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Related Concept Videos

General Anesthesia: Overview01:24

General Anesthesia: Overview

280
Anesthesia is a medical procedure that uses drugs for CNS suppression to enable painless surgeries and procedures. The selection of anesthetics is influenced by their pharmacokinetic properties, side effects, and patient characteristics. Various types of anesthesia include general, local, regional, spinal, and inhalational.
General anesthesia induces unconsciousness in the whole body, while the others target specific areas or sensations. It is administered to minimize adverse effects, maintain...
280
Inhalational Anesthetics: Overview01:20

Inhalational Anesthetics: Overview

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Inhalation anesthetics are drugs that induce general anesthesia upon inhalation. They work by increasing the sensitivity of GABAA receptors or inhibiting NMDA receptors, leading to a decrease in central nervous system activity. The depth of anesthesia can be rapidly adjusted by changing the concentration of the inhaled gas. Some common examples of inhalational anesthetics include volatile liquids like isoflurane, desflurane, sevoflurane and gases like xenon and nitrous oxide. Isoflurane, a...
482
Stages of General Anesthesia01:22

Stages of General Anesthesia

655
Various sedation levels offer significant advantages in facilitating procedural interventions for patients undergoing medical or invasive surgical procedures. These levels span from anxiolysis to general anesthesia, providing a spectrum of sedative effects to cater to specific patient needs. Anxiolysis reduces anxiety and is achieved through minimal sedation, enabling patients to remain awake and responsive while feeling more at ease during the procedure. This level can benefit minor...
655
Parenteral Anesthetics: Overview01:24

Parenteral Anesthetics: Overview

191
Intravenous anesthetics are drugs administered parenterally to induce anesthesia or sedation. Propofol is a widely used agent formulated as a 1% emulsion in soybean oil, glycerol, and egg phosphatide. It induces rapid anesthesia primarily due to its rapid distribution from the bloodstream to target tissues and is metabolized in the liver. However, it can cause significant pain on injection and hypertriglyceridemia. Fospropofol, a water-based prodrug of propofol, lacks these adverse effects.
191

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Related Experiment Video

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Incidence of Postoperative Cognitive Dysfunction Following Inhalational vs Total Intravenous General Anesthesia: A

Daniel Negrini1,2, Andrew Wu1, Atsushi Oba1,3

  • 1Division of Surgical Oncology, Department of Surgery, University of Colorado, Anschutz Medical Campus, Aurora, CO, USA.

Neuropsychiatric Disease and Treatment
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Summary

Total intravenous anesthesia (TIVA) is linked to a lower incidence of postoperative cognitive dysfunction (POCD) within 30 days after surgery, compared to inhalational anesthesia. Further research is needed for long-term effects.

Keywords:
POCDTIVAinhalational anesthesiapostoperative cognitive dysfunctionpostoperative complicationspsychometric teststotal intravenous anesthesia

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Area of Science:

  • Anesthesiology
  • Neuroscience
  • Geriatric Medicine

Background:

  • Postoperative cognitive dysfunction (POCD) is a recognized complication impacting patient recovery.
  • Distinguishing between early (≤30 days) and late (30 days–12 months) POCD is crucial for accurate assessment.
  • The choice between inhalational anesthesia and total intravenous anesthesia (TIVA) is investigated for its impact on POCD incidence.

Purpose of the Study:

  • To conduct a meta-analysis on the impact of general anesthesia type on POCD within 30 days postoperatively.
  • To systematically review the effect of anesthetic choice on POCD between 30 days and 12 months after surgery.

Main Methods:

  • A comprehensive literature search identified 1913 articles for the primary objective, resulting in ten studies with 3390 participants.
  • Four studies involving 480 patients were selected for the secondary objective's systematic review.
  • Meta-analysis was performed for early POCD; a meta-analysis was not feasible for late POCD due to heterogeneity.

Main Results:

  • Within 30 days postoperatively, TIVA was associated with a significantly lower incidence of POCD (Odds Ratio = 0.46, 95% CI = 0.26-0.81, p = 0.01) compared to inhalational anesthesia.
  • The meta-analysis confirmed TIVA's protective effect against early POCD.
  • A meta-analysis for POCD between 30 days and 12 months was not performed due to high heterogeneity among the selected studies.

Conclusions:

  • Total intravenous anesthesia (TIVA) demonstrates a reduced incidence of postoperative cognitive dysfunction in the early postoperative period (within 30 days).
  • The anesthetic's effect on long-term POCD (30 days to 12 months) remains unclear due to limited and heterogeneous data.
  • Further high-quality prospective studies are recommended to definitively address the long-term impact of anesthetic choice on POCD.