Media Articles Related to Terrell (Isoflurane)
General Anesthesia May Negate Endovascular Benefit in Stroke
Source: Medscape Critical Care Headlines [2015.02.17]
Subgroup analysis of the MR CLEAN trial has shown that patients who underwent endovascular clot retrieval under general anesthesia did not show the benefit seen overall in the trial.
Medscape Medical News
The Death of Joan Rivers: Endoscopy and Anesthesia Risks
Source: MedicineNet Heart Attack Pathology: Photo Essay Specialty [2014.12.09]
Title: The Death of Joan Rivers: Endoscopy and Anesthesia Risks
Category: Doctor's Views
Created: 9/8/2014 12:00:00 AM
Last Editorial Review: 12/9/2014 12:00:00 AM
Parsing Out Best Practices for Endovascular Thrombectomy (CME/CE)
Source: MedPage Today Emergency Medicine [2015.02.16]
(MedPage Today) -- "Time is brain" in endovascular thrombectomy, more evidence against general anesthesia.
Published Studies Related to Terrell (Isoflurane)
Effect of a heat and moisture exchanger on heat loss in isoflurane-anesthetized dogs undergoing single-limb orthopedic procedures. [2011.12.15]
Objective-To determine whether a heat and moisture exchange device (HME) prevents a decrease in body temperature in isoflurane-anesthetized dogs undergoing orthopedic procedures...
Protection by remote ischemic preconditioning during coronary artery bypass graft surgery with isoflurane but not propofol - a clinical trial. [2011.11.21]
BACKGROUND: Remote ischemic preconditioning (RIPC) of the myocardium by limb ischemia/reperfusion may mitigate cardiac damage, but its interaction with the anesthetic regimen is unknown. We tested whether RIPC is associated with differential effects depending on background anesthesia. Specifically, we hypothesized that RIPC during isoflurane anesthesia attenuates myocardial injury in patients undergoing coronary artery bypass graft (CABG) surgery, and that effects may be different during propofol anesthesia... CONCLUSION: Thus, RIPC during isoflurane but not during propofol anesthesia decreased myocardial damage in patients undergoing CABG surgery. Accordingly, effects of RIPC evoked by upper limb ischemia/reperfusion depend on background anesthesia, with combined RIPC/isoflurane exerting greater beneficial effects under conditions studied. (c) 2011 The Authors Acta Anaesthesiologica Scandinavica (c) 2011 The Acta Anaesthesiologica Scandinavica Foundation.
Increased lung clearance of isoflurane shortens emergence in obesity: a prospective randomized-controlled trial. [2011.09]
Background: There is a concern that obesity may play a role in prolonging emergence from fat-soluble inhalational anaesthetics. We hypothesized that increased pulmonary clearance of isoflurane will shorten immediate recovery from anaesthesia and post-anaesthesia care unit (PACU) stay in obese patients.
Respiratory resistance during anaesthesia with isoflurane, sevoflurane, and desflurane: a randomized clinical trial. [2011.09]
BACKGROUND: To investigate whether the effects of desflurane on inspiratory resistance are similar to those of isoflurane and sevoflurane during 30 min administration at 1 and 1.5 MAC in patients with healthy lungs... CONCLUSIONS: In healthy adults, neither sevoflurane nor isoflurane produced bronchodilation at 1 and 1.5 MAC. Desflurane did not affect respiratory resistance at 1 MAC, but at 1.5 MAC caused significant increase in both total and airway resistance with return to near baseline values after discontinuation of the agent.
Synergy of isoflurane preconditioning and propofol postconditioning reduces myocardial reperfusion injury in patients. [2011.07]
Either isoflurane preconditioning or high-dose propofol treatment has been shown to attenuate myocardial IRI (ischaemia/reperfusion injury) in patients undergoing CABG (coronary artery bypass graft) surgery. It is unknown whether isoflurane and propofol may synergistically attenuate myocardial injury in patients...
Clinical Trials Related to Terrell (Isoflurane)
Acceleration of Recovery From General Anesthesia - Efficacy of Isocapnic Hyperpnoea in Obese Patients Undergoing Isoflurane Anesthesia [Recruiting]
Faster recovery from anesthesia is important for obese patients because they are at high
risk of respiratory complications following tracheal extubation. Isoflurane has several
properties that make it a preferable agent for anesthesia in obese patients. Its main
limitation is a longer recovery time due to slower elimination in comparison to other
agents. Elimination of isoflurane from the lungs can be accelerated by increasing in
patient's minute ventilation, which decreases the level of CO2 in blood
(hypocapnia).Isocapnic Hyperpnoea (IH) is a method allowing increased ventilation and
therefore enhancement of the elimination of inhalation agents while maintaining a normal
blood CO2 level. The investigators will compare recovery time from isoflurane anesthesia in
obese patients during standard anesthesia management protocol (control) to a group treated
Effects of Propofol and Isoflurane on Pulmonary Vascular Resistance [Recruiting]
The investigators hypothesize that there is no difference between the effects of isoflurane
and propofol anaesthesia on pulmonary vascular resistance (PVR).
Closed Loop Isoflurane Administration With Bispectral Index in Open Heart Surgery [Recruiting]
With the advancement in microprocessor technology and better understanding of
pharmacodynamics and pharmacokinetics of anaesthetic agents, computer facilitated closed
loop control of anaesthesia using propofol has been shown to be accurate with better
performance than manual control (3,4). Literature on computer controlled administration of
inhalational anaesthetics is few (1), as it requires the computer to control the dial
setting on the vapouriser. The investigators intend to compare the computer controlled
closed loop administration of isoflurane by infusing it into the anaesthetic circuit with
conventional vaporiser control in elective open heart surgery.
40 patients (ASA II-IV; 18- 65 years) undergoing elective cardiac surgery requiring
cardiopulmonary bypass (CPB) will be randomly divided into manual or closed loop groups.
Propofol will be used for induction of anaesthesia in both groups followed by isoflurane for
maintenance. In the manual group, isoflurane will be administered through the Tech 7
vapouriser during pre and post CPB periods to target bispectral index (BIS) of 50. In closed
loop group, isoflurane will be administered using infusion of liquid isoflurane into
expiratory limb of the closed circuit. This rate of infusion though a conventional syringe
pump will be controlled by algorithm termed 'Improvised Anaesthetic Agent Delivery System'
(IAADS) to maintain BIS of 50. Patients in both groups will receive 500ml of 100 % oxygen as
fresh gas flow. The % of time bispectral index (BIS) is within the 10% of set target BIS of
50 will be the primary outcome measure. The secondary outcome measures will be median
performance error (MDPE)(2), median absolute performance error (MDAPE)(2), wobble(2),
divergence(2), amount of isoflurane used and hemodynamic parameters will be secondary
Sevoflurane and Isoflurane - During Cardiopulmonary Bypass With the MECC System (Minimized Extracorporeal Circuit) [Recruiting]
The use of volatile anesthetics in cardiac anesthesia is very common, because of their
cardioprotective effects and their ability to ensure a sufficient depth of anesthesia. In
line with the development of fast track concepts in cardiac anesthesia, volatile anesthetics
are widely used to avoid a delayed recovery from cardiac surgery and anesthesia. Volatile
anesthetics are delivered from calibrated vaporizers in the anesthesia machine or the
cardiopulmonary bypass machine (during extracorporeal circulation).
Isoflurane and Sevoflurane are the most commonly used volatile anesthetics in patients
undergoing cardiopulmonary bypass (CPB). The vaporizer of the anesthetics is on the
cardiopulmonary bypass machine and the volatile agent is blended with air and oxygen. Until
now, the pharmacokinetics of halothane, enflurane, isoflurane and desflurane during CPB have
Sevoflurane might be of advantage because of additional myocardial protective effects during
cardiac anesthesia and cardiopulmonary bypass. However, the pharmacokinetics of sevoflurane
during CPB have not been investigated so far, although its being used at many hospitals.
The investigators will conduct a randomized prospective study with either sevoflurane or
isoflurane during cardiopulmonary bypass surgery. The study will help to answer the
questions about the possible cardioprotective effects of the widely used volatile
anesthetics and the hemodynamic stability during cardiopulmonary bypass. Knowing the
pharmacokinetics of these drugs allows the anesthesiologist to titrate the volatile
anesthetics more precise.
The investigators hypothesizes that the maximal postoperative increase in troponin T will be
smaller in the sevoflurane group than in the isoflurane group. The investigators
hypothesizes that the total amount of noradrenaline needed during the entire period of
cardiopulmonary bypass will be smaller in the sevoflurane group than in the isoflurane
group. The investigators hypothesizes that kinetics of washin and washout at the CPB will be
faster in the sevoflurane group than in the isoflurane group. The investigators hypothesizes
that the time to extubation, respectively the length of stay in intensive care unit and
hospital is shorter in the sevoflurane group than in the isoflurane group.
Postoperative Pain After Laparoscopic Cholecystectomy After Anesthesia With Isoflurane, Desflurane, Sevoflurane or Propofol [Recruiting]
To the investigators' knowledge, no study has looked at differences in postoperative pain
when comparing maintenance of anesthesia with isoflurane, desflurane, sevoflurane, and
propofol in laparoscopic cholecystectomy. The investigators' hypothesis is that total
intravenous anesthesia with propofol will lead to less postoperative pain in the first 24
hours after laparoscopic cholecystectomy when compared to maintenance of anesthesia with
isoflurane, desflurane or sevoflurane.
To find out if maintenance of anesthesia with propofol leads to less postoperative pain
after laparoscopic cholecystectomy when compared to maintenance of anesthesia with
isoflurane, desflurane, or sevoflurane.