Intravenös anestesi med Propofol eller inhalationsanestesi med gasen Sevofluran är de två vanligaste anestesiformerna i Sverige. Syftet med studien vara att undersöka om patienters postoperativa återhämtning skiljer sig åt beroende på om de sövts med Propofol eller Sevofluran. Datainsamlingen till studien genomfördes med systematisk litteraturöversikt baserad på integrativ metod. Både kvalitativa och kvantitativa studier samlades in, men enbart kvantitativa artiklar inkluderades. Resultatet visade att det under den postoperativa återhämtningen var vanligt förekommande med två postoperativa komplikationer, smärta samt illamående och kräkningar. Resultatet visar inga statistiskt signifikanta skillnader när det gällde dessa beroende på val av anestesimedel. Men vidare studier behövs inom ämnet, framför allt om kön eller ålder kan vara ytterligare påverkande faktorer. / Intravenous anesthesia with Propofol or inhalation anesthesia with the gas Sevoflurane are the two most common forms of anesthesia in Sweden. The purpose of the study was to investigate whether patient's postoperative recovery differs depending on whether they have been anesthetized with Propofol or Sevoflurane. The data collection for the study was carried out with a systematic literature review based on integrative research Both qualitative and quantitative studies were collected, but only quantitative articles were included. The results showed that during postoperative recovery it was common with two postoperative complications, pain, nausea, and vomiting. The results show no statistically significant differences in these depending on the choice of anesthetic agents. However, further studies are needed in the subject, especially if gender or age can be additional influencers.

Einleitung: Zur Messung der Narkosetiefe standen bisher vor allem aus dem EEG abgeleitete Parameter im Mittelpunkt der Forschung, die sehr gut geeignet sind, die hypnotische Komponente der Anästhesie abzubilden. Eine Vorhersage auf motorische Reaktionen lassen sie jedoch nicht zu. Eine vorausgehende Studie hat gezeigt, dass unter Sevofluran der spinale H-Reflex mit der chirurgischen Immobilität korreliert. Die vorliegende Studie untersucht, ob motorische Reaktionen während Propofolmononarkosen mittels H-Reflex besser vorausgesagt werden können als mit den EEG-Parametern Bispektraler Index (BIS), spektrale Entropie (SE) und response Entropie (RE). Außerdem wurde der Einfluss von Propofol auf die Erholungskurve des H-Reflexes unter Doppelstimulation untersucht. Methodik: Nach Zustimmung der Ethikkommission und schriftlicher Einwilligung wurden 17 Patienten in die Studie eingeschlossen und ausgewertet. Nach der „up-and-down“-Methode von Dixon wurde die Konzentration von Propofol auf einen Wert eingestellt, bei dem die Hälfte der Patienten auf einen am Unterarm ausgelösten elektrischen Tetanus-Reiz (60 mA) mit einer gezielten motorischen Reaktion reagierten. Nach einer Kontrollmessung wurde die Konzentration von Propofol 15 min konstant gehalten. Danach wurde von einem „steady state“ ausgegangen und der Tetanusreiz wurde ausgelöst. Die Vorhersagefähigkeit der möglichen Narkosetiefe-parameter auf eine Bewegung wurde mit der „Prediction Probability“ (PK-Wert) ermittelt. Im zweiten Teil wurde der H-Reflex anhand der Doppelstimulation mit größer werdenden Interstimulusintervallen (50-8000 ms) untersucht. Ergebnisse: Die Wachwerte für die H-Reflexamplitude liegen bei 5,9 (± 3,8 SD) mV. Der von uns berechnete C50-Tetanus-Wert beträgt 4,5 ± 0,45 mg/l. Die PK-Werte 0,47 für den H-Reflex und 0,45 für die Herzfrequenz lassen nur zufällige Aussagen auf motorische Reaktionen zu. Die EEG-Parameter zeigen höhere PK-Werte: BIS (0,74), SE (0,73), RE (0,71). In diesem Bereich liegt auch der PK-Wert der Propofolzielkonzentration (0,76). Der Schmerzreiz beeinflusste weder die H-Reflexamplitude noch die EEG-Parameter. Bei der Doppelstimulation zeigte sich eine verzögerte Erholung des H-Reflexes unter Doppelstimulation, die am stärksten im Bereich der interkurrenten Fazilitation unter den Interstimulusabständen von 150 und 200 ms. Schlussfolgerung: Für die Vorhersage motorischer Reaktionen während Propofolmono-narkosen sind EEG-Parameter wie BIS, SE und RE etwas besser geeignet als der spinale H-Reflex. Dies steht im Gegensatz zu einer Untersuchung mit Sevofluran und wird auf die unterschiedlichen Wirkmechanismen von volatilen und intravenösen Anästhetika zurückgeführt. Die Unterdrückung der Erholungskurve des H-Reflexes unter Doppelstimula-tion, die vor allem im Bereich der interkurrenten Fazilitation stattfindet, ist möglicherweise durch eine Reduktion supraspinaler exzitatorischer Einflüsse zu erklären. / Introduction: The measurement of „depth of anaesthesia“ is mostly done by parameters of the electroencephalogram (EEG) which can predict hypnosis whereas the prediction of immobility is not possible with those parameters. A previous study has shown that the H-reflex amplitude can be used for monitoring of immobility during sevoflurane anaesthesia. This study examined whether the prediction of movement to painful stimulation is also possible during propofol anaesthesia on the basis of the H-reflex-amplitude compared with the EEG-parameters bispectral index (BIS), spectral entropy (SE) and response entropy (RE). Furthermore the influence of propofol on the H-reflex-recovery under double pulse stimulation was tested. Methods: After approval of the institutional review board and informed consent were obtained, 17 patients were included into this study. Using the “up-and down”-method the concentration of propofol was adjusted to the level where half of the patients do not move to painful stimulation (C50-tetanus-value). Propofol was administered after a baseline measurement. After at least 15 minutes of constant propofol concentration a "steady-state" was assumed and a painful electrical stimulation (tetanic stimulus of 60mA) was applied. To estimate and compare the predictive value of the parameters, prediction probability Pk was calculated. The H-reflex during double pulse stimulation was examined with interstimulus intervals ranging from 50 to 8000 ms. Results: At awake level, H-reflexes had a mean amplitude of 5.9 (+/- 3.8 SD) mV. The calculated C50-tetanus-value was 4.5 (+/- 0.45 SD) mg/l. With Pk-values of 0.47 for the H-reflex amplitude and 0.45 for the heart rate the prediction of movements is just by chance. The Pk-values of the EEG-parameters were higher: BIS (0.74), SE (0.73), RE (0.71). At this level was also the Pk-value of the propofol concentration (0.76). The painful stimulation influenced neither the H-reflex amplitude nor the EEG-parameters. The double pulse stimulation showed a delay in the H-reflex-recovery at interstimulus intervals of 150 and 200 ms. Conclusion: The prediction of movement during propofol anaesthesia is better using the EEG-parameters BIS, SE and RE compared to the H-reflex-amplitude. These results are in contrast to a previous study with sevoflurane which can be explained by the different molecular mechanisms of action of volatile and intravenous anaesthetics. The depression of the recovery-curve of the H-reflex under double pulse stimulation is possibly due to the reduction of supraspinal excitatory influences.

Orientador: Celso Antônio Rodrigues / Coorientador: Paulo Sergio Patto dos Santos / Banca: Stélio Pacca Loureiro Luna / Banca: Antônio José de Araújo Aguiar / Banca: Lídia Mitsuko Matsubara / Banca: Juan Carlos Duque Moreno / Resumo: O estudo teve por objetivo avaliar o índice biespectral e os efeitos hemodinâmicos, respiratórios e hemogasométricos da infusão contínua de propofol associado ou não ao fentanil em bezerros. Foram utilizados oito animais machos entre seis e doze meses de idade, holandeses, com massa corporal média de 123 ± 18 kg. Todos os animais participaram de ambos os grupos, respeitando-se sempre um intervalo mínimo de uma semana entre uma anestesia e outra, os bezerros foram aleatoriamente distribuídos entre os grupos. Os animais foram induzidos à anestesia com propofol na dose de 5 mg/kg; IV, grupo controle (GP) ou propofol 4 mg/kg associado ao fentanil 0,001 mg/kg; IV, grupo fentanil (GF) e posicionados em decúbito lateral direito, onde permaneceram respirando espontaneamente ar ambiente. Ato contínuo, a manutenção anestésica foi realizada pela infusão contínua de propofol na taxa de 0,6 mg/kg/minuto; IV, associado ou não à infusão de fentanil 0,001 mg/kg/hora.Em ambos os grupos os fármacos foram administrados por meio de bomba de infusão durante 60 minutos. A mensuração das variáveis hemodinâmicas (FC, PAS, PAD, PAM, DC, PVC, PAPm, PAPOm, IC, IS, IRVS e IRVP), respiratórias (ETCO2, f, SpO2, VTE e VME), hemogasométricas (PaO2, PaCO2, SaO2, DB, pH e HCO3-) e indice bispectral (BIS, IQS e EMG) foi feita antes da indução anestésica (MB), e 15, 30,45 e 60 minutos após o início da infusão contínua dos fármacos (M15, M30, M45 e M60, respectivamente). Os parâmetros hemodinâmicos mantiveram-se estáveis durante o período de avalição, não foram observadas diferenças significativas entre os grupos nas variáveis respiratórias ou no BIS, porém, todos os animais apresentaram depressão respiratória e acidose. Com a infusão de propofol associado ou não ao fentanil obteve-se manutenção satisfatória dos parâmetros hemodinâmicos com depressão respiratória, indicando, portanto, a necessidade do emprego de ventilação... / Abstract: The aim of this study was to evaluate the bispectral index and hemodynamic, respiratory and blood gas effects of continuous infusion of propofol with or without fentanyl in calves. Eight animals were used, with six to 12 months old, male Holstein calves, with an average weight of 123 ± 18 kg. All animals participated in both groups, respecting always a minimum interval of one week between the anesthetic procedures, the calves were randomly distributed between groups. They were induced to anesthesia with propofol at a dose of 5 mgkg-1 IV control group (GP) or propofol 4 mg kg-1 associated with fentanyl 0.001mgkg-1 IV fentanyl group (GF) and positioned in right lateral decubitus, where remained spontaneously breathing room air. Subsequently, the Anesthesia was maintained by continuous infusion of propofol at the rate of 0.6 mg kg-1 min-1 IV, with or without the infusion of fentanyl 0.001mg kg-1 hour-1. In both groups, drugs were administered through an infusion pump over 60 minutes. The measurements of hemodynamic parameters (HR, SAP, DAP, MAP, CO, CVP, mPAP, mPAPO, CI, SI, SVRI and PVRI), respiratory (ETCO2, f, SpO2,VME and VTE), blood gas(PaO2, PaCO2, SaO2, DB, pHandHCO3-) and bispectral index (BIS, SQI and EMG) were evaluated before anesthesia induction(MB), 15, 30, 45 and 60 minutes after the beginning of continuous infusion of drugs (M15, M30, M45 and M60, respectively). Hemodynamic parameters remained stable during the evaluate on period, no significant differences were observed between the groups in the respiratory variables and BIS, however, all animals presented respiratory acidosis. With the infusion of propofol associated or not with fentanyl the maintenance of the hemodynamic parameters was satisfactory with respiratory acidosis indicating, therefore, the use of mechanical ventilation / Doutor

avitsir@ccf.org / Hypertension is common in deep brain stimulator (DBS) placement predisposing to intracranial hemorrhage. This retrospective review evaluates factors predicting incremental antihypertensive use intraoperatively. Medical records of Parkinson’s disease (PD) patients undergoing DBS procedure between 2008–2011 were reviewed after Institutional Review Board approval. Anesthesia medication, preoperative levodopa dose, age, preoperative use of antihypertensive medications, diabetes mellitus, anxiety, motor part of the Unified Parkinson’s Disease Rating Scale score and PD duration were collected. Univariate and multivariate analysis was done between each patient characteristic and the number of antihypertensive boluses. From the 136 patients included 60 were hypertensive, of whom 32 were on angiotensin converting enzyme inhibitors (ACEI) or angiotensin receptor blockers (ARB), told to hold on the morning of surgery. Antihypertensive medications were given to 130 patients intraoperatively. Age (relative risk [RR] 1.01; 95% confidence interval [CI] 1.00–1.02; p = 0.005), high Joint National Committee (JNC) class (p < 0.0001), diabetes mellitus (RR 1.4; 95%CI 1.2–17; p < 0.0001) and duration of PD >10 years (RR 1.2; 95%CI 1.1–1.3; p = 0.001) were independent predictors for antihypertensive use. No difference was noted in the mean dose of levodopa (p = 0.1) and levodopa equivalent dose (p = 0.4) between the low (I/II) and high severity (III/IV) JNC groups. Addition of dexmedetomidine to propofol did not influence antihypertensive boluses required (p = 0.38). Intraoperative hypertension during DBS surgery is associated with higher age group, hypertensive, diabetic patients and longer duration of PD. Withholding ACEI or ARB is an independent predictor of hypertension requiring more aggressive therapy. Levodopa withdrawal and choice of anesthetic agent is not associated with higher intraoperative antihypertensive medications. / Revisión por pares

Made available in DSpace on 2014-06-11T19:22:21Z (GMT). No. of bitstreams: 0 Previous issue date: 2002Bitstream added on 2014-06-13T19:27:34Z : No. of bitstreams: 1 mannarino_r_me_botfm.pdf: 1143230 bytes, checksum: e78de0e8beeaacc11674b6664d6aa357 (MD5) / Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) / A vantagem da anestesia injetável é a facilidade de produzir os componentes da anestesia (inconsciência, analgesia, relaxamento muscular e proteção neurovegetativa) com doses definidas dos diversos fármacos. Existem controvérsias sobre as doses de propofol necessárias para prover analgesia para realização de cirurgias. Objetivaram-se definir as taxas mínimas de infusão do propofol isoladamente e em associação com a lidocaína para anestesia intravenosa em cães, e a possível potencialização analgésica da lidocaína, avaliando-se os efeitos cardiovasculares e grau de hipnose. As DE50 do propofol e propofol associado a lidocaína foram calculadas em 10 cães (12,85 l 1,22 kg), sem raça definida, anestesiados 2 vezes com intervalo de 15 dias. G1: indução anestésica com propofol (6 mg/kg/iv) e manutenção inicial na velocidade de 0,7 mg/kg/min. G2: indução anestésica com propofol (6 mg/kg) e lidocaína (1,5 mg/kg) e manutenção inicial com propofol (0,7 mg/kg/min) e lidocaína em velocidade constante (0,25 mg/kg/min). A analgesia foi avaliada através do pinçamento de membrana interdigital dos membros posteriores e da ponta da cauda por 15 (quinze) segundos. De acordo com a resposta, a velocidade foi aumentada ou diminuída em 0,05 mg/kg/min, verificando-se a analgesia 10 (dez) minutos após até a determinação da velocidade na qual não havia respostas aos dois estímulos. Esta velocidade foi mantida por mais 2 (duas) mensurações. Em não havendo resposta era considerada a DE50. A média entre as velocidades (com e sem resposta) foi utilizada na determinação da taxa de infusão mínima de cada grupo. Esta DE50 foi utilizada na 2o etapa. Doze cães (12,28 l 1,37 kg) foram divididos em 2 grupos de seis. G3: indução anestésica com 6 mg/kg de propofol e manutenção... / There is a controversy on the doses of propofol to produce sufficient surgical analgesia. This study aimed to define the minimum infusion rate of propofol and propofol combined to lidocaine for IV anesthesia in dogs. The ED50 of propofol and propofol combined with lidocaine was calculated in 10 dogs, weighing 12.85 l 1.22 kg, anesthetized twice with a interval of 15 days. Anesthesia was induced (6 mg/kg/iv) and maintained with propofol (0.7 mg/kg/min.) (G1) and induced with propofol (6 mg/kg) and lidocaine (1.5 mg/kg) and maintained with propofol (0.7 mg/kg/min) and lidocaine (0.25 mg/kg/min) (G2). Analgesia was investigated by tail clamping and podal reflex. The infusion rate was increased or reduced in 0.05 mg/kg/min, until no painful response was observed. The infusion rate was maintained for more 2 (two) evaluations, with a 10 minutes interval and this rate was considered the DE50 of propofol. The mean infusion rate between no pain response and positive response was considered the mean minimal infusion rate and was used in the second part of the study. Other 12 dogs (12.28 l 1.37 kg) were divided in 2 groups of 6 animals. G3 was treated with the same protocol as G1 and G4 as G2, with the propofol infusion rates previously calculated. Anesthesia was maintained for 2 hours. Hemodynamic and respiratory variables as well as BIS and temperature were measured during anesthesia. There was a smaller cardiovascular depression and greater vascular resistance and acidosis in animals treated with propofol and lidocaine. The BIS was maintained between 40 and 60 in both groups. Lidocaine potentiated in 21% the analgesia produced by propofol. The minimum infusion rate of propofol was 1.25 mg/kg/min when used alone and 0.985 mg/kg/min when combined to lidocaine. Lidocaine potentiated hypnosis and analgesia produced by propofol and minimized the cardiovascular depression, increasing recovery.

Orientador: Antônio José de Araújo Aguiar / Banca: Stélio Pacca L. Luna / Banca: Silvia Gaido Cortopassi / Banca: Denise Tabacchi Fantoni / Banca: Reinaldo C. Braz / Resumo: O emprego de procedimentos de anestesia intravenosa total em cães tem sido mais freqüente, devido ao melhor conhecimento do perfil farmacocinético dos fármacos empregados. Como ainda não existe um único fármaco que produza todas as características desejáveis em uma anestesia geral, há a necessidade de se associar ao hipnótico, agentes com propriedades analgésicas. O objetivo desse estudo foi avaliar os efeitos hemodinâmicos causados pela associação do cloridrato de dexmedetomidina, nas doses de 1 e 2 μg/kg/h, e propofol na dose de 0,3 mg/kg/min, administrada em infusão intravenosa contínua em cães, bem como o tempo de recuperação anestésica após duas horas de infusão. Seis cães, clinicamente sadios, sem raça definida, pesando 17,6±1,8 kg, foram submetidos a três tratamentos com intervalo de uma semana e em seqüência aleatória. Todos os animais foram inicialmente anestesiados com isofluorano a 5V% com fluxo de 3 l/min de O2. Após a indução e intubação, os animais foram posicionados em decúbito lateral esquerdo e mantidos com isofluorano na concentração de 1,8V%. As veias cefálicas e a artéria dorsal podal foram cateterizadas e um cateter de Swan Ganz 5F foi introduzido pela veia jugular. Após fixação dos cateteres na pele, a administração do isofluorano foi interrompida. Os cães permaneceram despertos por 1 hora, e após esse período, foi realizada a avaliação das variáveis hemodinâmicas. Em seguida os cães receberam um dos seguintes tratamentos: Controle: indução com propofol (6 mg/kg/30s) e solução de NaCl 0,9% (5 ml/10min) seguida de manutenção com propofol (0.3 mg/kg/min) e NaCl 0,9% (4 ml/h); Dex 1: indução com propofol (6 mg/kg/30s) e cloridrato de dexmedetomidina (1 μg/kg/10min) seguida de manutenção com propofol (0.3 mg/kg/min)... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Total intravenous anesthesia in dogs has been more frequently used, the pharmacokinetic profile of the new drugs is better understood. No injectable anesthetic produces all of the components of a general anesthesia, it is required to associate additional analgesics with hypnotic. The aim of this study was to evaluate the hemodynamic effects caused by the association of 1 and 2 μg/kg/h of dexmedetomidine and 0,3 mg/kg/min of propofol, administered by continuous intravenous infusion, as well time of anesthetic recovery after 2 hours of infusion. Six healthy dogs weighting 17,6±1,8 kg were randomly allocated to 3 treatments with at least one week intervals between each treatment. All animals were initially anesthetized with 5V% of isoflurane and 3 l/min of oxygen. After induction and intubation, the animals were posicionated in left lateral recumbence and maintained with 1.8% end tidal. All animals were instrumented with a cephalic veins and arterial catheter and a Swan Ganz catheter in order to a monitor hemodynamic parameters. After instrumentation isoflurane was interrupted and animals were awake and remained awake for one hour. After that, baselines parameters were taken. Dogs received each one of these treatments: Control: was induced with propofol (6 mg/kg/30s) and saline (5 ml/10 min), maintenance was with propofol (0.3 mg/kg/min) and saline (4 ml/h). Dex 1 was induced with propofol (6 mg/kg30s) and dexmedetomidine (1 μg/kg10 min), maintenance with propofol (0.3 mg/kg/min) and dexmedetomidine (1 μg/kg/h). Dex 2 was induced with propofol (6 mg/kg30s) and dexmedetomidine (2 μg/kg/10min), maintenance with propofol (0.3 mg/kg/min) and dexmedetomidine (2 μg/kg/h) during 120 minutes. The parameters (HR, SBP, MAP, DAP, CI, SI, CVP, PAP, POPA, SVRI, PVRI, RR, ETCO2, SaO2, pHa, PaO2, PaCO2, HCO3, Hb, CaO2, IDO2, temperature) were taken at 15, 30, 60, 90 e 120 minutes after induction... (Complete abstract click electronic access below) / Doutor

A utilização de ventilação mecânica em terapia intensiva é uma prática comum. Além da sua ação terapêutica, é aplicada para corrigir os efeitos depressores consequentes da ação dos fármacos em pacientes sob sedoanalgesia. Por isso, vem sendo estudada para uma melhor compreensão da sua função, principalmente no que diz respeito às diferentes concentrações de oxigênio e as modalidades ventilação controlada a volume (VCV) e ventilação controlada a pressão (VCP) que podem desencadear diferentes respostas dos indivíduos. O objetivo deste trabalho é realizar um estudo comparativo da dinâmica cardiorrespiratória de suínos (Sus scrofa domestica) sedados com propofol-remifentanil sob dois aspectos: avaliar os animais submetidos a três diferentes frações inspiradas de oxigênio (FIO2) (0.8, 0.6, e 0.4) sob ventilação mecânica; avaliar e comparar os animais submetidos à VCV versus os submetidos à VCP. Utilizou-se 20 animais para realizar o comparativo entre as frações inspiradas e destes, seis para o comparativo entre as modalidades ventilatórias. Para sedação receberam em média 0,29 mg.kg-1.min-1 de propofol e 0,3 mcg.kg-1.min-1 de remifentanil, sendo que a velocidade de infusão de propofol variou buscando manter o animal em uma escala de consciência baseada no índice biespectral entre 60 e 70. Na comparação entre as FIs os animais ficaram sedados por duas horas e na comparação entre VCP e VCV, duas horas em cada modalidade. Foram avaliadas as frequências cardíaca e respiratória, eletrocardiografia, saturação de oxigênio em hemoglobina, pressão arterial, fração de dióxido de carbono no final da expiração, ventilometria e a hemogasometria. Com a obtenção de resultados percebeu-se uma vantagem na utilização da FIO2 0.4, pois apresenta menor porcentagem de shunt pulmonar, mas não ao ponto de descartar a utilização das outras FIs. No estudo comparativo VCV versus VCP não se encontrou diferenças. Durante a experimentação o protocolo empregado demonstrou ser adequado, pois causa mínimas alterações hemodinâmicas nos pacientes, proporcionando rápido e tranquilo despertar dos animais. Vale ressaltar que durante toda a experimentação os parâmetros se mantiveram constantemente dentro do aceitável para a espécie, o que permite indicar a técnica para futuros estudos. Com relação às diferentes FIs para a ventilação mecânica, utilizando-se oxigênio 40% teremos menos efeitos adversos. / The use of mechanical ventilation in intensive care is a common practice. In addition to therapeutic action it is applied to correct the depressant effects resulting from the action of drugs in patients under sedoanalgesia. Thus it is being studied for better understanding, especially with regard to different concentrations of oxygen and ventilatory volume (VCV) and pressure controlled (PCV) which can trigger different responses from each individual. The aim of this paper is a comparative study of cardiorespiratory dynamics of swine (Sus scrofa domestica) sedated with propofol-remifentanil in two ways: to evaluate the animals subjected to three different fractions of inspired oxygen (FIO2) (0.8, 0.6 and 0.4) mechanical ventilation; evaluate and compare the animals receiving VCV versus those submitted to the VCP. 20 animals were used to make the comparison between fractions of inspired oxygen and six for the comparison between both ventilatory modes. For sedation the animals received an average of 0,29 mg.kg-1.min-1 propofol and 0.3 mcg.kg-1.min-1 remifentanil, and the rate of propofol infusion varied in order to maintain the animal in a scale of consciousness based on the bispectral index between 60 and 70. Comparing the FIs the animals were sedated for two hours and the comparison between VCP and VCV, two hours in each mode. There were evaluated heart and respiratory rates, ECG, oxygen saturation of hemoglobin, blood pressure, fraction of carbon dioxide in end-tidal gas analysis and respirometry. With the achievement of results it was observed apparent advantage in using the FIO2 0.4, because it had a lower percentage of pulmonary shunt, but not to the point of discarding the use of other FIs. In the comparative study VCP versus VCV there were no differences. During the trial the protocol employed proved to be appropriate, because it causes minimal hemodynamic changes in patients, providing a quick and quiet awakening of the animals. It is noteworthy that throughout the experiment parameters were kept constant within the acceptable levels for the species, which can be indicated the technique for future studies. For the mechanical ventilation the best FI used was oxygen 40%, because it has fewer adverse effects.

Includes bibliographical references. / 1 v. (various paging) : / Title page, contents and abstract only. The complete thesis in print form is available from the University Library. / Thesis (D.Nurs.)--University of Adelaide, Dept. of Clinical Nursing, 2002

Sepsis, a great challenge to the physician, is characterized with massive oxidative stress of tissue, cytokine inflammation and increases in nitric oxide (NO) production. Meanwhile, free radical induced by oxidative stress also injures cell membrane or DNA. The way to terminate free radical chain reaction is to administer antioxidant. The commonly used anesthetic, propofol, was thought to be with antioxidant capacity. In the first part of this thesis, we investigated the different role of oxidative injury and NO via systemic injection of LPS in rats. We demonstrated oxidative injury is associated with both early and late stage whereas NO is engaged primarily in late stage cardiovascular depression. Propofol, a rapid onset and fast recovery anesthetic, is attributed to protect anainst cardiovascular depression via attenuating the late stage NO surge in aorta by inhibition of iNOS upregulation. We also examine the influence of propofol on temporal changes in power density of frequency components of systemic arterial pressure (SAP) variability in rat with sepsis and the role of inducible NO synthase (iNOS). We have the conclusions that iNOS-induced NO might be involved in the manifestation of high-frequency and low-frequency components of the SAP spectrum during endotoxemia when low-dose propofol is used and the effect of NO is blunted when high-dose propofol is administered. Due to further investigation was needed to the cellular protective mechanisms of propofol, we delineate the effect of propofol to free radical related enzymel involved in sepsis via both in vivo and vitro studies with rats subjected to LPS (15 mg/kg) and H9C2, L2, NR8383 (derived from rat cardiac myocyte, lung, macrophage, respectively), respectively. Our results demonstrated that propofol may play the major protective role on iNOS, superoxide dismutase and p47 phox oxidative enzymes on lung epithelial cells. Propofol also provided protective effects on cardiac myocyte and macrophage with suppression of iNOS only although free radical production were all significantly suppressed. Ischemia-reperfusion (IR) injury may also produce a lot of free radical and cytokines to cause tissue damage and is common in clinical. We investigated the effect of propofol on free radical and cytokine production via this different model and compared with another rapid recovery anesthesitc, sevoflurane. Aortic decalmping surgery in porcine and their monocyte, aortic and coronary smooth muscle cells were applied for in vivo and in vitro model, respectively. We also demonstrated that propofol but not sevoflurane suppressed the production of free radical and cytokine in monocyte and smooth muscle cells but not in vivo model. In sepsis and IR model that produced a lot free radical and cytokines, propofol eliminated the free redical and cytokines via suppressed different kinds of oxidative enzymes in different cells of different organs to express its protective role. However, as an anesthetic, propofol must be used carefully to perform its maximal benefit.

Worldwide, millions of young and elderly patients receive procedures that could not be performed without the use of anesthetics. Unfortunately, emerging animal and human data suggest an association between exposure to general anesthesia and impairment of cognitive function in pediatric and geriatric patients. Recent laboratory data have shown that general anesthetics are potentially damaging to the developing and aging brain. However, the mechanism by which this happens is still unknown. General anesthetics affect learning and memory, a brain function involving neural plasticity. An important form of neural plasticity receiving attention is postnatal neurogenesis. This process is highly regulated and involved in hippocampal functions under physiological conditions. This dissertation hypothesizes that anesthetic induced alteration of postnatal neurogenesis may explain the cognitive impairment observed in some pediatric and geriatric patients after anesthesia. In order to accurately address this hypothesis, in the first portion of this dissertation, an animal model is used to examine the effects of two different anesthetics on cognition and new cell proliferation in young and aged rats. Furthermore, the second and third portion of this dissertation emphasizes on the effects of these two widely used anesthetics on each of the various stage of postnatal neurogenesis in young and aged rats.