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Background: The safety of healthy volunteer donors is one of the most important issues in living-donor liver transplantation. Use of the Pringle maneuver during donor hepatectomy can result in liver ischemia-reperfusion (IR) injury. The objective of this study was to examine the effects of isoflurane and propofol on IR injury caused by the Pringle maneuver during donor hepatectomy., Methods: A total of 70 American Society of Anesthesiology I-II donors aged 18-65 years who underwent hepatectomy were included in the study. The patients were randomly divided into 2 groups: propofol and isoflurane. Plasma superoxide dismutase (SOD), malondialdehyde (MDA), total oxidative status (TOS), total antioxidant capacity (TAC), and oxidative stress index (OSI) were measured before surgery (t0) and after surgery (t1)., Results: There were no statistically significant differences in demographic features, anesthesia, and times of surgery between the groups (P > .05). Plasma TAC levels at t0 and t1 were significantly lower in the propofol group than in the isoflurane group (P < .05). OSI at t1 was significantly higher in the propofol group than in the isoflurane group (P < .05). MDA levels were significantly higher in the propofol group than in the isoflurane group at t0 (P < .05). MDA levels level were significantly higher in the isoflurane group than in the propofol group at t1 (P < .05)., Conclusions: Propofol may have protective effects against IR injury caused by the Pringle maneuver during donor hepatectomy in living-donor transplantations. However, the effectiveness of propofol for clinical use needs to be investigated further., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Background and Objectives: Ketamine and propofol are the general anesthetics that also have antimicrobial and microbial growth-promoting effects, respectively. Although these agents are frequently applied together during clinical use, there is no data about their total effect on microbial growth when combined. In this study, we investigated some organisms' growth in a ketamine and propofol mixture., Method: We used standard strains including Escherichia coli, Staphylococcus aureus, Pseudomonas aeruginosa, and Candida albicans in this study. Time-growth analysis was performed to assess microbial growth rates in 1% propofol. Antimicrobial activity of ketamine, alone and in propofol was studied with microdilution method., Results: In propofol, studied strains grew from 10(3)-10(4) cfu/mL to ≥10(5) cfu/mL concentrations within 8-16 hours depending on the type of organism. Minimal inhibitory concentration (MIC) and minimal bactericidal concentration (MBC) (for candida, minimal fungicidal concentration) of ketamine were determined as follows (MIC, MBC): E.coli 312.5, 312.5 μg/mL; S.aureus 19.5, 156 μg/mL; P.aeruginosa 312.5, 625 μg/mL; and C.albicans 156, 156 μg/ml. In ketamine+propofol mixture, ketamine exhibited antimicrobial activity to E.coli, P.aeruginosa and C.albicans as MBCs at 1250, 625 and 625 μg/mL, respectively. Growth of S. aureus was not inhibited in this mixture (ketamine concentration=1250 μg/mL)., Conclusion: Ketamine has sustained its antimicrobial activity in a dose-dependent manner against some organisms in propofol, which is a strong microbial growth-promoting solution. Combined use of ketamine and propofol in routine clinical application may reduce the risk of infection caused by accidental contamination. However, one must keep in mind that ketamine cannot reduce all pathogenic threats in propofol mixture., (Copyright © 2013 Sociedade Brasileira de Anestesiologia. Published by Elsevier Editora Ltda. All rights reserved.)

We compared postoperative hepatic and renal functions and coagulation profiles in living donors undergoing right hepatectomy under isoflurane (n = 40) versus propofol (n = 40) anesthesia. After induction, anesthesia was maintained with isoflurane/air-O2 (group I) or propofol/air-O2 (group P) in addition to remifentanil and atracurium infusion in both groups. Aspartate aminotransferase, alanine aminotransferase, international normalized ratio (INR), activated partial thromboplastin time (aPTT), albumin, total bilirubin, blood urea nitrogen, creatinine, estimated glomerular filtration rate (GFR), platelet count, and hemoglobin levels were measured in the preoperative period, after end of the operation, and on the first, third, fifth and seventh postoperative days (PODs). INR was significantly increased on POD 3 and aPTT on POD 5 in group I compared with group P (P < .05). Albumin level was significantly lower in Group I on POD 1 and 3 (P < .05). GFR was significantly lower on POD 1 in the group I compared with group P (P < .05). The postoperative coagulation, GFR, and albumin values were superior following administration of propofol than isoflurane in donors who underwent living hepatectomy; however, both approaches were clinically safe, with no significant clinical difference., (Copyright © 2013 Elsevier Inc. All rights reserved.)

We compared the effectiveness of three anaesthetic regimens (propofol alone, propofol with remifentanil and sevoflurane alone), with respect to seizure duration and seizure quality in patients undergoing electroconvulsive therapy. Thirty-nine patients underwent a total of 234 electroconvulsive therapy treatments in this prospective, observer blinded, crossover study. Each patient received either propofol 1 mg/kg alone (Group P), propofol 0.5 mg/kg and remifentanil 1 µg/kg (Group R), or sevoflurane alone 6% (Group S) for their initial electroconvulsive therapy session. The patients subsequently received an alternative regimen in their next session, such as from propofol 1 mg/kg alone to propofol 0.5 mg/kg and remifentanil 1 µg/kg, from propofol 0.5 mg/kg and remifentanil 1 µg/kg to sevoflurane alone 6%, or from sevoflurane alone 6% to a continuing alternation between drugs at each session, until their sixth session. Muscle paralysis was achieved with 1 mg/kg succinylcholine. Seizure duration, postictal suppression index, early and midictal amplitude were recorded. The mean motor and electroencephalogram seizure durations were significantly longer in Groups P and R compared to Group S (P <0.001). The postictal suppression index and early and midictal amplitude values were not significantly different among the groups. These findings indicate that the three anaesthetic regimens had similar effects on seizure quality parameters, although sevoflurane was associated with shorter seizure durations than propofol or propofol-remifentanil.

The aim of this study was to evaluate the effect of a ketamine:propofol combination ('ketofol') for electroconvulsive therapy on seizure activity, haemodynamic response and recovery parameters, and to compare with these with the effects of propofol alone. Twenty-four patients underwent a total of 144 electroconvulsive therapy sessions, allocated in this prospective, double-blind, crossover study. Patients were randomly assigned to receive 1 mg/kg ketofol (0.5 mg/kg propofol plus 0.5 mg/kg ketamine) or 1 mg/kg propofol 1% for anaesthesia induction. Seizure duration and quality, haemodynamic data, recovery parameters and side-effects were recorded and analysed between groups. Both motor and electroencephalography seizure durations in the ketofol group (29 ± 17 and 41 ± 17 seconds, respectively) were similar to that in the propofol group (28 ± 13 and 38 ± 16 seconds, respectively). Postictal suppression index was higher in the ketofol group (89.63 ± 7.88) than in the propofol group (79.74 ± 14.6) (P <0.05). In the ketofol group, heart rate after the seizure ended and mean arterial pressures, recorded at 0 and 5 minutes after the seizure ended, were higher than in the propofol group. Time to obeying commands was longer in the ketofol group (P <0.05). There were no untoward psychological reactions following ketofol. Although no superiority to propofol in terms of seizure duration, haemodynamic or recovery parameters was found, the ketofol mixture selected in our study provided better seizure quality than propofol. We conclude that ketofol can be an alternative strategy to enhance the seizure quality and clinical efficiency of electroconvulsive therapy.

Background and Objective: Remifentanil and propofol have been proposed for intubation without muscle relaxant to avoid the adverse effects of muscle relaxants in children. We hypothesized that the addition of ketamine to remifentanil and propofol would improve intubating conditions and provide haemodynamic stability., Methods: We studied 88 children (3-12 years) undergoing elective surgery. Group K received ketamine 0.5mgkg(-1), remifentanil 3microgkg(-1) and propofol 3mgkg(-1). Group C received isotonic saline instead of ketamine, all other study drugs were same as in group K. Sixty seconds after administration of propofol, laryngoscopy and tracheal intubation were performed. Intubating conditions were graded. Mean arterial pressure (MAP), heart rate (HR) and SpO(2) were recorded., Results: The intubating conditions were regarded as clinically acceptable in 39 out of 44 (89%) children in group K and in 36 out of 44 (82%) children in group C. Although there was no failed intubation in group K, the intubation failed in six children in group C (P<0.05). Tracheal intubation failed in 4/6 children because of severe coughing and/or limb movement, and in 2/6 children because of closed vocal cords. Scores for limb movement were significantly lower in group K than in group C. When compared with baseline, HR and MAP significantly decreased in both groups during the study (P<0.05)., Conclusion: The addition of ketamine to remifentanil and propofol prevented failed intubation and slightly increased the percentage of acceptable intubating conditions. Ketamine had no influence on haemodynamic changes following remifentanil and propofol administration in given doses.

This study was designed to compare the effects of ketamine and alfentanil administered prior to induction of anaesthesia with propofol, on the haemodynamic changes and ProSeal laryngeal mask airway (PLMA) insertion conditions in children. Eighty children, aged between 3-132 months, were randomly allocated to receive either alfentanil 20 microg.kg(-1) (alfentanil group) or ketamine 0.5 mg.kg(-1) (ketamine group) before induction of anaesthesia. Ninety seconds following the administration of propofol 4 mg.kg(-1), a PLMA was inserted. In the ketamine group, heart rate and mean arterial pressure were higher during the study period compared with the alfentanil group (p < 0.05). The time for the return of spontaneous ventilation was prolonged in the alfentanil group (p = 0.004). In conclusion, we found that the administration of ketamine 0.5 mg.kg(-1) with propofol 4 mg.kg(-1) preserved haemodynamic stability, and reduced the time to the return of spontaneous ventilation, compared with alfentanil 20 microg.kg(-1) during PLMA placement. In addition, the conditions for insertion of the PLMA with ketamine were similar to those found with alfentanil.

Background and Objective: Percutaneous nephrolithotripsy (PCNL) is used for the fragmentation and removal of stones from the renal pelvis and renal calyceal systems. We compared the effects of propofol-alfentanil or propofol-remifentanil anaesthesia on haemodynamics, recovery characteristics and postoperative analgesic requirements during percutaneous nephrolithotripsy., Methods: Thirty non-premedicated patients were randomly allocated to receive either propofol-alfentanil (Group A) or propofol-remifentanil (Group R). The loading dose of the study drug was administered over 60 s (alfentanil 10 microg kg(-1) or remifentanil 1 microg kg(-1)) followed by a continuous infusion (alfentanil 15 microg kg(-1) h(-1) or remifentanil 0.15 microg kg(-1) min(-1)). Propofol was administered until loss of consciousness and maintained with a continuous infusion of 75 microg kg(-1) min(-1) in both groups. Atracurium was given for endotracheal intubation at a dose of 0.5 mg kg(-1) and maintained with a continuous infusion of 0.4 mg kg(-1) h(-1). Mean arterial pressure heart rate, the total amount of propofol, time of recovery of spontaneous ventilation, extubation and eye opening in response to verbal stimulus and analgesic requirement were recorded., Results: In Group A, mean arterial pressure was higher at the first minute in the prone position, and during skin incision and lithotripsy, and heart rate was higher during skin incision and lithotripsy when compared with Group R (P < 0.05). The total amount of propofol did not differ between groups. Time of recovery of spontaneous ventilation, extubation and eye opening were significantly shorter in Group R than Group A (P < 0.05)., Conclusions: Both propofol-remifentanil and propofol-alfentanil anaesthesia provided stable haemodynamics during percutaneous nephrolithotripsy, whereas propofol-remifentanil allowed earlier extubation.

Reactive oxygen species play a role during brain injury due to closed head trauma. Enzymatic or nonenzymatic antioxidants may protect brain tissue against oxidative damage. The present study was performed to assess the changes of endogenous indices of oxidative stress in serum from rats subjected to head trauma and whether treatment with propofol and/or erythropoietin (EPO) modifies the levels of endogenous indices of oxidative stress. For these purposes, female Wistar Albino rats were divided into five groups: non-traumatic sham group, trauma performed control, trauma with propofol (i.p.), trauma with EPO (i.p.) and trauma with propofol and EPO performed study groups. At the end of the experimental procedure, blood was taken by cardiac puncture to determine superoxide dismutase (SOD) and xanthine oxidase (XO) activities as well as malondialdehyde (MDA) and nitric oxide (NO) levels in serum. Serum MDA level of control traumatic brain injury (TBI) group was significantly higher than sham operation group (p<0.012). Serum MDA levels in propofol, EPO and propofol+EPO groups were found to be decreased in comparison with control group (p<0.039, p<0.030 and p<0.018, respectively). Serum NO level was found to be increased in TBI group, but difference was not statistically significant when compared to sham-operated group (p=0.092). Propofol, EPO and propofol+EPO administration efficiently reduced serum NO levels to reach sham-operated group (p<0.002, p<0.001 and p<0.015, respectively). These results suggested that acute administration of both propofol and EPO altered the indices of oxidative stress similarly against brain injury due to trauma.

Resumo Experiência e objetivos Cetamina e propofol são os anestésicos gerais que também exibem efei- tos antimicrobianos e promotores do crescimento microbiano, respectivamente. Embora esses agentes sejam frequentemente aplicados em combinação durante o uso clínico, não há dados sobre seu efeito total no crescimento microbiano na administração combinada. Nesse estudo, investigamos o crescimento de alguns microrganismos em uma mistura de cetamina e propofol. Método Nesse estudo, utilizamos cepas padronizadas: Escherichia coli , Staphylococcus aureus , Pseudomonas aeruginosa e Candida albicans . Realizamos uma análise de tempo-crescimento para avaliar as taxas de crescimento microbiano em propofol 1%. A atividade antimicrobiana de cetamina, isoladamente e em propofol, foi estudada pelo método de microdiluição. Resultados Em propofol, as cepas estudadas cresceram de concentrações de 10 3 -10 4 ufc/mL para = 10 5 ufc/mL, dentro de 8-16 horas, dependendo do tipo de microrganismo. Foram determinadas a concentração inibitória mínima (CIM) e a concentração bactericida mínima (CBM) (para Candida, concentração fungicida mínima) de cetamina, como se segue (CIM, CBM): E. coli 312,5, 312,5 µg/mL; S.aureus 19,5, 156 µg/mL; P. aeruginosa 312,5, 625 µg/mL; e C. albicans 156, 156 µg/mL. Na mistura cetamina + propofol, cetamina exibiu atividade antimicrobiana para E. coli , P. aeruginosa e C. albicans em CBMs a 1250, 625 e 625 µg/mL, respectivamente. O crescimento de S. aureus não foi inibido nessa mistura (concentração de cetamina = 1250 µg/mL). Conclusão Cetamina preservou sua atividade antimicrobiana de maneira dose-dependente con- tra alguns microrganismos em propofol, que é robusta solução promotora de crescimento micro- biano. O uso combinado de cetamina e propofol na aplicação clínica de rotina pode diminuir o risco de infecção causada por contaminação acidental. Entretanto, deve-se ter em mente que cetamina não pode reduzir todas as ameaças patogênicas na mistura com propofol. [ABSTRACT FROM AUTHOR]

The article discusses a study of the administration of Ketofol, a mixture of ketamine and propofol, in patients referred to electroconvulsive therapy. The researchers analyzed the seizure activity, hemodynamic response and recovery parameters in the 25 patients included in the study. They found similar motor and electroencephalography seizure durations in both the ketofol and propofol groups.

Background: This study was designed to evaluate the effect of dexmedetomidine on the acute hyperdynamic response, duration of seizure activity and recovery times in patients undergoing electroconvulsive therapy (ECT). Methods: Fourteen patients underwent a total of 84 ECT sessions as a crossover design. Patients were randomly allocated to receive either dexmedetomidine (1 μg/kg IV over a period of 10 min) or saline (control). Anaesthesia was induced with propofol 1 mg/kg, and then succinylcholine 0.5 mg/kg IV was administered. Arterial blood pressure and heart rate (HR) were recorded during the study period. Results: HR in the dexmedetomidine group was lower than that in the control group at 5 and 10 min after the start of study drug infusion, and at 1, 3 and 10 min after the seizure ended ( P<0.05). Peak HR was lower in the dexmedetomidine group compared with that in the control group ( P<0.05). The mean arterial pressure (MAP) values in the dexmedetomidine group were lower at 0, 1, 3 and 10 min after the seizure ended compared with the control group ( P<0.05). Both motor and electroencephalography (EEG) seizure duration in the control group (35.65 ± 14.89 and 49.07 ± 9.94 s, respectively) were similar to that in the dexmedetomidine group (33.30 ± 12.01 and 45.15 ± 17.79 s, respectively) ( P>0.05). Time to spontaneous breathing, eye opening and obeying commands were not different between the groups. Conclusion: A dexmedetomidine dose of 1 μg/kg IV administered over 10 min before the induction of anaesthesia with propofol may be useful in preventing the acute hyperdynamic responses to ECT without altering the duration of seizure activity and recovery time. [ABSTRACT FROM AUTHOR]

Background and objective: Pain on injection is still a major problem with propofol. In this study, we compared the efficacy of single-dose premedication of dexmedetomidine for pain on injection of propofol and its effect on the incidence and the severity of the pain after propofol injection. Methods: We conducted a prospective, randomized and double-blind study of 100 patients scheduled to undergo surgery. Patients were randomly assigned to one of two groups, either receiving dexmedetomidine (Group D) or saline (Group C) before the injection of propofol. Patients in Group D (n = 50) were given dexmedetomidine infusion 0.6 μg/kg for 10 min. Patients in Group C (n = 50) were given saline infusion in an identical manner. Pain perception was assessed during injection of propofol in all patients. Results: The median pain score on injection of propofol was significantly lower in Group D than in Group C (median pain score 2 [1–3] vs 1 [0–2]; P < 0.006). The number of patients with pain in Group D decreased (48/50 [96%] in Group C vs 42/50 [84%] in Group D; P = 0.046). Conclusions: Intravenous administration of a single dose of dexmedetomidine as a premedication reduced the incidence and severity of pain on propofol injection without significant adverse haemodynamic effects. [ABSTRACT FROM AUTHOR]

Objective: The aim of our study is to compare the effect of ketamine–propofol mixture (ketofol) and propofol on the laryngeal tube-Suction II (LTS II) insertion conditions and hemodynamics. Methods: Eighty American Society of Anesthesiologists class 1 and 2 patients were divided into 2 random groups to receive either 1 µg/kg remifentanil and propofol 2 mg/kg in Group P (n = 40), or 1 µg/kg remifentanil and ketofol (using a 1:1 single syringe mixture of 5 mg/mL ketamine and 5 mg/mL propofol) in Group K (n = 40) before induction of anesthesia. After induction, LTS II was inserted. Heart rate and noninvasive blood pressure were recorded before induction of anesthesia (t0); immediately following induction (t1); immediately after LTS II insertion (t2); and 3 minutes (t3), 5 minutes (t4), and 10 (t5) minutes after LTS II insertion. Conditions of insertion of LTS II were assessed and scored 1 to 3 using 6 variables as follows: mouth opening, swallowing, coughing, head and body movements, laryngospasm, and ease of LTS II insertion by the same experienced anesthesiologist who did not know the agents. LTS II insertion summed score was prepared depending upon these variables. Results: In regard to LTS II insertion summed score, Group K was more favorable than Group P (P < 0.05). Apnea duration was longer in Group P (385.0 seconds [range = 195.0–840.0 seconds]) compared with Group K (325.50 seconds [range = 60.0–840.0 seconds]) but this was not statically significant. The heart rate values were significantly lower at all measurement intervals in both groups compared with the baseline values (P < 0.05). There was no difference in heart rate between Group P and Group K. The mean arterial pressure values were significantly lower at all measurement intervals in Group P compared with baseline values (P < 0.05). In Group K, the mean arterial pressure values were significantly lower at all measurement intervals compared with the baseline values, except t2 (P < 0.05). There was a significant difference between Group P and Group K in terms of mean arterial pressure at t3 (P < 0.05). Conclusions: We found that ketofol provided better insertion summed score for LTS II than propofol, with minimal hemodynamic changes. [Copyright &y& Elsevier]