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Jan G Jakobsson - One of the best experts on this subject based on the ideXlab platform.

  • Desflurane and sevoflurane use during low and minimal flow anesthesia at fixed vaporizer settings
    Minerva Anestesiologica, 2016
    Co-Authors: Maria Horwitz, Jan G Jakobsson
    Abstract:

    BACKGROUND: The pharmacokinetics for sevoflurane and Desflurane makes them suitable for low-flow anesthesia. The aim of the present study was to assess the use of Desflurane and sevoflurane at constant vaporizer settings and fixed low fresh gas flows. METHODS: One hundred ASA 1-2 patients undergoing elective laparoscopic surgery were randomized into 4 groups (25 patients each): a fixed fresh gas flow 1.0 or 0.5 L/min with Desflurane (D1.0 and D0.5) or sevoflurane (S1.0 and S0.5) throughout anesthesia. A fixed vaporizer setting, sevoflurane 6% and Desflurane 18% was used during wash-in. Time to reach 1 and 1.5 minimum alveolar concentration (MAC), emergence and gas consumption from start to end of surgery was studied. RESULTS: Time to reach 1 MAC age adjusted Desflurane or sevoflurane was D0.5 8.5±1.7, D1.0 3.7±0.7, S0.5 15.2±2.4 and S1.0 6.2±1.3 minutes, respectively (P<0.001), and times to increase from 1 to 1.5 MAC differed also significantly. Desflurane anesthesia was associated to significantly shorter time to extubation 6.7±2.3 vs. 10±2.3 minutes for sevoflurane (P<0.001). The amount of agent consumed g/min. was significantly reduced for both 0.5 L/min groups: 30% less for Desflurane and 19% for sevoflurane. CONCLUSIONS: We found an almost twice as rapid wash-in with Desflurane and expectedly faster emergence. Gas consumption was lower at 0.5 L/min than it was at 1 L/min for both gases studied however most pronounced for Desflurane. Desflurane has clear advantages for minimal fresh gas flow anesthesia.

  • Desflurane a clinical update of a third generation inhaled anaesthetic
    Acta Anaesthesiologica Scandinavica, 2012
    Co-Authors: Jan G Jakobsson
    Abstract:

    Available volatile anaesthetics are safe and efficacious; however, their varying pharmacology provides small but potentially clinically important differences. Desflurane is one of the third-generation inhaled anaesthetics. It is the halogenated inhaled anaesthetic with the lowest blood and tissue solubilities, which promotes its rapid equilibration and its rapid elimination following cessation of administration at the end of anaesthesia. The low fat solubility of Desflurane provides pharmacological benefits, especially in overweight patients and in longer procedures by reducing slow compartment accumulation. A decade of clinical use has provided evidence for Desflurane's safe and efficacious use as a general anaesthetic. Its benefits include rapid and predictable emergence, and early recovery. In addition, the use of Desflurane promotes early and predictable extubation, and the ability to rapidly transfer patients from the operating theatre to the recovery area, which has a positive impact on patient turnover. Desflurane also increases the likelihood of patients, including obese patients, recovering their protective airway reflexes and awakening to a degree sufficient to minimise the stay in the high dependency recovery area. The potential impact of the rapid early recovery from Desflurane anaesthesia on intermediate and late recovery and resumption of activities of daily living requires further study.

Budreau David - One of the best experts on this subject based on the ideXlab platform.

  • comparison of the influence of Desflurane inhalation versus isoflurane inhalation on the morbidly obese patients undergoing laparoscopic gastric bypass surgery keeping adequate anesthetic depth and recovery
    The Chinese Journal of Clinical Pharmacology, 2007
    Co-Authors: Budreau David
    Abstract:

    Objective To compare the efficacy and recovery profile of isoflurane and Desflurane as the main anesthetics for morbidly obese patients under bispectral index(BIS) monitoring. Methods Forty morbidly obese patients (body mass index ≥35 kg·m -2) were randomly assigned into two groups. After intravenous induction of general anesthesia and tracheal intubation, anesthesia was maintained with either Desflurane or isoflurane as the main anesthetics. The concentrations of the volatile drugs were adjusted to maintain BIS between 40 to 50 and hemodynamic stable. When the surgeon started the skin suture, the end-tidal concentration of the inhalational drug was reduced to keep BIS at 60. At the last skin suture,the inhalational drug was discontinued.During the postope- rative period the Adrete test was carried out to evaluate the intermediate recovery. Results No differences in anesthetic exposure and intraoperative adjuvants consumptions were found between the two groups. Eye opening, hand grip, extubation and orientation times of Desflurane [(8.1±3.7),(9.8±4.1),(10.6±4.1),(14.1±5.5) min] were shorter than isoflurane[(13.2±4.9) ,(15.6±6.3),(16.9±6.9),(21.9±8.2) min] (P0.05). The time for Aldrete score reaching 9 was significantly shorter after desfurane than isoflurane(P0.05).Conclusion Under BIS monitoring,both Desflurane and isoflurane can provide a safe and effective intraoperative control of hemodynamic stability and keep adequate anesthetic depth in morbidly obese patients. But Desflurane has the advantage of a faster recovery and earlier discharge from the postanesthesia care unit than isoflurane.

Stefan W. Suttner - One of the best experts on this subject based on the ideXlab platform.

  • Desflurane anesthesia after sevoflurane inhaled induction reduces severity of emergence agitation in children undergoing minor ear-nose-throat surgery compared with sevoflurane induction and maintenance
    Anesthesia & Analgesia, 2006
    Co-Authors: Jochen Mayer, Joachim Boldt, Kerstin D. Röhm, Klaus Scheuermann, Stefan W. Suttner
    Abstract:

    Emergence agitation may occur after general anesthesia with volatile anesthetics in children. We designed this study to examine the emergence behavior of children undergoing ear-nose-throat surgery after sevoflurane induction and Desflurane maintenance versus both sevoflurane induction and maintenance using a recently published Pediatric Anesthesia Emergence Delirium (PAED) scale. In 38 premedicated children aged 12 mo to 7 yr mask induction with sevoflurane was performed and they were randomly assigned to receive either sevoflurane (n = 19) or Desflurane (n = 19) for maintenance of general anesthesia. Time to tracheal extubation, modified Aldrete score, emergence behavior, recovery complications, and pain scores were assessed. The PAED scale showed a significant advantage for Desflurane (6 [0-15] versus 12 [2-20], maximum total score of 20 for severe agitation). Time to extubation was significantly shorter with Desflurane than with sevoflurane (5.4 +/- 1.4 versus 13.4 +/- 1.8 min). The modified Aldrete score on arrival in the postanesthesia care unit (PACU) was significantly lower in children receiving sevoflurane for maintenance. Time to discharge from PACU to normal ward and the incidence of adverse effects were not significantly different between the groups. In conclusion, the use of Desflurane for maintenance of anesthesia after sevoflurane induction in children is associated with less severe emergence agitation and faster emergence times.

  • early recovery cognitive function and costs of a Desflurane inhalational vs a total intravenous anaesthesia regimen in long term surgery
    Acta Anaesthesiologica Scandinavica, 2006
    Co-Authors: K D Rohm, Stefan W. Suttner, Swen N Piper, S Schuler, J Boldt
    Abstract:

    Background:  The purpose of the study was to compare time of recovery, return of cognitive function, post-anaesthetic care unit (PACU) stay and costs of a propofol/remifentanil (TIVA) with a Desflurane/fentanyl-based anaesthesia (Desflurane group) in surgical procedures lasting more than 150 min. Methods:  Forty-nine patients undergoing elective abdominal prostatectomy were allocated randomly to receive bispectal index (BIS)-controlled Desflurane/fentanyl (n = 24) or propofol/remifentanil (n = 25). Awakening, clinical recovery, direct drug acquisition and post-operative pain treatment were documented. Cognitive skills were tested using the Mini-Mental Status (MMST) test. Results:  Extubation was significantly faster with Desflurane (6.9 ± 3.5 min) than with TIVA (11.2 ± 4.0 min) as well as times for stating name and date of birth (Desflurane: 6.1 ± 3.9 and 6.6 ± 4.0 min; TIVA: 12.4 ± 11.5 min and 13.4 ± 11.3 min). There were no significant differences in PACU discharge times or MMS scores between the groups. Significantly more patients suffered post-operative nausea and vomiting (PONV) in the Desflurane (33% vs. 0%) than the TIVA group. Overall costs were significantly higher in the TIVA (58.8 ± 11.6 €) than in the Desflurane group (35.0 ± 5.7 €). Conclusion:  Patients undergoing prolonged surgical procedures showed a faster early recovery after Desflurane/fentanyl than using TIVA, whereas stay in the PACU and recovery of cognitive function were similar in both groups. Costs of a TIVA regimen were significantly higher than using a Desflurane-based anaesthesia technique.

  • insignificant effect of Desflurane fentanyl thiopental on hepatocellular integrity a comparison with total intravenous anaesthesia using propofol remifentanil
    European Journal of Anaesthesiology, 2005
    Co-Authors: Kerstin D. Röhm, Stefan W. Suttner, J Boldt, T Schollhorn, Swen N Piper
    Abstract:

    BACKGROUND AND OBJECTIVE Inhalational anaesthetics have been associated with hepatotoxicity. Even Desflurane, with its low solubility in blood and tissues, and its minimal hepatic biotransformation, is known to affect hepatic integrity. The effects of propofol on hepatic function are, however, a matter of controversy. Alpha-glutathione S-transferase (alpha-GST), a sensitive and specific biomarker for hepatic integrity, was measured to assess the influence of total intravenous anaesthesia (TIVA) with propofol vs. anaesthesia with Desflurane. METHODS Forty-two patients scheduled for elective prostatectomy were randomly allocated to receive either Desflurane, fentanyl and thiopental (Desflurane group) or propofol and remifentanil (TIVA group). Depth of anaesthesia was guided by bispectral index. Plasma concentrations of alpha-GST and aminotransferases were measured before induction of anaesthesia (TO), at the end of surgery (T1), as well as 2 h (T2) and 24 h (T3) postoperatively. Haemodynamic parameters and bispectral index values were documented. RESULTS alpha-GST increased significantly in the Desflurane group from TO (3.0 +/- 2.2 microg L(-1)) to T1 and T2 (5.5 +/- 4.3 and 5.6 +/- 3.7 microg L(-1), respectively), whereas no changes were seen in the TIVA group. alpha-GST values above the normal upper limit (> 7.5 microg L(-1)) were seen in 24% of the patients receiving Desflurane. Aminotransferases remained unchanged in both groups throughout the study period. CONCLUSIONS The use of propofol as part of a TIVA regimen seems to have no influence on hepatocellular function during and after surgery. In contrast, patients receiving Desflurane showed a transient slight, but significant, increase of alpha-GST to above the normal upper limit after anaesthesia, although this was without further clinical relevance.

Edmond I. Eger - One of the best experts on this subject based on the ideXlab platform.

  • the pharmacology of inhaled anesthetics
    Seminars in Anesthesia Perioperative Medicine and Pain, 2005
    Co-Authors: Edmond I. Eger
    Abstract:

    The two most popular potent inhaled anesthetics, Desflurane and sevoflurane, differ in pharmacological advantages and disadvantages in sometimes subtle and sometimes obvious ways. Sevoflurane has a low solubility and absent pungency that makes it easy to use and is the anesthetic of choice for an inhalational induction of anesthesia. It does not stimulate the circulation. In contrast, concentrations exceeding 6% Desflurane can cause airway irritation and circulatory stimulation, especially early in anesthesia. Desflurane requires a greater educational investment to deal with these issues. The lower solubility of Desflurane (half that of sevoflurane) allows a faster recovery, often an earlier time to PACU discharge, and an earlier restoration of adequate ventilation and control of protective pharyngeal reflexes. Desflurane’s resistance to degradation by normal absorbents allows its use at low inflow rates (eg, 500 mL/min), whereas sevoflurane must be used at inflow rates of 1 L/min or more (2 L/min after 2 MAC-hours). Higher inflow rates increase cost. Desiccated absorbent degradation of sevoflurane (but not Desflurane) can result in high temperatures and fires. Desiccated absorbents degrade both anesthetics to carbon monoxide, more with Desflurane. Sevoflurane, but not Desflurane, can cause convulsions. Desflurane and sevoflurane share several desirable attributes. Both may be used with laryngeal mask airways with minimal evidence of airway irritation during maintenance of anesthesia in either smokers or nonsmokers. Organ toxicity is unremarkable. Both may protect vital organs by “anesthetic preconditioning” (APC). In animals, APC with Desflurane may provide greater myocardial protection against hypoxia, but in humans, Desflurane and sevoflurane appear to be equally protective. Because both are halogenated solely with fluorine, neither materially affects the ozone layer.

  • the effect of anesthetic duration on kinetic and recovery characteristics of Desflurane versus sevoflurane and on the kinetic characteristics of compound a in volunteers
    Anesthesia & Analgesia, 1998
    Co-Authors: Edmond I. Eger, Michael J. Laster, Pompiliu Ionescu, Diane Gong, Donald D Koblin, Terri Bowland, Richard B Weiskopf
    Abstract:

    This study documents the differences in kinetics of 2 h (n = 7) and 4 h (n = 9) of 1.25 minimum alveolar anesthetic concentration (MAC) of Desflurane (9.0%) versus (on a separate occasion) sevoflurane (3.0%), both administered in a fresh gas inflow of 2 L/min. These data are extensions of our previous 8-h (n = 7) studies of these anesthetics. By 10 min of anesthetic administration, average inspired (F (I)) and end-tidal concentration (FA) (FI/FA; the inverse of the more commonly used FA/FI) decreased to less than 1.15 for both anesthetics, with the difference from 1.0 nearly twice as great for sevoflurane as for Desflurane. During all sevoflurane administrations, FA/FI for Compound A [CH2 F-O-C(=CF2) (CF3); a vinyl ether resulting from the degradation of sevoflurane by Baralyme[registered sign]] equaled approximately 0.8, and the average inspired concentration equaled approximately 40 ppm. Compound A is of interest because at approximately 150 ppm-h, it can induce biochemical and histological evidence of glomerular and tubular injury in rats and humans. During elimination, FA/FA0 for Compound A (FA0 is the last end-tidal concentration during anesthetic administration) decreased abruptly to 0 after 2 h and 4 h of anesthesia and to approximately 0.1 (FA approximately 3 ppm) after 8 h of anesthesia. In contrast, FA/FA0 for Desflurane and sevoflurane decreased in a conventional, multiexponential manner, the decrease being increasingly delayed with increasing duration of anesthetic administration. FA/FA0 for sevoflurane exceeded that for Desflurane for any given duration of anesthesia, and objective and subjective measures indicated a faster recovery with Desflurane. Times (mean +/- SD) to initial response to command (2 h 10.9 +/- 1.2 vs 17.8 +/- 5.1 min, 4 h 11.3 +/- 2.1 vs 20.8 +/- 4.8 min, 8 h 14 +/- 4 vs 28 +/- 8 min) and orientation (2 h 12.7 +/- 1.6 vs 21.2 +/- 4.6 min, 4 h 14.8 +/- 3.1 vs 25.3 +/- 6.5 min, 8 h 19 +/- 4 vs 33 +/- 9 min) were shorter with Desflurane. Recovery as defined by the digit symbol substitution test, P-deletion test, and Trieger test results was more rapid with Desflurane. The incidence of vomiting was greater with sevoflurane after 8 h of anesthesia but not after shorter durations. We conclude that for each anesthetic duration, FI more closely approximates FA with Desflurane during anesthetic administration, FA/FA0 decreases more rapidly after anesthesia with Desflurane, and objective measures indicate more rapid recovery with Desflurane. Finally, it seems that after 2-h and 4-h administrations, all Compound A taken up is bound within the body. Implications: Regardless of the duration of anesthesia, elimination is faster and recovery is quicker for the inhaled anesthetic Desflurane than for the inhaled anesthetic sevoflurane. The toxic degradation product of sevoflurane, Compound A, seems to bind irreversibly to proteins in the body. (Anesth Analg 1998;86:414-21)

  • biotransformation of halothane enflurane isoflurane and Desflurane to trifluoroacetylated liver proteins association between protein acylation and hepatic injury
    Anesthesia & Analgesia, 1997
    Co-Authors: Dolores B. Njoku, Diane H. Gong, Michael J. Laster, Edmond I. Eger, George F Reed, Jackie L Martin
    Abstract:

    : In susceptible patients, halothane, enflurane, isoflurane, and Desflurane can produce severe hepatic injury by an immune response directed against reactive anesthetic metabolites covalently bound to hepatic proteins. The incidence of hepatotoxicity appears to directly correlate with anesthetic metabolism catalyzed by cytochrome P450 2E1 to trifluoroacetylated hepatic proteins. In the present study, we examined whether the extent of acylation of hepatic proteins in rats by halothane, enflurane, isoflurane, and Desflurane correlated with reported relative rates of metabolism. After pretreatment with the P450 2E1 inducer isoniazid, five groups of 10 rats breathed 1.25 minimum alveolar anesthetic concentration (MAC) of halothane, enflurane, isoflurane, or Desflurane in oxygen, or oxygen alone, each for 8 h. Immunochemical analysis of livers harvested 18 h after anesthetic exposure showed tissue acylation (greatest to least) after exposure to halothane, enflurane, or isoflurane. Reactivity was not different between isoflurane as compared to Desflurane or oxygen alone. An enzyme-linked immunosorbent assay showed halothane reactivity was significantly greater than that of enflurane, isoflurane, Desflurane, or oxygen, and that enflurane reactivity was significantly greater than Desflurane or oxygen. Sera from patients with a clinical diagnosis of halothane hepatitis showed antibody reactivity against hepatic proteins from rats exposed to halothane or enflurane. No reactivity was detected in rats exposed to isoflurane, Desflurane, or oxygen alone. These results indicate that production of acylated proteins may be an important mediator of anesthetic-induced hepatotoxicity.

Young Eun Jang - One of the best experts on this subject based on the ideXlab platform.