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Monitoring the effects of automated gas control of sevoflurane versus target-guided propofol infusion on hemodynamics of liver patients during liver resection. A randomized controlled trial
BACKGROUND AND AIMS: Cirrhotic patients are prone to hypotension during anesthesia. The primary aim of the study was to compare the effects of automated gas control (AGC) of sevoflurane and target-controlled infusion (TCI) of propofol on systemic and cardiac hemodynamics in hepatitis C cirrhotic pat...
Autores principales: | , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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Wolters Kluwer - Medknow
2023
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Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10220192/ https://www.ncbi.nlm.nih.gov/pubmed/37250255 http://dx.doi.org/10.4103/joacp.joacp_168_21 |
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author | Kamel, Yasmeen Abdelsalam Sasa, Noura Adel Ghareeb Helal, Safaa Mohamed Attallah, Hatem Amin Yassen, Khaled A. |
author_facet | Kamel, Yasmeen Abdelsalam Sasa, Noura Adel Ghareeb Helal, Safaa Mohamed Attallah, Hatem Amin Yassen, Khaled A. |
author_sort | Kamel, Yasmeen Abdelsalam |
collection | PubMed |
description | BACKGROUND AND AIMS: Cirrhotic patients are prone to hypotension during anesthesia. The primary aim of the study was to compare the effects of automated gas control (AGC) of sevoflurane and target-controlled infusion (TCI) of propofol on systemic and cardiac hemodynamics in hepatitis C cirrhotic patients undergoing surgery. The secondary aim was to compare the recovery, complications, and costs between the two groups. MATERIAL AND METHODS: This was a randomized controlled trial in adults with hepatitis C cirrhosis (Child A) who underwent open liver resection and received AGC (n = 25) or TCI (n = 25). AGC was initially set at FiO(2) 40% and end-tidal sevoflurane (ET SEVO) at 2.0% with a fresh gas flow of 300 mL/min. TCI of propofol was given using Marsh pharmacokinetic mode with an initial propofol target concentration (Cpt) of 4 μg/mL. Bispectral index score (BIS) was maintained between 40 and 60. Invasive arterial blood pressure (IBP), electrical cardiometry (EC), cardiac output (CO), and systemic vascular resistance (SVR), Fi SEVO, ET SEVO, propofol Cpt, and effect-site concentration (Ce) were recorded. RESULTS: IBP and EC CO, and SVR were least affected by TCI propofol. Only one (4.00%) patient required vasopressors with TCI vs. 4 (16.00%) with AGC (χ(2) ((Y) (df = 1)) = 0.88, P ((Y)) = 0.34). There was no delayed recovery, hypoxia, or awareness; however, ICU stay was shorter with TCI, (P = 0.006). BIS and EC guided median of ET SEVO was 1.90%, Fi SEVO was 2.10% with AGC, and propofol Cpt and Ce were 3.00 μg/dL with TCI. Only 0.14 [0.12–0.15] mL/min of SEVO was consumed with AGC and 0.87 [0.85–0.97] mL/min propofol with TCI. The cost was higher with TCI, P < 0.00. CONCLUSIONS: Both techniques are well tolerated hemodynamically, but TCI-propofol was found to be hemodynamically better. The recovery and complications were comparable in both groups, but TCI Propofol infusion was costlier. |
format | Online Article Text |
id | pubmed-10220192 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | Wolters Kluwer - Medknow |
record_format | MEDLINE/PubMed |
spelling | pubmed-102201922023-05-28 Monitoring the effects of automated gas control of sevoflurane versus target-guided propofol infusion on hemodynamics of liver patients during liver resection. A randomized controlled trial Kamel, Yasmeen Abdelsalam Sasa, Noura Adel Ghareeb Helal, Safaa Mohamed Attallah, Hatem Amin Yassen, Khaled A. J Anaesthesiol Clin Pharmacol Original Article BACKGROUND AND AIMS: Cirrhotic patients are prone to hypotension during anesthesia. The primary aim of the study was to compare the effects of automated gas control (AGC) of sevoflurane and target-controlled infusion (TCI) of propofol on systemic and cardiac hemodynamics in hepatitis C cirrhotic patients undergoing surgery. The secondary aim was to compare the recovery, complications, and costs between the two groups. MATERIAL AND METHODS: This was a randomized controlled trial in adults with hepatitis C cirrhosis (Child A) who underwent open liver resection and received AGC (n = 25) or TCI (n = 25). AGC was initially set at FiO(2) 40% and end-tidal sevoflurane (ET SEVO) at 2.0% with a fresh gas flow of 300 mL/min. TCI of propofol was given using Marsh pharmacokinetic mode with an initial propofol target concentration (Cpt) of 4 μg/mL. Bispectral index score (BIS) was maintained between 40 and 60. Invasive arterial blood pressure (IBP), electrical cardiometry (EC), cardiac output (CO), and systemic vascular resistance (SVR), Fi SEVO, ET SEVO, propofol Cpt, and effect-site concentration (Ce) were recorded. RESULTS: IBP and EC CO, and SVR were least affected by TCI propofol. Only one (4.00%) patient required vasopressors with TCI vs. 4 (16.00%) with AGC (χ(2) ((Y) (df = 1)) = 0.88, P ((Y)) = 0.34). There was no delayed recovery, hypoxia, or awareness; however, ICU stay was shorter with TCI, (P = 0.006). BIS and EC guided median of ET SEVO was 1.90%, Fi SEVO was 2.10% with AGC, and propofol Cpt and Ce were 3.00 μg/dL with TCI. Only 0.14 [0.12–0.15] mL/min of SEVO was consumed with AGC and 0.87 [0.85–0.97] mL/min propofol with TCI. The cost was higher with TCI, P < 0.00. CONCLUSIONS: Both techniques are well tolerated hemodynamically, but TCI-propofol was found to be hemodynamically better. The recovery and complications were comparable in both groups, but TCI Propofol infusion was costlier. Wolters Kluwer - Medknow 2023 2022-01-10 /pmc/articles/PMC10220192/ /pubmed/37250255 http://dx.doi.org/10.4103/joacp.joacp_168_21 Text en Copyright: © 2022 Journal of Anaesthesiology Clinical Pharmacology https://creativecommons.org/licenses/by-nc-sa/4.0/This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms. |
spellingShingle | Original Article Kamel, Yasmeen Abdelsalam Sasa, Noura Adel Ghareeb Helal, Safaa Mohamed Attallah, Hatem Amin Yassen, Khaled A. Monitoring the effects of automated gas control of sevoflurane versus target-guided propofol infusion on hemodynamics of liver patients during liver resection. A randomized controlled trial |
title | Monitoring the effects of automated gas control of sevoflurane versus target-guided propofol infusion on hemodynamics of liver patients during liver resection. A randomized controlled trial |
title_full | Monitoring the effects of automated gas control of sevoflurane versus target-guided propofol infusion on hemodynamics of liver patients during liver resection. A randomized controlled trial |
title_fullStr | Monitoring the effects of automated gas control of sevoflurane versus target-guided propofol infusion on hemodynamics of liver patients during liver resection. A randomized controlled trial |
title_full_unstemmed | Monitoring the effects of automated gas control of sevoflurane versus target-guided propofol infusion on hemodynamics of liver patients during liver resection. A randomized controlled trial |
title_short | Monitoring the effects of automated gas control of sevoflurane versus target-guided propofol infusion on hemodynamics of liver patients during liver resection. A randomized controlled trial |
title_sort | monitoring the effects of automated gas control of sevoflurane versus target-guided propofol infusion on hemodynamics of liver patients during liver resection. a randomized controlled trial |
topic | Original Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10220192/ https://www.ncbi.nlm.nih.gov/pubmed/37250255 http://dx.doi.org/10.4103/joacp.joacp_168_21 |
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