Sevoflurane: Approaching the Ideal Inhalational Anesthetic A Pharmacologic, Pharmacoeconomic, and Clinical Review

Delgado-Herrera, Leticia; Ostroff, Randall D.; Rogers, Sharon A.

doi:10.1111/j.1527-3458.2001.tb00190.x

Cited by 68 publications

(44 citation statements)

References 342 publications

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“…56,57 However, preclinical studies have demonstrated that early exposure to general anesthetics, such as ketamine, isoflurane, nitrous oxide, and sevoflurane, induces widespread neuronal apoptosis in many brain regions in rodent models. 5,6,17,21,25,49,50,58,59 in a previous study, 60 we also provided evidence of sevoflurane-induced neurotoxicity and some observations on the temporal features of this effect in neonatal rats. The first report describing neuronal cell damage in nonhuman primates exposed perinatally to anesthetics was published in 2007.…”

Section: Discussionsupporting

confidence: 53%

In VivoMonitoring of Sevoflurane-induced Adverse Effects in Neonatal Nonhuman Primates Using Small-animal Positron Emission Tomography

et al. 2016

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Background Animals exposed to sevoflurane during development sustain neuronal cell death in their developing brains. In vivo micro-positron emission tomography (PET)/computed tomography imaging has been utilized as a minimally invasive method to detect anesthetic-induced neuronal adverse effects in animal studies. Methods Neonatal rhesus monkeys (postnatal day 5 or 6, 3 to 6 per group) were exposed for 8 h to 2.5% sevoflurane with or without acetyl-l-carnitine (ALC). Control monkeys were exposed to room air with or without ALC. Physiologic status was monitored throughout exposures. Depth of anesthesia was monitored using quantitative electroencephalography. After the exposure, microPET/computed tomography scans using 18F-labeled fluoroethoxybenzyl-N-(4-phenoxypyridin-3-yl) acetamide (FEPPA) were performed repeatedly on day 1, 1 and 3 weeks, and 2 and 6 months after exposure. Results Critical physiologic metrics in neonatal monkeys remained within the normal range during anesthetic exposures. The uptake of [18F]-FEPPA in the frontal and temporal lobes was increased significantly 1 day or 1 week after exposure, respectively. Analyses of microPET images recorded 1 day after exposure showed that sevoflurane exposure increased [18F]-FEPPA uptake in the frontal lobe from 0.927 ± 0.04 to 1.146 ± 0.04, and in the temporal lobe from 0.859 ± 0.05 to 1.046 ± 0.04 (mean ± SE, P < 0.05). Coadministration of ALC effectively blocked the increase in FEPPA uptake. Sevoflurane-induced adverse effects were confirmed by histopathologic evidence as well. Conclusions Sevoflurane-induced general anesthesia during development increases glial activation, which may serve as a surrogate for neurotoxicity in the nonhuman primate brain. ALC is a potential protective agent against some of the adverse effects associated with such exposures.

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Section: Discussionsupporting

confidence: 53%

In VivoMonitoring of Sevoflurane-induced Adverse Effects in Neonatal Nonhuman Primates Using Small-animal Positron Emission Tomography

et al. 2016

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“…Compared with propofol, sevoflurane is metabolized independent of liver and renal function; therefore, it is more controllable (42).…”

Section: Discussionmentioning

confidence: 99%

Sevoflurane may be more beneficial than propofol in patients receiving endoscopic variceal ligation and endoscopic variceal sclerotherapy: A randomized, double-blind study

Tang

Liu

et al. 2017

Experimental and Therapeutic Medicine

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Abstract. The aim of the present study was to evaluate the safety and efficacy of various general anesthesia regimens during endoscopic variceal ligation (EVL) and endoscopic variceal sclerotherapy (EVS). A total of 123 patients with American Society of Anesthesiologists physical status III and IV, aged 40-70 years, undergoing general anesthesia for EVL and EVS were randomly divided into two groups: Sevoflurane anesthesia (group S; n=60) and propofol anesthesia (group P; n=60). Vital signs, particularly heart rate (HR) and mean arterial pressure (MAP), were monitored. The designated time points were as follows: 5 min before induction (T0), and 1, 5, 10, 15, 20, 25 and 30 min after intubation (T1, T2, T3, T4, T5, T6 and T7, respectively). Time intervals were recorded, including recovery time and extubation time. Following surgery, the observer recorded the Ramsay sedation scale (RSS) score and the visual analogue scale (VAS) score. Adverse reactions were noted. Results demonstrated that there were significant differences in MAP between the two groups at T2, T3, T5, T6 and T7 (P<0.05). There was a significant difference in HR between the two groups at T2, T3 and T4 (P<0.05). Recovery time and extubation time in group P were significantly longer than those in group S (P<0.05; 18.38±2.25 min vs. 14.57±1.04 min and 21.70±2.70 min vs. 15.83±0.88 min, respectively). The rate of ephedrine injected was 58.3% (35/60 patients) in group P vs. 28.3% (17/60 patients) in group S (P<0.05). There was a significant difference in the RSS score between the two groups 5 min after extubation (P<0.05). VRS scores demonstrated that anesthetists and patients were significantly more satisfied with the procedure in group S than in group P (P<0.01). In conclusion, the superiority and special clinical value of inhalational anesthesia has been demonstrated during EVL and EVS attributed to stable hemodynamics and high quality of anesthesia recovery in the present study.

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“…These properties imply that sevoflurane provides rapid and smooth induction and recovery from anaesthesia (13). However, it is known that sevoflurane may lead to cognitive dysfunction, despite the sub-anaesthetic dose usage in adults (14).…”

Section: Discussionmentioning

confidence: 99%

Short-Term and Long-Term Effects of Dexamethasone on Cognitive Dysfunction Induced by Sevoflurane in Adult Rats

Karaman

Doğru

et al. 2017

Turk J Anaesth Reanim

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Objective: Postoperative cognitive dysfunction (POCD) is common after anaesthesia in elderly patients. However, it may appear in patients of all ages. The main pathogenesis of cognitive dysfunction remains unclear, although there is some evidence that brain inflammation may alter cognitive abilities. In the present study, we aim to evaluate short-term and long-term effects of dexamethasone on cognitive dysfunction induced by sevoflurane anaesthesia in adult rats.Methods: Seven-month-old 30 male Wistar albino rats were randomised into three groups: sevoflurane group (exposure to sevoflurane), sevoflurane + dexamethasone group (exposure to sevoflurane and dexamethasone injection), and control group (exposure to 100% oxygen). Spatial learning and short-term (7 days after exposure) and long-term (30 days after exposure) memory were evaluated using Morris water maze test.Results: Sevoflurane induced significant deficit in spatial learning and short-term and long-term memory in adult rats. Dexamethasone-treated animals exposed to sevoflurane had equivalent performance as control animals in training and probe trials. Conclusion:Sevoflurane may impair spatial learning and short-term and long-term memories in adult rats. The co-administration of dexamethasone and sevoflurane may ameliorate short-term and long-term cognitive dysfunctions induced by sevoflurane in adult rats. Keywords: Sevoflurane, dexamethasone, cognitive disordersAmaç: Postoperatif kognitif disfonksiyon (POKD) yaşlı hastalarda anestezi sonrası sık olmaktadır. Ancak POKD tüm yaşlarda da görü-lebilmektedir. Kognitif disfonksiyonun temel patogenezi tam olarak bilinmemekle birlikte beyin inflamasyonunun bilişsel yetenekleri değiştirebildiğine dair bazı kanıtlar bulunmaktadır. Bu çalışmada, erişkin farelerde sevofluran anestezisi ile oluşturulmuş kognitif disfonksiyon üzerine deksametazonun erken ve geç dönem etkilerini araştırmayı amaçladık.Yöntemler: Yedi aylık 30 erkek wistar albino rat üç gruba ayrıldı; grup sevofluran (sevofluran anestezisine maruziyet), grup sevofluran+deksametazon (sevofluran anestezisiyle birlikte deksametazon enjeksiyonuna maruziyet) ve grup kontrol (%100 oksijene maruziyet). Uzaysal öğrenme, erken (maruziyetten 7 gün sonra) ve geç (maruziyetten 30 gün sonra) dönem hafıza Morris su labirenti testi ile değerlendirildi. Bulgular: Sevofluran anestezisi erişkin ratlarda uzaysal öğrenme, erken ve geç dönem hafıza üzerinde anlamlı derecede olumsuz etki oluşturdu. Deksametazon ile tedavi edilmiş ratlar ise eğitim ve araş-tırma testlerinde kontrol grubuna benzer bir performans gösterdi.Sonuç: Sevofluran erişkin ratlarda uzaysal öğrenmeyi, erken ve geç dönem hafızayı olumsuz etkileyebilir. Sevofluran anestezisi ile birlikte deksametazon uygulanması erişkin ratlarda sevofluran ile oluş-turulmuş erken ve geç dönem kognitif disfonksiyonu iyileştirebilir.Anahtar sözcükler: Sevofluran, deksametazon, biliş bozuklukları Abstract / Öz

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Sevoflurane: Approaching the Ideal Inhalational Anesthetic A Pharmacologic, Pharmacoeconomic, and Clinical Review

Cited by 68 publications

References 342 publications

In VivoMonitoring of Sevoflurane-induced Adverse Effects in Neonatal Nonhuman Primates Using Small-animal Positron Emission Tomography

In VivoMonitoring of Sevoflurane-induced Adverse Effects in Neonatal Nonhuman Primates Using Small-animal Positron Emission Tomography

Sevoflurane may be more beneficial than propofol in patients receiving endoscopic variceal ligation and endoscopic variceal sclerotherapy: A randomized, double-blind study

Short-Term and Long-Term Effects of Dexamethasone on Cognitive Dysfunction Induced by Sevoflurane in Adult Rats

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