Background: Sevoflurane induction for general anaesthesia has been reported to be safe, reliable and well accepted by patients. Sevoflurane induction uses either low or high initial concentrations. The low initial concentration technique involves initially administering a low concentration then gradually increasing the dose until the patient is anaesthetized. The high initial concentration technique involves administering high concentrations from the beginning, continuing until the patient is anaesthetized.
Objectives: We aimed to compare the induction times and complications between high and low initial concentration sevoflurane induction in patients who received inhalational induction for general anaesthesia. We defined 'high' as greater and 'low' as less than a 4% initial concentration.
Search Methods: We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2011, Issue 9); MEDLINE (1950 to September 2011); EMBASE (1980 to September 2011); LILACS (1982 to September 2011) and ISI Web of Science (1946 to September 2011). We also searched the reference lists of relevant articles, conference proceedings; and contacted the authors of included trials.
Selection Criteria: We sought all published and unpublished, randomized controlled trials comparing high versus low initial sevoflurane concentration inhalational induction. Our primary outcomes were two measures of anaesthesia (time to loss of the eyelash reflex (LOER) and time until a weighted object held in the patient's hand was dropped), time to successful insertion of a laryngeal mask airway (LMA), and time to endotracheal intubation. Other outcomes were complications of the technique.
Data Collection And Analysis: We used the standardized methods for conducting a systematic review as described by the Cochrane Handbook for Systematic Reviews of Interventions. Two authors independently extracted details of trial methodology and outcome data from reports of all trials considered eligible for inclusion. All analyses were made on an intention-to-treat basis, where possible. The overall treatment effects were estimated by using a fixed-effect model when there was no substantial heterogeneity, whereas the random-effects model was applied in the presence of considerable heterogeneity.
Main Results: We used data from 10 studies with 729 participants in the review, though most analyses were based on data from fewer participants. There was substantial heterogeneity in the trials. Thus, our results should be read with caution. It was not possible to combine the trials for the primary outcome (LOER) but individual trials found faster induction times (typically 24 to 82 seconds faster) with high initial concentration sevoflurane. Apnoea appeared to be more common in the high initial concentration sevoflurane group (two trials,160 participants). There was no evidence of a difference in the incidence of cough, laryngospasm, breath holding, bradycardia, salivation and hypotension between the two groups, with the overall incidence of complications being low.
Authors' Conclusions: A high initial concentration sevoflurane technique probably offers more rapid induction of anaesthesia and a similar rate of complications except for apnoea, which may be more common with a high initial concentration. However, this conclusion is not definitive.
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http://dx.doi.org/10.1002/14651858.CD006837.pub2 | DOI Listing |
ACS Pharmacol Transl Sci
January 2025
College of Pharmacy and Research Institute of Pharmaceutical Sciences, Seoul National University, Seoul 08826, Republic of Korea.
Everolimus presents significant dosing challenges due to between- and within-patient pharmacokinetic variabilities. This study aimed to develop and validate a model-informed precision dosing strategy for everolimus in liver transplant recipients. The dosing strategy was initially developed using retrospective data, employing nonlinear mixed-effects modeling.
View Article and Find Full Text PDFSisli Etfal Hastan Tip Bul
December 2024
Department of Radiation Oncology, University of Health Sciences Türkiye, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Türkiye.
Objectives: Nonsmall cell lung cancer (NSCLC) accounts for about 85% of all lung cancers. Asymmetric dimethylarginine (ADMA) is an emerging molecule that is highlighted in carcinogenesis and tumor progression in lung cancer. Since elevated concentrations of ADMA are observed in lung cancer patients, we aimed to explore its associations with inflammation markers and established prognostic indices.
View Article and Find Full Text PDFHeliyon
July 2024
Nano-optoelectronic Research Laboratory, School of Physics, Universiti Sains Malaysia, 11800, Pinang, Malaysia.
The degradation of methylene blue dye-contaminated wastewater via photocatalysis is an efficient approach towards environmental remediation. The SrZrO perovskite photocatalyst was synthesized using the modified Pechini sol-gel method, and characterized using XRD, FESEM, FTIR, and UV-visible spectrophotometer. Crystallite size obtained by the Scherrer and Williamson-Hall methods were 45.
View Article and Find Full Text PDFFront Antibiot
April 2024
Department of Biology, University of Copenhagen, Copenhagen, Denmark.
Initiation of chromosome replication is an essential stage of the bacterial cell cycle that is controlled by the DnaA protein. With the aim of developing novel antimicrobials, we have targeted the initiation of DNA replication, using antisense peptide nucleic acids (PNAs), directed against DnaA translation. A series of anti-DnaA PNA conjugated to lysine-rich bacterial penetrating peptides (PNA-BPPs) were designed to block DnaA translation.
View Article and Find Full Text PDFTob Prev Cessat
January 2025
Institute of Primary Health Care, University of Bern, Bern, Switzerland.
Introduction: Many tobacco smokers try to quit with electronic nicotine delivery systems (ENDS or e-cigarettes). We aimed to describe e-liquid flavors and nicotine concentration use over 6 months in a prospective cohort of smokers willing to quit with ENDS.
Methods: We included 622 participants from the intervention group of the Efficacy, Safety and Toxicology of ENDS randomized controlled trial.
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