Neoplasms

All Conditions

Digestive System Diseases

Symptoms and General Pathology

Carcinoma

Carcinoma, Hepatocellular

Neoplastic Cells, Circulating

Neoplasm Metastasis

Neoplastic Processes

Central Nervous System Depressants

All Drugs and Chemicals

Analgesics

Hematinics

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Anesthetics

Rocuronium

Propofol

Liver Extracts

Desflurane

Benzocaine

Hypnotics and Sedatives

Anesthetics, Intravenous

Anesthetics, General

Anesthetics, Inhalation

Tannic Acid

propofol（50ml,1g）,Intravenous propofol infusion was slowly pushed until loss of consciousness, and anesthesia was maintained at 4-8 mg/kg/h

In the general anesthesia group with desflurane( 240ml), intravenous propofol infusion was slowly pushed until consciousness disappeared, and then anesthesia was maintained with 4-6% desflurane

Propofol general anesthesia group (P group) : intravenous propofol infusion was slowly pushed until consciousness disappeared, and then anesthesia was maintained at 4-8 mg/kg/h. In the general anesthesia group with desflurane (group D), intravenous propofol infusion was slowly pushed until consciousness disappeared, and then anesthesia was maintained with 4-6% desflurane. The analgesic and muscle relaxant regimens were the same in both groups except for sedative drugs. All patients were treated with no medication before operation, and the operation was completed under endotracheal intubation and general anesthesia. The amount of propofol or desflurane was adjusted according to BIS or MAC values and hemodynamic changes during operation. Add 10mg of rocuronium every half hour. Vasoactive drugs can be used to maintain hemodynamic stability during the operation, and corresponding records should be made

Desﬂurane

Propofol general anesthesia group (P group) : intravenous propofol infusion was slowly pushed until consciousness disappeared, and then anesthesia was maintained at 4-8 mg/kg/h.

To investigate the effects of perioperative anesthetic drugs propofol and desflurane on circulating tumor nucleic acids (CK7, ELF3, EGFR and EphB4 mRNA) in the blood of patients with liver cancer, so as to provide scientific reference for clinical anesthesia in the perioperative treatment of tumor

Hepatocellular carcinoma (HCC) is one of the most malignant tumors in oncology. Its incidence is increasing, and there is a lack of reliable biomarkers for early diagnosis, prognosis evaluation and efficacy evaluation. There is a pool of tumor molecules derived from primary tumors in the blood circulation, including Circulating tumor proteins, Circulating tumor cells (CTCs), Extracellular vesicles, Evs, Tumor "educated" platelets (TEPs), and Circulating Tumor nucleic acids, known as Circulating Tumor DNA, CtDNA is a Circulating cell-free DNA (ccfDNA). Liquid biopsy is performed to detect tumor molecules from blood circulation. Small RNA (miRNA) and long noncoding RNA (miRNA) in liquid biopsy are detected. Circulating tumor RNA (ctRNA), such as lncRNA, can be used as epigenetic biomarkers to improve the early diagnosis of HCC and to treat patients with early and advanced HCC. Propofol and desflurane, as important anesthesia drugs in perioperative period, have been shown to affect the concentration of circulating nucleic acid in patients. Furong Song found that propofol could inhibit the overexpression of HOXA11-AS, which reversed the inhibitory effect of propofol treatment on HCC cell progression, by promoting the expression of Mir-4458, and had an impact on HCC cell progression . However, Dongmei Wang and their colleagues found that circulating H19 inhibited the effect of propofol in promoting HCC cell apoptosis by upregulating LIMK1 (LIM domain kinase 1) through spongy Mir-520a-3p . Meanwhile, Buschmann and his team found that propofol and desflurane inhibited key cancer-related pathways such as proliferation and migration in colorectal cancer, and found that propofol did not affect the size distribution and protein labeling of circulating vesicles, but could reduce their concentration . Compared with inhaled anesthetics, Bon-Wook Koo found that HCC patients treated with propofol had a lower recurrence rate and a longer average recurrence time than those treated with inhaled anesthetics . Hou-chuan Lai found that compared with desflurane anesthesia regimen, propofol anesthesia regimen significantly improved the survival rate of patients with liver cancer without distant metastasis or local recurrence . Meanwhile, Frederique Hovaguimian found that in nonmetastatic and metastatic breast cancer, the maximum number of circulating tumor cells increased by 36% after sevoflurane inhalation anesthesia and was independently associated with a higher risk of disease recurrence and reduced survival . At this time, the monitoring of circulating tumor cells can represent promising methods, such as the detection of suitable markers of circulating tumor cells, such as Cytokeratin 7 (CK7), E74-like factor 3 (ELF3), Epidermal growth factor receptor (EGFR) and Peripheral blood mononuclear cells, The expression of erythropoietin-producing hepatocellular carcinoma receptor B4 (EphB4) mRNA in PMBCs, In order to better understand the effect of anesthesia on perioperative tumor treatment, this evidence has been supported by domestic and foreign studies . Soo-ho Lee and his colleagues found that CK7-negative liver cancer patients had a higher survival rate than all positive patients \[9\], which was supported by Xialing Huang and his team . Longbo Zheng found that ELF3 inhibits ZE1 by inhibiting Mir-141-3p, thereby inhibiting E-cadherin in HCC cells and promoting EMT, which is a potential prognostic biomarker and/or therapeutic target for HCC . Zhe Wu found that lncrNA-UBE2R2-AS1 in HCC shows carcinogenic effect through the up-regulation of EGFR by Mir-302b, and can be used as a potential therapeutic target and prognostic biomarker for HCC patients , and this mechanism of action was confirmed by Zhen-Jiang Ma and his research . At the same time, it was found that the expression level of EphB4 was increased in HCC tumor tissues, and the levels of EphB4 and P-JAK2 were positively correlated in samples of HCC patients , while the expression of CIRC-EPHB4 was down-regulated. Circ-ephb4 overexpression inhibited the viability of HCC cells, induced apoptosis, and inhibited cell migration and invasion by inhibiting the expression of hypoxia-inducible factor-1α (HIF-1α) . However, the perioperative effects and molecular mechanisms of propofol and desflurane on circulating tumor nucleic acids in liver cancer are not very clear at present, and further relevant studies are needed to clarify, so as to provide support and guidance for the development of perioperative anesthesia plan and clinical diagnosis of liver cancer.

Propofol general anesthesia group (P group) : intravenous propofol infusion was slowly pushed until consciousness disappeared, and then anesthesia was maintained at 4-8 mg/kg/h.

In the general anesthesia group with desflurane (group D), intravenous propofol infusion was slowly pushed until consciousness disappeared, and then anesthesia was maintained with 4-6% desflurane

By statistical professionals using SAS software on the computer, according to the propofol group and halothane group the proportion of 1:1, to patients by ASA classification, disease category, coexist, the condition of the body after stratified according to stratified random methods such as random coding, in this study, each participant will be according to the center of the random number sequence into the propofol group and halothane group

Effect of Propofol and Desflurane on Nucleic Acid of Liver Circulating Tumor

Circulating tumor nucleic acid (CK7, ELF3, EGFR, and EphB4 mRNA) concentrations were determined by real-time RT-PCR in Applied Biosystems 7500 (Foster City, CA, USA) using SYBR® Premix Ex TaqTM II (Po, Otsu, Japan). Sequence of primers designed as previously described. Total mRNA was normalized to GAPDH and relative mRNA expression of the sample by calculating 2- δδCT, and differential expression of the sample was defined as upregulation when the cutoff value was set to 2x

Zhejiang Cancer Hospital

clinical professor

Rare Diseases

Stomach Neoplasms

Hypoxia

Signs and Symptoms, Respiratory

Stomach Cancer

Imidacloprid

Remazolam tosylate is an ultra-short-acting benzodiazepine drug, which has a mild inhibitory effect on the respiratory and circulatory systems and has anterograde amnesia. These advantages make remazolam tosylate very likely to replace propofol in painless gastroscopic anesthesia.

Remimazolam tosylate

Propofol is the most commonly used intravenous anesthetic for painless gastroscopy, but propofol significantly inhibits the respiratory and circulatory systems. Therefore, the incidence of intraoperative hypoxemia and hypotension is high.

Diansan Su, Dr.

Huichen zhu, M.S.

Xiangrui D Wang, Dr.

Ming Yao, PhD

Hongmei zhou

shibiao chen

Propofol is the most commonly used intravenous anesthetic for painless gastroscopy, but propofol significantly inhibits the respiratory and circulatory systems. Therefore, the incidence of intraoperative hypoxemia and hypotension is high. Remazolam tosylate is an ultra-short-acting benzodiazepine drug, which has a mild inhibitory effect on the respiratory and circulatory systems and has anterograde amnesia. These advantages make remazolam tosylate very likely to replace propofol in painless gastroscopic anesthesia.

Efficacy and Safety of Remimazolam Tosylate for Sedation in Gastroscopy

A Multicenter, Randomized, Single-blind, Parallel Controlled Clinical Study on the Efficacy and Safety of Remimazolam Tosylate for Sedation in Gastroscopy

1) Complete the entire process of gastroscopy; 2) No sedative remedy is given; 3) After the initial dose of the test drug is administered, additional administration ≤ 2 times within any 5-minute period; 4) The initial dose of propofol After the end, within any 5-minute period of additional administration ≤ 2 times, it is recorded as propofol (control group) successfully sedated

There is a scale from 1 to 10. Endoscopists and patients will score their satisfaction with the scale ,with 1-3 (dissatisfied),4-6 (satisfied) and 7-10 (very satisfied) after gastroscopy.

Sedation/Anaesthesia Discharge Rating Scale

(75% ≤ SpO2 \< 90% for \<60 s)；(SpO2 \< 75% for any duration or 75% \< SpO2 \< 90% for \>/=60 s)

other adverse events recorded by tools proposed by the World Society of Intravenous Anesthesia International Sedation Task Force and HFNC supportive oxygen therapy-related adverse events.

Study title	NCT ID	Conditions	Interventions	Eligibility	Organization
Effect of Propofol and Desflurane on Nucleic Acid of Liver Circulating Tumor	NCT05502458	Hepatocellular ... Desflurane Adve... Propofol Advers... Circulating Tum...	Desﬂurane Propofol	18 Years - 75 Years	Zhejiang Cancer Hospital
Efficacy and Safety of Remimazolam Tosylate for Sedation in Gastroscopy	NCT04727034	Hypoxia Gastric Cancer Sedation Compli... Propofol Advers...	Remimazolam tos... Propofol	18 Years - 60 Years	RenJi Hospital
Effect of Propofol and Desflurane on Nucleic Acid of Liver Circulating Tumor	NCT05502458	Hepatocellular ... Desflurane Adve... Propofol Advers... Circulating Tum...	Desﬂurane Propofol	18 Years - 75 Years	Zhejiang Cancer Hospital

Spots Global Cancer Trial Database for propofol adverse reaction