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Related Concept Videos

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...
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Parenteral Anesthetics: Overview01:24

Parenteral Anesthetics: Overview

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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.
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General Anesthesia: Overview01:24

General Anesthesia: Overview

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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...
283
Local Anesthetics: Clinical Application as Intravenous Regional Anesthesia01:16

Local Anesthetics: Clinical Application as Intravenous Regional Anesthesia

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Intravenous regional anesthesia or the Bier block technique is used to anesthetize a specific limb or extremity. It uses exsanguinated or blood-drained vessels to transport local anesthetics or LAs to the peripheral nerve trunks. Lidocaine without vasoconstrictors like epinephrine is most commonly used for this technique. Other drugs used are prilocaine, ropivacaine, and chloroprocaine. Bupivacaine is not recommended for this technique due to its high cardiac toxicity.
One of the advantages of...
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Stages of General Anesthesia01:22

Stages of General Anesthesia

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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...
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Drug Delivery: Parenteral Route01:29

Drug Delivery: Parenteral Route

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The parenteral route is a critical method of drug administration. It delivers compounds directly into the systemic circulation and bypasses the gastrointestinal tract. This approach is particularly advantageous for drugs that exhibit poor absorption or instability when administered orally.
There are three primary parenteral routes: intravenous (IV), intramuscular (IM), and subcutaneous (SC). The IV route introduces the drug directly into the bloodstream, ensuring immediate action. The IM route...
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An In Vivo Mouse Model of Total Intravenous Anesthesia During Cancer Resection Surgery
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Total Intravenous Versus Inhalational Anesthesia in High-Grade Glioma Surgery: A Systematic Review and Meta-Analysis.

Plamen Penchev1, Boris Tablov2, Mariano Gallo Ruelas3

  • 1Faculty of Medicine, Medical University of Plovdiv, 4002 Plovdiv, Bulgaria.

Medicina (Kaunas, Lithuania)
|August 28, 2025
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Summary

This meta-analysis found no significant difference in survival outcomes between total intravenous anesthesia (TIVA) and inhalational anesthesia (INHA) for high-grade glioma (HGG) patients. However, TIVA may offer a survival benefit for grade IV HGG tumors, warranting further research.

Keywords:
glioblastomahigh-grade gliomasinhalational anesthesia (INHA)total intravenous anesthesia (TIVA)

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Area of Science:

  • Neurosurgery
  • Anesthesiology
  • Oncology

Background:

  • High-grade gliomas (HGGs) are aggressive brain tumors with poor prognoses.
  • The impact of anesthetic techniques on HGG progression and survival is not well-established.
  • This study investigates the effects of total intravenous anesthesia (TIVA) versus inhalational anesthesia (INHA) on survival outcomes in HGG patients.

Purpose of the Study:

  • To evaluate the impact of TIVA compared to INHA on overall survival (OS) and progression-free survival (PFS) in patients with high-grade gliomas.
  • To analyze existing literature through a meta-analysis to provide evidence-based insights.

Main Methods:

  • Systematic literature search of PubMed, Scopus, and Cochrane databases.
  • Meta-analysis of five studies involving 827 participants (406 receiving TIVA).
  • Statistical analysis using a random-effects model to calculate pooled hazard ratios (HRs) and assess heterogeneity.

Main Results:

  • No statistically significant differences were found in OS (HR 0.77, p=0.07) or PFS (HR 0.88, p=0.27) between TIVA and INHA groups.
  • A subgroup analysis indicated a potential improvement in OS for TIVA in grade IV tumors (HR 0.70, p=0.03).
  • The subgroup difference test was not statistically significant (p=0.0669), requiring cautious interpretation.

Conclusions:

  • Current evidence does not support a significant difference in OS or PFS between TIVA and INHA for HGG surgery.
  • A potential survival advantage for TIVA in grade IV HGG warrants further investigation.
  • Additional research is necessary to clarify the role of anesthetic techniques in HGG patient outcomes.