丙泊酚和七氟醚对乳腺癌手术后生存率和复发率影响的Meta分析

目的 评价丙泊酚和七氟醚对乳腺癌手术后五年生存率和复发率的影响。
方法 计算机检索PubMed、Embase、Cochrane Library、Web of Science、维普、万方和知网数据库，收集关于丙泊酚和七氟醚对乳腺癌手术预后影响的随机对照试验和回顾性研究，检索时间为建库至2021年5月28日。按照纳入和排除标准进行文献筛选、数据提取和质量评价，采用RevMan 5.4统计软件进行Meta分析。
结果 共纳入8篇研究，患者10 662例，其中丙泊酚组4 210例，七氟醚组6 452例。Meta分析结果显示，与七氟醚组比较，丙泊酚组乳腺癌术后五年生存率明显升高（OR=1.82，95%CI 1.08～3.04，P=0.02）。两组术后的乳腺癌复发率（OR=0.71，95%CI 0.47～1.06，P=0.10）差异无统计学意义。
结论 与七氟醚麻醉比较,丙泊酚麻醉明显升高乳腺癌术后五年生存率，但对乳腺癌术后复发率的影响无明显差异。因受诸多因素影响，上述结论仍需更多大样本双盲随机对照试验予以验证。     

褪黑素对七氟醚重复暴露诱发新生大鼠远期认知障碍的影响

目的： 探讨褪黑素对七氟醚重复暴露诱发新生大鼠远期认知功能障碍的影响及可能机制。
方法： 选择新生雄性SD大鼠96只,6日龄,体重10～15 g。采用随机数字表法将大鼠分为四组：对照组（C组）、褪黑素组（M组）、七氟醚组（S组）和七氟醚+褪黑素组（SM组）,每组24只。C组自由饮食饮水;M组在出生后第6天开始每天接受1次腹腔注射褪黑素10 mg/kg,连续3 d,第21天分笼后开始饮用含褪黑素的水;S组在出生后第6天开始每天吸入3%七氟醚2 h,连续3 d;SM组在出生后第6天开始每天接受1次腹腔注射褪黑素10 mg/kg,后吸入3%七氟醚2 h,连续3 d,第21天分笼后开始饮用含褪黑素的水。大鼠出生后第35天采用旷场实验记录探索总路程以及中央格停留时间,第36天采用新物体识别实验记录识别指数;第37—39天采用场景性、条件性恐惧实验记录僵直时间。出生后第8、40天取大鼠脑组织,采用Western blot法检测大鼠前额叶皮层iNOS和CD68蛋白含量,ELISA法检测IL-1β和IL-6浓度。
结果： 与C组比较,S组识别指数明显降低,场景性、条件性恐惧测试阶段僵直时间明显缩短,出生后第8天前额叶皮层iNOS和CD68蛋白含量、IL-1β和IL-6浓度明显升高（P<0.05）。与S组比较,SM组识别指数明显升高,场景性、条件性恐惧测试阶段僵直时间明显延长,出生后第8天前额叶皮层iNOS和CD68蛋白含量、IL-1β和IL-6浓度明显降低（P<0.05）。出生后第40天四组间前额叶皮层iNOS和CD68蛋白含量、IL-1β和IL-6浓度差异无统计学意义。
结论： 褪黑素可以抑制前额叶皮层的炎症反应,改善七氟醚重复暴露导致的新生大鼠远期认知障碍。     

丙泊酚与七氟醚对妇科腹腔镜患者视神经鞘直径的影响

目的 应用超声测量视神经鞘直径（ONSD）方法评价丙泊酚与七氟醚对妇科腹腔镜患者颅内压的影响。
方法 选择择期行妇科腹腔镜手术患者40例,年龄20～60岁,BMI 18～27 kg/m²,ASAⅠ或Ⅱ级。采用随机数字表法分为丙泊酚组（P组）和七氟醚组（S组）,每组20例。麻醉维持：P组静脉泵注丙泊酚4～12 mg·kg^-1·h^-1,S组吸入1%～2%七氟醚。使用容量控制模式,V_T6～8 ml/kg,FiO₂ 50%,I∶E 1∶2,RR 12～20次/分。记录麻醉诱导后5 min（T₀）、气腹开始后头低脚高位5 min（T₁）、气腹开始后头低脚高位30 min（T₂）、气腹开始后头低脚高位60 min（T₃）时的HR、MAP、气道峰压（Peak）、气道平台压（Plat）、P_ET CO₂ 和ONSD。
结果 与T₀时比较,T₁—T₃时P组MAP明显降低,T₂—T₃时S组MAP明显降低（P＜0.05）,T₁—T₃时两组Peak、Plat明显升高（P＜0.05）,T₁—T₃时两组ONSD明显升高（P＜0.05）。T₁时P组MAP明显低于S组（P＜0.05）。T₃时P组ONSD明显低于S组（P＜0.05）。
结论 在妇科腹腔镜手术中,与单纯使用七氟醚比较,应用丙泊酚维持可一定程度减轻颅内压的升高。     

七氟醚对低温全心缺血-再灌注心脏电传导及Cx43 Ser368磷酸化的影响

目的 观察七氟醚对低温全心缺血-再灌注心室肌电传导及Cx43 Ser368磷酸化的影响。
方法 制备成功的离体灌注工作心脏24只,随机分为三组：对照组（C组）、低温全心缺血-再灌注组（IR组）和1.0 MAC七氟醚处理组（Sev组）,每组8只。C组：37 ℃ K-H液平衡灌注15 min后继续灌注37 ℃ K-H液105 min;IR组：37 ℃ K-H液平衡灌注15 min后继续灌注37 ℃ K-H液15 min,注射Thomas液（4 ℃,20 ml/kg）使心脏停搏60 min,4 ℃ K-H液保护心脏,停搏30 min时半量复灌Thomas液（4 ℃,10 ml/kg）,60 min时使用37 ℃ K-H液再灌注30 min;Sev组：37 ℃ K-H液平衡灌注15 min后继续灌注含饱和1.0 MAC七氟醚的37 ℃ K-H液15 min,注射Thomas液（4 ℃,20 ml/kg）使心脏停搏60 min,4 ℃ K-H液保护心脏,停搏30 min时半量复灌Thomas液（4 ℃,10 ml/kg）,60 min时使用含饱和1.0 MAC七氟醚的37 ℃ K-H液再灌注30 min。于再灌注即刻至灌注结束,记录离体心脏复跳时间（再灌注即刻至心脏首次跳动所需的时间）,室性心律失常（室性早搏、室性心动过速、室性颤动）发生情况和持续时间。采用心脏刺激仪行程控刺激,测定并记录有效不应期（ERP）、传导速度(CV）。采用免疫印迹法检测心室肌组织Cx43和Cx43 Ser368蛋白相对含量。
结果 与C组比较,IR组和Sev组ERP明显延长,CV明显减慢（P＜0.05）;IR组Cx43及Cx43 Ser368蛋白相对含量明显降低（P＜0.05）。与IR组比较,Sev组心脏复跳时间明显缩短,心律失常发生率明显降低,心律失常持续时间明显缩短,ERP明显缩短,CV明显增快,Cx43及Cx43 Ser368蛋白相对含量明显升高（P＜0.05）。
结论 七氟醚可以上调低温全心缺血-再灌注心室肌组织Cx43和Cx43 Ser368的表达,促使心室肌电传导增快、有效不应期缩短,降低再灌注心律失常的发生。     

七氟醚和丙泊酚对危重患儿肺功能影响的比较

目的 观察七氟醚和丙泊酚对危重患儿肺功能的影响。
方法 选择行腹部手术合并肺炎危重患儿64 例,男39例,女25例,日龄1～28 d,体重2～5 kg,ASA Ⅲ级。采用随机数字表法将患儿分为两组：七氟醚吸入麻醉组（S组）和丙泊酚静脉麻醉组（P组）,每组32例。记录插管后30 min、术毕、术后6 h的氧合指数（OI）、肺泡动脉氧分压差（PA-aO₂）、呼吸指数（RI）、血清髓系细胞表达触发受体-1（TREM-1）、白细胞介素-8（IL-8）浓度。记录低氧血症、心律失常、严重感染、新生儿呼吸窘迫、无法纠正的低血压等围术期不良事件的发生情况。
结果 与插管后30 min比较,S组术毕、术后6 h OI明显升高,PA-aO₂和RI明显降低（P<0.05）;P组术毕OI、术后6 h PA-aO₂明显降低（P＜0.05）。与术毕比较, S组术后6 h OI明显升高,RI明显降低（P＜0.05）,P组术后6 h PA-aO₂明显降低（P＜0.05）。与P组比较,术毕、术后6 h S组OI明显升高,RI明显降低,术后6 h PA-aO₂明显升高（P＜0.05）。两组不同时点血清TREM-1浓度差异无统计学意义。与术毕比较,P组术后6 h血清IL-8浓度明显降低（P＜0.05）。与P组比较,S组术毕、术后6 h血清IL-8浓度明显降低（P＜0.05）。两组患儿均无围术期不良事件发生。
结论 与丙泊酚比较,七氟醚能够降低危重患儿血清炎性因子IL-8浓度,对危重患儿具有肺保护作用。     

地氟醚、异氟醚和七氟醚对脑血流速率的影响

目的　通过经颅多普勒超声 (TCD)监测大脑中动脉 (MCA)血流速率 ,观察地氟醚、异氟醚和七氟醚三种吸入麻醉药对平均血流速率 (Vm)的影响。方法　 42例 18～ 6 0岁、ASAⅠ～Ⅱ级、择期非颅脑手术病人 ,随机接受地氟醚、异氟醚或七氟醚吸入麻醉。机械通气维持PETCO2 在 40± 1mmHg。当呼气末吸入麻醉药浓度分别为 :1 0MAC平衡 15分钟后 ,快速 (2分钟内 )从 1 0MAC升高至 1 5MAC即时 ,1 5MAC平衡 15分钟后 ,以及稳定于 1 5MAC并且维持和 1 0MAC平衡下相似的MAP时 ,记录Vm、MAP和心率。结果　 (1)吸入浓度从 1 0MAC上升至 1 5MAC ,且MAP维持相同水平的情况下 ,地氟醚和异氟醚使Vm增加非常显著 (分别从 5 6cm/s上升至 6 1cm/s,从47cm/s上升至 5 2cm/s,P <0 0 1) ,而七氟醚无显著变化 (从 6 0cm/s至 6 0cm/s,P >0 0 5 )。 (2 )当吸入浓度快速从 1 0MAC上升至 1 5MAC时 ,地氟醚使血压升高、心率增快 ,同时 ,脑血流速率显著增加 (从 5 6cm/s上升至 6 1cm/s,P <0 0 1)。而异氟醚和七氟醚在MAP显著下降的同时使Vm无显著变化 (从 47cm/s升至 49cm/s,P >0 0 5 ) ,或显著下降 (从 6 0cm/s降至 5 6cm/s,P <0 0 1)。结论　 (1)吸入浓度从 1 0MAC增加到 1 5MCA时 ,地氟醚、异氟醚使脑血流速率显著增加 ,而七氟醚作     

腹部手术患者吸入七氟醚与异氟醚麻醉恢复的比较

目的比较腹部手术患者吸入七氟醚与异氟醚麻醉恢复的情况。方法全麻下行开腹手术患者40例,随机分为2组（n=20）：七氟醚组（S组）及异氟醚组（Ⅰ组）。麻醉诱导后行气管插管,机械通气。诱导后吸入纯氧,氧流量2 L/min,30min后调整为1 L/min。手术开始前,调整吸入麻醉药的呼气末浓度为1.0 MAC。麻醉维持：吸入七氟醚或异氟醚,间断静脉注射罗库溴铵和芬太尼,维持血压和心率波动幅度不超过基础值30%。缝皮结束时,停止吸入七氟醚或异氟醚,纯氧流量调整为5 L/min。记录睁眼时间（停止吸入麻醉药到睁眼的时间）、拔除气管导管时间（停止吸入麻醉药到拔除气管导管的时间）、Aldrete评分达到9分时间（从停止吸入麻醉药计时）及麻醉后恢复室（PACU）停留时间。记录吸入麻醉药用量。结果与Ⅰ组比较,S组睁眼时间、拔除气管导管时间、Aldrete评分达到9分时间及PACU停留时间缩短（P〈0.05）,吸入麻醉药的总用量和单位时间用量差异无统计学意义（P〉0.05）。结论与异氟醚比较,吸入七氟醚患者麻醉恢复较快,且麻醉恢复质量较好。     

新辅助化疗后胃癌手术七氟醚最低肺泡有效浓度的测定

目的确定接受新辅助化疗后1个月行胃癌根治术的患者全凭吸入麻醉时外科切皮无体动反应的七氟醚最低肺泡有效浓度(minimum alveolar concentration,MAC)。方法择期行胃癌根治术患者25例,男14例,女11例,年龄30~50岁,ASAⅠ或Ⅱ级,于手术1个月前结束2个周期的奥沙利铂复合替吉奥化疗(1个化疗周期为14 d)。吸入6%七氟醚全麻诱导,至患者意识消失行气管插管术后,将呼气末七氟醚浓度调整至预定值,维持15 min不变,然后外科切皮。根据Dixon上下法进行试验,初始呼气末七氟醚浓度为2.2%,切皮时发生体动反应,下一例升高一个浓度梯度,切皮时未发生体动反应,下一例降低一个浓度梯度,相邻浓度梯度为0.2%。采用Probit分析计算出七氟醚的MAC和95%CI。结果本研究中进行外科切皮操作时,患者的体动反应表现为肢体轻微活动,所有患者均未发生身体大幅扭动、睁眼或术中知晓等严重并发症。有11例(44%)患者发生体动。接受新辅助化疗的胃癌患者在外科切皮时无体动反应的七氟醚MAC值为1.52%,95%CI为1.37%~1.65%。结论接受新辅助化疗的胃癌患者切皮无体动反应的七氟醚的MAC值为1.52%。     

七氟醚抑制帕金森病患者切皮时肾上腺素能反应的最低肺泡有效浓度

目的探讨七氟醚抑制帕金森病(PD)患者切皮时肾上腺素能反应的最低肺泡有效浓度(MAC_(BAR))。方法选择2019年10月至2021年3月择期行脑深部刺激器植入术患者21例,男10例,女11例,年龄40～64岁,BMI 18～30 kg/m~2,ASAⅠ—Ⅲ级。采用吸入8%七氟醚进行麻醉诱导,喉罩置入后调整呼气末七氟醚浓度(C_(ET)Sev)至预设水平。采用序贯法测定七氟醚MAC_(BAR)。第1例患者C_(ET)Sev调整至3%,稳定后15 min切开锁骨下皮肤。将切皮前3、1 min HR和MAP的平均值记录为基础值,将切皮后1、3 min HR和MAP的平均值记录为变化值,若HR或MAP升高幅度超过基础值的20%则定义为肾上腺素能反应阳性。若切皮时肾上腺素能反应为阳性,下一例采用高一级浓度,否则采用低一级浓度,浓度梯度为0.2%。当出现7个"阳性反应-阴性反应"的转折点时停止试验。采用概率回归法计算七氟醚MAC_(BAR)及其95%可信区间(CI)。结果肾上腺素能反应阳性的患者MAP变化值明显高于肾上腺素能反应阴性的患者(P0.05)。通过概率回归法算得PD患者切皮时七氟醚MAC_(BAR)为2.11%(95%CI 1.94%～2.27%)。结论七氟醚抑制帕金森病患者切皮时肾上腺素能反应的最低肺泡有效浓度为2.11%(95%CI 1.94%～2.27%)。     

吸入和全凭静脉麻醉用于患儿纤维支气管镜检查效果的比较

目的 比较吸入七氟醚保留自主呼吸和丙泊酚-瑞芬太尼静脉麻醉压力控制呼吸两种麻醉管理方式用于患儿纤维支气管镜检查的安全性及有效性。
方法 选择行纤维支气管镜检查患儿72例,男37例,女35例,年龄2～4岁,BMI 12～19 kg/m²,ASA Ⅰ或Ⅱ级,采用随机数字表法将患儿随机分为两组：吸入七氟醚保留自主呼吸组(吸入组)和丙泊酚-瑞芬太尼静脉麻醉压力控制呼吸组(静脉组),每组36例。吸入组给予七氟醚诱导,置入喉罩后持续吸入2.5%～3.0%七氟醚,保留自主呼吸维持麻醉。静脉组经外周静脉给予丙泊酚4 mg/kg+瑞芬太尼1 μg/kg缓慢推注诱导,置入喉罩后静脉泵入丙泊酚9 mg·kg^-1·h^-1、瑞芬太尼0.2 μg·kg^-1·min^-1,压力控制通气维持麻醉。记录麻醉诱导时间、诊疗时间、喉罩拔除时间和完全清醒时间。记录从开始给药到患儿完全清醒过程中低血压、心动过缓、低氧血症、镜检操作反应的发生情况以及镜检医师满意度评分。
结果 静脉组麻醉诱导时间明显短于吸入组［(1.8±0.3)min vs (3.1±0.8)min,P<0.05］,完全清醒时间明显短于吸入组［(11.7±4.6)min vs (13.6±5.1)min,P<0.05］,喉罩拔除时间明显长于吸入组［(5.6±1.2)min vs (0.5±0.2)min,P<0.01］,镜检操作反应发生率明显低于吸入组[14例（39%） vs 25例（69%）,P<0.01]。两组诊疗时间、低血压、心动过缓以及低氧血症的发生率差异无统计学意义。静脉组镜检医师满意度评分明显高于吸入组［8.5(8.1～9.0)分vs 7.4(7.2～7.9)分,P<0.01］。
结论 患儿纤维支气管镜检查中,丙泊酚-瑞芬太尼静脉麻醉压力控制呼吸优于吸入七氟醚保留自主呼吸。     

Early intravenous cannulation in children during sevoflurane induction

BACKGROUND: It has been shown that early placement of an intravenous line in children anesthetized with halothane is equally safe compared with later placement. Whether this is true of sevoflurane is not known. METHODS: Pediatric patients, age 1-18 years, undergoing elective general anesthesia via an inhalation induction were randomized to intravenous placement either 30 or 120 s following loss of lid reflex. Movement on intravenous placement and incidence of laryngospasm were determined. Difficulty with intravenous placement was recorded. RESULTS: Movement on intravenous placement was more prevalent in the early group than in the late group (P < 0.0001). There was no laryngospasm in the late group and eight cases in the early group (P < 0.004). Children who had laryngospasm were older (P < 0.02) and weighed more (P < 0.04). Older children in the early group were more likely to have significant movement. CONCLUSION: Following an inhalation induction with sevoflurane in children, movement with intravenous placement was greater, and the incidence of laryngospasm was higher, when the intravenous access was attempted 30 s rather than 120 s following loss of lid reflex. We recommend waiting two min following the loss of lid reflex before attempting intravenous placement in children receiving an inhalation induction with sevoflurane.     

Sevoflurane anaesthesia does not induce the formation of sister chromatid exchanges in peripheral blood lymphocytes of children

Background. Compound A, a degradation product of sevoflurane,has been demonstrated to induce sister chromatid exchanges (SCE)in Chinese hamster ovary cells in vitro as a marker for possiblegenotoxicity. We investigated the formation of SCE in mitogen-stimulatedT-lymphocytes of 40 children undergoing sevoflurane anaesthesiafor minor surgical procedures. Methods. Anaesthesia was induced by inhalation of up to 8% sevofluraneand maintained at 2.5–3% in oxygen/nitrous oxide (65/35%)at a fresh gas flow of 3 litre min^–1. Soda lime (humidity12–15%) was used as a carbon dioxide absorbent. Bloodwas drawn directly before induction and after termination ofanaesthesia. Twenty-five second division metaphases of mitogen-stimulatedT-lymphocytes per blood sample were screened for SCE rates usingstandard techniques. Results. Average duration of anaesthesia was 49.6 (SD 24.0)min. Before anaesthesia induction, 7.93 (1.23) SCE per metaphasewere determined. After sevoflurane anaesthesia [1.40 (0.77)MAC h] 7.92 (1.19) SCE per metaphase were observed. Additionally,no differences were evident between male or female children. Conclusion. Short-term administration of sevoflurane anaesthesiadid not induce SCE in T-lymphocytes of children. No indicationfor a possible genotoxic effect has been observed. Br J Anaesth 2003; 90: 233–5     

七氟醚在小儿麻醉中应用的体会

目的：七氟醚由于血／气分配系数低。诱导速度快．且无气道刺激性,是目前较为适宜做吸入诱导的吸入类麻醉药．尤其是针对小儿手术的麻醉。本文探讨七氟醚在小儿麻醉方面的应用。方法：选择3—10岁颌面外科唇裂．颌面部软组织损伤、囊肿．神经外科颅骨骨折复位、脊膜膨出．以及眼科眶内肿物摘除、假限植入等择期手术100例。随机分为2组,第一组完全使用常规静脉诱导插管全麻;第二组使用七氟醚全凭吸入诱导麻醉。结果;所有患者拔管前后无躁动、无呃逆．喉痉挛等不良反应,而各组数据比较后．第二组时间数据明显优千第一组（P〉0．05）．生命体征数据则第一组较第二组偏低（P〉0．01）。结论：七氟醚由于肝肾毒性小,起效快、代谢快,可以安全良好的应用于对肌松要求不高的小儿麻醉手术。     

Sevoflurane‐induced isoelectric EEG and burst suppression: differential and antagonistic effect of added nitrous oxide

The objective of this study was to investigate whether nitrous oxide influenced the ED50 of sevoflurane for induction of isoelectric electroencephalogram (ED50_isoelectric) differently from its influence on the ED50 of sevoflurane for electroencephalogram burst suppression (ED50_burst). In a prospective, randomised, double‐blind, parallel group, up–down sequential allocation study, 77 ASA physical status 1 and 2 patients received sevoflurane induction and, after tracheal intubation, were randomly allocated to receive sevoflurane with either 40% oxygen in air (control group) or 60% nitrous oxide in oxygen mixture (nitrous group). The ED50_isoelectric in the two groups was determined using Dixon's up and down method, starting at 2.5% with 0.2% step size of end‐tidal sevoflurane. The electroencephalogram was considered as isoelectric when a burst suppression ratio of 100% lasted > 1 min. The subsequent concentrations of sevoflurane administered were determined by the presence or absence of isoelectric electroencephalogram in the previous patient in the same group. The ED50_isoelectric in the nitrous group 4.08 (95%CI, 3.95–4.38)% was significantly higher than that in the control group 3.68 (95%CI, 3.50–3.78)% (p < 0.0001). The values for ED50_burst were 3.05 (95%CI, 2.66–3.90)% and 3.02 (95%CI, 3.00–3.05)% in nitrous group and control group, respectively (p = 0.52). The addition of 60% nitrous oxide increases ED50_isoelectric, but not the ED50_burst of sevoflurane. Neither result indicates an additive effect of anaesthetic agents, as might be expected, and possible reasons for this are discussed.     

Effects of rocuronium pretreatment on muscle enzyme levels following suxamethonium

BACKGROUND: The effects of different time intervals between rocuronium pretreatment and suxamethonium administration on muscle-derived enzymes and myoglobin were evaluated. METHODS: Fifty-two patients, aged 3-6 years, were allocated randomly to receive pretreatment of either rocuronium 1 min or 4 min, or a placebo, before suxamethonium. Serum creatine-phosphokinase (CK), lactate dehydrogenase (LDH), alanine aminotransferase, aspartate aminotransferase (AST) and myoglobin concentrations were measured before treatment and at 30 min, 6 h and 24 h after suxamethonium administration. RESULTS: Mean serum CK and myoglobin concentrations in the rocuronium groups were significantly less than in the saline group 24 h and 30 min after suxamethonium administration, respectively (P < 0.05). There were no significant differences between the rocuronium groups. Mean LDH and AST concentrations were higher at 6 h and 24 h after suxamethonium administration compared with preadministration levels, respectively (P < 0.05). CONCLUSIONS: We concluded that intervals of 1 min or 4 min between the rocuronium and suxamethonium administrations have the same effect on enzyme levels.     

Gene expression of pulmonary cytokines after sevoflurane or thiopentone anaesthesia in pigs

Background:  Volatile anaesthetics have diverse inflammatory effects on the lungs. They increase gene expression of some pro-inflammatory cytokines in alveolar macrophages whereas in alveolar type II cells they seem to decrease secretion and gene expression of pro-inflammatory cytokines. We have previously detected increased leukotriene C₄, nitrate and nitrite concentrations in bronchoalveolar lavage fluid after sevoflurane anaesthesia. In the current study, we measured gene expression of inflammatory cytokines in the lung tissue and plasma concentrations of cytokines in pigs after thiopentone or sevoflurane anaesthesia.
Methods:  Sixteen pigs were randomly selected to receive either a continuous thiopentone infusion (control group, n  = 8) or sevoflurane ( n  = 8) at 4.0% inspiratory concentration (1.5 MAC) in air for 6 h. Tissue samples were collected at the end of the study for measurement of gene expression of inflammatory cytokines. Blood samples were collected during anaesthesia for measurement of plasma cytokine concentrations.
Results:  Compared with thiopentone anaesthesia, lower gene expression of tumour necrosis factor-α (TNF-α) and interleukin-1β (IL-1β) in lung tissue was observed after sevoflurane anaesthesia. Of measured cytokines IL-1β, TNF-α, IL-6, IL-8 and IL-10 only plasma concentrations of IL-6 could be measured during the study without a difference between the groups.
Conclusion:  Lower gene expression of TNF-α and IL-1β was found in the intact porcine lung tissue after sevoflurane anaesthesia compared with thiopentone anaesthesia. Clinical significance of this finding is unknown.     

The correlation of the Narcotrend Index with endtidal sevoflurane concentrations and hemodynamic parameters in children

BACKGROUND: The Narcotrend Index (NI) of anesthetic depth is potentially a pharmacodynamic measure of the effects of sevoflurane on the brain. METHODS: In this prospective observational study of 30 pediatric surgical patients (1-11 years), we investigated the correlation between nonsteady-state endtidal sevoflurane (eT(Sevo)), NI, mean arterial pressure (MAP), and heart rate (HR). The performance of the Narcotrend for differentiation between consciousness and unconsciousness was evaluated using prediction probability (P(K)). RESULTS: Spearman correlation analysis showed significant correlations (P < 0.01) between eT(Sevo) and NI (r = -0.85) and MAP (r = -0.43). P(K)-values for differentiation between consciousness and unconsciousness were 1.0 for NI and <0.85 for MAP and HR. During the surgical procedure, NI-values showed a constant rise with each 0.5% step of lowering eT(Sevo) (P < 0.03), whereas MAP remained unaltered and HR showed a constant decline (P < 0.03), except between 1.5 and 1%. CONCLUSIONS: In children, nonsteady-state eT(Sevo) concentrations are more closely related with NI than with MAP or HR. In this study, only NI reliably differentiated consciousness from unconsciousness.     

Effect of sevoflurane on the mid-latency auditory evoked potentials measured by a new fast extracting monitor

BACKGROUND: Mid-latency auditory evoked potentials (MLAEP) are widely suppressed during general anesthesia and may therefore be useful for assessment of the depth of anesthesia. However, interpretation of amplitudes and latencies in the AEP signal is time consuming. A new monitor (A-line) that quantifies the MLAEP into an index has therefore been developed. The present study aimed to assess the precision of a prototype of the new monitor and to test the hypothesis that the depth of anesthesia index shows a graded response with changing steady-state end-expiratory concentrations of sevoflurane. METHODS: We studied 10 ASA physical status I or II patients undergoing elective hysterectomy under combined epidural and general anesthesia by sevoflurane. Baseline auditory evoked potentials were recorded in the conscious patient immediately before induction of general anesthesia. Depth of anesthesia indices were recorded before anesthesia and at decreasing end-expiratory steady-state sevoflurane concentrations of 2.0%, 1.5%, 1.0% and 0.5%. All indices were recorded in duplicate 6 s apart. By use of an autoregressive model with exogenous input (ARX-model), the monitor extracted the AEP within 6 s. The depth of anesthesia AEP index calculated in this way was defined as the A-line ARX index (AAI). RESULTS: Approximately 95% of the differences between repeated recordings were 5 AAI-units or less. A wide interindividual variation was observed at each observation point. AAI at 1%, 1.5% and 2% end-expiratory concentration was significantly less than the baseline AAI obtained before induction of anesthesia (P < 0.001). AAI did not change significantly in the 1-2% concentration range. CONCLUSION: The new monitor was precise. Attenuation of the A-line ARX-index (AAI) for mid-latency auditory evoked potentials (MLAEP) during general anesthesia was profound. However, the monitor did not show a graded response with changing end-expiratory steady-state concentrations of sevoflurane.