No abstract available.
Anesthetics, General* ; Brain Injuries* ; Brain*

No abstract available.
Anesthetics, General ; Child ; Humans ; Propofol

No abstract available.
Anesthetics, General ; Child ; Humans ; Propofol

Many historical general anesthetics have been waxed and waned in the market of anesthetic field, mostly due to organ toxicities related to their metabolism, active metabolites and biodegradation, or other reasons. Modern anesthetics available now are known to undergo metabolism to the extent of clinical insignificance compared with the old ones. However, animal studies provided extensive evidences showing that general anesthetics are neurotoxic or neuroprotective in certain circumstances along with the advancement of knowledge on simultaneous neural injury and healing processes. Until now, there have been few prospective randomized clinical trials conducted to reveal these two issues. In fact, the concerns of the long-term effect of anesthetics on cognitive and behavior decline seem to be in arrears compared with those of the immediate effect of anesthetics, such as the rapidity of onset/offset of action, intraoperative hemodynamic controls or postoperative nausea and vomiting, etc. At present, we anesthesiologists, are challenged with the rapidly changing environments, in which the elderly population grows or a variety of sedation depth are required especially for patients of extreme ages. Concerns on anesthetics' effects with double edged sword are mounting from basic scientists and/or anesthesiologists, as well as public society, such as FDA in US. Therefore, I review the current findings from animal and human researches regarding the anesthetic potentials for neuroprotection and/or neurotoxicity under certain circumstances and their links with findings of clinical researches.
Aged ; Anesthetics ; Anesthetics, General ; Animals ; Hemodynamics ; Humans ; Postoperative Nausea and Vomiting

Various anesthetic agents have successfully used for patients undergoing surgery for pheochromocytoma removal. A review of the literature on the anenthetic marnagement of pheochromocytoma discloses no general agreement regarding choice of an anesthetic agent. It would appear that the selection of the anesthetic agent is not as important as the proper management of the patient Previously the anesthetic experience of a case of pheochromocythma removal managed under methoxyflurane anesthesis has been reported by us. Thereafter we have had another five eases of pheochromocytoma removal operation under general anesthesia, employing methoxyflmrane as a primary anesthetic, with relatively satisfactory results.
Anesthesia, General ; Anesthetics ; Humans ; Methoxyflurane* ; Pheochromocytoma*

BACKGROUND: Cerebral state index (CSI) is an anesthesia depth monitor alternative to bispectral index (BIS). Published comparative studies have used propofol or sevoflurane. However, studies using desflurane have not been reported yet. Different volatile anesthetics have different electroencephalography signatures. The performance of CSI may be different in desflurane anesthesia. Therefore, the objective of this study was to compare CSI and BIS during desflurane anesthesia. METHODS: Thirty-three patients were recruited. Desflurane and remifentanil were used to maintain general anesthesia. BIS and CSI were recorded simultaneously every minute. End-tidal concentration of desflurane was maintained at 4% from the beginning of surgery for 5 minutes. Pairwise data of CSI and BIS were obtained five times at one-minute intervals. This process was repeated in the order of 6%, 8%, and 10%. RESULTS: BIS and CSI were negatively correlated with the end-tidal concentration of desflurane with a similar degree of correlation (correlation coefficient BIS: –0.847, CSI: –0.844). The relationship between CSI and BIS had a good linearity with a slope close to 1 (R2 = 0.905, slope = 1.01). For the relationship between CSI and BIS at each end-tidal concentration of desflurane, CSI and BIS showed good linearity in 4% and 10% (R2 = 0.559, 0.540). However, the linearity and slope were decreased in 6% and 8% (R2 = 0.163, 0.014). CONCLUSIONS: CSI showed an equivalent degree of overall performance compared to BIS in desflurane anesthesia. Accounting for previous literature, CSI can be used as a good substitute for BIS regardless of the kind of anesthetics used.
Anesthesia* ; Anesthesia, General ; Anesthetics ; Electroencephalography ; Humans ; Propofol

BACKGROUND: Sevoflurane and desflurane are widely used anesthetics and can be simulated in pharmacokinetic models. These models are related to steady state pharmacokinetics, As anesthetic elimination is a non-steady state process, we evaluated the elimination data of volatile anesthetics using a two-compartment model (bi-exponential function). 50, 80, and 90% context-sensitive decrement times were evaluated with this function. These times are related to awakening and cognitive function recovery. METHODS: Forty-eight healthy patients were enrolled for minimal surgery under general anesthesia. They were randomly anesthetized with either sevoflurane or desflurane. At the end of surgery, when the administration of the volatile anesthetics was discontinued, end-tidal concentrations (PE) were recorded for 15 minutes. We calculated and analyzed the fraction of anesthetic concentrations (PE/PE0) using a bi-exponential function (PE0: the last end-tidal concentration of anesthetics during anesthesia). RESULTS: A bi-exponential function was fit to the elimination data using non-linear mixed-effect modeling. It showed that the anesthetic duration had effects on the coefficients of early and late components and not on the log rate constants. The coefficient of late components increased and the coefficient of early components decreased with prolonged anesthetic duration. Irrespective to the type of anesthetics, prolonged anesthesia did not affect the context-sensitive half-life; however, a prolonged period of time was required to reach 80 and 90% decrement after prolonged anesthesia. CONCLUSIONS: Prolonged anesthetic duration slowed down the elimination of volatile anesthetics. It delayed awakeness and a return to normal cognitive function after anesthesia.
Anesthesia ; Anesthesia, General ; Anesthetics ; Humans ; Isoflurane ; Methyl Ethers

At the level of individual cells, signaling is crucial in cell division, differentiation, metabolic control and death. Reception of the signals depends on receptor proteins that are usually at the cell surface, and these receptor proteins bind the signal molecule. The binding activates the receptor, which in turn activates one or more of the intra-cellular signaling pathways. These relay chains of molecules, mainly intra-cellular signaling proteins, process the signal inside the receiving cell and distribute it to the appropriate intra-cellular targets. Cell signaling pathways are involved in the pathophysiology of many diseases and also in the mechanisms of action of many drugs, including local and general anesthetics. Knowledge of the basic cell signaling mechanisms is essential for understanding many of the pathophysiologic and pharmacologic mechanisms. Therefore, if we focus on applying the new cellular and molecular biologic research, these efforts could identify the mechanism of diseases and help develop new drugs in the field of anesthesiology and pain medicine.
Anesthesiology ; Anesthetics, General ; Blotting, Western ; Cell Division ; Proteins

General anesthesia is the most common method used for operations and volatile anesthetics are commonly used for general anesthesia. Moreover, it is known that the newly developed volatile anesthetics are safe in liver and kidney. However, inorganic fluoride levels increase with anesthetic time and increase the possibility of renal toxicity and repeat a anesthesia in short term period increase the possibility of hepatic failure. We experienced 2 cases who received general anesthesia with volatile anesthetics more than 50 times without any organ failure. Here, we review the anesthetic records and preoperative laboratory findings of each operation.
Anesthesia ; Anesthesia, General* ; Anesthetics ; Fluorides ; Kidney ; Liver ; Liver Failure

Polyuria is occasionally observed during general anesthesia. Usually urine output during general anesthesia is decreased because of anesthetic agents. The authors came across with a case of polyruia during sevoflurane anesthesia which occurred after induction of anesthesia. Polyuria is a nonspecific symptom, but can cause many serious complications. Therefore, it is very important to investigate the cause thoroughly and treat patient appropriately.
Anesthesia ; Anesthesia, General ; Anesthetics ; Humans ; Methyl Ethers ; Polyuria ; Porphyrins