Search Results (84)

Preeclampsia with severe features presents major anesthetic challenges, particularly in category 1 cesarean sections, in which rapid, safe, and hemodynamically stable induction is critical. Neuraxial techniques may be controversial due to neurological symptoms, making general anesthesia a viable option. However, traditional general anesthesia may exacerbate hypertension and increase maternal and fetal risks. Two primigravida patients with elevated blood pressure and neurological symptoms underwent category 1 cesarean delivery under TIVA-TCI with propofol, using the Marsh model. Hemodynamic stability, drug dosing, and maternal–neonatal outcomes were monitored. Sufentanil was administered for analgesia; neuromuscular blockade was achieved with rocuronium and reversed with sugammadex. No BIS or TOF monitoring was available. Both patients maintained stable hemodynamics and oxygenation throughout surgery. Intubation was successfully performed at an effect-site concentration of 3.5 µg/mL. Neonatal Apgar scores were within acceptable limits. No major complications occurred intraoperatively or postoperatively. TCI allowed individualized dosing and smooth emergence. TIVA-TCI with propofol appears to be a viable alternative to volatile-based general anesthesia in category 1 emergencies for cesarean sections for patients with preeclampsia with severe features, especially when neuraxial anesthesia is controversial. It offers hemodynamic stability and controlled depth of anesthesia, though its use requires experience and may not be optimal in cases requiring ultra-rapid induction. Full article

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

Background and Objectives: Lung cancer represents one of the principal causes of cancer-associated mortality worldwide. Despite the numerous novel therapeutic agents, surgical resection remains, in many cases, the mainstay treatment. A growing body of evidence indicates that the anesthetic technique of choice contributes to perioperative immunosuppression, thus having an impact on cancer recurrence and prognosis. The aim of this systematic review is to provide a thorough summary of the current literature regarding the modulation of the immune response induced by the various anesthetic techniques that are used in lung cancer surgery, with a particular emphasis on cellular immunity. Materials and Methods: PubMed, Scopus, and the Cochrane databases were systematically searched from November 2023 up to March 2024 to identify randomized controlled trials (RCTs) that met the eligibility criteria. Results: A total of seven RCTs were included. Four of the RCTs compared the administration of general anesthesia alone versus general anesthesia combined with epidural anesthesia. The subsequent meta-analysis showed that the combination of general and epidural anesthesia exerted a positive impact on the cell counts of the CD3+ cells (SMD −0.42, 95% Cl −0.70 to −0.13 24 h postoperatively and SMD −0.86 95% Cl −1.48 to −0.23 72 h postoperatively), the CD4+ cells (SMD −0.41 95% Cl −0.69 to −0.12 at the end of surgery and SMD −0.56 95% Cl −0.85 to −0.27 72 h later), and the CD4+/CD8+ ratio (SMD −0.31 95% Cl −0.59 to −0.02 immediately after surgery, SMD −0.50 95% Cl −0.86 to −0.14 24 h postoperatively, and SMD −0.60 95% Cl −0.89 to −0.31 72 h later). The pooled results regarding CD8+ and NK cell counts were inconclusive. The remaining three studies compared volatile-based anesthesia with total intravenous anesthesia (TIVA). Due to disparities between these studies, qualitative analysis was inconclusive, whereas quantitative analysis was not feasible. Conclusions: The supplementation of general anesthesia with epidural anesthesia favorably impacts CD3+ and CD4+ cell counts, as well as the CD4+/CD8+ ratio. The present results and the effects of anesthetic technique on other immune cells must be consolidated with further high-quality studies. Full article

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

Objectives: Comparative analyses of anesthetic agents on mutants with altered anesthetic sensitivity remain limited in the current literature. This study examines the sensitivity of various Drosophila melanogaster wild-type strains and mutants to the volatile anesthetics chloroform and isoflurane. We utilized recently identified mutants in ion channel-encoding genes and others historically selected for anesthetic resistance, such as AGAR (autosomal general anesthesia resistant) and har (halothane-resistant). Method: Based on the principles of the conventional inebriometer assay used to isolate these mutants, we developed a new, simpler method to measure the anesthetic response in these flies. Results: Interestingly, we discovered that wild-type flies exhibit varying levels of anesthetic resistance. Contrary to previous reports, AGAR and har mutants showed little resistance to anesthesia using our method. Several ion channel mutants displayed increased resistance or sensitivity. Across all strains, isoflurane was more potent than chloroform. To ensure objectivity, all experiments were conducted double-blind. These findings highlight the variability in anesthetic sensitivity among both wild-type and mutant flies and underscore the importance of assay design in assessing resistance. Full article

Background: With renewed interest in long-duration space missions, there is growing exploration into synthetic torpor as a countermeasure to mitigate physiological stressors. Sedative agents, particularly those used in clinical anesthesia, have been proposed to replicate aspects of natural torpor, including reduced metabolic rate, core temperature, and brain activity. Objectives: This systematic review aims to evaluate the potential of sedative agents to induce torpor-like states suitable for extended spaceflight. The review specifically investigates their pharmacokinetics, pharmacodynamics, and performance under space-related stressors such as microgravity and ionizing radiation. Methods: We conducted a comprehensive search across multiple databases (e.g., PubMed, Scopus, Web of Science) for studies published from 1952 to 2024. Eligible studies included experimental, preclinical, and clinical investigations examining sedative agents (especially inhalation anesthetics) in the context of metabolic suppression or space-relevant conditions. Screening, selection, and data extraction followed PRISMA guidelines. Results: Out of the screened records, 141 studies met the inclusion criteria. These were thematically grouped into seven categories, including torpor physiology, anesthetic uptake, metabolism, and inhalation anesthetics. Sedative agents showed variable success in inducing torpor-like states, with inhalation anesthetics demonstrating promising metabolic effects. However, concerns remain regarding delivery methods, safety, rewarming, and the unknown effects of prolonged use in space environments. Conclusions: Sedative agents, particularly volatile anesthetics, hold potential as tools for inducing synthetic torpor in space. Nevertheless, significant knowledge gaps and technical challenges persist. Further targeted research is required to optimize these agents for safe, controlled use in spaceflight settings. Full article

Neuroprotective strategies in coronary artery interventions are essential due to the rising number of high-risk patients undergoing procedures like coronary artery bypass grafting (CABG), totally endoscopic coronary artery bypass (TECAB), and hybrid revascularization. In this review article, we summarize the neurological complications associated with coronary artery disease intervention and the risk mitigation strategies. CABG carries significant risks, including ischemic stroke, encephalopathy, seizures, and peripheral nerve injuries. Risk factors include advanced age, hypertension, diabetes, and atherosclerosis. Off-pump CABG minimizes stroke risk by avoiding aortic manipulation and CPB. TECAB and hybrid revascularization have fewer reported neurological complications but still pose risks of stroke and cranial nerve injuries. Pharmacological neuroprotection includes agents such as barbiturates, volatile anesthetics, lidocaine, NMDA receptor antagonists, magnesium, nimodipine, corticosteroids, and aprotinin. Deep hypothermic circulatory arrest (DHCA) is reserved for complex aortic cases requiring a bloodless surgical field. Intraoperative strategies involve cerebral perfusion monitoring, embolic protection devices, and therapeutic hypothermia. Preoperative optimization targets risk factors, arrhythmia prevention, and antiplatelet therapy management. Postoperatively, timely antiplatelet administration, glucose control, hemodynamic stabilization, and cognitive monitoring are critical. Comprehensive neuroprotective approaches, spanning pre- to postoperative phases, aim to reduce neurological complications and enhance outcomes in coronary interventions. Full article

Biomedical sciences have made immense progress and numerous discoveries aimed at improving the quality of life and life expectancy in modern times. Anesthesiology is typically tailored to individual patients as its clinical effects depend on multiple factors, including a patient’s physiological and pathological states, age, environmental exposures, and genetic variations. Sex differences are also paramount for a complete understanding of the effects of specific anesthetic medications on men and women. However, women-specific research and the inclusion of women in clinical trials, specifically during child-bearing years, remain disproportionately low compared to the general population at large. This review describes and summarizes genetic variations, including sex differences, that affect responses to common anesthetic medications such as volatile anesthetics, induction agents, neuromuscular blocking drugs, opioids, and local anesthetics. It also discusses the influence of genetic variations on anesthesia outcomes, such as postoperative nausea and vomiting, allergic reactions, pain, depth of anesthesia, awareness under anesthesia and recall, and postoperative delirium. Full article

Hypoxia due to stroke is a major cause of neuronal damage, leading to loss of cognition and other brain functions. Sevoflurane preconditioning improves recovery after hypoxia. Hypoxia interferes with protein expression at the translational level; however, its effect on mRNA levels for neuronal protein kinase and anti-apoptotic genes is unclear. To investigate the link between sevoflurane preconditioning and gene expression, hippocampal slices were treated with 4% sevoflurane for 15 min, a 5 min washout, 10 min of hypoxia, and 60 min of recovery. We used quantitative PCR to measure mRNA levels in the CA1 region of rat hippocampi. The mRNA levels for specific critical proteins were examined, as follows: Protein kinases, PKCγ (0.22), PKCε (0.38), and PKMζ (0.55) mRNAs, and anti-apoptotic, bcl-2 (0.44) and bcl-xl (0.41), were reduced 60 min after hypoxia relative to their expression in tissue not subjected to hypoxia (set to 1.0). Sevoflurane preconditioning prevented the reduction in PKMζ (0.88 vs. 1.0) mRNA levels after hypoxia. Pro-apoptotic BAD mRNA was not significantly changed after hypoxia, even with sevoflurane preconditioning (hypoxia 0.81, sevo hypoxia 0.84 vs. normoxia 1.0). However, BAD mRNA was increased by sevoflurane in non-hypoxic conditions (1.48 vs. 1.0), which may partially explain the deleterious effects of volatile anesthetics under certain conditions. The DNA repair enzyme poly ADP-ribose polymerase 1 (PARP-1) was increased by sevoflurane in tissue not subjected to hypoxia (1.23). PARP-1 mRNA was reduced in untreated tissue after hypoxia (0.21 vs. 1.0); sevoflurane did not improve PARP-1 after hypoxia (0.27). Interestingly, the mRNA level of the cognitive kinase PKMζ, a kinase essential for learning and memory, was the only one protected against hypoxic downregulation by sevoflurane preconditioning. These findings correlate with previous studies that found that sevoflurane-induced improvement of neuronal survival after hypoxia was dependent on PKMζ. Maintaining mRNA levels for critical proteins may provide an important mechanism for preserving neuronal function after stroke. Full article

Background: Climate change poses significant challenges to global health, At the same time, the healthcare sector itself, with its high resource demands, also contributes substantially to global warming. Anesthesia, particularly through the use of volatile inhalation anesthetics, is a key contributor in this respect. The present exploratory study examines staff perceptions of precycling and recycling strategies aimed at reducing the environmental impact of anesthetic gases at the General Hospital Vienna, Austria. This large institution has recently implemented major changes, including the shutdown of the centralized nitrous oxide supply and the introduction of anesthetic gas recycling systems on anesthesia machines, alongside other precycling measures. Methods: We conducted a cross-sectional online survey of anesthesia team members (n = 103, 61.2% females) to assess current perceptions related to anesthetic gas usage, focusing on precycling and recycling aspects, and their willingness to engage in further sustainability efforts. Results: We found that participants expressed an, in general, positive attitude towards environmental protection measures and a high willingness to make additional efforts to recycle anesthetics. Thus, the anesthesia team members in our institution may be inclined to support strategies like minimizing the use of volatile anesthetics. Conclusions: These preliminary insights could inform actionable recommendations for advancing sustainable practices in anesthesiology at our hospital. Full article

Background: Intraoperative neuromonitoring (IONM) is crucial for the safety of scoliosis surgery, providing real-time feedback on the spinal cord and nerve function, primarily through motor-evoked potentials (MEPs). The choice of anesthesia plays a crucial role in influencing the quality and reliability of these neuromonitoring signals. This systematic review evaluates how different anesthetic techniques—total intravenous anesthesia (TIVA), volatile anesthetics, and regional anesthesia approaches such as Erector Spinae Plane Block (ESPB), spinal, and epidural anesthesia—affect IONM during scoliosis surgery. Methods: A systematic review was conducted following PRISMA guidelines. PubMed, MEDLINE, EMBASE, and Cochrane databases were searched for studies published between 2017 and 2024 that examined the impact of anesthetic techniques on neuromonitoring during scoliosis surgery. The focus was on studies reporting MEP outcomes, anesthetic protocols, and postoperative neurological and analgesic effects. Results: The search initially identified 998 articles. After applying inclusion criteria based on relevance, recency, methodological quality, and citation frequency, 45 studies were selected for detailed review. Conclusion: The erector Spinae Plane Block (ESPB) provides distinct benefits over spinal and epidural anesthesia in scoliosis surgery, particularly in maintaining neuromonitoring accuracy, reducing hemodynamic instability, and minimizing complications. The ESPB’s ability to deliver effective segmental analgesia without compromising motor function makes it a safer and more efficient option for postoperative pain management, enhancing patient outcomes. Full article

The development of inhaled anesthetics (IAs) has a rich history dating back many centuries. In modern times they have played a pivotal role in anesthesia and critical care by allowing deep sedation during periods of critical illness and surgery. In addition to their sedating effects, they have many systemic effects allowing for therapy beyond surgical anesthesia. In this narrative review we chronicle the evolution of IAs, from early volatile agents such as ether to the contemporary use of halogenated hydrocarbons. This is followed by a discussion of the mechanisms of action of these agents which primarily involve the modulation of lipid membrane properties and ion channel activity. IAs’ systemic effects are also examined, including their effects on the cardiovascular, respiratory, hepatic, renal and nervous systems. We discuss of the role of IAs in treating systemic disease processes including ischemic stroke, delayed cerebral ischemia, status epilepticus, status asthmaticus, myocardial ischemia, and intensive care sedation. We conclude with a review of the practical and logistical challenges of utilizing IAs outside the operating room as well as directions for future research. This review highlights the expanding clinical utility of IAs and their evolving role in the management of a diverse range of disease processes, offering new avenues for therapeutic exploration beyond anesthesia. Full article

Considerable attention has recently been given to the contribution of the greenhouse gas (GHG) emissions of the healthcare sector to climate change. GHGs used in medical practice are regularly released into the atmosphere and contribute to elevations in global temperatures that produce detrimental effects on the environment and human health. Consequently, a comprehensive assessment of their global warming potential over 100 years (GWP) characteristics, and clinical uses, many of which have evaded scrutiny from policy makers due to their medical necessity, is needed. Of major interest are volatile anesthetics, analgesics, and inhalers, as well as fluorinated gases used as tamponades in retinal detachment surgery. In this review, we conducted a literature search from July to September 2024 on medical greenhouse gases and calculated estimates of these gases’ GHG emissions in metric tons CO₂ equivalent (MTCO₂e) and their relative GWP. Notably, the anesthetics desflurane and nitrous oxide contribute the most emissions out of the major medical GHGs, equivalent to driving 12 million gasoline-powered cars annually in the US. Retinal tamponade gases have markedly high GWP up to 23,500 times compared to CO₂ and long atmospheric lifetimes up to 10,000 years, thus bearing the potential to contribute to climate change in the long term. This review provides the basis for discussions on examining the environmental impacts of medical gases with high GWP, determining whether alternatives may be available, and reducing emissions while maintaining or even improving patient care. Full article

Lung cancer remains a leading cause of cancer-related mortality worldwide. Although surgical treatment is a primary approach, residual cancer cells and surgery-induced pathophysiological changes may promote cancer recurrence and metastasis. Anesthetic agents and techniques have recently been shown to potentially impact these processes by modulating surgical stress responses, immune function, inflammatory pathways, and the tumor microenvironment. Anesthetics can influence immune-modulating cytokines, induce pro-inflammatory factors such as HIF-1α, and alter natural-killer cell activity, affecting cancer cell survival and spread. Preclinical studies suggest volatile anesthetics may promote tumor progression by triggering pro-inflammatory signaling, while propofol shows potential antitumor properties through immune-preserving effects and reductions in IL-6 and other inflammatory markers. Additionally, opioids are known to suppress immune responses and stimulate pathways that may support cancer cell proliferation, whereas regional anesthesia may reduce these risks by decreasing the need for systemic opioids and volatile agents. Despite these findings, clinical data remain inconclusive, with studies showing mixed outcomes across patient populations. Current clinical trials, including comparisons of volatile agents with propofol-based total intravenous anesthesia, aim to provide clarity but highlight the need for further investigation. Large-scale, well-designed studies are essential to validate the true impact of anesthetic choice on cancer recurrence and to optimize perioperative strategies that support long-term oncologic outcomes for lung cancer patients. Full article

Only some subpopulations of natural killer (NK) cells have cytotoxic functionality, and the effects of anesthetics on these subpopulations are unknown. This study aimed to evaluate the in vitro effects of various anesthetics, both alone and in combination, on the distribution and cytotoxic function of NK cells and their subpopulations. Peripheral blood mononuclear cells (PBMCs) from eight healthy volunteers were treated for 4 h in vitro with dexmedetomidine, remifentanil, lidocaine, propofol, sevoflurane, and combinations in clinically relevant concentrations or left untreated. Flow cytometry was used to quantify the percentage of sampled NK cells and evaluate their distribution (CD56^brightCD16^neg, CD56^brightCD16^dim, CD56^dimCD16^neg, CD56^dimCD16^bright, and CD56^negCD16^bright) and cytotoxicity (Granzyme B (GrzB) and perforin) of NK cell subpopulations. Although the percentage of total NK cells did not change following exposure to anesthesia, the most important cytotoxic subpopulation (CD56^dimCD16^bright NK cells) decreased after exposure to both propofol (−3.58%, p = 0.045) and sevoflurane (−16.10%, p = 0.008) alone, and most combinations, especially in combination with lidocaine (propofol with lidocaine (−9.66%, p = 0.002) and sevoflurane with lidocaine (−21.90%, p < 0.001)). Dexmedetomidine and remifentanil had no effect on CD56^dimCD16^bright NK cells. Furthermore, no anesthetic regimen or combination altered the expression of GrzB and perforin in NK cells or NK cell subpopulations. In short, propofol and sevoflurane suppressed the highly cytotoxic phenotype (CD56^dimCD16^bright) of NK cells, with those exposed to sevoflurane combinations showing greater reductions. Immunosuppression was intensified with the inclusion of lidocaine in the anesthetic regimen. Full article