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Anesthesia and the Patient with Epilepsy
Published in Stanley R. Resor, Henn Kutt, The Medical Treatment of Epilepsy, 2020
Samantha L. Mullis, A. Donald Finek
Desflurane (1–653) is a new volatile anesthetic that is structurally similar to isoflurane by the simple substitution of a fluorine for a chlorine atom. Because of the anesthetic’s low blood solubility, it has the potential for allowing for a rapid induction and emergence from anesthesia and may prove to be an ideal agent in ambulatory procedures (37). Although the EEG effects of desflurane have not yet been studied in humans, the agent has been investigated in swine and shown to produce electrical activity similar to that produced by isoflurane (38). There is no evidence to suggest that desflurane will induce epileptiform activity or clinical seizures. Unlike enflurane, hypocapnia did not seem to have any effect upon EEG activity in the animals exposed to desflurane (38). Certainly, more data will need to be accumulated in regard to the EEG effects of desflurane in the patient with preanesthetic EEG abnormalities before any conclusions can be drawn concerning its usage in the patient with a history of seizures.
General Anesthetics
Published in Sahab Uddin, Rashid Mamunur, Advances in Neuropharmacology, 2020
Aman Upaganlawar, Abdulla Sherikar, Chandrashekhar Upasani
Desflurane is difluoromethyl 1-fluoro-2, 2, 2-trifluoromethyl ether. At room temperature, desflurane is a pungent, non-inflammatory, non-corrosive, and highly volatile liquid (vapor pressure=681 mmHg) brought in to clinical practice in 1992 by the USA. It is at room temperature. Generally heated vaporizers are used for delivery of a precise concentration of desflurane as a pure vapor in combination ith other gases (O2, air, or N2O; Brunton et al., 2011; Wilson and Gisvold, 2004).
Perioperative cardiovascular evaluation and treatment of elderly patients undergoing noncardiac surgery
Published in Wilbert S. Aronow, Jerome L. Fleg, Michael W. Rich, Tresch and Aronow’s Cardiovascular Disease in the Elderly, 2019
Dipika Gopal, Monika Sanghavi, Lee A. Fleisher
Two other inhalation agents, desflurane and sevoflurane, are available. Desflurane has the fastest onset of inhaled anesthetics and is commonly used in the outpatient setting, although it has been shown to be associated with airway irritability leading to tachycardia. In a large-scale study comparing a narcotic-based anesthetic with desflurane, the desflurane group had a significantly higher incidence of myocardial ischemia (87). By including narcotics with desflurane, this tachycardia can be avoided. Sevoflurane is the newest approved agent for use in the United States.
An assessment of the survival impact of multimodal anesthesia/analgesia technique in adults undergoing cytoreductive surgery with hyperthermic intraperitoneal chemotherapy: a propensity score matched analysis
Published in International Journal of Hyperthermia, 2019
Juan P. Cata, Linh T. Nguyen, Ifeyinwa C. Ifeanyi-Pillette, Antoinette Van Meter, Lori A. Dangler, Lei Feng, Pascal Owusu-Agyemang
Several aspects of care including the choice of anesthetic agents and pain management were not standardized. However, typical anesthetic management involved the placement of an epidural catheter or transversus abdominus plane block (with liposomal bupivacaine), followed by a general anesthesia with either volatile-opioid anesthesia (VO group) or multimodal opioid-sparing TIVA (MA group). The VO group commonly received desflurane in a mixture of air and oxygen, and intravenous (IV) infusions of an opioid (sufentanil or fentanyl) and muscle relaxant (rocuronium or cisatracurium). Occasionally, IV infusions of lidocaine, ketamine, dexmedetomidine or low dose propofol were used in combination with volatile agents. Patients in the MA group received the preoperative administration of pregabalin (75 mg), celecoxib (200–400 mg) and tramadol (300 mg), followed by continuous infusions of propofol (50–150 mcg/kg/min), dexmedetomidine (0.075–0.3 mcg/kg/h), ketamine (2.5–10 mg/h), IV lidocaine (0.5 mg/min), and a muscle relaxant (rocuronium or cisatracurium). Intermittent boluses of opioids (sufentanil or fentanyl) were administered according to clinical judgment. In both groups, a continuous epidural infusion of bupivacaine (0.075%) with hydromorphone (5–10 mcg/ml) was used in patients with epidural catheters.
Evaluation and control of waste anesthetic gas in the postanesthesia care unit within patient and caregiver breathing zones
Published in Baylor University Medical Center Proceedings, 2019
George W. Williams, Sam D. Gumbert, Evan G. Pivalizza, Tariq A. Syed, Tyrone Burnett, Omar L. Mancillas, Leslie A. Vargas, Stephanie H. Ahn, Chunyan Cai, Carin A. Hagberg
In the operating room, standard American Society of Anesthesiologists monitors were applied. General anesthesia was induced by bolus administration of propofol (1.5 to 2 mg/kg) and fentanyl (1 mcg/kg), and rocuronium (0.6 mg/kg) was administered to provide muscle relaxation. The patient’s lungs were ventilated via anesthesia face mask and 100% oxygen until the patient was completely relaxed (train of four on twitch monitor was 0). The patient’s airway was then secured either by placement of a supraglottic airway or laryngoscopy and endotracheal intubation. Anesthesia was maintained with either sevoflurane or desflurane inhalational agents. The lungs were mechanically ventilated with a semiclosed circle system to maintain an end-tidal carbon dioxide near 35 mm Hg.
Dosage of sugammadex according to the calculated lean body mass in obese female patients: time to reverse moderate neuromuscular blockade induced by rocuronium
Published in Southern African Journal of Anaesthesia and Analgesia, 2019
Cheik Tidiane Hafid Wind-Pouiré Bougouma, Jean-Luc RJ Demeere
Stout et al.13 and Wulf et al.14 found that desflurane did not significantly alter the time to recovery from rocuronium. However, desflurane anaesthesia significantly prolonged the duration of action of rocuronium at 0.9 mg/kg single bolus dose, when compared with sevoflurane or propofol anaesthesia maintenance regimens.15 In our study, all the anaesthesia procedures were done with desflurane and rocuronium 1.2 mg/kg. Desflurane can change the time to recovery, but should the effect of sugammadex be influenced by the inhalational anaesthetic? Reversal of rocuronium-induced block by sugammadex did not differ between anaesthesia with propofol or sevoflurane.16