Evaluation of airway stress response and respiratory complications in adults undergoing general anesthesia with sevoflurane plus mivacurium chloride and positive pressure ventilation via laryngeal mask.
2026· American journal of translational research· Vol 18 7, pp.
5664-5676
· 0 citations
Medicine
TL;DR
Sevoflurane combined with MC provides a better anesthetic effect and a favorable safety profile in adult patients undergoing general anesthesia.
Abstract
Objective
This research aimed to evaluate the effect of sevoflurane combined with mivacurium chloride (MC) and positive pressure ventilation by a laryngeal mask airway in adult patients undergoing general anesthesia.
Methods
This retrospective study included 88 adult patients who underwent surgery under general anesthesia induced with sevoflurane, MC, and fentanyl. Based on the anesthesia method documented in medical records, patients were divided into an endotracheal general anesthesia (EGA) group (n=44) and a laryngeal mask airway general anesthesia (LMAGA) group (n=44).
Results
The LMAGA group had lower heart rate, mean arterial pressure, end-tidal carbon dioxide, and cortisol levels than the EGA group (P < 0.05). Time to loss of eyelash reflex, extubation time, and awakening time were significantly shortened in the LMAGA group (P < 0.05). In the LMAGA group, postoperative time to first ambulation and first oral intake was significantly less than that in the EGA group (P < 0.05). Bispectral index values and Narcotrend index at the defined time points T2 and T5 were significantly higher in the EGA group (P < 0.05). The LMAGA group had a lower complication rate than the EGA group (P < 0.05) and exhibited better postoperative cognitive status (P < 0.05).
Conclusion
Sevoflurane combined with MC provides a better anesthetic effect and a favorable safety profile.
Background We compared benefits and adverse effects of anesthesia induction with ciprofol, propofol, and etomidate in elderly patients undergoing gastrointestinal endoscopy anesthesia. Methods A total of 391 patients who underwent painless gastrointestinal endoscopy; age ≥ 60 years; ASA I-III were involved between April 30 and 30 December 2025. The primary outcome was hypoxemia or apnea during anesthesia. Secondary outcomes included systolic blood pressure (SBP), diastolic blood pressure (DBP), mean blood pressure (MBP), heart rate (HR), respiratory rate (RR), SpO2 during surgery, and adverse reactions such as coughing dizziness and agitation. Results No differences were found in hypoxemia and apnea. Except for RR, other hemodynamic and respiratory parameters were significantly different among the groups (p < 0.05), and the degree of blood pressure decline in group E was smaller than groups C and P. Group E patients had lower intraoperative hypotension (p = 0.007) and lower demand for vasoactive drugs (p = 0.006). The injection pain scores in groups C and E were lower, but patients in group E had a higher incidence of myoclonus, and the proportion of coughing and hiccups during endoscopy was higher in group E. The incidence of dizziness was lower in Group C. Conclusion No significant differences were observed in the incidence of hypoxemia and apnea among three groups. Etomidate has the advantage of stable hemodynamics; however, the incidence of myoclonus, bucking, and hiccups is high. Injection pain occurred less frequently with ciprofol and etomidate, while ciprofol was associated with a low incidence of postoperative dizziness. Clinical Trail Registration https://www.chictr.org.cn/showproj.html?proj=269837, identifier ChiCTR2500101280.
Yingchao Guan, Gang Zhou, Conghui Wang et al.· Frontiers in Aging· 0 citations
Background: Direct laryngoscopy and endotracheal intubation are associated with significant sympathetic stimulation resulting in tachycardia, hypertension, and increased myocardial oxygen demand. Attenuation of this cardiovascular response is an important anesthetic consideration, especially in patients with limited cardiovascular
reserve.
Aim: To study and compare the effects of intravenous esmolol hydrochloride (0.5 mg/kg), labetalol hydrochloride
(0.25 mg/kg), and lignocaine hydrochloride (1 mg/kg) in attenuation of the cardiovascular response to direct laryngoscopy and endotracheal intubation.
Materials and Methods: This prospective, randomized, comparative clinical study was conducted on 90 adult
patients belonging to ASA physical status I and II, scheduled for elective surgical procedures under general anaesthesia. Patients were randomly allocated into three groups of 30 each. Group L received intravenous lignocaine
(1 mg/kg), Group E received intravenous esmolol (0.5 mg/kg), and Group B received intravenous labetalol (0.25
mg/kg), administered two minutes prior to laryngoscopy. Heart rate, systolic blood pressure, diastolic blood pressure, mean arterial pressure, and rate pressure product were recorded at baseline, immediately before laryngoscopy, and at 1, 3, 5, 7, and 10 minutes following endotracheal intubation. Data were statistically analyzed using
appropriate tests.
Results: Demographic parameters and baseline hemodynamic variables were comparable among the three groups.
Following laryngoscopy and intubation, all groups showed an increase in heart rate and blood pressure. The lignocaine group demonstrated the maximum increase in hemodynamic parameters. Esmolol effectively attenuated
the heart rate response but provided partial control of blood pressure. Labetalol demonstrated the most effective
attenuation of both heart rate and blood pressure, with better control of rate pressure product. All drugs were well
tolerated with no serious adverse effects.
Conclusion: Intravenous labetalol hydrochloride at a dose of 0.25 mg/kg is more effective than esmolol and
lignocaine in attenuating the cardiovascular response to laryngoscopy and endotracheal intubation. Labetalol
provides superior hemodynamic stability with minimal adverse effects and can be safely recommended for routine
clinical use in ASA I and II patients
Rojalin Sahoo, S. Sahoo, A. Patra· International Journal of Pha...· 0 citations
Background: The choice of anesthetic agent for maintenance of general anesthesia significantly influences
intraoperative stability, ‘
recovery profile, and postoperative outcomes. Propofol and sevoflurane are commonly
used agents, yet their comparative performance remains clinically relevant.
Aim: To compare propofol and sevoflurane for maintenance of anesthesia with respect to hemodynamic stability,
recovery characteristics, and adverse events.
Methodology: This prospective, randomized comparative study included 80 ASA I–II patients undergoing
elective surgeries. Patients were allocated into two groups: Group P (propofol infusion) and Group S (sevoflurane
inhalation). Hemodynamic parameters, recovery times, Modified Aldrete Score, and perioperative adverse events
were assessed and analyzed statistically.
Results: Demographic variables were comparable between groups. Group P demonstrated significantly better
intraoperative hemodynamic stability with lower heart rate and blood pressure values (p < 0.05). Recovery was
faster in Group P, with shorter times to eye opening, verbal response, and extubation (p < 0.001). Postoperative
nausea, vomiting, and emergence agitation were significantly lower with propofol.
Conclusion: Propofol provided superior hemodynamic control, faster recovery, and fewer postoperative adverse
effects compared to sevoflurane, making it a preferable agent for maintenance of anesthesia in short elective
surgeries.
Ranjeet Kumar, Faseehullah Alam· International Journal of Pha...· 0 citations
Background The induction of general anesthesia with propofol often results in hypotension, primarily attributed to decreased cardiac index (CIx) among elderly patients. Norepinephrine (NE) is typically used to manage anesthesia-induced hypotension. We hypothesized that NE attenuates the reduction in CIx while preserving blood pressure. Methods In a randomized, double-blinded trial, 60 elderly patients undergoing elective major abdominal surgery were randomly allocated to receive NE (6 µg/ml) (NE group) or saline (control [CT] group) during induction. CIx was monitored using the FloTrac/Vigileo system, and the primary outcome was the change in CIx (△CIx) (△Value = value measured at the study time point–baseline value) at 10 min post-intubation (T10). Changes in systemic vascular resistance index (△SVRI) and mean arterial pressure (△MAP) were also evaluated for comparison. Results In NE group, CIx decreased from 3.9 to 2.9 L/min/m2 at 10 min post-intubation (T10), whereas in CT group, it declined from 3.7 to 2.6 L/min/m2. After adjusting for propofol dosage per weight, the decreases in △CIx (β = 0.63, 95% confidence interval [CI] 0.18 to 1.07; P = 0.006) and △MAP (β = 11.99, 95% CI 2.05 to 21.94; P = 0.018) at T10 were significantly less in NE group compared to CT group, whereas △SVRI did not show a significant difference between the two groups. Conclusions Prophylactic infusion of NE effectively attenuated the decrease in △CIx during propofol-induced anesthesia in elderly patients while maintaining MAP.
Wenping Peng, Xiaolu Sun, Shuang Zhao et al.· Anesthesia and Pain Medicine· 0 citations
BACKGROUND
Obese patients are prone to rapid oxygen desaturation during induction of general anesthesia due to reduced functional residual capacity and atelectasis formation. Transnasal humidified rapid insufflation ventilatory exchange (THRIVE) prolongs safe apnea time; however, its effects on lung volume dynamics during apnea remain unclear.
METHODS
In this single-center randomized controlled trial, adults with body mass index ≥35 kg/m2 undergoing elective surgery were assigned to apneic oxygenation with THRIVE or facemask oxygen following induction of general anesthesia. Electrical impedance tomography was used to assess changes in end-expiratory lung impedance (ΔEELI), a surrogate of lung volume. The primary outcome was mean global ΔEELI during an early apneic window (2-6 min).
RESULTS
Thirty-two patients were analyzed. Mean global ΔEELI during early apnea was significantly better preserved with THRIVE than with facemask oxygen (-0.22 ± 0.03 vs. -0.89 ± 0.07; mean difference 0.67, 95% CI 0.55-0.80; P < 0.001). THRIVE attenuated the rate of ΔEELI decline and was associated with greater preservation of lung volume, particularly in mid-ventral and mid-dorsal regions. Safe apnea time was significantly prolonged in the THRIVE group (median 600 vs. 319 s).
CONCLUSIONS
In obese patients, THRIVE transiently preserves lung volume during early apnea by slowing the decline in end-expiratory lung volume. These findings provide physiological insight into the mechanisms underlying improved oxygenation during apneic oxygenation.
Soichi Tanaka, Tomohiro Chaki, S. Tachibana et al.· Journal of clinical anesthes...· 0 citations
Background: “
Laryngoscopy and tracheal intubation trigger sympathetic responses, causing transient elevations
in heart rate and blood pressure, which may be hazardous in patients with cardiovascular risk. Beta-blockers such
as esmolol and labetalol are commonly used to attenuate these hemodynamic responses.
Aim: To compare the efficacy of intravenous esmolol and labetalol in blunting the hemodynamic response during
laryngoscopy and tracheal intubation in adult patients undergoing elective surgery.
Methodology: A prospective, hospital-based, comparative observational study was conducted on 90 ASA I–II
adult patients, randomized to receive esmolol (0.5 mg/kg, n=45) or labetalol (0.25 mg/kg, n=45) before intubation.
Hemodynamic parameters—heart rate, diastolic blood pressure, and rate pressure product—were recorded at
baseline, post-induction, intubation, and at 1, 3-, 5-, 10-, and 15-minutes post-intubation.
Results: Baseline parameters were comparable between groups. Labetalol produced significantly lower heart
rates, diastolic pressures, and rate pressure product than esmolol at most time points, indicating superior
attenuation of cardiovascular stress. A transient 3–5-minute window showed comparable efficacy.
Conclusion: Intravenous labetalol (0.25 mg/kg) provides more sustained hemodynamic stability than esmolol
(0.5 mg/kg) during laryngoscopy and intubation, making it the preferred agent for peri-intubation cardiovascular
protection
Vikash Gaurav· International Journal of Pha...· 0 citations
We use cookies to run the site and, with your consent, for analytics and to show ads.
See our Cookie Policy.
