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Propofol is an ultra-fast-acting intravenous anesthetic, which is rapidly metabolized primarily into inactive compounds in the live and then excreted in the urine. The purpose of this study is to explore the risk signals of propofol based on the US FDA Adverse Event Reporting System database. The risk signals of propofol-related adverse reactions in adverse event (AE) reports from 2004 to 2021 in the US FAERS were mined using ratio-report method (ROR) and the ratio-report ratio method (PRR) methods. We screened out 1651 pairs AE reports using propofol as primary suspect (PS) drugs. ROR, PRR, BCPNN and MGPS methods were used to calculate respectively, there are 363 positive preferred terms (PT) signals with 9549 cases. Among them, the top 3 adverse reactions associated with using propofol from the FAERS database were anaphylactic shock, hypotension and propofol infusion syndrome. The top 3 systems of the body associated with adverse reaction of propofol from the FAERS database were General disorders, Cardiac disorders and administration site conditions and Respiratory, thoracic and mediastinal disorders. The top 4 indication of using propofol from the FAERS database, including anaesthesia, induction of anaesthesia, sedation, general anaesthesia. There are many adverse reactions that are not included in the drug insert of propofol and involve a wide range of organs and/or systems. Caution should be exercised in the clinical use of propofol. [ABSTRACT FROM AUTHOR]

Liver cancer, one of the most common malignant tumors, has seriously threatened people's physical and mental health. The paper was conducted to investigate the functions of two different anesthesia methods on Tumor necrosis factor-α (TNF-α), C-reactive protein (CRP) and T lymphocyte subsets in patients undergoing liver cancer resection, and to explore the liver function impact of patients undergoing liver cancer surgery. 80 liver cancer patients were split into propofol intravenous anesthesia group and sevoflurane inhalation anesthesia group. The patient's operation-related indicators and changes in TNF-α, CRP and T lymphocyte subsets before anesthesia, after anesthesia, 1 day after anesthesia, and 3 days after anesthesia were calculated. The levels of TNF-α and CRP in the two groups after operation were clearly higher than those before anesthesia, but there was no obvious difference between the two groups. After operation, the TNF-α of the propofol intravenous anesthesia group was lower than the sevoflurane inhalation anesthesia group. The CD3+, CD4+ and CD4+/CD8+ levels in both groups recovered to the pre-anaesthesia level 3 days after the operation. The levels of ALT, AST, ALB and TBIL returned to normal at d4 in both propofol intravenous anesthesia and sevoflurane inhalation anesthesia groups. Compared with evoflurane inhalation anesthesia for patients with liver cancer, intravenous anesthesia with propofol can reduce the body's inflammatory response to a certain extent, has weak inhibitory effect on T lymphocyte immune function, and a smaller effect on liver function. [ABSTRACT FROM AUTHOR]

This retrospective study investigated the effects of three dexmedetomidine (Dex) injection approaches on analgesic and hemodynamics in elderly cholecystolithiasis patients undergoing laparoscopic cholecystectomy. The clinical data of 150 elderly patients with cholecystolithiasis were collected, and they were divided into the Dex A (n=50), Dex B (n=50), and Dex C (n=50) cohorts. Patient's heart rate (HR) and mean arterial pressure (MAP) were collected at T0, T1, and T2 for blood gas analysis. The difference in oxygen content between cerebral arterial and venous blood (Da-jvO2) was calculated. The duration of surgery, occurrence of cardiovascular and respiratory suppression, and the time of spontaneous respiratory recovery and extubation were recorded. At T2, T3, and T4, HR and MAP in the Dex C group were smaller than Dex A group and Dex B group (Dex C

Background and Aims: Antipsychotic drugs are critical in managing psychosis but they also carry risks when misused, leading to toxicity. Case Presentation: A patient overdosed on olanzapine, resulting in anticholinergic toxidrome with symptoms like tachycardia and altered mental status. Immediate recognition and management of antipsychotic toxicity-induced toxidromes in emergency settings are crucial. Treatment strategy includes maintaining airway, breathing and circulation along with decontamination. There is no specific antidote. Conclusion: This case underscores the need for emergency physicians to remain vigilant and proactive in identifying and addressing such toxicity by identification of toxidromes to prevent complications and missed diagnosis in emergency department. [ABSTRACT FROM AUTHOR]

To compare the incidence of delirium and early (at 1 week) postoperative cognitive dysfunction (POCD) between propofol-based total intravenous anesthesia (TIVA) and volatile anesthesia with sevoflurane in adult patients undergoing elective coronary artery bypass graft surgery (CABG) with cardiopulmonary bypass (CPB). This was a prospective randomized single-blinded study. The study was conducted at a single institution, the Sree Chitra Tirunal Institute for Medical Sciences and Technology, a tertiary care institution and university-level teaching hospital. Seventy-two patients undergoing elective CABG under CPB participated in this study. This study was conducted on 72 adult patients (>18 years) undergoing elective CABG under CPB who were randomized to receive propofol or sevoflurane. Anesthetic depth was monitored to maintain the bispectral index between 40 and 60. Delirium was assessed using the Confusion Assessment Method for the Intensive Care Unit. Early POCD was diagnosed when there was a reduction of >2 points in the Montreal Cognitive Assessment score compared to baseline. Cerebral oximetry changes using near-infrared spectroscopy (NIRS), atheroma grades, and intraoperative variables were compared between the 2 groups. Seventy-two patients were randomized to receive propofol (n = 36) or sevoflurane (n = 36). The mean patient age was 59.4 ± 8.6 years. The baseline and intraoperative variables, including atheroma grades, NIRS values, hemoglobin, glycemic control, and oxygenation, were comparable in the 2 groups. Fifteen patients (21.7%) patients developed delirium, and 31 patients (44.9%) had early POCD. The incidence of delirium was higher with sevoflurane (n = 12; 34.2%) compared to propofol (n = 3; 8.8%) (odds ratio [OR], 1.72; 95% confidence interval [CI], 1.13-2.62; p = 0.027)*. POCD was higher with sevoflurane (n = 20; 57.1%) compared to propofol (n = 11; 32.3%) (OR, 1.63; 95% CI, 1.01-2.62; p = 0.038)*. In patients aged >65 years, delirium was higher with sevoflurane (7/11; 63.6%) compared to propofol (1/7; 14.2%) (p = 0.03)*. Propofol-based TIVA was associated with a lower incidence of delirium and POCD compared to sevoflurane in this cohort of patients undergoing CABG under CPB. Large-scale, multicenter randomized trials with longer follow-up are needed to substantiate the clinical relevance of this observation. [ABSTRACT FROM AUTHOR]

Background: Post-operative cognitive dysfunction (POCD) is an important issue that is associated with substantial morbidity and increased mortality, especially in elderly patients who have undergone major surgical procedures under general anesthesia. The symptoms of POCD may last for several months after surgery, leading to extended hospital stays, a decline in life quality, an increased need for social assistance, and significant financial strain on the patients. Settings and Design: It was a Prospective Randomized interventional study. Methods: A total of 120 patients (≥65 years) were divided into two groups of 60 each for this study at Alexandria Main University Hospital and planned for elective lumbar disc surgery under general anesthesia. Either propofol or sevoflurane was used to maintain anesthesia after it was induced. MMSE score, S100β levels and hemodynamic measures were all evaluated. Results: Incidence of POCD was not statistically significant different between the two studied groups. There was a statistical significant negative correlation between S100β level and MMSE score in early post-operative period. Conclusion: In terms of POCD, both propofol-based and sevoflurane-based anesthesia have the same effects on cognitive functions in early post-operative period. [ABSTRACT FROM AUTHOR]

The aim of this study was to determine what is considered a long oral surgery and conduct a cost-effective analysis of sedative agents used for intravenous sedation (IVS) and sedation protocols for such procedures. Pubmed and Google Scholar databases were used to identify human studies employing IVS for extractions and implant-related surgeries, between 2003 and July/2023. Sedation protocols and procedure lengths were documented. Sedative satisfaction, operator satisfaction, and sedation assessment were also recorded. Cost estimation was based on The British National Formulary (BNF). To assess bias, the Cochrane Risk of Bias tools were employed. This review identified 29 randomised control trials (RCT), six cohorts, 14 case-series, and one case-control study. The study defined long procedures with an average duration of 31.33 minutes for extractions and 79.37 minutes for implant-related surgeries. Sedative agents identified were midazolam, dexmedetomidine, propofol, and remimazolam. Cost analysis revealed midazolam as the most cost-effective option (<10 pence per procedure per patient) and propofol the most expensive option (approximately £46.39). Bias analysis indicated varying degrees of bias in the included studies. Due to diverse outcome reporting, a comparative network approach was employed and revealed benefits of using dexmedetomidine, propofol, and remimazolam over midazolam. Midazolam, dexmedetomidine, propofol, and remimazolam demonstrated safety and efficacy as sedative agents for conscious IVS in extended procedures like extractions or implant-related surgeries. While midazolam is the most cost-effective option, dexmedetomidine, propofol, and remimazolam offer subjective and clinical benefits. The relatively higher cost of propofol may impede its widespread use. Dexmedetomidine and remimazolam stand out as closely priced options, necessitating further clinical investigations for comparative efficacy assessment. [ABSTRACT FROM AUTHOR]

Our hypothesis was that total intravenous anesthesia (TIVA) is associated with an increase in hypothermia. Inclusion criteria were patients from the National Anesthesia Clinical Outcomes Registry undergoing a general anesthetic during 2019. Data collected included patient age, sex, American Society of Anesthesiologists physical status classification system score (ASAPS), duration of anesthetic, use of TIVA, type of procedure, and hypothermia. Continuous variables were compared using Student's t test or Mann Whitney rank sum as appropriate. Mixed effects multiple logistic regression was performed to determine the association between independent variables and hypothermia. There was a low incidence of hypothermia (1.2%). Patients who became hypothermic were older, had a higher median ASAPS, and had a higher rate of TIVA. TIVA patients had a significantly increased odds for hypothermia when controlling for covariates. Patients undergoing obstetrical, thoracic, or radiological procedures had increased odds for hypothermia. In a matched cohort subset, TIVA was associated with a greater rate and increased odds for hypothermia. The novel and noteworthy finding was the association between TIVA and perianesthesia hypothermia. Thoracic, radiologic, and obstetrical procedures were associated with greater rates of and odds for hypothermia. Other identified factors can help to stratify patients for risk for hypothermia. [ABSTRACT FROM AUTHOR]

Sedative and analgesic drugs are commonly used in the diagnosis and treatment of cancer patients. Analyzing the impact of these drugs on the prognosis of cancer patients can help improve patient outcomes. This study aimed to analyze the use of propofol, benzodiazepines, and opioids on the survival of cancer patients in the intensive care unit (ICU) based on the Medical Information Mart for Intensive Care III (MIMIC-III) database. A total of 2,567 cancer patients from the MIMIC-III database between 2001 and 2012 were included in this retrospective cohort study. Logistic regression analyses were utilized to assess the relationship between propofol, benzodiazepine, and opioid and survival in cancer patients. The follow-up was 1 year from the patient's first admission to the ICU. Outcomes were ICU mortality, 28-day mortality, and 1-year mortality. Stratified analyses were based on patients' metastatic status. The use of propofol [odds ratio (OR) = 0.66; 95% confidence interval (CI), 0.53–0.80] and opioids (OR = 0.65; 95%CI, 0.54–0.79) were associated with a decreased risk of 1-year mortality. Both benzodiazepines and opioids use were related to an increased risk of ICU mortality and 28-day mortality (all P < 0.05), whereas propofol use was associated with a decreased risk of 28-day mortality (OR = 0.59; 95%CI, 0.45–0.78). Compared with the use of benzodiazepines combined with opioids, patients who used propofol and opioids were related to a decreased risk of 1-year mortality (OR = 0.74; 95%CI, 0.55–0.98). Similar results were found in patients with metastasis and metastasis-free. Cancer patients who used propofol may experience a lower risk of mortality than benzodiazepine use. [ABSTRACT FROM AUTHOR]

This study aims to compare the anesthetic effects of remimazolam tosilate and propofol in patients undergoing radical mastectomy. The study group received remimazolam tosilate in combination with sufentanil and cisatracurium besilate for anesthesia induction, while the control group received propofol with sufentanil and cisatracurium besilate. In the study group, the eyelash reflex disappearance time was longer and the recovery time was shorter compared to the control group (p < 0.05). No significant differences were observed in Post-Anesthesia Care Unit (PACU) retention time and Visual Analogue Scale (VAS) scores at 24 hours post-operation between the groups (p > 0.05). Furthermore, the study group exhibited a lower decrease in Mean Arterial Pressure (MAP) at 1, 3 and 5 minutes after anesthesia induction (p<0.05). After losing consciousness, there was no statistically significant difference in HR decrease between both groups (p > 0.05). The study group also had higher respiratory rate (RR) and Tidal volume (VT) levels, with a lower incidence of apnea compared to the control group (p < 0.05). Thirty minutes before anesthesia, no significant differences were found in the five indicators between the groups (p>0.05). At 24 hours post-operation, the study group showed higher Cluster of Differentiation 3+ (CD3+), CD4+, natural killer (NK) cell levels and CD4+/CD8+ ratios compared to the control group (p < 0.05). However, at 72 hours post-operation, no statistically significant differences were observed in these five indicators between the groups (p > 0.05). Compared with propofol, remimazolam tosilate achieves rapid sedation, maintains adequate sedation, and reduces suppression of the respiratory and circulatory systems. [ABSTRACT FROM AUTHOR]

Objective: Postoperative pain is a major issue with subcutaneous implantable cardioverter defibrillators (S-ICD). In 2020, we introduced intravenous patient-controlled analgesia (IV-PCA) in addition to the conventional, request-based analgesia for postoperative pain control in S-ICD. To determine the effect and safety, we quantitatively assessed the effect of IV-PCA after S-ICD surgery over conventional methods. Methods: During the study period, a total of 113 consecutive patients (age, 50.1 ± 15.5 years: males, 101) underwent a de novo S-ICD implantation under general anesthesia. While the postoperative pain was addressed with either request-based analgesia (by nonsteroid anti-inflammatory drugs, N = 68, dubbed as "PCA absent") or fentanyl-based IV-PCA in addition to the standard care (N = 45, dubbed as "PCA present"). The degree of postoperative pain from immediately after surgery to 1 week were retrospectively investigated by the numerical rating scale (NRS) divided into four groups at rest and during activity (0: no pain, 1-3: mild pain, 4-6: moderate pain, 7-10: severe pain). Results: Although IV-PCA was removed on Day 1, it was associated with continued better pain control compared to PCA absent group. At rest, the proportion of patients expressing pain (mild or more) was significantly lower in the PCA present group from Day 0 to Day 4. In contrast to at rest, a better pain control continued through the entire study period of 7 days. No serious adverse events were observed. A few patients experienced nausea in both groups and the inter-group difference was not found significant. Conclusion: IV-PCA suppresses postoperative pain in S-ICD without major safety concerns. [ABSTRACT FROM AUTHOR]

Background: Postoperative nausea and vomiting (PONV) following atrial fibrillation (AF) ablation can cause considerable distress. Aim: Continuous intravenous propofol sedation with adaptive servo-ventilation (ASV) with or without an analgesic, pentazocine, during AF ablation was studied in 272 consecutive patients with paroxysmal, persistent, and long-standing persistent AF. The study objectives were to determine the incidence of PONV after AF ablation and to assess the predictive value of factors for PONV using the area under the receiver operating characteristic curve (AUC). Results: The present sedation maneuver was successfully accomplished with a low incidence of hypotension and without discontinuation of ablation or switching to general anesthesia, while maintaining an acceptable procedural time (102 ± 32 min). The incidence of PONV was 5.5% (15/272). Nausea occurred in nine patients after an average of 4.6 ± 3.5 h (range: 2-12 h) postablation, and vomiting with nausea occurred in six patients after an average of 4.5 ± 3.1 h (range: 1-9 h) postablation. The postablation interval did not differ significantly between the occurrence of nausea and nausea accompanied by vomiting. AUCs based on various factors, including the Apfel score, ranged from 0.55 to 0.67, indicating low accuracy in predicting PONV occurrence. Conclusions: The incidence of PONV after propofol sedation with ASV was the lowest (5.5%) reported to date. Scoring systems, which included the Apfel score, were ineffective in predicting PONV. The low PONV incidence in addition to the efficacy of propofol sedation with ASV revealed the adequacy of this regimen for AF ablation. [ABSTRACT FROM AUTHOR]

Although propofol is widely used for gastrointestinal endoscopic sedation, cardiopulmonary adverse events remain common. Ciprofol is a new intravenous anaesthetic agent demonstrating respiratory and hemodynamic stability. This study aimed to clarify the benefits of ciprofol combined with alfentanil in bidirectional endoscopy (esophagogastroduodenoscopy followed by colonoscopy) to reduce adverse events and improve post-endoscopic recovery. A total of 185 patients scheduled to undergo bidirectional endoscopy were randomly divided into two groups: ciprofol combined with alfentanil or propofol combined with alfentanil. All patients received 7 µg/kg alfentanil intravenously before the study drugs were administered. The propofol group received a bolus of 1.2 mg/kg (0.12 ml/kg) propofol intravenously, whereas the ciprofol group received a bolus of 0.3 mg/kg (0.12 ml/kg) ciprofol intravenously. The primary outcome was the proportion of patients with cardiopulmonary adverse events (i.e., any one of the airway obstruction, apnoea, hypotension, hypertension, bradycardia, tachycardia or arrhythmias). Compared with propofol, ciprofol reduced cardiopulmonary adverse events by 43.51 % (34.4% vs. 60.9 %, P <0.001), mitigated respiratory adverse events by 54.74 % (17.2% vs. 38.0 %, P = 0.002) overall and by 59.05 % (12.9% vs. 31.5 %, P = 0.002) during the induction period. Ciprofol can significantly decrease respiratory depression events and provides a better sedative efficacy than propofol with higher recovery quality and satisfaction. [ABSTRACT FROM AUTHOR]

Propofol is a potential injectable anesthetic agent used in total intravenous anesthesia. However, the sparing effect of fentanyl and medetomidine on the required propofol dose in dogs remains unclear. We aimed to investigate the effect of fentanyl constant-rate infusion (CRI) with or without medetomidine on the minimum infusion rate of propofol required to prevent motor movement (MIRNM) in dogs. Six healthy purpose-bred dogs were anesthetized on three occasions with propofol alone (loading dose [LD], 8 mg/kg to effect; initial infusion rate [IR], 0.70 mg/kg/min); propofol (LD, 6 mg/kg to effect; IR, 0.35 mg/kg/min) and fentanyl (LD, 2 µg/kg; IR, 0.10 µg/kg/min); or propofol (LD, 4 mg/kg to effect; IR, 0.25 mg/kg/min), fentanyl (LD, 2 µg/kg; IR, 0.10 µg/kg/min), and medetomidine (LD, 2 µg/kg; IR, 0.5 µg/kg/hr) under controlled ventilation. The MIRNM was determined by observing the response to a noxious electrical stimulus. Heart rate, blood pressure, and blood gas analyses were performed at 1, 2, 3, and 4 hr after initiating CRI. The MIRNM (mean [range]) was significantly lower in the propofol-fentanyl-medetomidine group (0.16 [0.10-0.27] mg/kg/min) than that in the propofol-alone group (0.63 [0.47-0.82] mg/kg/min) (P=0.0004). Fentanyl combined with medetomidine did not significantly decrease the mean arterial pressure in dogs receiving propofol CRI 1-3 hr after initiating CRI compared with propofol CRI alone (P>0.9999, P=0.1536, and P=0.0596, respectively), despite inducing a significantly lower heart rate. [ABSTRACT FROM AUTHOR]

The purpose of this study is to observe the postoperative sleep quality of insomnia patients undergoing laparoscopic gynecologic oncology surgery after total intravenous anesthesia. Prospective study. We conducted a prospective, observational study in our hospital. All patients underwent propofol-remifentanil anesthesia without other sedative medications before or during the operation. Pittsburgh Sleep Quality Index (PSQI) scores of the baseline value, night-1 (the first night after surgery), night-3, night-5, and night-30 were observed. Sixty-nine female insomnia patients were allocated based on the results of the PSQI and the diagnostic criteria of insomnia. The PSQI global scores were respectively 6 (5–8), 5 (4–6), 5 (3–6), and 6 (5–7) on night-1, night-3, night-5, and night-30, significantly lower than the baseline 7 (6–8) (P < 0.05). The 5 components (subjective sleep quality, sleep latency, sleep duration, sleep efficiency and daytime dysfunction) had significant changes at different postoperative time points (P < 0.05). The daytime dysfunction could also be improved 1 month after the surgery (P < 0.05). In contrast, the variations of sleep disturbance and use of sleep medication had no statistical differences. The sleep quality of female patients with insomnia was improved on the first night after surgery in the sides of sleep latency and daytime dysfunction, and the improvement could also be obtained 1 month after propofol-remifentanil general anesthesia. [ABSTRACT FROM AUTHOR]

In this study, an electrochemical sensor for the real-time monitoring of propofol (PPF) in anesthesia was developed using molecularly imprinted polymers and reduced graphene oxide-modified glassy carbon electrodes (MIPs/rGO/GCE). To make the electrode, GO was thermally reduced into rGO, which was then electrodeposited on GCE (rGO/GCE), followed by the electropolymerization of MIPs using LiClO 4 , pyrrole, and PPF (template) solution on rGO/GCE (MIPs/rGO/GCE). The PPF was then taken out of the pyrrole polymer. X-ray Diffraction (XRD), Scanning Electron Microscopy (SEM), and X-ray Photoelectron Spectroscopy (XPS) examinations of surface composition and morphology revealed that electropolymerization MIP on rGO/GCE and reduction and deposition of rGO on GCE were both successful processes. MIPs/rGO/GCE revealed significant sensitivity and selectivity towards PPF in electrochemical tests utilizing cyclic voltammetry (CV) and amperometry. Results demonstrated a linear range from 0.5 to 250 μM that was steady and wide, with a sensitivity of 1.0776 μA/μM and a detection limit value of 0.08 μM. MIPs/rGO/GCE demonstrated outstanding electrocatalytic activity over a broad linear range and a reasonable detection limit value for PPF concentrations. To assess the method's applicability for the analysis of PPF, it was applied to real biological samples of human plasma and urine. [ABSTRACT FROM AUTHOR]

Background: Whether peripheral vasodilation or decrease in cardiac output causes the reduction in blood pressure (BP) following induction of anaesthesia, is not clearly understood. Therefore, an attempt was made to elucidate the mechanism of hypotension in terms of change in perfusion index (PI) and cardiac output. Methods: With institutional ethics committee permission and consent, 66 patients were assigned equally to three groups. Each group received a titrated dose of a different induction agent, namely thiopentone (5 mg/kg), propofol (2 mg/kg) or etomidate (0.3 mg/kg). PI, heart rate (HR), and systolic, diastolic and mean arterial pressure were recorded at baseline and then every minute until 10 minutes post intubation. Echocardiography parameters (i.e. ejection fraction (EF), contractility and left ventricular end diastolic volume (LVEDV)) were measured at baseline, three minutes post induction and five minutes post intubation. Statistical analysis included one-way analysis of variance (ANOVA), Bonferroni test or Kruskal Wallis/Mann Whitney-U test. Results: The EF and contractility remained stable after induction with all three induction agents. However, LVEDV and hence stroke volume increased significantly with etomidate (p = 0.011). There was gradual and continued increase in PI and reduction in the BP from the time of induction, which was minimal with etomidate and maximum with propofol. A marginal increase in HR was seen with thiopentone, while others caused a steady fall. Conclusion: Vasodilation and reduced HR were responsible for the hypotension following induction of anaesthesia by intravenous agents. The effect was maximal with propofol with no evidence of myocardial depression. Etomidate lead to increase in stroke volume which explains its cardiovascular stability [ABSTRACT FROM AUTHOR]

BACKGROUND: COVID-19 is associated with variable symptoms and clinical sequelae. Studies have examined the clinical course of these patients, finding a prolonged need for invasive ventilation and variable re-intubation rates. However, no research has investigated factors and outcomes related to reintubation secondary to respiratory failure among patients with COVID-19 with ARDS. METHODS: We conducted a single-center, retrospective study on subjects intubated for ARDS secondary to COVID-19. The primary outcome was re-intubation status; secondary outcomes were hospital and ICU stay and mortality. Data were analyzed using between-group comparisons using chisquare testing for categorical information and Student t test for quantitative data. Univariate and multivariate logistic regression was performed to determine factors related to re-intubation and mortality as dependent variables. RESULTS: One hundred and fourteen subjects were included, of which 32% required re-intubation. No between-group differences were detected for most demographic variables or comorbidities. No differences were detected in COVID-19 treatments, noninvasive respiratory support, mechanical circulatory support, or duration of ventilation. Midazolam (odds ratio [OR] 5.55 [95% CI 1.83-16.80], P = .002), fentanyl (OR 3.64 [95% CI 1.26-10.52], P = .02), and APACHE II scores (OR 1.08 [95% CI 1.030-1.147], P = .005) were independently associated with re-intubation (area under the curve 5 0.81). Re-intubated subjects had extended hospital (36.7 6 22.7 d vs 26.1 6 12.1 d, P = .01) and ICU (29.6 ± 22.4 d vs 15.8 ± 10.4 d, P < .001) stays. More subjects died who failed extubation (49% vs 3%, P < .001). Age (OR 1.07 [95% CI 1.02-1.23], P = .005), male sex (OR 4.9 [95% CI 1.08-22.35], P = .041), positive Confusion Assessment Method for the ICU (CAM-ICU) (OR 5.43 [95% CI 1.58-18.62], P = .007), and re-intubation (OR 12.75 [95% CI 2.80-57.10], P < .001) were independently associated with death (area under the curve 5 0.93). CONCLUSIONS: Midazolam, fentanyl, and higher APACHE II scores were independently associated with re-intubation secondary to respiratory failure in subjects with COVID-19--related ARDS. Furthermore, age, male sex, positive CAM-ICU, and re-intubation were independently associated with mortality. Re-intubation also correlated with prolonged hospital and ICU stay. [ABSTRACT FROM AUTHOR]

To compare the effects of volatile anesthetics and propofol on neurocognitive function after cardiac surgery. A systematic review and meta-analysis of randomized controlled trials. A literature search of PubMed, EMBASE, CENTRAL, CINAHL, Scopus, and Web of Science databases was conducted. A total of 10 randomized controlled trials comparing volatile anesthetics and propofol in cardiac surgery were included in the study. The standardized mean difference and risk ratio were calculated to estimate pooled effect sizes. The primary outcome was the postoperative neurocognitive function score, and the secondary outcome was the incidence of delirium after cardiac surgery. The analysis did not show significant differences in postoperative neurocognitive function scores (standardized mean difference − 0.06, 95% CI − 0.81-0.69; p = 0.879). The incidences of delirium (risk ratio 1.10, 95% CI 0.81-1.50) between the volatile anesthetics and propofol groups were not significant (p = 0.533). Unlike noncardiac surgery, there are no differences between volatile anesthetics and propofol regarding postoperative neurocognitive dysfunction after cardiac surgery. [ABSTRACT FROM AUTHOR]

Propofol is commonly used in ICUs, but its long-term effects have not been thoroughly studied. In vitro studies suggest it may harm mitochondrial function, potentially affecting clinical outcomes. This study aimed to investigate the association between substantial propofol sedation and clinical outcomes in critically ill patients. We conducted a single-centre cohort study of critically ill, mechanically ventilated (≥7 days) adults to compare patients who received a substantial dose of propofol (cumulative >500 mg) during the first week of ICU admission with those who did not. The primary outcome was the association between substantial propofol administration and 6-month mortality, adjusted for relevant covariates. Subanalyses were performed for administration in the early (day 1–3) and late (day 4–7) acute phases of critical illness due to the metabolic changes in this period. Secondary outcomes included tracheostomy need and duration, length of ICU and hospital stay (LOS), discharge destinations, ICU, hospital, and 3-month mortality. A total of 839 patients were enrolled, with 73.7 % receiving substantial propofol administration (substantial propofol dose group). Six-month all-cause mortality was 32.4 %. After adjusting for relevant variables, we found no statistically significant difference in 6-month mortality between both groups. There were also no significant differences in secondary outcomes. Our study suggests that substantial propofol administration during the first week of ICU stay in the least sick critically ill, mechanically ventilated adult patients is safe, with no significant associations found with 6-month mortality, ICU or hospital LOS, differences in discharge destinations or need for tracheostomy. [ABSTRACT FROM AUTHOR]

OBJECTIVE: This study aimed at determining the optimal dose combination of alfentanil and propofol for outpatient abortion anesthesia. PATIENTS AND METHODS: The study was separated into two parts. In the first part, patients were to determine the median effective dose (ED50) and the 95% effective dose (ED95) of alfentanil in combination with 2.5 mg·kg-1 propofol to inhibit body movements during the abortion using the Dixon up-and-down sequential allocation method. In the second part, 170 patients were randomly divided into group C (2.0 mg·kg-1 propofol with alfentanil 12.16 µg·kg-1) and group E (2.5 mg·kg-1 propofol with its ED95) to compare the anesthetic effect. The primary outcome was the sedation level during general anesthesia. The secondary outcomes were circulation, respiratory complications, and postoperative recovery quality. RESULTS: The ED50 and the ED95 values of alfentanil were 3.37 µg·kg-1 (95% CI: 2.58-3.97 µg·kg-1) and 4.68 µg·kg-1 (95% CI: 4.04-9.32 µg·kg-1). The frequency of deep sedation in group E was significantly higher than in group C (76.5% vs. 60%). Patients in group C showed more wakefulness even during the surgery (14.3% vs. 4.4%). The results of our exploratory analyses did not reveal differences in respiratory depression, circulatory depression, postoperative side effects, or recovery outcomes. CONCLUSIONS: The combination of 2.5 mg·kg-1 propofol and 4.68 µg·kg-1 alfentanil produces a better sedative effect than the combination of 2.0 mg·kg-1 p ropofol a nd 12.16 µ g·kg-1 alfentanil without increasing additional risks associated with anesthesia. [ABSTRACT FROM AUTHOR]

Background: Propofol-based sedations are used widely during endoscopic retrograde cholangiopancreatography (ERCP) procedures. However, respiratory depression and cardiovascular adverse events commonly occur. Therefore, we designed this study to evaluate the effects of adding a single boules induction dose of fentanyl or magnesium sulphate to propofol infusion for sedation of patients subjected to ERCP. Methods: This randomized parallel double-blind controlled trial included 60 adult patients scheduled for ERCP procedures. Before starting the propofol infusion, patients immediately received either magnesium sulphate 50 mg.kg-1 intravenously (IV) over 10 min (Group M) (n = 30) or fentanyl 2 µg.kg-1 IV over 10 min (Group F) (n- = 30). Continuous propofol infusion was given with a syringe pump for maintenance, with the initial rate set at 25-75 mic/kg/min IV during the first 10-15 min. Results: The magnesium group had significantly reduced the total propofol consumption and increased the onset time of sedation than the fentanyl group (P < 0.05). Heart rate and mean arterial pressure were statistically lower after adjuvant bolus injection and 15 min in the magnesium group than in the fentanyl group (P < 0.001). Procedure time, involuntary movement, physician satisfaction, and complications exhibited no significant differences between both groups. Conclusions: During ERCP, adding a single bolus of magnesium sulphate to propofol was associated with a lower total propofol consumption and better hemodynamics than fentanyl but with a delayed onset time of sedation and comparable respiratory depression. [ABSTRACT FROM AUTHOR]

Background: A wide range of drugs are used for sedation in gastrointestinal (GI) endoscopy procedures, including midazolam, dexmedetomidine, and ketamine. Therefore, this study aimed to compare the effects of these drugs in combination with propofol among cancer patients undergoing GI endoscopy. Methods: This randomized, double-blinded study was carried out on 75 cancer patients who underwent GI endoscopy. Patients were categorized into three equal groups. Group D: received dexmedetomidine 0.5 µg/kg bolus infusion over 10 min. Group K: received ketamine 0.5 mg/kg. Group M: received midazolam 0.05 mg/kg. With these drugs, 0.5 mg/kg propofol was administered intravenously with incremental 20 mg till achievement of Ramsey sedation score (RSS) 3-4. After that, 0.5 mg/kg propofol boluses were offered for rescue sedation. Results: The endoscopy duration was comparable in the three groups. Time of RSS 3-4 achievement and total propofol dose (P < 0.05) were significantly lower in group D and group K compared to group M. Time to eye-opening were significantly lower in groups D, and K compared to group M, with insignificant difference between group K and group D. Moreover, the heart rate (HR) and mean arterial pressure (MAP) of group K at 10 min, 15 min, 20 min, 25 min, and 30 min, and PACU were significantly greater than D and M groups (P < 0.05). Incidence of hypotension and bradycardia were comparable in the three groups. Conclusions: In cancer patients who underwent GI endoscopy, dexmedetomidine-propofol and ketamine-propofol had better sedation efficacy [lower achievement time of RSS 3-4, total propofol dose, and eye-opening time] compared to midazolam-propofol group with superior sedative effect of ketamine-propofol than dexmedetomidine-propofol. While ketaminepropofol had more stable HR and MAP. [ABSTRACT FROM AUTHOR]

Objective: To compare the impact of propofol-based total intravenous anesthesia (TIVA) versus inhalational anesthesia (IA) on the overall survival following cancer surgery. Background: The association between intraoperative anesthetics and patients' long-term outcomes following cancer surgery remains controversial. Methods: This retrospective cohort study used nationwide data from the Korean National Health Insurance Service. Adult patients who underwent cancer resection surgery (breast, gastric, lung, liver, kidney, colorectal, pancreatic, esophageal, and bladder cancer) under general anesthesia between January 2007 and December 2016 were included. Patients were divided into propofol-based TIVA or IA groups according to the type of anesthesia received. A total of 312,985 patients (37,063 in the propofol-based TIVA group and 275,922 patients in the IA group) were eligible for analysis. The primary outcome was the comparison of overall survival following surgery between the groups in each cancer type. We compared the all-cause mortality between the 2 groups, stratified by cancer type using time-dependent Cox regression after propensity score- based inverse probability of treatment weighting. We further examined the comparison of overall survival in a meta-analysis using data from our study and previously published data comparing propofol-based TIVA with IA after cancer surgery. Results: The number of deaths in the propofol-based TIVA and IA groups was 5037 (13.6%) and 45,904 (16.6%), respectively; the median (interquartile range) follow-up duration was 1192 (637-2011) days. Multivariable Cox proportional hazards regression analysis revealed no significant association between the type of general anesthesia and overall survival after cancer surgery in the weighted cohort for each cancer type (all P>0.05) and for total population [adjusted hazard ratio (HR): 0.98, 95% confidence interval (CI): 0.93-1.04]. In a meta-analysis, single-center studies showed higher overall survival in the TIVA group than in the IA group (pooled adjusted HR: 0.65, 95% CI: 0.47-0.91, P= 0.01), while multicenter studies showed insignificant pooled adjusted HRs (pooled adjusted HR: 1.05, 95% CI: 0.82-1.33, P=0.71). Conclusions: There is no association between the type of general anesthesia used during cancer surgery and postoperative overall, 1-, and 5-year survival. [ABSTRACT FROM AUTHOR]

Background: Propofol is the most widely used intravenous anesthetic in endoscopic surgery, but is associated with several adverse reactions. Public research has shown that remimazolam, a safe general anesthetic, is increasingly being used as a substitute for propofol in clinical operations. Our meta-analysis aimed to analyze whether the adverse reaction rate of remimazolam in endoscopic surgery is acceptable and whether the surgical success rate is not lower than that of propofol. Aim: This meta-analysis examined the adverse events and efficacy of remimazolam vs. propofol during endoscopic surgery. Method: MEDLINE, Embase, ClinicalTrials.gov, and Google Scholar were comprehensively searched. Seven studies comparing remimazolam and propofol were included in our meta-analysis. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and Cochrane manual were used to assess the quality of the results published in all included studies to ensure that our meta-analysis results are reliable and worthwhile. Results: Compared to propofol, the use of remimazolam reduced postoperative injection pain [relative risk (RR) = 0.06, 95% confidence interval (CI): 0.03-0.12, P<0.00001], postoperative hypotension (RR=0.45, 95% CI: 0.28-0.73, P=0.001), and postoperative respiratory depression (RR=0.20, 95% CI: 0.08-0.47, P=0.0002); however, it also slightly reduced the success rate of the operation [risk difference (RD)= - 0.02, 95% CI: - 0.04 to - 0.01, P=0.0007]. There were no significant differences in the occurrence of bradycardia symptoms after the operation (RD= - 0.01, 95% CI: - 0.03 to 0.01, P= 0.35), recovery time after the operation [standardized mean difference (SMD)=0.68, 95% CI: - 0.43 to 1.80, P =0.23] or discharge time (SMD =0.17, 95% CI: -0.58 to 0.23, P =0.41). We also performed a subgroup analysis of each corresponding outcome. Conclusion: Our analysis showed that remimazolam may be a safer shock option than propofol for endoscopic surgery. However, further research is required to determine their utility. [ABSTRACT FROM AUTHOR]

Although procedural sedation is an established method of anesthesia for transcatheter aortic valve replacement (TAVR), reliable evidence to guide the choice of a suitable sedative agent remains scarce. Accordingly, this trial aimed to compare the effect of procedural sedation with dexmedetomidine versus propofol on postoperative neurocognitive and related clinical outcomes in patients undergoing TAVR. Prospective, randomized, double-blind clinical trial. The study was conducted at the University Medical Centre Ljubljana, Slovenia. The study enrolled 78 patients who underwent TAVR under procedural sedation between January 2019 and June 2021. Seventy-one patients randomized into the propofol group (n = 34) and dexmedetomidine group (n = 37) were included in the final analysis. Patients in the propofol group received sedation with propofol (continuous intravenous infusion of 0.5-2.5 mg/kg/h), whereas patients in the dexmedetomidine group received sedation with dexmedetomidine (loading dose of 0.5 µg/kg over 10 minutes followed by continuous intravenous infusion of 0.2-1.0 µg/kg/h). Minimental state examination (MMSE) was performed before and 48 hours after TAVR. There was no statistically significant difference in MMSE scores between groups before TAVR (p = 0.253), but the MMSE after the procedure revealed a significantly lower incidence of delayed neurocognitive recovery (p = 0.005) and thus better cognitive outcomes in the dexmedetomidine group (p = 0.022). Compared with propofol, procedural sedation with dexmedetomidine in TAVR was associated with a significantly lower incidence of delayed neurocognitive recovery. [ABSTRACT FROM AUTHOR]

Some patients experience sleep disturbances after endoscopy performed under sedation. This study aimed to evaluate the effects of propofol on sleep quality after gastrointestinal endoscopy (GE). This study was a prospective cohort study. This study enrolled 880 patients who underwent GE. Patients who chose to undergo GE under sedation received intravenous propofol, whereas the control group did not. The Pittsburgh Sleep Quality Index (PSQI) was measured before GE (PSQI-1) and 3 weeks (PSQI-2) after GE. The Groningen Sleep Score Scale (GSQS) was used before GE (GSQS-1) and 1 (GSQS-2) and 7 days (GSQS-3) after GE. There was a significant increase in GSQS scores from baseline to days 1 and 7 after GE (GSQS-2 vs GSQS-1, P <.001, GSQS-3 vs GSQS-1, P =.008). However, no significant changes were observed in the control group (GSQS-2 vs GSQS-1, P =.38, GSQS-3 vs GSQS-1, P =.66). On day 21, there were no significant changes in the baseline PSQI scores over time in either group (sedation group, P =.96; control group, P =.95). GE with propofol sedation negatively affected sleep quality for 7 days after GE but not 3 weeks after GE. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To compare the sedation profiles and the pharmacokinetic, pharmacodynamic and safety characteristics of ciprofol and propofol at 3 escalated dose levels in healthy Chinese male subjects. PATIENTS AND METHODS: Eighteen subjects were planned to be enrolled into 3 dose groups in turn: group 1 (ciprofol-0.4 mg/kg vs. propofol-2.0 mg/kg), group 2 (ciprofol-0.6 mg/kg vs. p ropofol-3.0 m g/kg) a nd g roup 3 (ciprofol-0.8 mg/kg vs. propofol-4.0 mg/kg). They were randomly assigned into a ciprofol or propofol group in a ratio of 1:1, with sequences of ciprofol-propofol or propofol-ciprofol, separated with a washout period of at least 48 h. RESULTS: A total of 19 subjects were enrolled and 18 completed the trial. The median time to being fully alert after induction by ciprofol was longer than for propofol. The bispectral index (BIS) recovered significantly slower with ciprofol than with propofol 5 min and 10 min after reaching its lowest points. Systolic blood pressure (group 1: p=0.041; group 2: p=0.015; group 3: p=0.004) and mean arterial pressures (group 1: p=0.026; group 2: p=0.015; group 3: p=0.004) measured by the area under the curve below the baseline during the 2 min after induction were significantly less for ciprofol compared to propofol, but a significant change in diastolic blood pressure was only observed in group 3 (p=0.002). Eighteen (100.0%) subjects experienced 47 ciprofol-related treatment emergent adverse events (TEAEs) and 17 (94.4%) subjects had 54 propofol-related TEAEs, which were mainly hypotension, involuntary movements, respiratory depression, and pain at the injection site with severity of grade 1 or 2. CONCLUSIONS: Ciprofol may be well tolerated at higher doses in the clinical practice and exhibited significantly different sedation profiles to propofol. [ABSTRACT FROM AUTHOR]

• What is the primary question addressed by this study? Can propofol enhance slow wave sleep in geriatric patients to address core pathophysiology of depression and associated cognitive dysfunction? • What is the main finding of this study? Two older adults with treatment-resistant depression received two morning infusions of propofol. One of the two demonstrated slow wave sleep enhancement and a sustained improvement of depression. • What is the meaning of the finding? The above case series lays the groundwork for an ongoing open-label Phase I clinical trial by providing proof-of-concept of propofol-induced slow wave sleep enhancement and antidepressant response. Slow wave sleep (SWS), characterized by large electroencephalographic oscillations, facilitates crucial physiologic processes that maintain synaptic plasticity and overall brain health. Deficiency in older adults is associated with depression and cognitive dysfunction, such that enhancing sleep slow waves has emerged as a promising target for novel therapies. Enhancement of SWS has been noted after infusions of propofol, a commonly used anesthetic that induces electroencephalographic patterns resembling non-rapid eye movement sleep. This paper 1) reviews the scientific premise underlying the hypothesis that sleep slow waves are a novel therapeutic target for improving cognitive and psychiatric outcomes in older adults, and 2) presents a case series of two patients with late-life depression who each received two propofol infusions. One participant, a 71-year-old woman, had a mean of 2.8 minutes of evening SWS prior to infusions (0.7% of total sleep time). SWS increased on the night after each infusion, to 12.5 minutes (5.3% of total sleep time) and 24 minutes (10.6% of total sleep time), respectively. Her depression symptoms improved, reflected by a reduction in her Montgomery-Asberg Depression Rating Scale (MADRS) score from 26 to 7. In contrast, the other participant, a 77-year-old man, exhibited no SWS at baseline and only modest enhancement after the second infusion (3 minutes, 1.3% of total sleep time). His MADRS score increased from 13 to 19, indicating a lack of improvement in his depression. These cases provide proof-of-concept that propofol can enhance SWS and improve depression for some individuals, motivating an ongoing clinical trial (ClinicalTrials.gov NCT04680910). [ABSTRACT FROM AUTHOR]

OBJECTIVE: The novel short-acting benzodiazepine remimazolam besylate acts rapidly and is used to induce easily controlled sedation. The aim of this study was to investigate the effects of remimazolam besylate combined with alfentanil in patients undergoing fiberoptic bronchoscopy with preserved spontaneous breathing. PATIENTS AND METHODS: 192 patients undergoing painless fiberoptic bronchoscopy were randomly assigned to either propofol (P group) or remimazolam besylate (R group); both groups also received alfentanil 10 µg/ kg. The respiratory rate was recorded during the inspection. Mean arterial pressure (MAP), heart rate (HR), oxygen saturation (SpO2), Narcotrend values and Modified Observer’s Assessment of Alertness and Sedation (MOAA/S) scores were recorded after entry to the operating room (T0), 1 min (T1), 2 min (T2) and 3 min (T3) after anesthesia, immediately after the bronchoscope entered the vocal cords (T4), when the bronchoscope reached the carina (T5), the patient’s eyes opened (T6), and 30 min postoperatively (T7). Secondary outcomes included intraoperative hypotension and body movement grading, etc. RESULTS: There was less respiratory depression during the inspection in the R group than in the P group (p < 0.01). The rate of hypotension during the examination was higher in the P group than in the R group (p < 0.01). Narcotrend values in the P group were less for the R group at the T1-T5 time points (p < 0.01). No difference in the number of body movements ≥ grade 3 was found between the two groups (p > 0.05). CONCLUSIONS: Remimazolam besylate combined with alfentanil for painless fiberoptic bronchoscopy can better preserve the patient’s spontaneous breathing and reduce the incidence of respiratory depression during the inspection than propofol. [ABSTRACT FROM AUTHOR]

Intravenous sedation with propofol in the dental treatment offers an alternative to inhalation sedation or general anesthesia. The aim of this study was to evaluate the safety and identify risk factors for intraoperative complications. Uncooperative children who could not complete dental treatment under non-pharmacological behavior management or mild-to-moderate sedation in the outpatient pediatric department were selected. Details and time of dental treatment; intraoperative vital signs data, including blood pressure, heart rate, respiratory rate, pulse oxygen saturation (SpO 2), end-tidal carbon dioxide, and electrocardiogram; and incidence of intraoperative and postoperative complications were recorded. Overall, 344 children were selected, with 342 completing dental treatment. The dental treatment time was 20–155 (median, 85; interquartile range, 70–100) min. The number of treated teeth was at least 1 and at most 13 (median, 6; interquartile range, 5–8). Among 342 children, 35 (10.2%) had their treatment interrupted temporarily due to choking cough. No serious complications occurred; the incidence rate of minor complications was 47/342 (13.7%). Tachycardia was observed in 5/342 (1.5%) cases, oxygen desaturation (SpO 2 < 95%) in 18, and hypoxemia (SpO2 ≤ 90%) in 25. The treatment duration was significant longer in cases with than without complications (P < 0.05), and children coughing during treatment were more likely to have complications (P < 0.05). Postoperative restlessness occurred in six children, but there was no vomiting, aspiration, or respiratory obstruction. Decreased oxygen saturation is the most common complications. Cough during treatment and longer treatment duration were risk factors for complications. [ABSTRACT FROM AUTHOR]

In the present study, we investigated the hypothesis that the depth of general anesthesia affects emergence agitation (EA) in children in the early postanesthetic period. We retrospectively examined male and female children (aged 1-9 years) who underwent ambulatory surgery that lasted < 2 h. Various parameters, including the modified Yale Preoperative Anxiety Score (mYPAS) before anesthesia induction, the Pediatric Anesthesia Emergence Delirium (PAED) score at recovery time, and the value of the patient state index (PSI), were extracted from our electronic anesthesia database. The relationships between the PAED score and the mean PSI values were examined with univariate analyses. We also investigated the associations among the mean PSI, propofol anesthesia, age, mYPAS, the type of surgery, and the total amount of fentanyl divided by body weight with the PAED score using multiple regression analysis with interaction terms. There were 32 and 34 patients in the sevoflurane and propofol groups, respectively. The PAED scores (all patients: r = 0.34, p = 0.0048; sevoflurane group: r = -0.37, p = 0.036) were negatively correlated with the mean PSI, whereas the PAED score in the propofol group [r = 0.31 (-0.03, 0.59), p = 0.073] did not show a significant positive correlation with the mean PSI in the univariate analysis. The multiple linear regression analysis outcomes revealed that the mean PSI value was an independent clinical factor associated with the PAED score. Intraoperative electroencephalogram monitoring may be proved as one of the useful tools for the assessment of EA risks in children. [ABSTRACT FROM AUTHOR]

Background: Extubation at the end of general anaesthesia (GA) should be performed in a way that ensures patient comfort and minimises cardiorespiratory changes to prevent harm. Several drugs have been shown to attenuate these changes during emergence. This study aimed to investigate if a sub-hypnotic dose of propofol can produce such favourable peri-extubation conditions. Methods: A total of 50 American Society of Anesthesia (ASA) physical status I-II patients (aged 18-70) undergoing elective abdominal or pelvic surgery under GA with a volatile agent were randomly assigned to a propofol group (n = 28) or a control group (n = 22). At the end of the surgery, once the minimal alveolar concentration reached 0.6, patients received either propofol 0.5 mg kg-1 or an equivalent volume of 0.9% normal saline intravenously (IV). The primary outcome was the incidence and severity of bucking and coughing observed during emergence, with the assessment performed by a blinded anaesthetist. Haemodynamic parameters, airway responses, extubation complications, and time to extubation were evaluated during the emergence period at predetermined intervals. Results: The demographic and clinical characteristics of the two groups were comparable before surgery. Results indicated the incidence and severity of bucking at extubation were significantly lower in the propofol group (21.4%) compared to the control group (68.2%, p < 0.001). Similarly, patients in the propofol group had significantly fewer heart rate (HR) (p = 0.031) and systolic blood pressure (BP) (p = 0.031) changes at extubation. Conclusion: The addition of propofol 0.5 mg kg-1 before extubation successfully attenuated cardiorespiratory responses following GA in ASA Grade I-II adult patients undergoing elective abdominal or pelvic surgery, but did not reduce the overall incidence of cough at extubation. [ABSTRACT FROM AUTHOR]

To compare the effect on mortality and length of hospital stay of propofol with that of sodium thiopentone for the management of dogs with status epilepticus (SE) and refractory status epilepticus (RSE). In this cohort study, medical records of a veterinary referral clinic in Argentina were retrospectively searched for dogs that were hospitalised and required induction of therapeutic coma (TC) with either propofol or sodium thiopentone for the management of SE or RSE of any cause. A logistic regression model was performed to evaluate the association between the type of anaesthetic used and in-hospital mortality adjusting for the type of epilepsy (idiopathic, structural, or reactive). Kaplan-Meier estimated survival curves for the length of hospital stay by the type of anaesthetic drug were compared using the log-rank test (deaths were considered censored events). Cox proportional hazards regression was used to estimate hazard ratios for time to hospital discharge, unadjusted and adjusted for type of epilepsy. A total of 24 dogs with SE were included in the study: eight treated with propofol and 16 treated with sodium thiopentone. Four dogs treated with propofol (proportion = 0.50; 95% CI = 0.15–0.84), and eight treated with sodium thiopentone (proportion = 0.50; 95% CI = 0.50–0.74) died during hospitalisation. The median hospitalisation time was 43 (IQR 24–56) hours for dogs that were treated with propofol and 72 (IQR 64–96) hours for dogs that were treated with sodium thiopentone. There was no evidence of a difference in the median duration of TC in dogs treated with propofol (12 (IQR 8–24) hours) or with sodium thiopentone (12 (IQR 7.5–20) hours; p = 0.946). In the logistic regression model, no evidence of association between the anaesthetic protocol for the management of RSE and in-hospital mortality, adjusted for the type of epilepsy, was found (OR 1.09 (95% CI = 0.17–6.87); p = 0.925). Cox regression analysis revealed a difference in the time to hospital discharge, adjusted by the type of epilepsy, between treatment groups (HR = 0.05 (95% CI = 0.01–0.54); p = 0.013). The time spent in hospital before discharge was longer in dogs with RSE treated with sodium thiopentone compared to those treated with propofol. However, as the sample size was very small, the results obtained in the present study should be analysed with caution. Further studies including a greater number of dogs are required. [ABSTRACT FROM AUTHOR]

Background: Induction of anesthesia is a critical part of anesthetizing patients with end-stage renal disease, as they are at risk of wide hemodynamic fluctuation due to their pathophysiological alterations in the cardiovascular system. It is desirable to use pharmacological agents that provide hemodynamic stability with fewer adverse effects. Aims and Objectives: This study aimed to evaluate the effects of propofol and etomidate by comparing hemodynamic variables such as a change in mean arterial pressure (MAP) and heart rate (HR) during induction, laryngoscopy, and up to 10 min after tracheal intubation as a primary outcome and any associated adverse effect as a secondary outcome. Methods: After getting institutional ethical committee approval, 60 American Society of Anesthesiologist Grade III patients aged 20-60 years, scheduled for renal transplantation, were randomized into two groups (Group P: propofol 1% and Group E: etomidate). The dose of induction agents was targeted to achieve a bispectral index value of 40. Hemodynamic variables were recorded at induction, laryngoscopy, and up to 10 min after tracheal intubation. Adverse effects related to the study drug were recorded. Results: The decrease in MAP in Group P was statistically significant (P < 0.05) as compared to Group E, at induction of anesthesia. We observed a significant increase in HR at induction of anesthesia in Group E (P < 0.05). The incidence of myoclonus was 0 versus 73.3% in Groups P and E, respectively, while pain on injection and hypotension were more in Group P (P < 0.05). Conclusions: In conclusion, etomidate provides better hemodynamic stability with fewer adverse effects in patients with end-stage renal disease. [ABSTRACT FROM AUTHOR]

Increased incidence of postoperative cognitive dysfunction (POCD) is observed in elderly patients underwent intravenous anesthesia (TIVA) with endotracheal intubation. Modulation of anesthetics compatibility may reduce the severity of POCD. Elderly patients scheduled for TIVA with endotracheal intubation were randomly divided into the control group (1.00-2.00 mg/kg propofol) and the etomidate and propofol combination group (1.00-2.00 mg/kg propofol and 0.30 mg/kg etomidate). Serum cortisol, S100ß, and neuron-specific enolase (NSE), interleukin (IL)-6, and IL-10 were monitored during or after the operation. Mini-mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) were utilized to assess the severity of POCD. 63 elderly patients in the etomidate and propofol combination group and 60 patients in the control group were enrolled, and there was no significant difference in gender, American Society of Anesthesiologists (ASA) physical status, surgical specialty, intraoperative blood loss, and operation time between the two groups. Significantly increased serum cortisol, S100ß, NSE, IL-6, and reduced MMSE and MoCA scores were detected in the control group at different time points after the operation (0-72 h post operation) when compared to those before the operation. Similar trends for these observed factors were found in the etomidate and propofol combination group. In addition, the etomidate and propofol combination group showed better effects in reducing the serum levels of cortisol, S100ß, NSE, IL-6, and increasing the MMSE and MoCA scores when compared to the control group. The present study demonstrates that the combination of propofol with etomidate could alleviate POCD in elderly patients underwent TIVA with endotracheal intubation anesthesia. [ABSTRACT FROM AUTHOR]

OBJECTIVE: Propofol, thiopental and dexmedetomidine are hypnotic, sedative, antiepileptic and analgesic agents used in general anesthesia and intensive care. There are many known and yet unknown side effects. Our aim in this study was to examine and compare the cytotoxic, reactive oxygen species (ROS) and apoptotic effects of propofol, thiopental and dexmedetomidine drugs, which are widely used in anesthesia, on liver cells (AML12) in vitro. MATERIALS AND METHODS: The half-maximum inhibitory concentration (IC50) doses of the three drugs on AML12 cells were determined using the 3-[4,5-dimethylthiazol-2yl]-2,5-diphenyltetrazolium bromide (MTT) method. Then at two different doses of each of the three drugs, apoptotic effects were determined by the Annexin-V method, morphological examinations were determined by acridine orange ethidium bromide method and intracellular reactive oxygen species (ROS) levels were determined by flow cytometry. RESULTS: The IC50 thiopental, propofol and dexmedetomidine doses were found to be 255.008, 254.904 and 34.501 µgr/mL, respectively (p<0.001). The highest cytotoxic effect on liver cells was found in the lowest dose of dexmedetomidine (34.501 µgr/mL) compared to the control group. This was followed by thiopental and propofol, respectively. CONCLUSIONS: In this study, propofol, thiopental and dexmedetomidine drugs on AML12 cells were found to have toxic effects by increasing intracellular ROS at two different concentrations higher than clinical doses. It was determined that cytotoxic doses caused an increase in ROS and induced apoptosis in cells. We believe that the toxic effects of these drugs can be prevented by examining the values obtained from this study and the results of future studies. [ABSTRACT FROM AUTHOR]

OBJECTIVE: Myoclonus is one of the main complications of etomidate anesthesia, which would develop into serious consequences during surgery. The present analysis was performed to evaluate systematically the effect of propofol on preventing etomidate-induced myoclonus in adult patients. MATERIALS AND METHODS: Systematic electronic literature search was performed in the databases PubMed, Cochrane Library, OVID, Wanfang and China National Knowledge Infrastructure (CNKI) from inception to May 20, 2021, without any language restrictions. All randomized controlled trials evaluating the efficacy of propofol on preventing etomidate-induced myoclonus were enrolled. The primary outcome included the incidence and degree of etomidate-induced myoclonus. RESULTS: 1,420 patients (with 602 received etomidate anesthesia and 818 received propofol plus etomidate anesthesia) from 13 studies were eventually included. Whatever the intravenous propofol dose for anesthesia induction 0.8-2 mg/kg (RR:4.04, 95% CI [2.42,6.74] p<0.0001, I2=56.5%), or the dose of propofol for anesthesia induction 0.5-0.8 mg/kg (RR:3.26, 95% CI [2.03,5.22] p<0.0001, I2=0%), or the dose of propofol for anesthesia induction 0.25-0.5mg/kg (RR:1.68, 95% CI [1.1,2.56] p=0.0160, I2=0%), combination of propofol and etomidate could significantly decrease the occurrence of etomidate-related myoclonus (RR=2.99, 95% CI [2.40, 3.71] p<0.0001, I2=43.4%), compared with etomidate alone. In addition, propofol plus etomidate attenuated the incidence of mild (RR:3.40, 95% CI [1.7,6.82] p=0.0010, I2=54.3%), moderate (RR:5.4, 95% CI [3.01, 9.67] p<0.0001, I2=12.6%), severe (RR:4.15, 95% CI [2.11, 8.13] p<0.0001, I2=0%) of etomidate-induced myoclonus without adverse effects except for the increased incidence of pain on injection (RR:0.47, 95% CI [0.26, 0.83] p=0.0100, I2=41.5%) compared with etomidate alone. CONCLUSIONS: The meta-analysis currently generates the evidence of combination of propofol with the dosage of 0.25-2 mg/kg and etomidate can alleviate the occurrence and severity of etomidate-induced myoclonus, with decreased incidence of postoperative nausea and vomiting (PONV) and comparative side effects of hemodynamic and respiratory depression of patients in comparison with etomidate alone. [ABSTRACT FROM AUTHOR]

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Despite of the effectiveness of on pump cardiac surgeries in valvular diseases, cardioplegic arrest and myocardial reperfusion injury are still an obstacle. Many cardioprotective additives are tried but the obtained laboratory results are mixed. Our objective was to compare the effects of supplementing the cardioplegia solution with propofol or insulin evaluated not only by laboratory biomarkers but also with papillary muscle biopsy in patients undergoing on pump valvular surgeries. Sixty adult patients were randomly assigned into three equal groups to receive: cold blood cadioplegia (control (C) group), supplemented with either 9 mg/L propofol 10% (P group), or 10 IU/L regular insulin (I group) Propofol induced significant higher myocardial protection presented by better histopathological grading of the obtained muscle biopsies when compared to either group C (P = 0.0460) or group I (P = 0.014), lower postoperative dysrhythmia (P = 0.004), lower troponin I release (40.57 ± 8.5 vs 47.7 ± 6.22-fold increase), and more eukalemic state with lower need for K supplementation than insulin. Propofol was superior to insulin in providing higher grade of myocardial protection with lower troponin I release, more steady K level and lower postoperative complications. [ABSTRACT FROM AUTHOR]

Emergence delirium (ED) is a common complication after general anesthesia in pediatrics, as reported by pediatric anesthesiologists. Multiple drugs have been suggested to prevent the incidence of this problem. Herein, we compared dexmedetomidine and propofol in the prevention of ED in pediatric patients undergoing cataract surgery under general anesthesia. Patients and methods: This prospective study included 80 children who were randomly allocated into two groups; the Dex group, which received dexmedetomidine, and the Pro group, which received propofol. All operations were performed under general anesthesia, and both drugs were administered 20 minutes before the end of surgery. Our primary outcome was to compare between the incidence of ED in both groups, while secondary outcomes included hemodynamic changes, pain scores, and other complications. Age, gender, and the duration of PACU stay showed no significant difference between the two groups. ED was encountered in 5% and 27.5% of patients in the Dex and Pro groups, respectively, with a significant decline in association with dexmedetomidine. Delirium and pain scores were significantly decreased in the Dex group throughout all times of measurement. The same group expressed a significant decrease in most heart rate and arterial pressure measurements. Hypotension was encountered in 15% of patients in the Dex group versus no cases in the Pro group. Dexmedetomidine is superior to propofol in the prevention of ED in pediatrics. It is also associated with better post-operative pain scores. [ABSTRACT FROM AUTHOR]

Atrial fibrillation is a common complication associated with cardiac surgery after cardiopulmonary bypass with a deleterious effect on morbidity and mortality. The current study aimed to compare between dexmedetomidine and propofol in reducing atrial fibrillation after cardiac surgery. A randomized prospective cohort study. Conducted in Alexandria main university hospital. 98 patients of either sex ASA II physical status aged 40–60 years. All patients were subjected to either propofol or dexmedetomidine infusion after cardiac surgery according to the assigned group. The patients were divided into two groups where first group received dexmedetomidine infusion as postoperative sedation and the second group received propofol infusion. Both groups were assessed for incidence of atrial fibrillation, hypotension and length of intensive care stay. Incidence with atrial fibrillation was 0.9% in dexmedetomidine group vs. 13% in propofol group (P = 0.001) and intensive care stay was prolonged in propofol group 4.6 ± 1.2 day vs. 2.7 ± 1 for dexmedetomidine group (P = 0.002). There was no statistically significant difference between both groups regarding blood pressure or heart rate. The use of dexmedetomidine for sedation after cardiac surgery was associated with a lower incidence of atrial fibrillation and hence decreased the duration of intensive care stay. [ABSTRACT FROM AUTHOR]

Transcranial motor evoked potentials (TcMEP) were proved to be useful during complicated spinal surgeries to prevent iatrogenic complications. The effect of anesthetic agents was comprehensively discussed in literature. We investigated a new balanced anesthetic protocol using propofol and sevoflurane in addition to continuous fentanyl infusion in which we compared values and ratios of amplitudes and latencies of TcMEP waves at different time point. A total of 60 patients underwent spinal surgeries were randomly allocated into two groups who received either 75–100 µg/kg/min propofol (P group) or 25 ug/kg/min propofol and 0.2% below corrected-to-age- half MAC of sevoflurane (BA group). TcMEP was recorded before positioning (R1), after positioning (R2), and after skin incision (R3). R2/R1 and R3/R2 ratios were calculated. Modified Aldrete Score was recorded on discharge from PACU. Fluids infused and urine output were significantly increased in P group (p˂0.001). HR and MAP were significantly lower in P group (p˂0.001), but CVP was lower in P group at R1 and R2 (p = 0.019, 0.037). TcMEP was recorded from Vastus lateralis (VL) and Deltoid(D) muscles, which showed a significant lower amplitude in P group at different time points (p˂0.05) without significance in latencies. While when ratios were compared (L2/L1 and L3/L2), it showed significant differences (P˂0.001 and 0.041, respectively). Aldrete score was significantly higher in BA group. Balanced regimen using propofol and sevoflurane resulted in a comparable TcMEP recording, hemodynamic stability and a better recovery from anesthesia during spinal surgeries. [ABSTRACT FROM AUTHOR]

Background: The primary aim of this essay was to explore the best fitting model in remifentanil-propofol combined administrations during esophageal instrumentation (EI) from five distinct response surface models. The secondary aim was to combine the models to give appropriate effect-site drug concentrations (Ces) range with maximal comfort and safety.Methods: The Greco, reduced Greco, Minto, Scaled C50 Hierarchy and Fixed C50 Hierarchy models were constructed to fit four drug effects: loss of response to esophageal instrumentation (LREI), loss of response to esophageal instrumentation revised (LREIR), intolerable ventilatory depression (IVD) and respiratory compromise (RC). Models were tested by chi-square statistical test and evaluated with Akaike Information Criterion (AIC). Model prediction performance were measured by successful prediction rate (SPR) and three prediction errors.Results: The reduced Greco model was the best fitting model for LREI and RC, and the Minto model was the best fitting model for LREIR and IVD. The SPRs of reduced Greco model for LREI and RC were 81.76% and 79.81%. The SPRs of Minto model for LREIR and IVD were 80.32% and 80.12%. Overlay of the reduced Greco model for LREI and Minto model for IVD offered visual aid for guidance in drug administration.Conclusion: Using proper response surface model to fit different drug effects will describe the interactions between anesthetic drugs better. Combining response surface models to select the more reliable effect-site drug concentrations range can be used to guide clinical drug administration with greater safety and provide an improvement of anesthesia precision. [ABSTRACT FROM AUTHOR]