Effects of intravenous anesthesia with sevoflurane combined with propofol on intraoperative hemodynamics, postoperative stress disorder and cognitive function in elderly patients undergoing laparoscopic surgery

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Abstract

Objectives:

To analyze the effects of intravenous anesthesia with sevoflurane combined with propofol on intraoperative hemodynamics, postoperative stress disorder and cognitive function in elderly patients undergoing laparoscopic surgery.

Methods:

Eighty elderly patients undergoing laparoscopic surgery in Xianning Central Hospital from September 2014 to February 2018. Enrolled patients were divided into observation group (n=40) and control group (n=40) according to the random regionalization method. Patients in the control group were given intravenous anesthesia with propofol, while those in the observation group were provided with a combined use of sevoflurane based on the method in the control group. The general surgical data, intraoperative hemodynamics, postoperative stress disorder and cognitive function were compared between the two groups.

Results:

There were no blood transfusions and no complications during operation in the two groups, and the operation completed successfully. There was no significant difference in the time of unconsciousness, intubation time, and duration of pneumoperitoneum establishment (p>0.05). However, the spontaneous breathing time, eye opening time upon calling and extubation time in observation group were shorter than those in control group (p<0.05). The heart rate (HR) in the two groups at intubation and at exploration was significantly higher than that at the time of entering the room (p<0.05), which was lower in observation group than that in control group (p<0.05). While there was no significant difference in the index at the other time points compared with that before entering the room and control group (p>0.05). The systolic blood pressure (SBP) had different degrees of change before intubation, after 0 minutes, three minutes and six minutes of intubation, after 0 minutes and five minutes of pneumoperitoneum establishment and at exploration when compared with that before entering the room (p<0.05). But the SBP at intubation and at exploration was significantly lower in observation group than that in control group (p<0.05). MAP was only decreased significantly at intubation compared with that before entering the room (p<0.05). At exploration, there was no significant fluctuation in the MAP level in observation group (p>0.05), but the MAP was increased significantly in control group (p<0.05). In addition, the postoperative stress disorder in observation group was milder than that in control group (p<0.05), and the postoperative cognitive function was better than that in control group (p<0.05).

Conclusions:

Intravenous anesthesia with sevoflurane combined with propofol has little effects on intraoperative hemodynamics and postoperative cognitive function in elderly patients undergoing laparoscopic surgery. Besides, it can obtain better recovery quality and have milder postoperative stress disorder than single use of propofol.

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Most cited references 20

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Clinical Pharmacokinetics and Pharmacodynamics of Propofol

Marko Sahinovic, Michel M. R. F. Struys, Anthony Absalom (2018)

Propofol is an intravenous hypnotic drug that is used for induction and maintenance of sedation and general anaesthesia. It exerts its effects through potentiation of the inhibitory neurotransmitter γ-aminobutyric acid (GABA) at the GABAA receptor, and has gained widespread use due to its favourable drug effect profile. The main adverse effects are disturbances in cardiopulmonary physiology. Due to its narrow therapeutic margin, propofol should only be administered by practitioners trained and experienced in providing general anaesthesia. Many pharmacokinetic (PK) and pharmacodynamic (PD) models for propofol exist. Some are used to inform drug dosing guidelines, and some are also implemented in so-called target-controlled infusion devices, to calculate the infusion rates required for user-defined target plasma or effect-site concentrations. Most of the models were designed for use in a specific and well-defined patient category. However, models applicable in a more general population have recently been developed and published. The most recent example is the general purpose propofol model developed by Eleveld and colleagues. Retrospective predictive performance evaluations show that this model performs as well as, or even better than, PK models developed for specific populations, such as adults, children or the obese; however, prospective evaluation of the model is still required. Propofol undergoes extensive PK and PD interactions with both other hypnotic drugs and opioids. PD interactions are the most clinically significant, and, with other hypnotics, tend to be additive, whereas interactions with opioids tend to be highly synergistic. Response surface modelling provides a tool to gain understanding and explore these complex interactions. Visual displays illustrating the effect of these interactions in real time can aid clinicians in optimal drug dosing while minimizing adverse effects. In this review, we provide an overview of the PK and PD of propofol in order to refresh readers’ knowledge of its clinical applications, while discussing the main avenues of research where significant recent advances have been made.

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First report of Enterobacter hormaechei with respiratory disease in calves

Zhicheng Wang, Lisha Duan, Fei Liu … (2020)

Background Enterobacter hormaechei is commonly considered a causative pathogen for nosocomial infections and it does not usually cause diseases in animals. However, researchers have recently dissociated the pathogenic Enterobacter hormaechei from foxes and piglets. Here, the Enterobacter hormaechei was first found to be associated with respiratory disease in unweaned calves in China. Case presentation A 2-month-old calf was severely sick and diagnosed with respiratory infection by a rural veterinarian, and it died 5 days after treatment with penicillin G. The lung sample was then run through histopathological analysis and pathogen isolation. The sequence analysis and biochemical tests results showed the isolated bacterium strain to be Enterobacter hormaechei, and drug sensitivity tests showed resistance to all β-lactam antimicrobials and sensitivity to quinolones. Thickened alveoli septum, inflammatory cell infiltration, and erythrocyte diapedesis around the pulmonary alveoli septum were visible in lung histopathological sections. One week later, at the same farm, another calf showed similar clinical signs, and the Enterobacter hormaechei strain was isolated from its nasal discharge; after a week of treatment with enrofloxacin, as suggested by the results of drug sensitivity tests, this calf fully recovered. Conclusions To the best of our knowledge, this is the first case report of calves with respiratory disease that was associated with E. hormaechei, and multi-drug resistance was observed in isolates.

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Volatile versus Total Intravenous Anesthesia for Cancer Prognosis in Patients Having Digestive Cancer Surgery

Kanako Makito, Hiroki Matsui, Kiyohide Fushimi … (2020)

Previous experimental and clinical studies have shown that anesthetic agents have varying effects on cancer prognosis; however, the results were inconsistent among these studies. The authors compared overall and recurrence-free survival in patients given volatile or intravenous anesthesia for digestive tract cancer surgery. The authors selected patients who had elective esophagectomy, gastrectomy, hepatectomy, cholecystectomy, pancreatectomy, colectomy, and rectal cancer surgery from July 2010 to March 2018 using the Japanese Diagnosis Procedure Combination database. Patients were divided into a volatile anesthesia group (desflurane, sevoflurane, or isoflurane with/without nitrous oxide) and a propofol-based total intravenous anesthesia group. The authors hypothesized that total intravenous anesthesia is associated with greater overall and recurrence-free survival than volatile anesthesia. Subgroup analyses were performed for each type of surgery. The authors identified 196,303 eligible patients (166,966 patients in the volatile anesthesia group and 29,337 patients in the propofol-based total intravenous anesthesia group). The numbers (proportions) of death in the volatile anesthesia and total intravenous anesthesia groups were 17,319 (10.4%) and 3,339 (11.4%), respectively. There were no significant differences between the two groups in overall survival (hazard ratio, 1.02; 95% CI, 0.98 to 1.07; P = 0.28) or recurrence-free survival (hazard ratio, 0.99; 95% CI, 0.96 to 1.03; P = 0.59), whereas instrumental variable analyses showed a slight difference in recurrence-free survival (hazard ratio, 0.92; 95% CI, 0.87 to 0.98; P = 0.01). Subgroup analyses showed no significant difference in overall or recurrence-free survival between the groups in any type of surgery. Overall and recurrence-free survival were similar between volatile and intravenous anesthesia in patients having digestive tract surgery. Selection of the anesthetic approach for these patients should be based on other factors.

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Author and article information

Journal

Journal ID (nlm-ta): Pak J Med Sci

Journal ID (iso-abbrev): Pak J Med Sci

Title: Pakistan Journal of Medical Sciences

Publisher: Professional Medical Publications (Pakistan )

ISSN (Print): 1682-024X

ISSN (Electronic): 1681-715X

Publication date (Print): Sep-Oct 2022

Volume: 38

Issue: 7

Pages: 1938-1944

Affiliations

[1 ]Li Yang, Department of Anesthesiology, Xianning Central Hospital, The First Affiliated Hospital of Hubei University of Science and Technology, Xianning 437000, Hubei, P.R. China

[2 ]Zhigang Chen, Department of Anesthesia and Pain, Wuhan Xinzhou District People’s Hospital, Wuhan 430400, Hubei, P.R. China

[3 ]Dengguo Xiang, Department of Anesthesiology, The Central Hospital of Enshi Tujia and Miao Autonomous Prefecture, Enshi 445000, Hubei, P.R. China

Author notes

Correspondence: Dengguo Xiang, Department of Anesthesiology, The Central Hospital of Enshi Tujia and Miao Autonomous Prefecture, Enshi 445000, Hubei, P.R. China. E-mail: yangli790523@ 123456163.com

Article

Publisher ID: PJMS-38-1938

DOI: 10.12669/pjms.38.7.5763

PMC ID: 9532675

PubMed ID: 36246684

SO-VID: c3fb1a10-0971-45e5-a497-d6fdcc782bf6

License:

This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

History

Date received : 26 November 2021

Date revision received : 16 May 2022

Date revision received : 20 May 2022

Date accepted : 05 June 2022

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Effects of intravenous anesthesia with sevoflurane combined with propofol on intraoperative hemodynamics, postoperative stress disorder and cognitive function in elderly patients undergoing laparoscopic surgery

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Abstract

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International Journal of Applied Technology in Medical Sciences

Most cited references 20

Clinical Pharmacokinetics and Pharmacodynamics of Propofol

First report of Enterobacter hormaechei with respiratory disease in calves

Volatile versus Total Intravenous Anesthesia for Cancer Prognosis in Patients Having Digestive Cancer Surgery

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