Comparison of the Level of Free Hexafluoro-isopropanol in Adults’ Blood and the Incidence of Emergence Agitation After Anesthesia With Different Concentrations of Sevoflurane in Laparoscopic Gastrointestinal Surgery: A Randomized Controlled Clinical Trial

Abstract

Purpose: The aim of the study is to compare the free hexafluoro-isopropanol (HFIP) concentration in adults' blood and the incidence of emergence agitation (EA) after inhaled different concentrations of sevoflurane. Methods: Sixty adult patients planning to undergo laparoscopic gastrointestinal surgery were randomly assigned to 3 groups. Each group received sevoflurane as the volatile anesthetic at different concentrations: 0.5 minimum alveolar concentration (MAC), 1.0 MAC, and 1.5 MAC. The use of sevoflurane was continued until the end of surgery. Venous blood samples were obtained at 30, 60, 120, and 180 minutes after starting the use of sevoflurane and subsequently at 60, 180, and 300 minutes after discontinuation of volatile anesthetic administration. Blood concentrations of sevoflurane and free HFIP were determined using gas chromatography. The recovery time and the incidence of EA at different time points were evaluated among the 3 groups. Findings: Changes in the blood concentrations of sevoflurane and free HFIP during and after the use of sevoflurane were similar in all 3 groups. The peak blood concentration of free HFIP occurred 60 minutes after onset of sevoflurane anesthesia in all 3 groups (P < 0.05). The lowest level of free HFIP and the longest recovery time were found in the 1.5-MAC group (P < 0.05). No significant difference was found in the incidence of EA or moderate pain among the 3 groups during recovery. Implications: The generation of HFIP would be inhibited when the inhaled sevoflurane concentration increased to 1.5 MAC. However, the incidence of EA during recovery had nothing to do with the inhaled different sevoflurane concentrations (within 1.5

Effects of grade B liver dysfunction on the level of free hexafluoroisopropanol of sevoflurane metabolites in patients with abdominal surgery

“…It may delay the anesthesia recovery time, even result in the occurrence of emergence agitation during recovery. In this study, longer recovery time and deeper sedation and analgesia were found in the patients with grade B liver dysfunction than the patients with normal liver function during the period of anesthesia recovery (Table 4- 5). Is this phenomenon caused by the retained free HFIP in the body?…”

Effects of sevoflurane and its metabolite hexafluoroisopropanol on hypoxia/reoxygenation-induced injury and mitochondrial bioenergetics in murine cardiomyocytes

“…Approximately 2% of sevoflurane is metabolised to HFIP by liver cytochrome P450, 26 which can be detected 5 min after sevoflurane application and peaks after 60 min. 26 , 27 Eighty-five percent is rapidly converted into HFIP-glucuronide and eliminated via the kidneys. 26 Concentrations of HFIP in our experiments were similar to previous in vitro 28 and in vivo 24 studies but higher than those measured during sevoflurane anaesthesia.…”

Predictive Value of Preoperative Profiling of Serum Metabolites for Emergence Agitation After General Anesthesia in Adult Patients

“…Airway obstruction, hypoxia, inadequately treated pain, and hemodynamic instability were corrected immediately if they occurred ( Munk et al, 2016 ). A low dose of propofol or midazolam was used for severe agitation, and repeat dosing was instigated until the patient could emerge calmly from general anesthesia ( Demir and Yuzkat, 2018 ; Feng et al, 2019 ). All patients returned to the ward when they were fully awake and met the criteria for PACU discharge.…”