity that occurs in genetically predisposed individuals, with a very low incidence in pediatrics (1 in 10,000-15,000 anesthetic procedures). Case report: We report a case of malignant hyperthermia related to exposure to sevoflurane during adenoidectomy surgery in a 6-year-old female. The patient presented with tachycardia, hypercapnia, and hyperthermia, requiring two successive doses of dantrolene sodium administration, with an adequate response to the treatment. Conclusions: Malignant hyperthermia syndrome is a rare condition in pediatric patients that should be detected in early stages since it is essential to initiate the treatment as soon as possible.
Asunto(s)
Niño , Femenino , Humanos , Anestésicos por Inhalación , Sevoflurano , Hipertermia Maligna , Adenoidectomía , Anestésicos por Inhalación/efectos adversos , Dantroleno/uso terapéutico , Sevoflurano/efectos adversos , Hipertermia Maligna/etiología , Hipertermia Maligna/tratamiento farmacológicoRESUMEN
Background: Malignant hyperthermia syndrome is a hereditary pharmacogenetic disorder of skeletal muscle characterized by hypermetabolic state related to the exposure of volatile anesthetic gases or depolarizing muscle relaxants. It is an infrequent entity that occurs in genetically predisposed individuals, with a very low incidence in pediatrics (1 in 10,000-15,000 anesthetic procedures). Case report: We report a case of malignant hyperthermia related to exposure to sevoflurane during adenoidectomy surgery in a 6-year-old female. The patient presented with tachycardia, hypercapnia, and hyperthermia, requiring two successive doses of dantrolene sodium administration, with an adequate response to the treatment. Conclusions: Malignant hyperthermia syndrome is a rare condition in pediatric patients that should be detected in early stages since it is essential to initiate the treatment as soon as possible.
Background: Introducción">El síndrome de hipertermia maligna es un trastorno farmacogenético del músculo esquelético de carácter hereditario, que se caracteriza por un estado hipermetabólico relacionado con la exposición a anestésicos inhalatorios o relajantes musculares despolarizantes. Se trata de una afección infrecuente en individuos genéticamente predispuestos, con una incidencia muy baja en pediatría (1 de cada 10,000-15,000 procedimientos anestésicos). Caso clínico: Se presenta un caso de hipertermia maligna relacionado con la exposición a sevoflurano durante una cirugía de adenoidectomía en un paciente de sexo femenino de 6 años de edad. La paciente presentó taquicardia, hipercapnia e hipertermia, que precisaron la administración de dos dosis sucesivas de dantroleno sódico. La evolución posterior fue buena. Conclusiones: El síndrome de hipertermia maligna es un cuadro poco frecuente en la edad pediátrica. Se debe sospechar de forma precoz, ya que es fundamental su detección temprana para iniciar el tratamiento.
Asunto(s)
Anestésicos por Inhalación , Hipertermia Maligna , Sevoflurano , Adenoidectomía , Anestésicos por Inhalación/efectos adversos , Niño , Dantroleno/uso terapéutico , Femenino , Humanos , Hipertermia Maligna/tratamiento farmacológico , Hipertermia Maligna/etiología , Sevoflurano/efectos adversosRESUMEN
Studies in animal models have revealed that long exposures to anesthetics can induce apoptosis in the newborn and young developing brain. These effects have not been confirmed in humans because of the lack of a non-invasive, practical in vivo imaging tool with the ability to detect these changes. Following the successful use of ultrasound backscatter spectroscopy (UBS) to monitor in vivo cell death in breast tumors, we aimed to use UBS to assess the neurotoxicity of the anesthetic sevoflurane (SEVO) in a non-human primate (NHP) model. Sixteen 2- to 7-day-old rhesus macaques were exposed for 5 h to SEVO. Ultrasound scanning was done with a phased array transducer on a clinical ultrasound scanner operated at 10 MHz. Data consisting of 10-15 frames of radiofrequency (RF) echo signals from coronal views of the thalamus were obtained 0.5 and 6.0 h after initiating exposure. The UBS parameter "effective scatterer size" (ESS) was estimated by fitting a scattering form factor (FF) model to the FF measured from RF echo signals. The approach involved analyzing the frequency dependence of the measured FF to characterize scattering sources and selecting the FF model based on a χ2 goodness-of-fit criterion. To assess data quality, a rigorous acceptance criterion based on the analysis of prevalence of diffuse scattering (an assumption in the estimation of ESS) was established. ESS changes after exposure to SEVO were compared with changes in a control group of five primates for which ultrasound data were acquired at 0 and 10 min (no apoptosis expected). Over the entire data set, the average measured FF at 0.5 and 6.0 h monotonically decreased with frequency, justifying fitting a single FF over the analysis bandwidth. χ2 values of a (inhomogeneous continuum) Gaussian FF model were one-fifth those of the discrete fluid sphere model, suggesting that a continuum scatterer model better represents ultrasound scattering in the young rhesus brain. After application of the data quality criterion, only 5 of 16 subjects from the apoptotic group and 5 of 5 subjects from the control group fulfilled the acceptance criteria. All subjects in the apoptotic group that passed the acceptance criterion exhibited a significant ESS reduction at 6.0 h. These changes (-6.4%, 95% Interquartile Range: -14.3% to -3.3%) were larger than those in the control group (-0.8%, 95% Interquartile Range: -2.0% to 1.5%]). Data with a low prevalence of diffuse scattering corresponded to possibly biased results. Thus, ESS has the potential to detect changes in brain microstructure related to anesthesia-induced apoptosis.
Asunto(s)
Anestésicos/efectos adversos , Análisis Espectral/métodos , Tálamo/efectos de los fármacos , Ultrasonografía/métodos , Animales , Animales Recién Nacidos , Apoptosis/efectos de los fármacos , Macaca mulatta , Sevoflurano/efectos adversosRESUMEN
OBJECTIVE: To report on a case of malignant hyperthermia in a child after a magnetic resonance imaging of the skull was performed using sevoflurane anesthesia. CASE DESCRIPTION: A 3-year-old boy admitted to the pediatric intensive care unit after presenting clinical and laboratory findings consistent with unspecified viral meningoencephalitis. While the patient was sedated, a magnetic resonance imaging of the skul was performed using propofol followed by the administration of sevoflurane through a laryngeal mask in order to continue anesthesia. Approximately three hours after the start of the procedure, the patient presented persistent tachycardia, tachypnea, generalized muscular stiffness and hyperthermia. With a diagnostic hypothesis of malignant hyperthermia, dantrolene was then administered, which immediately induced muscle stiffness, tachycardia, tachypnea and reduced body temperature. COMMENTS: Malignant hyperthermia is a rare pharmacogenetic syndrome characterized by a severe hypermetabolic reaction after the administration of halogenated inhalational anesthetics or depolarizing muscle relaxants such as succinylcholine, or both. Although it is a potentially fatal disease, the rapid administration of continued doses dantrolene has drastically reduced the morbidity and mortality of the disease.
Asunto(s)
Anestésicos por Inhalación/efectos adversos , Imagen por Resonancia Magnética , Hipertermia Maligna/etiología , Sevoflurano/efectos adversos , Aciclovir/uso terapéutico , Anestésicos por Inhalación/administración & dosificación , Anestésicos Intravenosos/administración & dosificación , Antivirales/uso terapéutico , Preescolar , Dantroleno/uso terapéutico , Humanos , Masculino , Hipertermia Maligna/tratamiento farmacológico , Meningoencefalitis/tratamiento farmacológico , Meningoencefalitis/virología , Relajantes Musculares Centrales/uso terapéutico , Propofol/administración & dosificación , Sevoflurano/administración & dosificaciónRESUMEN
PURPOSE: To associate medications, anesthetic techniques, and clinical conditions that interfere in the time of patient approval in the safety protocol for thirst management. DESIGN: A quantitative, analytical, and longitudinal study conducted in Southern Brazil. METHODS: A nonprobabilistic sample, of 203 adult patients in the immediate postoperative period, evaluated every 15 minutes for 1 hour. FINDINGS: A general prevalence of thirst of 67.7%, and mean intensity of 6.38. Fentanyl, morphine, rocuronium, and sevoflurane increased lack of approval in the protocol within 30 minutes (P < .05). General anesthesia (P < .0001) and level of consciousness (95.4%) presented the highest nonapproval rates. CONCLUSIONS: Anesthetics and general anesthesia delayed protocol approval; however, after 30 minutes, 75.4% of patients had been approved. Level of consciousness was the main criterion of disapproval. The protocol identified crucial clinical conditions that made it impossible for the patient to receive thirst relief strategies and demonstrated that thirst can be satiated precociously with safety.
Asunto(s)
Seguridad del Paciente/normas , Sed , Adyuvantes Anestésicos/efectos adversos , Adyuvantes Anestésicos/farmacología , Adyuvantes Anestésicos/uso terapéutico , Adulto , Anestésicos por Inhalación/efectos adversos , Anestésicos por Inhalación/farmacología , Anestésicos por Inhalación/uso terapéutico , Brasil , Femenino , Fentanilo/efectos adversos , Fentanilo/farmacología , Fentanilo/uso terapéutico , Humanos , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Seguridad del Paciente/estadística & datos numéricos , Periodo Posoperatorio , Sevoflurano/efectos adversos , Sevoflurano/farmacología , Sevoflurano/uso terapéuticoRESUMEN
ABSTRACT Objective: To report on a case of malignant hyperthermia in a child after a magnetic resonance imaging of the skull was performed using sevoflurane anesthesia. Case description: A 3-year-old boy admitted to the pediatric intensive care unit after presenting clinical and laboratory findings consistent with unspecified viral meningoencephalitis. While the patient was sedated, a magnetic resonance imaging of the skul was performed using propofol followed by the administration of sevoflurane through a laryngeal mask in order to continue anesthesia. Approximately three hours after the start of the procedure, the patient presented persistent tachycardia, tachypnea, generalized muscular stiffness and hyperthermia. With a diagnostic hypothesis of malignant hyperthermia, dantrolene was then administered, which immediately induced muscle stiffness, tachycardia, tachypnea and reduced body temperature. Comments: Malignant hyperthermia is a rare pharmacogenetic syndrome characterized by a severe hypermetabolic reaction after the administration of halogenated inhalational anesthetics or depolarizing muscle relaxants such as succinylcholine, or both. Although it is a potentially fatal disease, the rapid administration of continued doses dantrolene has drastically reduced the morbidity and mortality of the disease.
RESUMO Objetivo: Relatar um caso de hipertermia maligna em criança após exame de ressonância magnética de crânio realizada sob efeito anestésico de sevoflurano. Descrição do caso: Menino de três anos de idade, admitido na Unidade de Terapia Intensiva Pediátrica (UTIP) após apresentar quadros clínico e laboratorial compatíveis com meningoencefalite viral não especificada. Foi realizado um exame de ressonância magnética de crânio com sedação utilizando, na indução anestésica, o propofol seguido pela administração de sevoflurano por meio de máscara laríngea para manutenção anestésica. Aproximadamente três horas após o início do procedimento, o paciente apresentou taquicardia, taquipneia, rigidez muscular generalizada e hipertermia persistentes. Com hipótese diagnóstica de hipertermia maligna, foi então administrado dantrolene, que fez ceder de forma imediata a rigidez muscular, a taquicardia, a taquipneia e reduziu a temperatura corporal. Comentários: A hipertermia maligna é uma síndrome farmacogenética rara, que se caracteriza por reação hipermetabólica grave após administração de anestésicos inalatórios halogenados e/ou relaxantes musculares despolarizantes, como a succinilcolina. Apesar de ser uma doença potencialmente fatal, a rápida administração de dantrolene, junto às doses de manutenção, tem reduzido drasticamente a morbimortalidade da doença.
Asunto(s)
Humanos , Masculino , Preescolar , Imagen por Resonancia Magnética , Anestésicos por Inhalación/efectos adversos , Sevoflurano/efectos adversos , Hipertermia Maligna/etiología , Antivirales/uso terapéutico , Aciclovir/uso terapéutico , Propofol/administración & dosificación , Anestésicos Intravenosos/administración & dosificación , Anestésicos por Inhalación/administración & dosificación , Dantroleno/uso terapéutico , Sevoflurano/administración & dosificación , Hipertermia Maligna/tratamiento farmacológico , Meningoencefalitis/tratamiento farmacológico , Meningoencefalitis/virología , Relajantes Musculares Centrales/uso terapéuticoRESUMEN
Abstract Background and objectives: Emergence delirium after general anesthesia with sevoflurane has not been frequently reported in adults compared to children. This study aimed to determine the incidence of emergence delirium in adult patients who had anesthesia with sevoflurane as the volatile agent and the probable risk factors associated with its occurrence. Design & methods: A prospective observational study was conducted in adult patients who had non-neurological procedures and no existing neurological or psychiatric conditions, under general anesthesia. Demographic data such as age, gender, ethnicity and clinical data including ASA physical status, surgical status, intubation attempts, duration of surgery, intraoperative hypotension, drugs used, postoperative pain, rescue analgesia and presence of catheters were recorded. Emergence delirium intensity was measured using the Nursing Delirium Scale (NuDESC). Results: The incidence of emergence delirium was 11.8%. The factors significantly associated with emergence delirium included elderly age (>65) (p = 0.04), emergency surgery (p = 0.04), African ethnicity (p = 0.01), longer duration of surgery (p = 0.007) and number of intubation attempts (p = 0.001). Factors such as gender, alcohol and illicit drug use, and surgical specialty did not influence the occurrence of emergence delirium. Conclusions: The incidence of emergence delirium in adults after general anesthesia using sevoflurane is significant and has not been adequately reported. Modifiable risk factors need to be addressed to further reduce its incidence.
Resumo Justificativa e objetivos: O delirium do despertar após a anestesia geral com sevoflurano não tem sido relatado com frequência em adultos como nas crianças. Este estudo teve como objetivo determinar a incidência de delirium do despertar em pacientes adultos submetidos à anestesia com sevoflurano como agente volátil e os prováveis fatores de risco associados à sua ocorrência. Desenho e métodos: Um estudo observacional prospectivo foi conduzido com pacientes adultos sem distúrbios neurológicos ou psiquiátricos submetidos à anestesia geral para procedimentos não neurológicos. Dados demográficos como idade, sexo, etnia e dados clínicos, inclusive estado físico ASA, estado cirúrgico, tentativas de intubação, tempo de cirurgia, hipotensão intraoperatória, drogas usadas, dor pós-operatória, analgesia de resgate e presença de cateteres, foram registrados. A intensidade do delirium do despertar foi medida com a Escala de Triagem de Delirium em Enfermagem (Nursing Delirium Scale - NuDESC). Resultados: A incidência de delirium do despertar foi de 11,8%. Os fatores significativamente associados ao delirium do despertar incluíram idade avançada (> 65) (p = 0,04), cirurgia de emergência (p = 0,04), descendência africana (p = 0,01), tempo maior de cirurgia (p = 0,007) e número de tentativas de intubação (p = 0,001). Fatores como sexo, uso de álcool e drogas ilícitas e especialidade cirúrgica não influenciaram a ocorrência de delirium do despertar. Conclusões: A incidência de delirium do despertar em adultos após a anestesia geral com sevoflurano é significativa e não tem sido relatada adequadamente. Fatores de risco modificáveis precisam ser abordados para reduzir ainda mais sua incidência.
Asunto(s)
Humanos , Masculino , Femenino , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Adulto Joven , Anestésicos por Inhalación/administración & dosificación , Delirio del Despertar/epidemiología , Sevoflurano/administración & dosificación , Anestesia General/métodos , Incidencia , Estudios Prospectivos , Factores de Riesgo , Anestésicos por Inhalación/efectos adversos , Tempo Operativo , Sevoflurano/efectos adversos , Anestesia General/efectos adversos , Persona de Mediana EdadRESUMEN
BACKGROUND AND OBJECTIVES: Emergence delirium after general anesthesia with sevoflurane has not been frequently reported in adults compared to children. This study aimed to determine the incidence of emergence delirium in adult patients who had anesthesia with sevoflurane as the volatile agent and the probable risk factors associated with its occurrence. DESIGN AND METHODS: A prospective observational study was conducted in adult patients who had non-neurological procedures and no existing neurological or psychiatric conditions, under general anesthesia. Demographic data such as age, gender, ethnicity and clinical data including ASA physical status, surgical status, intubation attempts, duration of surgery, intraoperative hypotension, drugs used, postoperative pain, rescue analgesia and presence of catheters were recorded. Emergence delirium intensity was measured using the Nursing Delirium Scale (NuDESC). RESULTS: The incidence of emergence delirium was 11.8%. The factors significantly associated with emergence delirium included elderly age (>65) (p=0.04), emergency surgery (p=0.04), African ethnicity (p=0.01), longer duration of surgery (p=0.007) and number of intubation attempts (p=0.001). Factors such as gender, alcohol and illicit drug use, and surgical specialty did not influence the occurrence of emergence delirium. CONCLUSIONS: The incidence of emergence delirium in adults after general anesthesia using sevoflurane is significant and has not been adequately reported. Modifiable risk factors need to be addressed to further reduce its incidence.