Hou-Chuan Lai

Interference of patent blue dye with pulse oximetry readings, methemoglobin measurements, and blue urine in sentinel lymph node mapping: A case report and review of the literature

Patent blue (PB) dye has been successfully used worldwide in breast and cervix surgeries with few complications. Interference of oxyhemoglobin saturation reading by pulse oximetry (SpO(2)) and methemoglobinemia, from injection of PB dye, have rarely been reported in breast and cervix surgeries. We report here the first case of interference of SpO(2) reading, advent of methemoglobinemia, and blue urine from the use of PB dye, which occurred concurrently in a female undergoing bilateral modified radical mastectomy. The unexpected events might be a consequence of excessive administration of PB dye. We also reviewed the published discourses in literature on the adverse effects of PB dye.

Analysis of anesthesia-controlled operating room time after propofol-based total intravenous anesthesia compared with desflurane anesthesia in gynecologic laparoscopic surgery: A retrospective study

Background: Anesthesia technique may contribute to the improvement of operation room (OR) efficiency by reducing anesthesia-controlled time (ACT). We compared the difference between propofol-based total intravenous anesthesia (TIVA) and desflurane (DES) anesthesia for gynecologic laparoscopic surgery undergoing general anesthesia. Materials and Methods: We performed a retrospective study using data collected in our hospital to compare the ACT of gynecologic laparoscopic surgery using either TIVA via target-controlled infusion (TCI) with propofol/fentanyl or DES/fentanyl-based anesthesia between January 2010 and December 2011. The various time intervals (waiting for anesthesia, operation time, anesthesia time, emergence time, exit from OR after extubation, total OR time and postanesthesia care unit stay time) and the incidence of prolonged extubation (≥15 min) were compared between the two anesthetic techniques. Results: We included data from 926 patients, with 377 patients receiving TIVA and 549 patients receiving DES. The only significant difference is emergence time, TIVA was faster than the DES group (7.3 ± 3.3 min vs. 8.3 ± 3.1 min; P < 0.001). The factors of prolonged extubation are DES anesthesia, body mass index, surgical time, and anesthesia time. Conclusion: In our hospital, propofol-based TIVA by TCI provide faster emergence compared with DES anesthesia in gynecologic laparoscopic surgery.

Planning for operating room efficiency and faster anesthesia wake-up time in open major upper abdominal surgery

Abstract Reducing anesthesia-controlled time (ACT) may improve operation room (OR) efficiency result from different anesthetic techniques. However, the information about the difference in ACT between desflurane (DES) anesthesia and propofol-based total intravenous anesthesia (TIVA) techniques for open major upper abdominal surgery under general anesthesia (GA) is not available in the literature. This retrospective study uses our hospital database to analyze the ACT of open major upper abdominal surgery without liver resection after either desflurane/fentanyl-based anesthesia or TIVA via target-controlled infusion with fentanyl/propofol from January 2010 to December 2011. The various time intervals including waiting for anesthesia time, anesthesia time, surgical time, extubation time, exit from OR after extubation, total OR time, and postanesthetic care unit (PACU) stay time and percentage of prolonged extubation (≥15 minutes) were compared between these 2 anesthetic techniques. We included data from 343 patients, with 159 patients receiving TIVA and 184 patients receiving DES. The only significant difference is extubation time, TIVA was faster than the DES group (8.5 ± 3.8 vs 9.4 ± 3.7 minutes; P = 0.04). The factors contributed to prolonged extubation were age, gender, body mass index, DES anesthesia, and anesthesia time. In our hospital, propofol-based TIVA by target-controlled infusion provides faster emergence compared with DES anesthesia; however, it did not improve OR efficiency in open major abdominal surgery. Older, male gender, higher body mass index, DES anesthesia, and lengthy anesthesia time were factors that contribute to extubation time.

Comparison of Anesthesia-Controlled Operating Room Time between Propofol-Based Total Intravenous Anesthesia and Desflurane Anesthesia in Open Colorectal Surgery: A Retrospective Study

We conducted a retrospective study to investigate the anesthesia-controlled time and factors that contribute to prolonged extubation in open colorectal surgery. Using our hospital database, demographic data, various time intervals (waiting for anesthesia time, anesthesia time, surgical time, emergence time, exit from operating room after extubation, total operating room time, and post-anesthesia care unit stay time), and incidence of prolonged extubation (≥ 15 mins), were compared between patients who received desflurane/fentanyl-based anesthesia and total intravenous anesthesia via target-controlled infusion with fentanyl/propofol. Logistic regression analyses were performed to assess the association between variables that contributed to prolonged extubation. In conclusion, the anesthesia-controlled time was similar in desflurane anesthesia and propofol-based total intravenous anesthesia for open colorectal surgery in our hospital. Surgical time greater than 210 minutes, as well as age, contributed to prolonged extubation.

Atypical involuntary movements following fentanyl anesthesia.

Postanesthetic involuntary movements are triggered by a variety of drugs, including propofol, sevoflurane, anti-emetics, and anti-psychotics. A case of acute involuntary movements in a healthy man after fentanyl exposure is presented. The movements consisted of large-amplitude motions of the upper limbs of the elbow joint for flexion and extension, and shaking of the head from side to side.

Efficacy of sevoflurane as an adjuvant to propofol-based total intravenous anesthesia for attenuating secretions in ocular surgery.

Background: The incidence of nasal secretions into the operative field is as high as 5% in ophthalmic surgery under general anesthesia. It may induce postoperative endophthalmitis. Secretions under propofol-based total intravanous anesthesia (TIVA) are greater than sevoflurane anesthesia during surgery. Postoperative nausea and vomiting (PONV) after inhalational anesthesia is higher than TIVA and may increase intraocluar pressure. We investigated the effect of sevoflurane combination with propofol-based TIVA on nasopharyngeal secretions and PONV in ocular surgery. Methods: Fifty patients undergoing ocular operations were randomly assigned for propofol-based TIVA or propofol/sevoflurane anesthesia. In the TIVA group (n = 25), anesthesia was induced and maintained with propofol and fentanyl; in the propofol/sevoflurane group (n = 25), 1% sevoflurane anesthesia was added. Results: Nasopharyngeal excretion volume was significantly higher in the propofol-based TIVA group than in the propofol/sevoflurane group (31.0 ± 18.1 vs 13.7 ± 12.6 ml; P < .001). No significant difference in extubation time was noted (propofol-based TIVA: 6.4 ± 3.6 vs propofol/sevoflurane: 7.4 ± 3.0 minutes; P = .34). No postoperative endophthalmitis or PONV in both groups was observed. Conclusion: Sevoflurane attenuated secretions under propofol-based TIVA and did not increase the incidence of PONV or prolonged extubation in ocular surgery.

Relationship between anesthesia and postoperative endophthalmitis: A retrospective study

Abstract Previous study showed that patients under general anesthesia (GA) had nasopharyngeal secretions on the face at the end of ocular surgery, especially in propofol-based total intravenous anesthesia (TIVA), it might induce postoperative endophthalmitis. Therefore, we conducted a retrospective study to compare the incidence of endophthalmitis after ocular surgery under topical, inhalation anesthesia, and propofol-based TIVA in our medical center from 2011 to 2015. A total of 21,032 patients were included, and we evaluated epidemiologic factors, systemic diseases, other ocular pathologic characteristics, complications during the surgery, technique of ocular surgery, method of antibiotic prophylaxis, vitreous culture, and vision outcome in these patients. Fifteen endophthalmitis cases among 21,032 operations reported, equaling an incidence of 0.071%. The incidence rates under topical, inhalation anesthesia, and propofol-based TIVA were 0.083%, 0.039%, and 0%, respectively (P = 0.39). Moreover, the risk of endophthalmitis under GA (0.024%) was significantly lower than topical anesthesia (0.083%) (P < 0.001). We also found that elder was the risk factor for endophthalmitis following ocular surgery. In conclusion, propofol-based TIVA or inhalation anesthesia did not increase the risk of endophthalmitis after ocular surgery. Thus, GA was not a risk factor for postoperative endophthalmitis. By contrast, elder was the risk factor for postoperative endophthalmitis.

The optimal effect-site concentration of propofol for endotracheal suctioning in intensive care unit patients

Objective: To evaluate the optimal effect-site concentration (Ce) of propofol during endotracheal suction (ETS) in the postoperative Intensive Care Unit (ICU) sedated patients. Design and Setting: The study design was a prospective randomized clinical study in a 13-bed ICU in a medical center. Patients: Thirteen mechanically ventilated patients were included in this study. Methods: All included postoperative patients received sedation by target-controlled infusion (TCI) of propofol under bispectral index (BIS) monitoring and 2–4 μg/kg/h fentanyl infusion for analgesia to keep numerical rating scale ≤4. While ETS was need, the sedation interventions were performed. We used the up-and-down method with a step size of propofol Ce 0.2 μg/ml for the next intervention. The sedation interventions of 1, 2, and 3 were baseline propofol Ce, baseline propofol Ce +0.2 mg/ml, and baseline propofol Ce +0.4 μg/ml, respectively. The predetermined propofol Ce was maintained for 5 min before ETS. Arterial systolic blood pressures (SBPs), arterial diastolic blood pressure (DBP), heart rates (HRs), and BIS before and after ETS were recorded. No moderate or severe coughing with limb movement was the primary outcome, and the surge of SBP, DBP, and HR ≤20% of baseline was the secondary outcome. Results: There were 39, 72, and 45 ETS were performed in the intervention 1, 2, and 3, respectively. In the primary outcome, the successful rates of ETS were 100%, 37.5%, and 15.4% in the intervention 3, 2, and 1, respectively (P < 0.001). In the secondary outcomes, the successful rates were 100% in all interventions. However, the surge of SBP (P = 0.009), DBP (P = 0.025), and HR (P = 0.009) were significant higher in the intervention 1 and 2 than the intervention 3. Right after the ETS, significant increase in BIS level was observed in the intervention 1 (13.9± 7.9) and 2 (14.4± 7.5) except for intervention 3 (−2.8± 14.5) (P = 0.003). Conclusions: An increase of propofol Ce 0.4 mg/ml for 5 min before ETS provided adequate sedation result in markedly attenuated ETS-induced coughing, limb movement, and hyperdynamic status during ETS while the use of TCI propofol sedation in postoperative ICU patients.

Baicalein attenuates neuropathic pain and improves sciatic nerve function recovery in rats with partial sciatic nerve transection

Background: Modulating the inflammatory response to nerve injury may provide therapeutic opportunities by aborting the neurobiological alterations that support the development of persistent pain. Baicalein, a 12‐lipoxygenase inhibitor, has anti‐inflammation properties. It also demonstrates anti‐inflammatory functions by inhibiting lipopolysaccharide‐induced barrier disruption, expression of cell adhesion molecules, and adhesion and migration of leukocytes. The aim of the present study was to assess the possibility of early treatment of neuropathic pain via the systemic injection of baicalein in rats with left partial sciatic nerve transection (PST). Methods: Wistar rats were divided into Sham, Vehicle, and Baicalein groups. The Vehicle and Baicalein rats underwent PST, whereas the Sham rats were not transected. Baicalein was administered 20 mg/kg/day intraperitoneally for 7 days after PST and after behaviour tests. After PST, rats developed mechanical and cold allodynia, and impaired sciatic nerve function. Results: Baicalein attenuated mechanical and cold allodynia and improved sciatic nerve function after PST. Baicalein significantly inhibited the expression of tumour necrosis factor &agr; (TNF‐&agr;), interleukin 6 (IL‐6), and IL‐1&bgr; on days 14 and 28, and attenuated the activation of astrocytes in the L4–5 spinal cord less than day 28 after PST. Conclusion: Our study revealed that early and multiple doses of systemic baicalein attenuated neuropathic pain and improved sciatic nerve function by inhibiting pro‐inflammatory cytokine expression and attenuating the activation of astrocytes in the spinal cord.

Propofol-based Total Intravenous Anesthesia Is Associated with Better Survival Than Desflurane Anesthesia in Colon Cancer Surgery

What We Already Know about This Topic Propofol may better preserve host defenses against cancer Whether cancer recurrence is less likely with propofol than volatile anesthesia remains unknown What This Article Tells Us That Is New The authors conducted a propensity-matched retrospective analysis of 1,158 patients who had colon cancer surgery Patients anesthetized with propofol had better overall survival Background: Previous research has shown different effects of anesthetics on cancer cell growth. Here, the authors investigated the association between type of anesthetic and patient survival after elective colon cancer surgery. Methods: A retrospective cohort study included patients who received elective colon cancer surgery between January 2005 and December 2014. Patients were grouped according to anesthesia received: propofol or desflurane. After exclusion of those who received combined propofol anesthesia with inhalation anesthesia or epidural anesthesia, survival curves were constructed from the date of surgery to death. After propensity matching, univariable and multivariable Cox regression models were used to compare hazard ratios for death. Subgroup analyses were performed for tumor–node–metastasis staging and postoperative metastasis. Results: A total of 706 patients (307 deaths, 43.5%) with desflurane anesthesia and 657 (88 deaths, 13.4%) with propofol anesthesia were eligible for analysis. After propensity matching, 579 patients remained in each group (189 deaths, 32.6%, in the desflurane group vs. 87, 15.0%, in the propofol group). In the matched analyses, the propofol-treated group had a better survival, irrespective of lower tumor–node–metastasis stage (hazard ratio, 0.22; 95% CI, 0.11 to 0.42; P < 0.001) or higher tumor–node–metastasis stage (hazard ratio, 0.42; 95% CI, 0.32 to 0.55; P < 0.001) and presence of metastases (hazard ratio, 0.67; 95% CI, 0.51 to 0.86; P = 0.002) or absence of metastases (hazard ratio, 0.08; 95% CI, 0.01 to 0.62; P = 0.016). Simple propensity score adjustment produced similar findings. Conclusions: Propofol anesthesia for colon cancer surgery is associated with better survival irrespective of tumor–node–metastasis stage.