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Increased minimum alveolar concentration-awake of Sevoflurane in women of breast surgery with sleep disorders

BACKGROUND: Sleep disorders are commonly encountered in clinic. Evidences showed that sleep deprivation may modulate the effectiveness of general anesthetics in rats. However, this phenomenon has not been explored in humans. The study aimed to investigate whether the hypnotic potency of sevoflurane...

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Autores principales: Cao, Yuanyuan, Zhang, Lei, Peng, Xiaohui, Wu, Yun, Zhang, Qunlin, Gu, Erwei, Zhang, Ye
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6970294/
https://www.ncbi.nlm.nih.gov/pubmed/31959101
http://dx.doi.org/10.1186/s12871-020-0931-3
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author Cao, Yuanyuan
Zhang, Lei
Peng, Xiaohui
Wu, Yun
Zhang, Qunlin
Gu, Erwei
Zhang, Ye
author_facet Cao, Yuanyuan
Zhang, Lei
Peng, Xiaohui
Wu, Yun
Zhang, Qunlin
Gu, Erwei
Zhang, Ye
author_sort Cao, Yuanyuan
collection PubMed
description BACKGROUND: Sleep disorders are commonly encountered in clinic. Evidences showed that sleep deprivation may modulate the effectiveness of general anesthetics in rats. However, this phenomenon has not been explored in humans. The study aimed to investigate whether the hypnotic potency of sevoflurane in patients with sleep disorders differ from patients with normal sleep habits. METHODS: We recruited 44 patients scheduled for elective breast surgery and eventually analyzed 38 patients, including 19 subjects with normal sleep habits and 19 subjects with sleep disorders. According to the Dixon ‘up-and-down’ design, patients received sevoflurane at preselected concentrations starting at 1.0 vol%. After a steady-state period, a verbal command for testing awakening was performed. Based on the negative or positive response to the verbal command, we decreased or increased the concentration of sevoflurane by 0.2 vol% in the next patient accordingly. Plasma orexin-A was also measured before observation. RESULTS: The MACawake of sevoflurane was 0.80% [95% confidence interval (CI), 0.683–0.926%] in the sleep disordered group vs 0.60% [95% CI, 0.493–0.689%] in the control group. The relative median potency between groups was 0.750 (95% CI, 0.236–0.969). Patients with sleep disorders had significantly higher orexin-A levels than control (72.17 ± 18.24 vs. 36.16 ± 14.18 pg/mL). A significant, positive relationship was detected between orexin-A level and probability of awakening (OR = 1.081, 95% CI is 1.020–1.146, P = 0.008). CONCLUSIONS: MACawake of sevoflurane is higher in mild-aged women of breast surgery with sleep disorders compared to those with normal sleep habits. The increased anesthetic requirement may be related to changes of orexin-A levels. These findings suggest that sleep may have a potential impact on clinical anesthesia, including changes of sensitivity to anesthetics or postoperative complications. Further research is needed to confirm this hypothesis. CLINICAL TRIAL REGISTRATION: Chinese Clinical Trial Registry (ChiCTR1800016022), date of registration 07 May 2018.
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spelling pubmed-69702942020-01-27 Increased minimum alveolar concentration-awake of Sevoflurane in women of breast surgery with sleep disorders Cao, Yuanyuan Zhang, Lei Peng, Xiaohui Wu, Yun Zhang, Qunlin Gu, Erwei Zhang, Ye BMC Anesthesiol Research Article BACKGROUND: Sleep disorders are commonly encountered in clinic. Evidences showed that sleep deprivation may modulate the effectiveness of general anesthetics in rats. However, this phenomenon has not been explored in humans. The study aimed to investigate whether the hypnotic potency of sevoflurane in patients with sleep disorders differ from patients with normal sleep habits. METHODS: We recruited 44 patients scheduled for elective breast surgery and eventually analyzed 38 patients, including 19 subjects with normal sleep habits and 19 subjects with sleep disorders. According to the Dixon ‘up-and-down’ design, patients received sevoflurane at preselected concentrations starting at 1.0 vol%. After a steady-state period, a verbal command for testing awakening was performed. Based on the negative or positive response to the verbal command, we decreased or increased the concentration of sevoflurane by 0.2 vol% in the next patient accordingly. Plasma orexin-A was also measured before observation. RESULTS: The MACawake of sevoflurane was 0.80% [95% confidence interval (CI), 0.683–0.926%] in the sleep disordered group vs 0.60% [95% CI, 0.493–0.689%] in the control group. The relative median potency between groups was 0.750 (95% CI, 0.236–0.969). Patients with sleep disorders had significantly higher orexin-A levels than control (72.17 ± 18.24 vs. 36.16 ± 14.18 pg/mL). A significant, positive relationship was detected between orexin-A level and probability of awakening (OR = 1.081, 95% CI is 1.020–1.146, P = 0.008). CONCLUSIONS: MACawake of sevoflurane is higher in mild-aged women of breast surgery with sleep disorders compared to those with normal sleep habits. The increased anesthetic requirement may be related to changes of orexin-A levels. These findings suggest that sleep may have a potential impact on clinical anesthesia, including changes of sensitivity to anesthetics or postoperative complications. Further research is needed to confirm this hypothesis. CLINICAL TRIAL REGISTRATION: Chinese Clinical Trial Registry (ChiCTR1800016022), date of registration 07 May 2018. BioMed Central 2020-01-20 /pmc/articles/PMC6970294/ /pubmed/31959101 http://dx.doi.org/10.1186/s12871-020-0931-3 Text en © The Author(s). 2020 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research Article
Cao, Yuanyuan
Zhang, Lei
Peng, Xiaohui
Wu, Yun
Zhang, Qunlin
Gu, Erwei
Zhang, Ye
Increased minimum alveolar concentration-awake of Sevoflurane in women of breast surgery with sleep disorders
title Increased minimum alveolar concentration-awake of Sevoflurane in women of breast surgery with sleep disorders
title_full Increased minimum alveolar concentration-awake of Sevoflurane in women of breast surgery with sleep disorders
title_fullStr Increased minimum alveolar concentration-awake of Sevoflurane in women of breast surgery with sleep disorders
title_full_unstemmed Increased minimum alveolar concentration-awake of Sevoflurane in women of breast surgery with sleep disorders
title_short Increased minimum alveolar concentration-awake of Sevoflurane in women of breast surgery with sleep disorders
title_sort increased minimum alveolar concentration-awake of sevoflurane in women of breast surgery with sleep disorders
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6970294/
https://www.ncbi.nlm.nih.gov/pubmed/31959101
http://dx.doi.org/10.1186/s12871-020-0931-3
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