Intraoperative prevention of cognitive impairment in total intravenous anesthesia in school-age children: randomized clinical trial

A.V. Lugovoy, M.V. Panteleeva, E.D. Nadkina, A.M. Ovezov

Vladimirsky Moscow Regional Clinical Research Institute, Moscow

For correspondence: Alexandr V. Lugovoy — research fellow of Department of anesthesiology of Vladimirsky Moscow Regional Clinical Research Institute; e-mail: alelugovoj@yandex.ru

For citation: Lugovoy A.V., Panteleeva M.V., Nadkina E.D., Ovezov A.M. Intraoperative prevention of cognitive impairment in total intravenous anesthesia in school-age children: randomized clinical trial. Alexander Saltanov Intensive Care Herald. 2018;4:57–64.

DOI: 10.21320/1818-474X-2018-4-57-64


Objective. To determine the possibility of prophylactic use of the domestic drug Cytoflavin to reduce the incidence of cognitive impairment after total intravenous anesthesia based on propofol and fentanyl in school-age children.

Material and methods. A prospective randomized clinical trial involving 90 school-age children (ASA I–II) was conducted. Children operated under total intravenous anesthesia on the basis of propofol and fentanyl were randomized into two groups: intraoperative cerebroprotection with cytoflavine 0.25 mg/kg per minute by succinate was performed in group 1 (n = 30), and no cerebroprotection was performed in group 2 (n = 30). For the Z-assessment of cognitive potential, neuropsychological testing of children of the same age who were not subjected to anesthesia was performed (group 3, n = 30).

Research results. There were no significant differences in hemodynamic and neurophysiological parameters in the groups using total intravenous anesthesia based on propofol and fentanyl. Analysis of these parameters showed the safety of the study drug. In the 1 group postoperative cognitive dysfunction (POCD) was detected on the first day of 6.67 % of children, and on the 7th day of postoperative period — at 3.33 %. In group 2, on the first day of the postoperative period, POCD was verified in 13.79 % of patients, on the 7th day — in 27.59 %.

Conclusion. The obtained data showed the effectiveness and safety of the domestic drug Cytoflavin as a prophylactic agent of POCD in school-age children with total intravenous anesthesia based on propofol and fentanyl.

Keywords: postoperative cognitive dysfunction, total intravenous anesthesia, propofol, cytoflavine, school-age children

Received: 05.10.2018


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  1. Овезов А.М., Пантелеева М.В., Луговой А.В. Интраоперационная церебропротекция при тотальной внутривенной анестезии у детей школьного возраста. Журнал неврологии ипсихиатрии им. С.С. Корсакова. 2017; 10: 28–33. [Ovezov A.M., Panteleeva M.V., Lugovoy A.V. Intraoperative cerebroprotection in total intravenous anesthesia in children of school age. S.S. Korsakov Journal of Neurology and Psychiatry. 2017; 10: 28–33. (In Russ)]. DOI: 10.17116/jnevro201711710128–33.

 

Change of the temperature balance of the brain in various types of general anesthesia

A.V. Butrov, K.A. Salimova, B.J. Torosyan, G.R. Makhmutova, P.P. Davydov

Peoplesʼ Friendship University of Russia, Moscow

For correspondence: Salimova Kamila Azatovna — resident Peoplesʼ Friendship University of Russia, Moscow, Moscow; e-mail: telluriya@mail.ru

For citation: Butrov AV, Salimova KA, Torosyan BJ, Makhmutova GR, Davydov PP. Change of the temperature balance of the brain in various types of general anesthesia. Alexander Saltanov Intensive Care Herald. 2018;3:72–6.

DOI: 10.21320/1818-474X-2018-3-72-76


Under the influence of general anesthesia various functions of the body can change depending on the main and concomitant diseases, the type and volume of the surgical intervention. General anesthesia is traditionally associated with the loss of normal thermoregulatory mechanisms. The intracranial temperature of 32 patients were measured in this study. These patients were divided into 3 groups depending on the type of general anesthesia. The brain temperature of all patients were measured by recording the strength of the electromagnetic radiation from deep brain tissues and also, the axillary and tympanic temperatures were measured. According to the thermometry results of the brain, it was evident that when using Propofol, the temperature of the brain during anesthesia decreased by 1.21 ± 0.19 °C. During the maintenance of inhalational anesthesia the temperature of the brain decreased by 0.69 ± 0.15 °C. There was a decrease of brain temperature in all patients from all 3 groups and the temperature gradient of the brain/axillary region increased. Therefore, we concluded that the decrease in brain temperature occurs not only because of thermoregulatory center temperature decrease, but also because of reduced brain metabolism and/or cerebral blood flow. Propofol in a greater degree causes brain temperature decrease which may be important for the prevention or treatment of conditions that are accompanied by an increase in brain temperature or perfusion-metabolic balance disturbances (for example in neuroanesthesiology and in operations on the main cerebral vessels).

Keywords: brain temperature, temperature balance, microwave thermometry, propofol, sevoflurane, general anesthesia

Received: 02.04.2018


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Propofol Infusion Syndrome

A.A. Birkun, A.A. Babanin, M.A. Glotov, A.L. Govdalyuk, P.V. Mel’nychenko, N.Yu. Pylaeva, S.A. Samarin, M.I. Fedosov

Medical Academy named after S.I. Georgievsky of V.I. Vernadsky Crimean Federal University, Simferopol

For correspondence: Alexei A. Birkun — Cand. Sci. Med., assistant professor of the chair of anesthesiology-resuscitaion and emergency medicine in Medical Academy named after S.I. Georgievsky of V.I. Vernadsky Crimean Federal University; e-mail: birkunalexei@gmail.com

For citation: Birkun AA, Babanin AA, Glotov MA, Govdalyuk AL, Mel’nychenko PV, Pylaeva NYu, Samarin SA, Fedosov MI. Propofol Infusion Syndrome. Intensive Care Herald. 2016;3:38–42. 


Propofol infusion syndrome (PRIS) is rare but extremely dangerous complication of propofol administration that is characterized by increased mortality level. Pathogenesis of PRIS is represented by the conjunction of intensified lipolysis, disturbances of fatty acid oxidation and impaired mitochondrial respiratory chain function. PRIS typically develops in patients with critical conditions receiving continuous high-dose propofol infusion and presents as lactate acidosis, rhabdomyolysis and acute circulatory failure. For PRIS there is no specific treatment and the prognosis is largely determined by an ability of the clinician to recognize the syndrome early and stop propofol administration. This review provides a modern insight into pathogenesis, clinical presentations, preventive measures and intensive care of the syndrome and is generally intended to raise an alertness and improve understanding of the problem among practicing physicians.

Keywords: propofol infusion syndrome, PRIS, propofol, hyperlipidemia, rhabdomyolysis, acidosis, Brugada syndrome, ECMO

Received: 26.03.2016


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