Articles: anesthetics.
-
Randomized Controlled Trial Multicenter Study Comparative Study
Short-term outcomes in infants following general anesthesia with low-dose sevoflurane/dexmedetomidine/remifentanil versus standard dose sevoflurane (The TREX trial).
The Trial Remifentanil DEXmedetomidine (TREX) trial aimed to determine whether, in children less than 2 yr old, low-dose sevoflurane/dexmedetomidine/remifentanil anesthesia is superior to standard-dose sevoflurane anesthesia in terms of global cognitive function at 3 yr of age. The aim of the current secondary analyses was to compare incidence of intraoperative hypotension and bradycardia, postoperative pain, time to recovery, need for treatment of intraoperative hypotension and bradycardia, incidence of light anesthesia and need for treatment, need for postoperative pain medications, and morbidity and mortality outcomes at 5 days between the two arms. ⋯ These early postoperative results suggest that in children less than 2 yr of age receiving greater than 2 h of general anesthesia, the low-dose sevoflurane/dexmedetomidine/remifentanil anesthesia technique and the standard sevoflurane anesthesia technique are broadly clinically similar, with no clear evidence to support choosing one technique over the other.
-
A narrative expert review aiming to summarize the clinical epidemiology and management of critically ill patients with malignant hyperthermia (MH). ⋯ Increasing use of inhalational anesthetics in the ICU underscores the need for enhanced education on the diagnosis and management of MH to ensure optimal patient sedation care and safety.
-
Review
Mitigating the systemic loss of nitrous oxide: a narrative review and data-driven practice analysis.
Given the negative health impacts of climate change, clinicians have a fundamental responsibility to take an active role in mitigating the environmental impact of their practices. Inhaled anaesthetics are potent greenhouse gases, including nitrous oxide (N2O), with their long atmospheric lifetime, high global warming potential, and ozone-depleting properties. However, few clinicians realise that losses from central N2O supply systems account for the vast majority of overall N2O consumption in healthcare. ⋯ To date, this mitigation initiative has been successfully implemented at over 25 hospitals in our system. Raising awareness of this considerable source of healthcare-specific N2O emissions empowers clinicians to spearhead facility-level engagement and action. As healthcare leaders, clinicians should advocate for decarbonisation of clinical practices and systems while ensuring high-quality patient care.
-
Interest in passive flow filter systems to remove sevoflurane from anaesthetic machine exhaust have increased recently to mitigate the environmental impact of volatile anaesthetics. These filter systems consist of chemically activated carbon, with limited evidence on their performance characteristics. We hypothesised that their efficiency depends on filter material. ⋯ Depending on the filter material and saturation, the likelihood of sevoflurane passing through passive flow carbon filters depends on the filter material and fresh gas flow. Combining the filter systems with anaesthetic gas scavenging systems could protect from pollution of ambient air with sevoflurane.
-
Minerva anestesiologica · Dec 2024
Randomized Controlled Trial Comparative StudyComparison of postoperative awakening between ciprofol and propofol in elderly patients undergoing hip replacement surgery: a single-blind, randomized, controlled trial.
The aim of this paper was to compare the impact of continuous infusion of ciprofol versus propofol on postoperative awakening in elderly patients following hip replacement surgery. ⋯ Compared to propofol, the administration of ciprofol in elderly patients following hip replacement surgery is associated with prolonged awakening time, spontaneous breathing recovery time, and extubation. The average intravenous maintenance dosage of ciprofol in geriatric patients under general anesthesia was 0.8 mg·kg-1·h-1.