BisEducation

Pharmacokinetic-pharmacodynamic modeling of propofol in children.

Pharmacokinetic-pharmacodynamic modeling of propofol in children.

Anesthesiology. 2010 Aug;113(2):343-52

Authors: Rigouzzo A, Servin F, Constant I

BACKGROUND: The aim of this study was to identify the best model to describe pharmacokinetics and pharmacodynamics in prepubertal children and therefore to calculate the corresponding pharmacodynamic parameters. In addition, and to confirm our method, a group of postpubertal subjects was also studied. METHODS: Sixteen children (9.5 yr, range 6-12) and 13 adults (22 yr, range 13-35) were included. Induction was performed by plasma target-controlled infusion of propofol (6 microg/ml) based on the Kataria model in children and on the Schnider model in adults. The relationship of bispectral index to predicted concentrations was studied during induction using the Kataria, pediatric Marsh, SchÃ¼ttler, and Schnider models in children. Because the best performance was obtained, strangely enough, with the Schnider model, the two groups were pooled to investigate influence of puberty on pharmacodynamic parameters (kE0 [plasma effect-site equilibration rate constant] and Ce50 [effect-site concentration corresponding with 50% of the maximal effect]). The time-to-peak effect was calculated, and the kE0 was determined for the Kataria model (nonlinear mixed-effects modeling; pkpdtools). RESULTS: In children, the predicted concentration/effect relationship was best described using the Schnider model. When the whole population was considered, a significant improvement in this model was obtained using puberty as a covariate for kE0 and Ce50. The time to peak effect, Tpeak (median, 0.71 [range, 0.37-1.64] and 1.73 [1.4-2.68] min), and the Ce50 (3.71 [1.88-4.4] and 3.07 [2.95-5.21] microg/ml) were shorter and higher, respectively, in children than in adults. The kE0 linked to the Kataria model was 4.6 [1.4-11] min. CONCLUSIONS: In children, the predicted concentration/effect relationships were best described using the Schnider model described for adults compared with classic pediatric models. The study suggests that the Schnider model might be useful for propofol target-control infusion in children.

PMID: 20613468 [PubMed - indexed for MEDLINE]

Pharmacokinetic-pharmacodynamic modeling of propofol in children.

Pharmacokinetic-pharmacodynamic modeling of propofol in children.

Anesthesiology. 2010 Aug;113(2):343-52

Authors: Rigouzzo A, Servin F, Constant I

PMID: 20613468 [PubMed - indexed for MEDLINE]

[Effect of transcutaneous electrical acupoint stimulation on BIS and VAS in artificial abortion operation]

[Effect of transcutaneous electrical acupoint stimulation on BIS and VAS in artificial abortion operation]

Zhongguo Zhen Jiu. 2010 Apr;30(4):305-7

Authors: Cheng X, Wang ZQ, Lin QM, Chen MH

OBJECTIVE: To observe the sedative and analgesic effects of transcutaneous electrical acupoint stimulation (TEAS) in patients with artificial abortion operation. METHODS: Ninety patients, with American Society of Anesthesiologists (ASA) physical status I - II, and scheduled for artificial abortion operation, were randomly divided into three groups, 30 cases in each group. The patients in group A were treated with TEAS on Neiguan (PC 6) and Taichong (LR 3), in group B with paracervical block anesthesia (BA), and in group c with both TEAS and BA. Continuous monitoring of the mean arterial blood pressure (MAP), heart rate (HR), oxygen saturation and bispectral index (BIS) of the patients lasted to 30 min after the operation. The BIS, Visual Analogue Scale (VAS) during the operation and the adverse reactions after the operation were analyzed. RESULTS: After 15 minutes TEAS, the BIS in group A and C were decreased significantly, with no significant difference between the two groups (P > 0.05) and being both better than that in group B (both P < 0.05), which had no significant change. There were no significant differences in the VAS among the three groups (all P > 0.05), while the adverse reactions in both group A and C were lower than that in group B (both P < 0.05). CONCLUSION: TEAS has sedative and analgesic effect during artificial abortion operation and can decrease the adverse reactions.

PMID: 20568437 [PubMed - indexed for MEDLINE]

[Effect of transcutaneous electrical acupoint stimulation on BIS and VAS in artificial abortion operation]

[Effect of transcutaneous electrical acupoint stimulation on BIS and VAS in artificial abortion operation]

Zhongguo Zhen Jiu. 2010 Apr;30(4):305-7

Authors: Cheng X, Wang ZQ, Lin QM, Chen MH

PMID: 20568437 [PubMed - indexed for MEDLINE]

A comparison of the effect on QT interval between thiamylal and propofol during anaesthetic induction*.

A comparison of the effect on QT interval between thiamylal and propofol during anaesthetic induction*.

Anaesthesia. 2010 Jul;65(7):679-83

Authors: Higashijima U, Terao Y, Ichinomiya T, Miura K, Fukusaki M, Sumikawa K

SUMMARY: The aim of this study was to determine the effect of thiamylal and propofol on heart rate-corrected QT (QTc) interval during anaesthetic induction. We studied 50 patients undergoing lumbar spine surgery. Patients were administered 3 microgxkg(-1) fentanyl and were randomly allocated to receive 5 mgxkg(-1) thiamylal or 1.5 mgxkg(-1) propofol as an induction agent. Tracheal intubation was performed after vecuronium administration. Heart rate, mean arterial pressure, bispectral index score, and 12-lead electrocardiogram were recorded at the following time points: just before (T1) and 2 min after (T2) fentanyl administration; 2 min after anaesthetic administration (T3); 2.5 min after vecuronium injection (T4); and 2 min after intubation (T5). Thiamylal prolonged (p < 0.0001), but propofol shortened (p < 0.0001), the QTc interval.

PMID: 20528837 [PubMed - indexed for MEDLINE]

A comparison of the effect on QT interval between thiamylal and propofol during anaesthetic induction*.

A comparison of the effect on QT interval between thiamylal and propofol during anaesthetic induction*.

Anaesthesia. 2010 Jul;65(7):679-83

Authors: Higashijima U, Terao Y, Ichinomiya T, Miura K, Fukusaki M, Sumikawa K

PMID: 20528837 [PubMed - indexed for MEDLINE]

Comparison of surgical stress index-guided analgesia with standard clinical practice during routine general anesthesia: a pilot study.

Comparison of surgical stress index-guided analgesia with standard clinical practice during routine general anesthesia: a pilot study.

Anesthesiology. 2010 May;112(5):1175-83

Authors: Chen X, Thee C, Gruenewald M, Wnent J, Illies C, Hoecker J, Hanss R, Steinfath M, Bein B

BACKGROUND: Surgical stress index (SSI), a novel multivariate index, has recently been proven to react well to surgical nociceptive stimuli and analgesic drug concentration changes during general anesthesia. We investigated the feasibility of application of SSI for guidance of remifentanil administration during propofol-remifentanil anesthesia. METHODS: Eighty patients scheduled for elective ear-nose-throat surgery were randomized into two groups, SSI-guided analgesia group (SSI group) and standard practice analgesia group (control group). In both groups, anesthesia was maintained with a propofol target-controlled infusion and adjusted stepwise by 0.5 microg/ml to keep bispectral index values between 40 and 60. In the SSI group, the predicted effect-site concentration of remifentanil was adjusted stepwise by 1 ng/ml to keep SSI values between 20 and 50, whereas in the control group, predicted effect-site concentration of remifentanil was adjusted according to traditional inadequate analgesia criteria. Anesthetics consumption, recovery times, and incidence of unwanted events were recorded. RESULTS: Remifentanil consumption (average normalized infusion rate) was lower in the SSI group than in the control group (mean +/- SD, 9.5 +/- 3.8 microg . kg(-1) . h(-1) vs. 12.3 +/- 5.2 microg . kg(-1) . h(-1); P < 0.05). The number of unwanted events was less in the SSI group (84) than in the control group (556; P < 0.01). Recovery times were comparable between groups. No patient reported intraoperative recall. CONCLUSIONS: SSI-guided anesthesia resulted in lower remifentanil consumption, more stable hemodynamics, and a lower incidence of unwanted events.

PMID: 20418698 [PubMed - indexed for MEDLINE]

Comparison of surgical stress index-guided analgesia with standard clinical practice during routine general anesthesia: a pilot study.

Comparison of surgical stress index-guided analgesia with standard clinical practice during routine general anesthesia: a pilot study.

Anesthesiology. 2010 May;112(5):1175-83

Authors: Chen X, Thee C, Gruenewald M, Wnent J, Illies C, Hoecker J, Hanss R, Steinfath M, Bein B

PMID: 20418698 [PubMed - indexed for MEDLINE]

Association of perioperative risk factors and cumulative duration of low bispectral index with intermediate-term mortality after cardiac surgery in the B-Unaware Trial.

Association of perioperative risk factors and cumulative duration of low bispectral index with intermediate-term mortality after cardiac surgery in the B-Unaware Trial.

Anesthesiology. 2010 May;112(5):1116-27

Authors: Kertai MD, Pal N, Palanca BJ, Lin N, Searleman SA, Zhang L, Burnside BA, Finkel KJ, Avidan MS,

BACKGROUND: Current data suggest that mortality after noncardiac surgery may be associated with persistent hypotension and the cumulative duration of low processed electroencephalogram-based bispectral index (BIS). This study assessed the relationships among cumulative duration of low BIS (BIS < 45), intermediate-term mortality, and anesthetic dose after cardiac surgery. METHODS: The authors studied 460 patients (mean age, 63.0 +/- 13.1 yr; 287 men) who underwent cardiac surgery between September 2005 and October 2006 at Washington University Medical Center, St Louis, Missouri. By using multivariable Cox regression analysis, perioperative factors were evaluated for their potential association with intermediate-term all-cause mortality. RESULTS: A total of 82 patients (17.8%) died during a median follow-up of 3 yr (interquartile range, 2.7-3.3 yr). Comparing patients who died with those who survived, there was no statistically significant difference in the relationship between end-tidal anesthetic gas concentrations during the anesthetic maintenance phase and the BIS. Cumulative duration of low BIS was independently associated with intermediate-term mortality. The 1.29 adjusted hazard ratio (95% CI, 1.12-1.49) for intermediate-term mortality with cumulative duration of low BIS translated into a 29% increased risk of death for every cumulative hour spent with a BIS less than 45. The final multivariable Cox regression model showed a good discriminative ability (c-index of 0.78). CONCLUSIONS: This study found an association between cumulative duration of low BIS and mortality in the setting of cardiac surgery. Notably, this association was independent of both volatile anesthetic concentration and duration of anesthesia, suggesting that intermediate-term mortality after cardiac surgery was not causally related to excessive anesthetic dose.

PMID: 20418692 [PubMed - indexed for MEDLINE]

Association of perioperative risk factors and cumulative duration of low bispectral index with intermediate-term mortality after cardiac surgery in the B-Unaware Trial.

Association of perioperative risk factors and cumulative duration of low bispectral index with intermediate-term mortality after cardiac surgery in the B-Unaware Trial.

Anesthesiology. 2010 May;112(5):1116-27

Authors: Kertai MD, Pal N, Palanca BJ, Lin N, Searleman SA, Zhang L, Burnside BA, Finkel KJ, Avidan MS,

PMID: 20418692 [PubMed - indexed for MEDLINE]

Differences between bispectral index and spectral entropy during xenon anaesthesia: a comparison with propofol anaesthesia.

Differences between bispectral index and spectral entropy during xenon anaesthesia: a comparison with propofol anaesthesia.

Anaesthesia. 2010 Jun;65(6):595-600

Authors: HÃ¶cker J, Raitschew B, Meybohm P, Broch O, Stapelfeldt C, Gruenewald M, Cavus E, Steinfath M, Bein B

We enrolled 114 patients, aged 65-83 years, undergoing elective surgery (duration > 2h) into a randomised, controlled study to evaluate the performance of bispectral index and spectral entropy for monitoring depth of xenon versus propofol anaesthesia. In the propofol group, bispectral index and state entropy values were comparable. In the xenon group, bispectral index values resembled those in the propofol group, but spectral entropy levels were significantly lower. Mean arterial blood pressure was higher and heart rate was lower in the xenon group than in the propofol group. Bispectral index and spectral entropy considerably diverged during xenon but not during propofol anaesthesia. We therefore conclude that these measures are not interchangeable for the assessment of depth of hypnosis and that bispectral index is likely to reflect actual depth of anaesthesia more precisely compared with spectral entropy.

PMID: 20412149 [PubMed - indexed for MEDLINE]

Differences between bispectral index and spectral entropy during xenon anaesthesia: a comparison with propofol anaesthesia.

Differences between bispectral index and spectral entropy during xenon anaesthesia: a comparison with propofol anaesthesia.

Anaesthesia. 2010 Jun;65(6):595-600

Authors: HÃ¶cker J, Raitschew B, Meybohm P, Broch O, Stapelfeldt C, Gruenewald M, Cavus E, Steinfath M, Bein B

PMID: 20412149 [PubMed - indexed for MEDLINE]

Bispectral index monitoring to facilitate early extubation following cardiovascular surgery.

Bispectral index monitoring to facilitate early extubation following cardiovascular surgery.

Clin Nurse Spec. 2010 May-Jun;24(3):140-8

Authors: Anderson J, Henry L, Hunt S, Ad N

Frequently, intensive care nurses assume responsibility for extubating patients after undergoing cardiac surgery. Bispectral index (BIS) monitoring assesses level of mental arousal and awareness when sedated. This study was to determine if the BIS might facilitate earlier extubation of patients following cardiac surgery. A study was conducted comparing 25 stable patients returning to the intensive care unit with a BIS with 25 patients managed without the BIS (N = 50). Data collected included age, sex, surgery, pH, CO2, and temperature on arrival/extubation, total intravenous propofol and pain medication, and BIS scores. Student t tests determined that there were no differences between groups for age, amount of propofol and pain medication received, or time to extubation (P > .05). Regression analysis determined that total propofol, total hydromorphone, and age were significant predictors of time to extubation. In this study, the BIS monitor did not facilitate earlier extubation in the stable patient after cardiac surgery.

PMID: 20404622 [PubMed - indexed for MEDLINE]

Bispectral index monitoring to facilitate early extubation following cardiovascular surgery.

Bispectral index monitoring to facilitate early extubation following cardiovascular surgery.

Clin Nurse Spec. 2010 May-Jun;24(3):140-8

Authors: Anderson J, Henry L, Hunt S, Ad N

PMID: 20404622 [PubMed - indexed for MEDLINE]

Noxious stimulation response index: a novel anesthetic state index based on hypnotic-opioid interaction.

Noxious stimulation response index: a novel anesthetic state index based on hypnotic-opioid interaction.

Anesthesiology. 2010 Apr;112(4):872-80

Authors: LuginbÃ¼hl M, Schumacher PM, Vuilleumier P, Vereecke H, Heyse B, Bouillon TW, Struys MM

BACKGROUND: The noxious stimulation response index (NSRI) is a novel anesthetic depth index ranging between 100 and 0, computed from hypnotic and opioid effect-site concentrations using a hierarchical interaction model. The authors validated the NSRI on previously published data. METHODS: The data encompassed 44 women, American Society of Anesthesiology class I, randomly allocated to three groups receiving remifentanil infusions targeting 0, 2, and 4 ng/ml. Propofol was given at stepwise increasing effect-site target concentrations. At each concentration, the observer assessment of alertness and sedation score, the response to eyelash and tetanic stimulation of the forearm, the bispectral index (BIS), and the acoustic evoked potential index (AAI) were recorded. The authors computed the NSRI for each stimulation and calculated the prediction probabilities (PKs) using a bootstrap technique. The PKs of the different predictors were compared with multiple pairwise comparisons with Bonferroni correction. RESULTS: The median (95% CI) PK of the NSRI, BIS, and AAI for loss of response to tetanic stimulation was 0.87 (0.75-0.96), 0.73 (0.58-0.85), and 0.70 (0.54-0.84), respectively. The PK of effect-site propofol concentration, BIS, and AAI for observer assessment of alertness and sedation score and loss of eyelash reflex were between 0.86 (0.80-0.92) and 0.92 (0.83-0.99), whereas the PKs of NSRI were 0.77 (0.68-0.85) and 0.82 (0.68-0.92). The PK of the NSRI for BIS and AAI was 0.66 (0.58-0.73) and 0.63 (0.55-0.70), respectively. CONCLUSION: The NSRI conveys information that better predicts the analgesic component of anesthesia than AAI, BIS, or predicted propofol or remifentanil concentrations. Prospective validation studies in the clinical setting are needed.

PMID: 20216387 [PubMed - indexed for MEDLINE]

Noxious stimulation response index: a novel anesthetic state index based on hypnotic-opioid interaction.

Noxious stimulation response index: a novel anesthetic state index based on hypnotic-opioid interaction.

Anesthesiology. 2010 Apr;112(4):872-80

Authors: LuginbÃ¼hl M, Schumacher PM, Vuilleumier P, Vereecke H, Heyse B, Bouillon TW, Struys MM

PMID: 20216387 [PubMed - indexed for MEDLINE]

The Entropy Module and Bispectral Index as guidance for propofol-remifentanil anaesthesia in combination with regional anaesthesia compared with a standard clinical practice group.

The Entropy Module and Bispectral Index as guidance for propofol-remifentanil anaesthesia in combination with regional anaesthesia compared with a standard clinical practice group.

Anaesth Intensive Care. 2010 Jan;38(1):159-66

Authors: Ellerkmann RK, Soehle M, Riese G, Zinserling J, Wirz S, Hoeft A, Bruhn J

This study was designed to investigate the impact of the Entropy Module and Bispectral Index (BIS) monitoring on drug consumption and recovery times compared with standard anaesthetic practice in patients undergoing orthopaedic surgery using a combination of regional and general anaesthesia as performed by an experienced anaesthesiologist. We hypothesised that electroencephalogram monitoring would lead to a lower drug consumption as well as shorter recovery times. With institutional review board approval and written informed consent, 90 adult patients undergoing surgery to the upper or lower extremity received regional anaesthesia for post- and intraoperative pain control and were randomised to receive general anaesthesia by propofol/remifentanil infusion controlled either solely by clinical parameters or by targeting Entropy or BIS values of 50. Recovery times and drug consumption were recorded. Data from 79 patients were analysed. Compared with standard practice, patients with Entropy or BIS monitoring showed a similar propofol consumption (standard practice 101 +/- 22 microg/kg/minute, Entropy 106 +/- 24 microg/kg/minute, BIS 104 +/- 20 microg/kg/minute) and showed similar Aldrete scores (10/10) one minute after extubation: 9.1 +/- 0.3, 9.2 +/- 0.6 and 9.3 +/- 0.5, respectively. Time points of extubation were 7.3 +/- 2.9 minutes, 9.2 +/- 3.9 minutes and 6.8 +/- 2.9 minutes, respectively, demonstrating a significant difference between Entropy and BIS (P = 0.023). Compared with standard practice, targeting an Entropy or BIS value of 50 did not result in a reduction of propofol consumption during general anaesthesia combined with regional anaesthesia as performed by an experienced anaesthesiologist in orthopaedic patients.

PMID: 20191792 [PubMed - indexed for MEDLINE]

The Entropy Module and Bispectral Index as guidance for propofol-remifentanil anaesthesia in combination with regional anaesthesia compared with a standard clinical practice group.

The Entropy Module and Bispectral Index as guidance for propofol-remifentanil anaesthesia in combination with regional anaesthesia compared with a standard clinical practice group.

Anaesth Intensive Care. 2010 Jan;38(1):159-66

Authors: Ellerkmann RK, Soehle M, Riese G, Zinserling J, Wirz S, Hoeft A, Bruhn J

PMID: 20191792 [PubMed - indexed for MEDLINE]

Study of the time course of the clinical effect of propofol compared with the time course of the predicted effect-site concentration: Performance of three pharmacokinetic-dynamic models.

Study of the time course of the clinical effect of propofol compared with the time course of the predicted effect-site concentration: Performance of three pharmacokinetic-dynamic models.

Br J Anaesth. 2010 Apr;104(4):452-8

Authors: Coppens M, Van Limmen JG, Schnider T, Wyler B, Bonte S, Dewaele F, Struys MM, Vereecke HE

BACKGROUND: In the ideal pharmacokinetic-dynamic (PK-PD) model for calculating the predicted effect-site concentration of propofol (Ce(PROP)), for any Ce(PROP), the corresponding hypnotic effect should be constant. We compared three PK-PD models (Marsh PK with ShÃ¼ttler PD, Schnider PK with fixed ke0, and Schnider PK with Minto PD) in their ability to maintain a constant bispectral index (BIS), while using the respective effect-site-controlled target-controlled infusion (TCI) algorithms. METHODS: We randomized 60 patients to Group M (Marsh's model with k(e0)=0.26 min(-1)), Group S1 or Group S2 (Schnider's model with a fixed k(e0)=0.456 min(-1) or a k(e0) adapted to a fixed time-to-peak effect=1.6 min, respectively). All patients received propofol at a constant rate until loss of consciousness. The corresponding Ce(PROP), as calculated by the respective models, was set as a target for effect-site-controlled TCI. We observed BIS for 20 min. We hypothesized that BIS remains constant, if Ce(PROP) remains constant over time. RESULTS: All patients in Group M woke up, one in Group S1 and none in Group S2. In Groups S1 and S2, BIS remained constant after 11 min of constant Ce(PROP), at a more pronounced level of hypnotic drug effect than intended. CONCLUSIONS: Targeting Ce(PROP) at which patients lose consciousness with effect-site-controlled TCI does not translate into an immediate constant effect.

PMID: 20190259 [PubMed - indexed for MEDLINE]

Study of the time course of the clinical effect of propofol compared with the time course of the predicted effect-site concentration: Performance of three pharmacokinetic-dynamic models.

Study of the time course of the clinical effect of propofol compared with the time course of the predicted effect-site concentration: Performance of three pharmacokinetic-dynamic models.

Br J Anaesth. 2010 Apr;104(4):452-8

Authors: Coppens M, Van Limmen JG, Schnider T, Wyler B, Bonte S, Dewaele F, Struys MM, Vereecke HE

PMID: 20190259 [PubMed - indexed for MEDLINE]

A beat-by-beat cardiovascular index, CARDEAN: a prospective randomized assessment of its utility for the reduction of movement during colonoscopy.

A beat-by-beat cardiovascular index, CARDEAN: a prospective randomized assessment of its utility for the reduction of movement during colonoscopy.

Anesth Analg. 2010 Mar 1;110(3):765-72

Authors: Martinez JY, Wey PF, Lions C, Cividjian A, Rabilloud M, Bissery A, Bourdon L, Puidupin M, Escarment J, Quintin L

BACKGROUND: We sought to determine whether online use of a beat-by-beat cardiovascular index, CARDEAN (Alpha-2, Lyon, France), modifies the incidence of patient movement during colonoscopy under anesthesia. METHODS: Monitoring included an electrocardiogram, oscillometric and noninvasive beat-by-beat arterial blood pressure, O2 saturation, bispectral index (BIS), and CARDEAN. CARDEAN consists of beat-by-beat Finapres (Ohmeda, Madison, WI) combined with an algorithm that detects hypertension followed by tachycardia and produces an index scaled 0 to 100. The anesthesiologist was denied access to Finapres and CARDEAN. Propofol was adjusted to keep 40<BIS<60. Alfentanil 3.5 microg x kg(-1) was administered according to conventional signs (tachycardia, hypertension, and movement), unless the patient had signs of brady/apnea or Spo(2) <95%. One hundred fifty-nine patients presenting for colonoscopy under propofol anesthesia were prospectively randomized to (i) control: no other intervention, or (ii) CARDEAN: in addition to conventional signs, an observer instructed the anesthesiologist to administer alfentanil when CARDEAN was >60. The primary outcome was the number of observed movements. RESULTS: Data were analyzed in 146 patients (control: 75; CARDEAN: 71). The doses of propofol and alfentanil were similar in both groups. When BIS was <60, movements were less frequent in the CARDEAN group (3.3 movements/100 min [2.3-4.8]) than in the control group (6.7 [5.3-8.5]) (odds ratio: 0.5 [0.32; 0.76], P = 0.001). During the first 10 minutes of the procedure, the incidence of movements was 38% and 59% in the CARDEAN and control groups, respectively (P = 0.04). CONCLUSION: With BIS <60, CARDEAN-guided opioid administration is associated with a reduction of 51% of clinically unpredictable movements in unparalyzed patients undergoing colonoscopy. More studies are required to refine the role of CARDEAN in surgical settings.

PMID: 20185655 [PubMed - indexed for MEDLINE]

A beat-by-beat cardiovascular index, CARDEAN: a prospective randomized assessment of its utility for the reduction of movement during colonoscopy.

A beat-by-beat cardiovascular index, CARDEAN: a prospective randomized assessment of its utility for the reduction of movement during colonoscopy.

Anesth Analg. 2010 Mar 1;110(3):765-72

Authors: Martinez JY, Wey PF, Lions C, Cividjian A, Rabilloud M, Bissery A, Bourdon L, Puidupin M, Escarment J, Quintin L

PMID: 20185655 [PubMed - indexed for MEDLINE]

Desflurane versus sevoflurane to reduce blood loss in maxillofacial surgery.

Desflurane versus sevoflurane to reduce blood loss in maxillofacial surgery.

J Oral Maxillofac Surg. 2010 May;68(5):1007-12

Authors: Rossi A, Falzetti G, Donati A, Orsetti G, Pelaia P

PURPOSE: In our study, desflurane was hypothesized to reduce blood loss more than sevoflurane, both used with targeted mild controlled hypotension. PATIENTS AND METHODS: A total of 20 American Society of Anesthesiologists Class I patients undergoing maxillofacial elective surgery for maxillary and mandibular osteotomies were randomized to a desflurane group or a sevoflurane group. Anesthesia was performed with an end tidal value of the inhaled agent to obtain a bispectral index value <30 but without burst-suppression patterns (minimal alveolar concentration age-corrected between 0.7 and 0.9). Remifentanil was administered at a dose of 0.5 microg x kg(-1) x min(-1) to obtain analgesia and a <2 surgical field level in Fromme's modified scale. Sodium-nitroprusside was administered on demand to have a surgical field level of <2 when the anesthesia plan was not sufficient to achieve this target. The minimal value of the mean arterial pressure achievable was 60 mm Hg. RESULTS: In the desflurane group, blood loss was more restricted. The hypotensive drug was used in 8 patients in the sevoflurane group and 2 patients in the desflurane group. CONCLUSIONS: Anesthesia with desflurane can reduce blood loss and could give an acceptable surgical field with mild controlled hypotension and with a substantial reduction in the vasoactive drug requirement. These data need to be assessed with an enlargement of the statistical sample.

PMID: 20156668 [PubMed - indexed for MEDLINE]

Desflurane versus sevoflurane to reduce blood loss in maxillofacial surgery.

Desflurane versus sevoflurane to reduce blood loss in maxillofacial surgery.

J Oral Maxillofac Surg. 2010 May;68(5):1007-12

Authors: Rossi A, Falzetti G, Donati A, Orsetti G, Pelaia P

PMID: 20156668 [PubMed - indexed for MEDLINE]

[Effects of electroacupuncture on bispectral index and plasma beta-endorphin in patients undergoing colonoscopy]

[Effects of electroacupuncture on bispectral index and plasma beta-endorphin in patients undergoing colonoscopy]

Zhen Ci Yan Jiu. 2009 Oct;34(5):339-43

Authors: Ni YF, Li J, Wang BF, Jiang SH, Chen Y, Zhang WF, Lian QQ

OBJECTIVE: To observe the effect of electroacupuncture (EA) on bispectral index (BIS) and plasma beta-endorphin (beta-EP) level in patients undergoing colonoscopy. METHODS: Sixty patients were equally randomized into EA group and control group with 30 cases in each. EA (2 Hz/100 Hz, 4-6 V) was applied to the right Zusanli (ST 36) and Shangjuxu (ST 37), and the left Yinlingquan (SP 9), Sanyinjiao (SP 6) and bilateral Hegu (LI 4) respectively 30 min before colonoscopy. The mean arterial pressure (MAP), heart rate (HR) and BIS in two groups were continuously monitored during the study. Plasma beta-EP concentration was detected by radioimmunoassay. The patient's adverse reactions (including pain, satisfaction degree, etc.) were evaluated by visual analog scale (VAS) and verbal stress scale (VSS). RESULTS: Self-comparison showed that MAP and HR in control group increased significantly during colonoscope's splenic flexure passing (P<0.05). Whereas the 2 indexes in EA group had no significant changes during colonoscope insertion, and its splenic flexure passing, hepatic flexure passing and post-enteroscopy (P>0.05). Comparison between two groups showed that MAP at the time-point of colonoscope insertion, and HR at the time-point of colonoscope's splenic flexure passing in EA group were significantly lower than those in control group (P<0.05). BIS values of EA group were significantly lower than those of control group at different time-points after colonoscope insertion (P<0.01). Plasma beta-EP concentrations at the time-points of colonoscope's hepatic flexure passing and post-enteroscopy were evidently increased in both groups in comparison with pre-enteroscopy (P<0.01), and beta-EP was significantly lower in EA group than that in control group at the time-point of colonoscope's hepatic flexure passing (P<0.05). The dosage of Midazolam used for conscious-sedation and the scores of VAS and VSS were also considerably lower in EA group than those in control group (P<0.05, P<0.01). No significant differences were found between two groups in the adverse reactions as dizziness, nausea, vomiting and abdominal pain, but the patients' satisfaction degree in EA group was evidently higher than that in control group (P<0.05). CONCLUSION: Acupuncture analgesia can effectively lower the colonoscopy patients' BIS value and plasma beta-EP level, meaning attenuation of the patients' stress responses during colonoscopy after EA.

PMID: 20128295 [PubMed - indexed for MEDLINE]

[Effects of electroacupuncture on bispectral index and plasma beta-endorphin in patients undergoing colonoscopy]

[Effects of electroacupuncture on bispectral index and plasma beta-endorphin in patients undergoing colonoscopy]

Zhen Ci Yan Jiu. 2009 Oct;34(5):339-43

Authors: Ni YF, Li J, Wang BF, Jiang SH, Chen Y, Zhang WF, Lian QQ

PMID: 20128295 [PubMed - indexed for MEDLINE]

Peri-intubation hemodynamic changes during low dose fentanyl, remifentanil and sufentanil combined with etomidate for anesthetic induction.

Peri-intubation hemodynamic changes during low dose fentanyl, remifentanil and sufentanil combined with etomidate for anesthetic induction.

Chin Med J (Engl). 2009 Oct 5;122(19):2330-4

Authors: Zhang GH, Sun L

BACKGROUND: Although etomidate is associated with very few cardiovascular side-effects and minimal histamine release, it has a less inhibitory effect on the pharyngolaryngeal reflex. Hence, blunting the responses to endotracheal intubation is more dependent of opioids for etomidate-based anesthetic induction. This prospective, randomized, double-blinded study was designed to investigate the effects of low dose remifentanil, fentanyl or sufentanil on etomidate induction with respect to hemodynamics, conscious level changes and drug consumption. METHODS: Ninety unpremedicated and normotensive patients with American Society of Anesthesiologists (ASA) physical status I or II undergoing elective major abdominal surgery were randomly assigned in a double blinded fashion to each of the three groups: groups F, R and S. A bolus dose of fentanyl 1 microg/kg, sufentanil 0.1 microg/kg or remifentanil 1 microg/kg was given over 60 seconds in groups F, S and R, respectively. In each instance this loading dose was followed by a continuous infusion (0.1, 0.01 or 0.1 microg x kg(-1) x min(-1) of fentanyl, sufentanil or remifentanil, respectively). After 5 minutes from start of opioid infusion, etomidate was titrated at a rate of 20 mg/min to a decrease in bispectral index (BIS) to 50. The time from administration of etomidate to loss of eyelash reflex or to a decrease in BIS to 50 was recorded. The blood pressure and heart rate were also recorded at different five time points. The average maximum percent changes of systolic blood pressure (|maximal or minimal measuring value-baseline|/baseline x 100%) were calculated. RESULTS: The time and the dosage of etomidate necessary to loss consciousness were greater in group F ((70.0 +/- 15.6) seconds; (0.35 +/- 0.05) mg/kg) than in groups S ((52.3 +/- 15.9) seconds; (0.26 +/- 0.06) mg/kg) and R ((56.2 +/- 20.2) seconds; (0.27 +/- 0.07) mg/kg) (P < 0.01). The three groups took similar time and amount of etomidate to achieve an adequate depth anesthesia (BIS = 50). The average maximum changes of systolic blood pressure were significantly different among the three groups: F, (25 +/- 6)% vs R, (13 +/- 4)% or S, (12 +/- 5)% (P < 0.001). The endotracheal intubation caused marked increases in blood pressure and heart rate in groups F and S, but not in group R, respectively (P < 0.01). The great hemodynamic changes occurred more frequently in group F than in groups R and S (P < 0.01). The incidence of heart rate decreases of more than 30% of the baselines after induction was higher in group R compared with groups F and S (P < 0.01). CONCLUSIONS: In normotensive and unpremedicated young adult patients receiving etomidate induction, low dose remifentanil or sufentanil significantly reduced the time and the amount of etomidate taken to loss unconsciousness compared with low dose fentanyl, but similar time interval and doses of etomidate were required to acquire adequate depth of anesthesia (BIS = 50) for these three opioids. Remifentanil was more effective in blunting the cardiovascular responses to endotracheal intubation, nevertheless, accompanying significant lower heart rate after induction.

PMID: 20079135 [PubMed - indexed for MEDLINE]

Peri-intubation hemodynamic changes during low dose fentanyl, remifentanil and sufentanil combined with etomidate for anesthetic induction.

Peri-intubation hemodynamic changes during low dose fentanyl, remifentanil and sufentanil combined with etomidate for anesthetic induction.

Chin Med J (Engl). 2009 Oct 5;122(19):2330-4

Authors: Zhang GH, Sun L

PMID: 20079135 [PubMed - indexed for MEDLINE]

A randomized trial of propofol consumption and recovery profile with BIS-guided anesthesia compared to standard practice in children.

A randomized trial of propofol consumption and recovery profile with BIS-guided anesthesia compared to standard practice in children.

Paediatr Anaesth. 2010 Feb;20(2):160-7

Authors: Bhardwaj N, Yaddanapudi S

AIM: To evaluate the impact of bispectral index (BIS) monitoring on the consumption of propofol and recovery from anesthesia compared to the standard clinical practice in children. BACKGROUND: Titrating propofol administration using BIS reduces its requirement and shortens the recovery from anesthesia in adults. However, there is still mixed evidence for utility of anesthesia depth monitors in reducing anesthesia requirement in children. METHODS/MATERIALS: A prospective randomized study was conducted in 50 ASA I children of 2-12 years, randomly assigned into standard practice (SP) or BIS group. After induction with propofol, anesthesia was maintained with 150 microg x kg(-1) x min(-1) propofol infusion. The propofol infusion rate was altered by 20 microg x kg(-1) x min(-1) to maintain the systolic blood pressure within 20% of the baseline (SP group) or BIS value between 45 and 60 (BIS group). The rate of propofol infusion was reduced by 50% about 15 min before the end of surgery. The amount of propofol used and the times from stopping the propofol infusion to eye opening, extubation, response to commands and attaining Steward score of 6 were recorded. RESULTS: There was no evidence of a difference in the mean propofol consumption in the two groups (BIS 232.6 +/- 136.7 mg, SP 250.8 +/- 118.2 mg). The intraoperative hemodynamics and BIS values were similar in the two groups. There was no evidence for a difference between groups in the mean times from termination of anesthetic to eye opening, extubation, response to commands and to achieve a Steward Recovery score of 6. CONCLUSIONS: Our study showed no benefit of BIS-guided propofol administration on anesthetic consumption or recovery compared to standard anesthetic practice.

PMID: 20078813 [PubMed - indexed for MEDLINE]

A randomized trial of propofol consumption and recovery profile with BIS-guided anesthesia compared to standard practice in children.

A randomized trial of propofol consumption and recovery profile with BIS-guided anesthesia compared to standard practice in children.

Paediatr Anaesth. 2010 Feb;20(2):160-7

Authors: Bhardwaj N, Yaddanapudi S

PMID: 20078813 [PubMed - indexed for MEDLINE]