Foreign body
Mohammad Ibrarullah in Atlas of Diagnostic Endoscopy, 2019
This chapter presents various types of foreign bodies detected in the UGI tract. Endoscopy also plays a therapeutic role in removing the foreign bodies. Esophageal inlet is the commonest site of foreign body (FB) impaction. Dysphagia, odynophagia, chest pain and excessive salivation are the usual symptoms. Contrary to the common practice, FB extraction should always be performed under general anesthesia. It is our practice to use intravenous propofol anesthesia in adults and intubation anesthesia in the pediatric age group. A quiet patient, relaxed cricopharyngeus, secure airway and proper instrument are paramount in successful removal of a FB from the UGI tract.
Dissociative Anesthetics
D. Hank Ellison, Olaf Drummer in Karch's Pathology of Drug Abuse, 2016
The drugs described in this chapter-phencyclidine (PCP), ketamine, γ-hydroxybutyrate (GHB), dextromethorphan (DXM), Salvia divinorum, and propofol-are hallucinogens. All save Salvia are N-methyl-d-aspartate (NMDA) channel blockers (Jordan et al., 2006). In vitro evidence suggests that none of them binds to the D2 dopamine receptor, as do stimulant drugs such as cocaine and methamphetamine. While the psychological profiles produced by their use appear to be grossly similar, Salvia is a pure κ blocker that operates via a completely different mechanism than other hallucinogens. Propofol is an agonist at γ-aminobutyric acid (GABA)-A receptors, occasionally exerting hallucinogenic effects, depending on dosage. DXM is a cough remedy that shares many of the hallucinogenic properties of other NMDA blockers, but only when used to excess.
Day Surgery
T.M. Craft, P.M. Upton in Key Topics In Anaesthesia, 2021
A surgical day case is a patient who is admitted for an investigation or operation on a non-resident basis but who also requires facilities for recovery. The British definition of a day case is one who does not stay overnight. Accurate selection of both patients and procedures is the key to safe and effective day case surgery. Potential difficulties arising from day surgery include: less time for preoperative communication and psychological preparation, limited patient and operation suitability, a need for rapid recovery from anaesthesia, postoperative hospital admission must be possible, limited care maybe available to the patient after discharge. Premedication with small doses of anxiolytics or short-acting opioids does not delay recovery in the majority. The problems of general anaesthesia are avoided but prolonged block may delay discharge, e.g. urinary retention following caudal, spinal or epidural blocks. Individual nerve blocks and local infiltration have fewer side-effects. Intravenous sedation with propofol or midazolam maybe required.
miR-455-3p alleviates propofol-induced neurotoxicity by reducing EphA4 expression in developing neurons
Published in Biomarkers, 2020
Xiaojuan Zhu, Huifang Li, Ming Tian, Shuqin Zhou, Yuqin He, Ming Zhou
Purpose Propofol, an aesthetic agent in paediatric patients, results in neurotoxicity in the developing neurons. To reduce side effects of propofol, the protective role of miR-455-3p (microRNA-455-3p) in developing rat brain was investigated. Materials and methods Primary hippocampal neurons were isolated from postnatal day 1 or 2 SD (Sprague-Dawley) rats. The neurons were exposed to various concentrations of propofol (0, 10, 30, or 50 μM) for 6 h. Propofol-induced cell viability was assessed by MTT assay, expression levels of miR-455-3p and EphA4 (erythropoietin-producing hepatocellular A4) in propofol-induced neurons were determined using qRT-PCR and western blot, respectively. Binding ability between miR-455-3p and EphA4 was predicted, and then validated by luciferase reporter assay. Neurons expressing miR-455-3p mimics, were treated with 50 μM propofol for 6 h, and apoptosis status was evaluated by flow cytometry. Results Exposure to propofol significantly decreased cell viability of developing neurons isolated from neonatal rats. Propofol decreased miR-455-3p expression, while increased EphA4 level in the neurons. miR-455-3p mimics increased propofol-induced reduce in cell viability, and attenuated propofol-induced cell apoptosis of neurons. MiR-455-3p could target EphA4, and decreased expression of EphA4 in neurons exposure to propofol. EphA4 knockdown counteracted with the promotive effects of propofol on cell viability and apoptosis of neurons. Conclusion Propofol treatment induces neurotoxicity and suppresses miR-455-3p levels in the developing hippocampal neurons. However, miR-455-3p could alleviate such neurotoxicity by reducing EphA4 expression, provided new insights into miR-455-3p as novel therapeutic target to prevent propofol-induced damages from bench to clinic.
Propofol hemisuccinate suppression of experimental autoimmune encephalomyelitis
Published in Autoimmunity, 2007
G. Vansant, R. J. Trauger, A. Cameron, M. Vendemelio, S. Kreitschitz, A. T. Carlo, M. G. Banaszczyk, D. J. Carlo, S. Hendler, C. R. Ill
Propofol hemisuccinate is a prodrug water soluble form of the lipophilic, phenolic compound propofol (2,6-di-isopropylphenol), that is the active ingredient in the widely used anesthetic agent Diprovan. Propofol binds to GABAA receptors but also has a phenolic structure that confers antioxidant properties to the molecule. The effects of propofol hemisuccinate in rat experimental autoimmune encephalomyelitis (EAE) were studied using different doses and time regimes. Propofol hemisuccinate, 100 mg/kg given three times a day from day 7 or day 12 until day 16 after disease initiation, significantly reduced maximal EAE score. Histology studies supported the clinical findings demonstrating reduction in the inflammatory response in the lumbar spinal cord in animals treated with propofol hemisuccinate. Decreased levels of nitrotyrosine and unchanged levels of induced nitric oxide synthase suggest propofol hemisuccinate crossed the blood brain barrier and exerted its effects by lowering reactive oxygen species levels. The results suggest that propofol hemisuccinate may provide an alternative mode of treatment for acute exacerbations of multiple sclerosis.
A prospective, randomised, controlled clinical trial to evaluate the effect of nitrous oxide on propofol requirement in elective craniotomy in which entropy was used to measure depth of anaesthesia
Published in Southern African Journal of Anaesthesia and Analgesia, 2016
P Nanda, P Prakash, KJ Choudhury, VP Singh, S Prakash
Background: Propofol is known to have a favourable effect on cerebral haemodynamics. The role of nitrous oxide (N2O) in neurosurgical anaesthesia is still being debated. The primary aim of this study was to assess the dose-sparing effect of N2O on propofol infusion maintenance dosing. Method: Fifty American Society of Anesthesiology (ASA) grade I and II adults scheduled for elective craniotomies for supratentorial tumours were enrolled in the study. The patients received a standard anaesthetic comprising a fentanyl 2 μg/kg bolus prior to propofol induction. Anaesthesia was maintained with an infusion of fentanyl (2 μg/kg/hour), atracurium and propofol. The patients were randomised into two groups. Group A received 67% N2O. Group B did not receive N2O concomitantly with the propofol infusion. Entropy was used to guide the titration of the propofol infusion in both groups. Results: The propofol maintenance dose requirements were 47% lower in Group A (54.30 ± 11.47 μg/kg/minute) vs. Group B (102.30 ± 14.00 μg/kg/minute), (p < 0.001). Conclusion: The use of supplemental N2O significantly decreased propofol infusion rate requirements, compared with the propofol infusion alone, in ASA I and II patients undergoing elective supratentorial tumour excision.
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