Comparative Evaluation of Modern Inhalation Anesthetics in Carotid Endarterectomy

Purpose — to carry out a comparative assessment of inflammation based on evaluation of intraoperative and early postoperative dynamics of blood serum cytokines in pulmonary malignant neoplasm patients in different anesthesia and analgesia settings.Material and methods. 24 patients of 45 to 50 years of age divided into 2 groups were examined. All patients suffered from verified new onset malignant neoplasms without true signs of metastases. Tumor differentiation by morphology was not undertaken since that was beyond the study design. Patients did not receive radio- or chemotherapy. In Group I (the main group, n=12), a multimodal combined anesthesia [1] followed by extended postoperative epidural analgesia was applied. In Group II (the comparison group, n=12), a combined general anesthesia including mechanical lung ventilation followed by morphine analgesia was used. 4 study points were determined: prior to induction, and one, 12, and 24 hours post-surgery.Results. 12 hours after surgery completion, the concentration of TNFα in the main group was lesser by 57.1% vs. the comparison group; by the end of the first 24 hours, it fell down by 64.3%. Within the same period, in both groups IL-6 turned out to be significantly higher than the upper reference limit. By the end of the first 24 hours, IL-6 tend to decrease in both groups; however, in the comparison group, this parameter was 15% higher than in the main group. Serum IL-10 was within the reference range in both groups. One hour after surgery, concentrationof IL-10 was exponentially growing in both groups and exceeded multifold the upper reference limit, whereas the content of IL-10 in the main group remained reliably higher: the difference amounted to 35.6% percent.Conclusion. During the postoperative period, patients undergone lung resection displayed significant changes in cytokines concentrations demonstrating an inflammation reaction. Inflammation was significant in patients who received epidural analgesia as evidenced by an altered content of anti-inflammatory cytokines.

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Dynamics of Serum Cytokines During Resection Surgery for Malignant Neoplasms in the Lungs

Соловьев

Долгих

Новичкова

et al. 2020

Obŝaâ reanimatologiâ

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Prospects of inhalation sedation in intensive care

Гребенчиков¹,

Kulabukhov²,

Шабанов³

et al. 2022

Anaes. i reanim.

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Prognostic significance of predictors of early postoperative cognitive disorders in patients after traumatic surgeries (prospective cohort study)

Ermokhina,

Kuzovlev,

Davydov

et al. 2024

Vestn. anesteziol. reanimatol.

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The objective was to determine the prognostic value of predictors of early postoperative cognitive disorders in traumatological patients to assess the development of the main clinical outcomes (postoperative delirium and delayed neurocognitive recovery).Materials and methods. A two-center prospective cohort observational study of patients aged 45–74 years after planned traumatological operations (endoprosthetics of large joints of the lower extremities, spinal fusion surgery, transpedicular fixation of vertebrae) under general anesthesia with tracheal intubation was conducted in the period from March 2021 to June 2022. Before the operation, demographic indicators, concomitant diseases, background therapy, laboratory tests and testing (ASA, MoCA, AUDIT, CFS, HADS-A, RASS). At the end of the operation after extubation and in the postoperative period, patients were analyzed according to the scales RUS, CAM- ICU and CAM-ICU-7, NRS and BPS. Statistical analysis was carried out using the software SPSS Statistics 27.0.1.0.Results. The study included 200 patients. Early postoperative cognitive disorders (ePCD) (agitation and emergence delirium (ED)) 61 (30.5%) patients were diagnosed, 139 (69.5%) patients had adequate awakening in the operating room. Independent predictors of the development of ePCD were the age of patients (≥ 60), glucose level ≥ 5.6 and a high score on the Clinical Frailty Scale (≥ 4). The prevalence of postoperative delirium (POD) was 11% (22 patients). The independent risk factors for POD were the duration of hypotension and the presence of hyperactive ED. Delayed neurocognitive recovery after surgery and anesthesia was observed in 115 patients (57.8%). At the same time, a statistically significant predictor of this condition was the duration of hypotension for more than 15 minutes (sensitivity 59.18%, specificity 65.85%).Conclusion. When comparing the influence of the study group (patients with ePCD) with the control group, it was determined that ePCD is an independent risk factor for the development of POD (p < 0.001).

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Comparative Evaluation of Modern Inhalation Anesthetics in Carotid Endarterectomy

Cited by 3 publications

References 28 publications

Dynamics of Serum Cytokines During Resection Surgery for Malignant Neoplasms in the Lungs

Dynamics of Serum Cytokines During Resection Surgery for Malignant Neoplasms in the Lungs

Prospects of inhalation sedation in intensive care

Prognostic significance of predictors of early postoperative cognitive disorders in patients after traumatic surgeries (prospective cohort study)

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