Up to date in inhalation anaesthesia: the desflurane

Diabetes & Metabolism, 2010

Aim. -We tested the hypothesis that brief exposure to desflurane at the time of reoxygenation might be able to protect against hypoxia-reoxygenation injury in human myocardium from diabetic (insulin-dependent, ID; and non-insulin-dependent, NID) patients and nondiabetic (ND) subjects.

Journal of Cardiothoracic and Vascular Anesthesia, 2007

The authors performed a meta-analysis to investigate whether the cardioprotective effects of volatile anesthetics translate into decreased morbidity and mortality in patients undergoing cardiac surgery.

Turkish Journal of Thoracic and Cardiovascular Surgery, 2012

Bu çalışmada fentanil bazlı total intravenöz anestezi (TİVA), sevofluran ve izofluranın miyokardiyal koruyucu etkileri karşılaştırıldı. Ça lış ma pla nı: Etik komite onayı alındıktan sonra kardiyopulmoner baypas (KPB) ile açık kalp cerrahisi planlanan 57 hasta üç gruba ayrıldı. Standart indüksiyon sonrası grup 1'de (TİVA grup; n=17) fentanil-midazolam-pankuronyum ile grup 2'de (Sevo grup; n=20) 1 MAC sevofluran ile grup 3'de (Iso grup; n=20) 1 MAC izofluran ile idame yapıldı. Ameliyat öncesi dönemde ve ameliyat sonrası üçüncü günde sol ventrikül fonksiyonları ve kardiyak skorlar transtorasik ekokardiyografi ile değerlendirildi. Kardiyak troponin I (cTnI) ve kreatin kinaz MB fraksiyonu (CKMB) KPB'den önce ve KPB'den sonraki altıncı saatte, birinci, ikinci ve üçüncü günlerde ölçüldü. Laktat ölçümü için kan örnekleri, KPB öncesi ve sonrası ve klempin kaldırılışını takiben arteriyel hattan ve retrograd kanülden alındı. Bul gu lar: Demografik parametreler her üç grupta benzer idi. Kardiyopulmoner baypas sonrası kardiyak indeks ve debi her üç grupta da artış gösterdi. Kardiyopulmoner baypas öncesi CKMB ve cTnI seviyeleri gruplar arasında benzer iken, KPB sonrası altıncı saatte bu değerler tüm gruplarda artış gösterdi. İstatistiksel olarak gruplar arasında anlamlı fark olmasa da bu artış TİVA grubunda en yüksekti. Klempin alınmasını takiben retrograd kanülden alınan kan örneklerinde laktat seviyesi tüm gruplarda yükseldi. So nuç: Sonuç olarak, bütün grupların önkoşullama potansiyeli olduğundan, miyokardiyal koruma açısından fentanil bazlı TİVA ve volatil anestezik grupları arasında istatistiksel olarak anlamlı bir fark bulamasak da volatil anestezik gruplarının fentanil bazlı TİVA grubuna göre daha kardiyoprotektif olduğunu söyleyebiliriz. Anah tar söz cük ler: İskemik önkoşullama; laktik asit; miyokardium. Background:In this study we compared the myocardial protective effects of fentanyl-based total intravenous anesthesia (TIVA), sevoflurane and isoflurane. Methods: After ethic committee approval, 57 patients who were scheduled to undergo open heart surgery using cardiopulmonary bypass (CPB) were randomized into three groups. Following standard induction, group 1 (TIVA group; n=17) received fentanyl-midazolam-pancuronium, group 2 (Sevo group; n=20) received 1 MAC sevoflurane and group 3 (Iso group; n=20) received 1 MAC isoflurane for maintenance. During preoperative period and on postoperative third day, left ventricle functions and cardiac scores were evaluated by transthoracic echocardiography. Cardiac troponin I (cTnI) and creatine kinase MB fraction (CKMB) were measured before CPB and at sixth hour, day one, two and three following CPB. For lactate measurement, blood samples were collected from arterial line and retrograde cannula before and after CPB and following declamping. Results: Demographic parameters were similar among three groups. Cardiac index and output increased in all three groups after CPB. Creatine kinase MB fraction and cTnI levels were similar among groups before CPB, those levels increased in all groups at sixth hour after CPB. Although there was not a statistically significant difference among the groups, this increase was the highest in TIVA group. After declamping, the lactate levels collected from retrograde cannula increased in all groups. Conclusion:As a result, as all the groups have preconditioning potential, although we did not find a significant difference between fentanyl-based TIVA group and volatile anesthetics in terms of myocardial protection, we could say that volatile anesthetics are more cardioprotective, compared to fentanylbased TIVA group.

1998

It is known that volatile anaesthetics protect myocardial tissue against ischaemic and reperfusion injury in vitro. In this investigation, we have determined the effects of the inhalation anaesthetics, enflurane, isoflurane, sevoflurane and desflurane, administered only during early reperfusion, on myocardial reperfusion injury in vivo. Fifty chloralose-anaesthetized rabbits were subjected to 30 min of occlusion of a major coronary artery followed by 120 min of reperfusion. Left ventricular pressure (LVP, tip-manometer), cardiac output (CO, ultrasonic flow probe) and infarct size (triphenyltetrazolium staining) were determined. During the first 15 min of reperfusion, five groups of 10 rabbits each received 1 MAC of enflurane (enflurane group), isoflurane (isoflurane group), sevoflurane (sevoflurane group) or desflurane (desflurane group), and 10 rabbits served as untreated controls (control group). Haemodynamic baseline values were similar between groups (mean LVP 106 (SEM 2) mm Hg; CO 281(7) ml min 91 ). During coronary occlusion, LVP and CO were reduced to the same extent in all groups (LVP 89% of baseline; CO 89%). Administration of inhalation anaesthetics during early reperfusion further reduced both variables, but they recovered after discontinuation of the anaesthetics to values not different from control animals. Infarct size was reduced from 49 (5)% of the area at risk in the control group to 32 (3)% in the desflurane group (P:0.021), and to 36 (2)% in the sevoflurane group (P:0.097). In the enflurane group, infarct size was 39 (5)% (P:0.272). Isoflurane had no effect on infarct size (48 (5)%, P:1.000). The results show that desflurane and sevoflurane markedly reduced infarct size and therefore can protect myocardium against reperfusion injury in vivo. Enflurane had only a marginal effect and isoflurane offered no protection against reperfusion injury in vivo. These different effects suggest different protective mechanisms at the cellular level. (Br. J. Anaesth. 1998; 81: 905-912).

Journal of Interdisciplinary Medicine, 2016

Background: Numerous studies discuss the protective effects of halogenated anesthetics on myocyte injury induced by the ischemia-reperfusion syndrome of the heart. This mechanism is known as pharmacological preconditioning. Aim of the study: The objective of this study was to identify the effects of two volatile anesthetics frequently used in current clinical practice, Isoflurane and Sevoflurane, on the in situ heart. The study was performed on laboratory animals with induced brain death. Material and methods: The animals were divided into 3 groups, the control group (n = 8), IZO-PRE group (n = 8) and SEVO-PRE group (n = 8), on which the experimental protocol established for this study was applied. From a molecular point of view, the expressions of protein kinase C-epsilon (PKCε) and of glycogen synthase kinase – 3 beta (GSK-3β) were investigated. Results: Following the statistical analysis, we observed a significant reduction in the size of the infarcted area in the IZO-PRE group c...

Canadian Journal of Anaesthesia, 1992

Influence of desflurane, isoflurane and halothane on regional tissue perfusion in dogs The actions of desflurane, isoflurane and halothane on regional tissue perfusion were studied using radioactive microspheres in dogs chronically instrumented for measurement of arterial and left ventricular pressure, global (left ventricular dP/dtm~) and regional (percent segment shortening) contractile function, and diastolic coronary blood flow velocity. Systemic and coronary haemodynamics and regional tissue perfusion were measured in the conscious state and during anaesthesia with equihypotensive concentrations of desflurane, isoflurane, and halothane. All three volatile anaesthetics (P < 0.05) increased heart rate and decreased mean arterial pressure, left ventricular systolic pressure, and left venlricular dP/dtm~ Myocardial perfusion was unchanged in subendocardial, midmyocardial, and subepicardial regions by the administration of either dose of desflurane. No redistribution of intram yocardial blood flow (endo/epi ratio) was observed during desflurane anaesthesia. Although regional myocardial perfusion was reduced (P < 0.05

Arya Atheroscler, 2013

BACKGROUND: Some pharmacological preconditioning approaches are utilized as an effective adjunct to myocardial protection, particularly following cardiac procedures. The current study addressed the potential clinical implications and protective effects of isoflurane as an anesthetic most applicable on postoperative myocardial function measured by cardiac biomarkers.

IP Innovative Publication Pvt. Ltd., 2019

Introduction: Equilibration point of an inhalational agent is the transition point when ratio of expired (Fe) to inspired (Fi) concentration of inhalational anaesthetic agent (Fe/Fi) reaches 0.8 or when uptake of volatile agent reaches 80%. It helps in reducing the duration of initial high gas flows before switching over to low flows. Aim: To compare Desflurane with Isoflurane for equilibration time, intraoperative hemodynamic parameters and post extubation recovery parameters. Materials and Methods: Depending on the volatile anesthetic agent being used patients were randomly allocated into two groups. Group I (n =25) received Desflurane and Group II (n=25) received Isoflurane as inhalational anesthetic agent. In all patients low flow anaesthesia was given after achieving equilibration time and that time was noted. Other parameters measured were intraoperative heart rate, mean blood pressure, mean EtN2O, mean EtFe (End tidal volatile anesthetic agent concentration), recovery parameters (recovery time, recovery score and vitals) and any complications if any. Statistics: Analysis was performed on SPSS (Statistical package for social sciences) version 17.0 Statistical Analysis Software. Result: The equilibration point for group I was achieved in 2.18 ± 0.84 min and for group II was achieved in 10.08 ± 2.36 min and this difference was statistically significant. The intraoperative heart rate and MAP did not differ significantly (p>0.05) between the two groups at all time periods. On comparing, post extubation vitals i.e. HR (8.1%) and recovery time (69.9%) they were found significantly (p<0> Conclusion: Desflurane use results in shorter equilibrium time and earlier reduction of FGF with early and better recovery than Isoflurane. Keywords: Desflurane, Isoflurane, Low flow Anaesthesia, Equilibration time.

Canadian Anaesthetists’ Society Journal, 1980

Fifty patients with ischaemic heart disease scheduled for coronary artery bypass surgery received either an enflurane or a halothane anaesthetic. The anaesthetic techniques were randomly assigned to the patients and consisted of induction with diazepam 0.5 rag. kg t and pancuronium 0. I mg. kg-r supplemented by nitrous oxide and oxygen (50:50). Enflurane in dosages of 0.5-1.5 volumes per cent and halothane 0.3-0.7 volumes per cent were administered to Group E (25 patients) and Group H (25 patients), respectively. The inhalation drug dosage was varied to maintain heart rate and systemic blood pressure within predetermined limits. The two patient groups (E and H) were compared with regard to myocardial damage (deterrnined electrocardiographically and enzymatically) as well as by haemodynamic changes and adjuvant cardiovascular drug therapy. One patient in group H sustained a postoperative infarction detected by electrocardiogram and sustained CK MB release. There was no o[her unequivocal electrocardiographic evidence of myocardial infarction in either group and the myocardial damage estimated from CK MB curves was remarkably low and similar in both anaesthetic groups. Myocardial damage was estimated by CK MB maximum release (CK MB MAX) ofS. I 4-1.001U/l (Group E), 7.8 + 1.32 lUll (Group H), by area under the CK MB disappearance curve (CK MB AREA) of 144 + 21.9 IU/I x hr (Group E), 173 + 32.9 IU/I x hr (Group H), and by the accumulated CK MB or CK MB damage size (CK MB DS) of 10.5 + 1.791U[I (Group E), 10.3 + 2.261U/I (Group H). There was no release ofCK M B before cardiopulmonary bypass in either group. There was no statistically significant difference between the two groups for myocardial damage, haemodynamics or adjuvant drug interventions. There was a trend toward greater use of vasodilators in Group H than in Group E. It is concluded that enflurane and halothane are associated with equally low levels of myocardial damage when used for anaesthesia in patients with ischaemic heart disease. The release of CK MB occurred following cardiopulmonary bypass and probably represents imperfect myocardial preservation. Patients with severely impaired ventricular function were not studied, and in these patients enflurane and halothane must be used judiciously. ANAESTHETIC MANAGEMENT using halothane, nitrous oxide and adjuvant agents for patients undergoing myocardial revascularization is associated with a low level of myocardial damage, i The purpose of this prospective investigation was to determine the incidence and extent of myocardial damage associated with an enflurane technique compared to halothane. The specific question to be answered was whether the use of either

Acta Anaesthesiologica Scandinavica, 2011

Available volatile anaesthetics are safe and efficacious; however, their varying pharmacology provides small but potentially clinically important differences. Desflurane is one of the thirdgeneration inhaled anaesthetics. It is the halogenated inhaled anaesthetic with the lowest blood and tissue solubilities, which promotes its rapid equilibration and its rapid elimination following cessation of administration at the end of anaesthesia. The low fat solubility of desflurane provides pharmacological benefits, especially in overweight patients and in longer procedures by reducing slow compartment accumulation. A decade of clinical use has provided evidence for desflurane's safe and efficacious use as a general anaesthetic. Its benefits include rapid and predictable emergence, and early recovery. In addition, the use of desflurane promotes early and predictable extubation, and the ability to rapidly transfer patients from the operating theatre to the recovery area, which has a positive impact on patient turnover. Desflurane also increases the likelihood of patients, including obese patients, recovering their protective airway reflexes and awakening to a degree sufficient to minimise the stay in the high dependency recovery area. The potential impact of the rapid early recovery from desflurane anaesthesia on intermediate and late recovery and resumption of activities of daily living requires further study.

Anesthesiology, 2006

Background The myocardial negative inotropic effects of desflurane are less pronounced than those of other halogenated anesthetics, partly because of intramyocardial catecholamine store release. However, the effects of desflurane on aging myocardium are unknown, whereas aging is known to be associated with an attenuation of catecholamine responsiveness. Methods The effects of desflurane (1.9-9.3 vol%) were studied in left ventricular papillary muscle of adult and senescent rats (29 degrees C; 0.5 mm Ca; stimulation frequency 12 pulses/min). The inotropic effects were compared under low and high loads, using the maximum unloaded shortening velocity and maximum isometric active force, and without or with alpha- and beta-adrenoceptor blockade. Results Desflurane induced a moderate positive inotropic effect in adult rats but a negative inotropic effect in senescent rats. After alpha- and beta-adrenoceptor blockade, desflurane induced a comparable negative inotropic effect in adult and s...

Open Medicine, 2010

The aim of this study was to investigate the effect of sevoflurane and desflurane on cardiac arrhythmias in adult patients who will be anesthetized. A total of 40 patients who were in the ASA I–II group and who were to undergo elective surgery were included in the study. No pre-medication was administered to the patients. They were monitored with the Holter equipment at preoperative 24 hours, and also at postoperative 24 hours on condition that Holter monitoring will begin before induction. Following routine monitoring, the patients were randomly divided into two equal groups; group one was given sevoflurane and group two was given desflurane. In this study, desflurane and sevoflurane resulted in both a significant prolongation of QT and QTc and a significant increase in QT and QTc dispersion when compared with the basal values. In the sevoflurane group, there was no significant increase in postoperative ventricular arrhythmia, compared to that during the preoperative period. Howeve...

Anesthesia & Analgesia, 1999

Objective: δ-Opioid receptors are involved in the cardioprotective effect of ischemic preconditioning. This study was designed (1) to assess the protective capacities of ischemic preconditioning and the synthetic δ-opioid receptor agonist D-Ala 2 -D-Leu 5 enkephalin (DADLE) in a functionally oriented experimental model of ischemia and reperfusion and (2) to assess whether the effects of both protective measures are similarly blocked by naloxone, a nonspecific δ-opioid receptor antagonist.

Advances in Clinical and Experimental Medicine, 2017

Background. Preconditioning is one of the most powerful mechanisms preventing the myocardial ischemic damage that occurs during coronary artery bypass grafting. Objectives. We aimed to investigate the effects of different propofol and/or desflurane administration protocols in terms of the prevention of ischaemia-reperfusion damage. Material and methods. Ninety patients, aged > 18 years, American Society of Anesthesiologists (ASA) category III, scheduled to undergo primary elective coronary artery bypass grafting (CABG), were included in the study. During maintenance, the patients in group 1 (n = 30) received a propofol infusion (5-6 mg/ kg/h) combined with a fentanyl infusion (3-5 mcg/kg/h); the patients in group 2 (n = 30) also received a propofol infusion (5-6 mg/kg/h) combined with a fentanyl infusion (3-5 mcg/kg/h), but they were also given 6% desflurane inhalation for 15 min both before cross-clamping of the aorta and after removal of the clamp; the patients in group 3 (n = 30) received a propofol infusion (2-3 mg/kg/h) combined with a fentanyl infusion (3-5 mcg/kg/h) and received the continuous 6% desflurane inhalation. Blood samples were drawn in the preoperative period (S1), during cardiopulmonary bypass, before cross-clamping the aorta (S2), after removal of the cross-clamp (S3) and 24 h after the operation (S4). Results. All groups were similar in terms of age and BMI (p > 0.05). TNF-α levels were higher at S3 compared to S1, S2 and S4 (p > 0.001). The TNF-α levels at S4 were lower in group 3 than those in group 1 and group 2 (p < 0.05). In all groups, h-FABP levels showed an increase in S3 but were significantly lower at S4 (p < 0.05). In group 3, h-FABP levels at S2 and S3 were significantly lower than those in group 1 (p < 0.05). There was a moderate correlation between h-FABP and TNF-α levels (Spearman's rho = 0.472, p < 0.001). Conclusions. On the basis of the measurement of h-FABP and TNF-α, low-dose propofol and continuous desflurane inhalation provide more effective preconditioning than propofol alone or a short course of desflurane in patients undergoing CABG.

Acta Anaesthesiologica Scandinavica, 1994

The effects of anaesthesia for major abdominal vascular surgery on coronary flow regulation and mechanisms of myocardial ischaemia were studied in 56 patients with CAD, using a randomized, partly double-blinded protocol. After induction with fentanyl (3 pg. kg-l) and thiopentone (2-4 mg. kg-I) and tracheal intubation, principal anaesthetics were nitrous oxide/oxygen (60/40) with isoflurane (n=20), halothane (n= 19) or fentanyl (15-20 pg. kg-') (n= 17). Conventional invasive techniques and coronary venous retrograde thermodilution were used to assess systemic and coronary haemodynamics. Coronary vascular resistance was estimated from myocardial oxygen extraction. Myocardial ischaemia was diagnosed by 12-lead ECG and/or anterior wall motion abnormalities by cardiokymography and/or myocardial lactate production. When adjustment of anaesthetic dose was insufficient for haemodynamic control, iv phenylephrine and nitroglycerine were adminstered to treat hypotension and hypertension or cardiac failure respectively. Measurements were performed at four specific intervals; awake, before surgery and 10 and 30 min after abdominal incision. Comparable changes of systemic haemodynamics and myocardial oxygen consumption were observed in the three groups. Coronary vasodilation was evidenced in isoflurane patients only and was linearly dose-dependent (EO.00 I). Partial Least Squares Projections to Latent Structures modelling with cross validation confirmed this dose-dependency and ruled out a clinically measurable influence by intervention drugs or simultaneous systemic haemodynamic abnormalities. The incidence of myocardial ischaemia during anaesthesia and surgery was comparable in the three groups (35, 37 and 24'10, respectively) and there was an association with systemic haemodynamic aberrations in 19 of the 27 ischaemic episodes. In contrast to ischaemic halothane and fentanyl patients, isoflurane patients with ischaemia had significantly lower myocardial oxygen extraction (P=O.OOS and P=O.OO 1, respectively), indicating that the oxygen extraction reserve was not utilized in a normal way during ischaemia.