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Dinu AR, Rogobete AF, Popovici SE, Bedreag OH, Papurica M, Dumbuleu CM, Velovan RR, Toma D, Georgescu CM, Trache LI, Barsac C, Luca L, Buzzi B, Maghiar A, Sandesc MA, Rimawi S, Vaduva MM, Bratu LM, Luminosu PM, Sandesc D. Impact of General Anesthesia Guided by State Entropy (SE) and Response Entropy (RE) on Perioperative Stability in Elective Laparoscopic Cholecystectomy Patients-A Prospective Observational Randomized Monocentric Study. ENTROPY 2020; 22:e22030356. [PMID: 33286130 PMCID: PMC7516829 DOI: 10.3390/e22030356] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Revised: 03/17/2020] [Accepted: 03/18/2020] [Indexed: 12/29/2022]
Abstract
Laparoscopic cholecystectomy is one of the most frequently performed interventions in general surgery departments. Some of the most important aims in achieving perioperative stability in these patients is diminishing the impact of general anesthesia on the hemodynamic stability and the optimization of anesthetic drug doses based on the individual clinical profile of each patient. The objective of this study is the evaluation of the impact, as monitored through entropy (both state entropy (SE) and response entropy (RE)), that the depth of anesthesia has on the hemodynamic stability, as well as the doses of volatile anesthetic. A prospective, observational, randomized, and monocentric study was carried out between January and December 2019 in the Clinic of Anesthesia and Intensive Care of the “Pius Brînzeu” Emergency County Hospital in Timișoara, Romania. The patients included in the study were divided in two study groups: patients in Group A (target group) received multimodal monitoring, which included monitoring of standard parameters and of entropy (SE and RE); while the patients in Group B (control group) only received standard monitoring. The anesthetic dose in group A was optimized to achieve a target entropy of 40–60. A total of 68 patients met the inclusion criteria and were allocated to one of the two study groups: group A (N = 43) or group B (N = 25). There were no statistically significant differences identified between the two groups for both demographical and clinical characteristics (p > 0.05). Statistically significant differences were identified for the number of hypotensive episodes (p = 0.011, 95% CI: [0.1851, 0.7042]) and for the number of episodes of bradycardia (p < 0.0001, 95% CI: [0.3296, 0.7923]). Moreover, there was a significant difference in the Sevoflurane consumption between the two study groups (p = 0.0498, 95% CI: [−0.3942, 0.9047]). The implementation of the multimodal monitoring protocol, including the standard parameters and the measurement of entropy for determining the depth of anesthesia (SE and RE) led to a considerable improvement in perioperative hemodynamic stability. Furthermore, optimizing the doses of anesthetic drugs based on the individual clinical profile of each patient led to a considerable decrease in drug consumption, as well as to a lower incidence of hemodynamic side-effects.
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Affiliation(s)
- Anca Raluca Dinu
- Faculty of Medicine, “Victor Babes” University of Medicine and Pharmacy, Timisoara 300041, Romania; (A.R.D.); (O.H.B.); (M.P.); (L.M.B.); (D.S.)
| | - Alexandru Florin Rogobete
- Faculty of Medicine, “Victor Babes” University of Medicine and Pharmacy, Timisoara 300041, Romania; (A.R.D.); (O.H.B.); (M.P.); (L.M.B.); (D.S.)
- Clinic of Anaesthesia and Intensive Care, Emergency County Hospital “Pius Brinzeu”, Timisoara 325100, Romania; (S.E.P.); (C.M.D.); (R.R.V.); (D.T.); (C.M.G.); (L.I.T.); (C.B.); (L.L.); (B.B.); (A.M.); (S.R.); (M.M.V.); (P.M.L.)
- Department of Clinical Research and Medical Education, Romanian Society of Anaesthesia and Intensive Care (SRATI), Timisoara 325100, Romania
- Correspondence: (A.F.R.); (M.A.S.); Tel.: +40-728 001-971 (A.F.R.)
| | - Sonia Elena Popovici
- Clinic of Anaesthesia and Intensive Care, Emergency County Hospital “Pius Brinzeu”, Timisoara 325100, Romania; (S.E.P.); (C.M.D.); (R.R.V.); (D.T.); (C.M.G.); (L.I.T.); (C.B.); (L.L.); (B.B.); (A.M.); (S.R.); (M.M.V.); (P.M.L.)
- Department of Clinical Research and Medical Education, Romanian Society of Anaesthesia and Intensive Care (SRATI), Timisoara 325100, Romania
| | - Ovidiu Horea Bedreag
- Faculty of Medicine, “Victor Babes” University of Medicine and Pharmacy, Timisoara 300041, Romania; (A.R.D.); (O.H.B.); (M.P.); (L.M.B.); (D.S.)
- Clinic of Anaesthesia and Intensive Care, Emergency County Hospital “Pius Brinzeu”, Timisoara 325100, Romania; (S.E.P.); (C.M.D.); (R.R.V.); (D.T.); (C.M.G.); (L.I.T.); (C.B.); (L.L.); (B.B.); (A.M.); (S.R.); (M.M.V.); (P.M.L.)
- Department of Clinical Research and Medical Education, Romanian Society of Anaesthesia and Intensive Care (SRATI), Timisoara 325100, Romania
| | - Marius Papurica
- Faculty of Medicine, “Victor Babes” University of Medicine and Pharmacy, Timisoara 300041, Romania; (A.R.D.); (O.H.B.); (M.P.); (L.M.B.); (D.S.)
- Clinic of Anaesthesia and Intensive Care, Emergency County Hospital “Pius Brinzeu”, Timisoara 325100, Romania; (S.E.P.); (C.M.D.); (R.R.V.); (D.T.); (C.M.G.); (L.I.T.); (C.B.); (L.L.); (B.B.); (A.M.); (S.R.); (M.M.V.); (P.M.L.)
- Department of Clinical Research and Medical Education, Romanian Society of Anaesthesia and Intensive Care (SRATI), Timisoara 325100, Romania
| | - Corina Maria Dumbuleu
- Clinic of Anaesthesia and Intensive Care, Emergency County Hospital “Pius Brinzeu”, Timisoara 325100, Romania; (S.E.P.); (C.M.D.); (R.R.V.); (D.T.); (C.M.G.); (L.I.T.); (C.B.); (L.L.); (B.B.); (A.M.); (S.R.); (M.M.V.); (P.M.L.)
- Department of Clinical Research and Medical Education, Romanian Society of Anaesthesia and Intensive Care (SRATI), Timisoara 325100, Romania
| | - Raluca Ramona Velovan
- Clinic of Anaesthesia and Intensive Care, Emergency County Hospital “Pius Brinzeu”, Timisoara 325100, Romania; (S.E.P.); (C.M.D.); (R.R.V.); (D.T.); (C.M.G.); (L.I.T.); (C.B.); (L.L.); (B.B.); (A.M.); (S.R.); (M.M.V.); (P.M.L.)
- Department of Clinical Research and Medical Education, Romanian Society of Anaesthesia and Intensive Care (SRATI), Timisoara 325100, Romania
| | - Daiana Toma
- Clinic of Anaesthesia and Intensive Care, Emergency County Hospital “Pius Brinzeu”, Timisoara 325100, Romania; (S.E.P.); (C.M.D.); (R.R.V.); (D.T.); (C.M.G.); (L.I.T.); (C.B.); (L.L.); (B.B.); (A.M.); (S.R.); (M.M.V.); (P.M.L.)
- Department of Clinical Research and Medical Education, Romanian Society of Anaesthesia and Intensive Care (SRATI), Timisoara 325100, Romania
| | - Corina Maria Georgescu
- Clinic of Anaesthesia and Intensive Care, Emergency County Hospital “Pius Brinzeu”, Timisoara 325100, Romania; (S.E.P.); (C.M.D.); (R.R.V.); (D.T.); (C.M.G.); (L.I.T.); (C.B.); (L.L.); (B.B.); (A.M.); (S.R.); (M.M.V.); (P.M.L.)
- Department of Clinical Research and Medical Education, Romanian Society of Anaesthesia and Intensive Care (SRATI), Timisoara 325100, Romania
| | - Lavinia Ioana Trache
- Clinic of Anaesthesia and Intensive Care, Emergency County Hospital “Pius Brinzeu”, Timisoara 325100, Romania; (S.E.P.); (C.M.D.); (R.R.V.); (D.T.); (C.M.G.); (L.I.T.); (C.B.); (L.L.); (B.B.); (A.M.); (S.R.); (M.M.V.); (P.M.L.)
- Department of Clinical Research and Medical Education, Romanian Society of Anaesthesia and Intensive Care (SRATI), Timisoara 325100, Romania
| | - Claudiu Barsac
- Clinic of Anaesthesia and Intensive Care, Emergency County Hospital “Pius Brinzeu”, Timisoara 325100, Romania; (S.E.P.); (C.M.D.); (R.R.V.); (D.T.); (C.M.G.); (L.I.T.); (C.B.); (L.L.); (B.B.); (A.M.); (S.R.); (M.M.V.); (P.M.L.)
- Department of Clinical Research and Medical Education, Romanian Society of Anaesthesia and Intensive Care (SRATI), Timisoara 325100, Romania
| | - Loredana Luca
- Clinic of Anaesthesia and Intensive Care, Emergency County Hospital “Pius Brinzeu”, Timisoara 325100, Romania; (S.E.P.); (C.M.D.); (R.R.V.); (D.T.); (C.M.G.); (L.I.T.); (C.B.); (L.L.); (B.B.); (A.M.); (S.R.); (M.M.V.); (P.M.L.)
- Department of Clinical Research and Medical Education, Romanian Society of Anaesthesia and Intensive Care (SRATI), Timisoara 325100, Romania
| | - Bettina Buzzi
- Clinic of Anaesthesia and Intensive Care, Emergency County Hospital “Pius Brinzeu”, Timisoara 325100, Romania; (S.E.P.); (C.M.D.); (R.R.V.); (D.T.); (C.M.G.); (L.I.T.); (C.B.); (L.L.); (B.B.); (A.M.); (S.R.); (M.M.V.); (P.M.L.)
- Department of Clinical Research and Medical Education, Romanian Society of Anaesthesia and Intensive Care (SRATI), Timisoara 325100, Romania
| | - Andra Maghiar
- Clinic of Anaesthesia and Intensive Care, Emergency County Hospital “Pius Brinzeu”, Timisoara 325100, Romania; (S.E.P.); (C.M.D.); (R.R.V.); (D.T.); (C.M.G.); (L.I.T.); (C.B.); (L.L.); (B.B.); (A.M.); (S.R.); (M.M.V.); (P.M.L.)
- Department of Clinical Research and Medical Education, Romanian Society of Anaesthesia and Intensive Care (SRATI), Timisoara 325100, Romania
| | - Mihai Alexandru Sandesc
- Faculty of Medicine, “Victor Babes” University of Medicine and Pharmacy, Timisoara 300041, Romania; (A.R.D.); (O.H.B.); (M.P.); (L.M.B.); (D.S.)
- Correspondence: (A.F.R.); (M.A.S.); Tel.: +40-728 001-971 (A.F.R.)
| | - Samir Rimawi
- Clinic of Anaesthesia and Intensive Care, Emergency County Hospital “Pius Brinzeu”, Timisoara 325100, Romania; (S.E.P.); (C.M.D.); (R.R.V.); (D.T.); (C.M.G.); (L.I.T.); (C.B.); (L.L.); (B.B.); (A.M.); (S.R.); (M.M.V.); (P.M.L.)
- Department of Clinical Research and Medical Education, Romanian Society of Anaesthesia and Intensive Care (SRATI), Timisoara 325100, Romania
| | - Madalin Marian Vaduva
- Clinic of Anaesthesia and Intensive Care, Emergency County Hospital “Pius Brinzeu”, Timisoara 325100, Romania; (S.E.P.); (C.M.D.); (R.R.V.); (D.T.); (C.M.G.); (L.I.T.); (C.B.); (L.L.); (B.B.); (A.M.); (S.R.); (M.M.V.); (P.M.L.)
- Department of Clinical Research and Medical Education, Romanian Society of Anaesthesia and Intensive Care (SRATI), Timisoara 325100, Romania
| | - Lavinia Melania Bratu
- Faculty of Medicine, “Victor Babes” University of Medicine and Pharmacy, Timisoara 300041, Romania; (A.R.D.); (O.H.B.); (M.P.); (L.M.B.); (D.S.)
| | - Paul Manuel Luminosu
- Clinic of Anaesthesia and Intensive Care, Emergency County Hospital “Pius Brinzeu”, Timisoara 325100, Romania; (S.E.P.); (C.M.D.); (R.R.V.); (D.T.); (C.M.G.); (L.I.T.); (C.B.); (L.L.); (B.B.); (A.M.); (S.R.); (M.M.V.); (P.M.L.)
- Department of Clinical Research and Medical Education, Romanian Society of Anaesthesia and Intensive Care (SRATI), Timisoara 325100, Romania
| | - Dorel Sandesc
- Faculty of Medicine, “Victor Babes” University of Medicine and Pharmacy, Timisoara 300041, Romania; (A.R.D.); (O.H.B.); (M.P.); (L.M.B.); (D.S.)
- Clinic of Anaesthesia and Intensive Care, Emergency County Hospital “Pius Brinzeu”, Timisoara 325100, Romania; (S.E.P.); (C.M.D.); (R.R.V.); (D.T.); (C.M.G.); (L.I.T.); (C.B.); (L.L.); (B.B.); (A.M.); (S.R.); (M.M.V.); (P.M.L.)
- Department of Clinical Research and Medical Education, Romanian Society of Anaesthesia and Intensive Care (SRATI), Timisoara 325100, Romania
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Minhas JS, Rook W, Panerai RB, Hoiland RL, Ainslie PN, Thompson JP, Mistri AK, Robinson TG. Pathophysiological and clinical considerations in the perioperative care of patients with a previous ischaemic stroke: a multidisciplinary narrative review. Br J Anaesth 2020; 124:183-196. [PMID: 31813569 PMCID: PMC7034810 DOI: 10.1016/j.bja.2019.10.021] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 09/24/2019] [Accepted: 10/18/2019] [Indexed: 12/28/2022] Open
Abstract
With an ageing population and increasing incidence of cerebrovascular disease, an increasing number of patients presenting for routine and emergency surgery have a prior history of stroke. This presents a challenge for pre-, intra-, and postoperative management as the neurological risk is considerably higher. Evidence is lacking around anaesthetic practice for patients with vascular neurological vulnerability. Through understanding the pathophysiological changes that occur after stroke, insight into the susceptibilities of the cerebral vasculature to intrinsic and extrinsic factors can be developed. Increasing understanding of post-stroke systemic and cerebral haemodynamics has provided improved outcomes from stroke and more robust secondary prevention, although this knowledge has yet to be applied to our delivery of anaesthesia in those with prior stroke. This review describes the key pathophysiological and clinical considerations that inform clinicians providing perioperative care for patients with a prior diagnosis of stroke.
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Affiliation(s)
- Jatinder S Minhas
- Cerebral Haemodynamics in Ageing and Stroke Medicine (CHIASM) Research Group, Leicester Biomedical Research Centre, University of Leicester, Leicester, UK.
| | - William Rook
- Academic Department of Anaesthesia, Critical Care, Pain, and Resuscitation, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Ronney B Panerai
- Cerebral Haemodynamics in Ageing and Stroke Medicine (CHIASM) Research Group, Leicester Biomedical Research Centre, University of Leicester, Leicester, UK; National Institute for Health Research, Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
| | - Ryan L Hoiland
- Centre for Heart, Lung, and Vascular Health, University of British Columbia, Kelowna, BC, Canada
| | - Phil N Ainslie
- Centre for Heart, Lung, and Vascular Health, University of British Columbia, Kelowna, BC, Canada
| | - Jonathan P Thompson
- Anaesthesia and Critical Care, Department of Cardiovascular Sciences, Leicester Biomedical Research Centre, University of Leicester, Leicester, UK; University Hospitals of Leicester NHS Trust, Leicester Royal Infirmary, Leicester, UK
| | - Amit K Mistri
- University Hospitals of Leicester NHS Trust, Leicester Royal Infirmary, Leicester, UK
| | - Thompson G Robinson
- Cerebral Haemodynamics in Ageing and Stroke Medicine (CHIASM) Research Group, Leicester Biomedical Research Centre, University of Leicester, Leicester, UK; National Institute for Health Research, Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
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Miller D, Lewis SR, Pritchard MW, Schofield‐Robinson OJ, Shelton CL, Alderson P, Smith AF. Intravenous versus inhalational maintenance of anaesthesia for postoperative cognitive outcomes in elderly people undergoing non-cardiac surgery. Cochrane Database Syst Rev 2018; 8:CD012317. [PMID: 30129968 PMCID: PMC6513211 DOI: 10.1002/14651858.cd012317.pub2] [Citation(s) in RCA: 104] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND The use of anaesthetics in the elderly surgical population (more than 60 years of age) is increasing. Postoperative delirium, an acute condition characterized by reduced awareness of the environment and a disturbance in attention, typically occurs between 24 and 72 hours after surgery and can affect up to 60% of elderly surgical patients. Postoperative cognitive dysfunction (POCD) is a new-onset of cognitive impairment which may persist for weeks or months after surgery.Traditionally, surgical anaesthesia has been maintained with inhalational agents. End-tidal concentrations require adjustment to balance the risks of accidental awareness and excessive dosing in elderly people. As an alternative, propofol-based total intravenous anaesthesia (TIVA) offers a more rapid recovery and reduces postoperative nausea and vomiting. Using TIVA with a target controlled infusion (TCI) allows plasma and effect-site concentrations to be calculated using an algorithm based on age, gender, weight and height of the patient.TIVA is a viable alternative to inhalational maintenance agents for surgical anaesthesia in elderly people. However, in terms of postoperative cognitive outcomes, the optimal technique is unknown. OBJECTIVES To compare maintenance of general anaesthesia for elderly people undergoing non-cardiac surgery using propofol-based TIVA or inhalational anaesthesia on postoperative cognitive function, mortality, risk of hypotension, length of stay in the postanaesthesia care unit (PACU), and hospital stay. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL; 2017, Issue 11), MEDLINE (1946 to November 2017), Embase (1974 to November 2017), PsycINFO (1887 to November 2017). We searched clinical trials registers for ongoing studies, and conducted backward and forward citation searching of relevant articles. SELECTION CRITERIA We included randomized controlled trials (RCTs) with participants over 60 years of age scheduled for non-cardiac surgery under general anaesthesia. We planned to also include quasi-randomized trials. We compared maintenance of anaesthesia with propofol-based TIVA versus inhalational maintenance of anaesthesia. DATA COLLECTION AND ANALYSIS Two review authors independently assessed studies for inclusion, extracted data, assessed risk of bias, and synthesized findings. MAIN RESULTS We included 28 RCTs with 4507 randomized participants undergoing different types of surgery (predominantly cardiovascular, laparoscopic, abdominal, orthopaedic and ophthalmic procedures). We found no quasi-randomized trials. Four studies are awaiting classification because we had insufficient information to assess eligibility.All studies compared maintenance with propofol-based TIVA versus inhalational maintenance of anaesthesia. Six studies were multi-arm and included additional TIVA groups, additional inhalational maintenance or both. Inhalational maintenance agents included sevoflurane (19 studies), isoflurane (eight studies), and desflurane (three studies), and was not specified in one study (reported as an abstract). Some studies also reported use of epidural analgesia/anaesthesia, fentanyl and remifentanil.We found insufficient reporting of randomization methods in many studies and all studies were at high risk of performance bias because it was not feasible to blind anaesthetists to study groups. Thirteen studies described blinding of outcome assessors. Three studies had a high of risk of attrition bias, and we noted differences in the use of analgesics between groups in six studies, and differences in baseline characteristics in five studies. Few studies reported clinical trials registration, which prevented assessment of risk of selective reporting bias.We found no evidence of a difference in incidences of postoperative delirium according to type of anaesthetic maintenance agents (odds ratio (OR) 0.59, 95% confidence interval (CI) 0.15 to 2.26; 321 participants; five studies; very low-certainty evidence); we noted during sensitivity analysis that using different time points in one study may influence direction of this result. Thirteen studies (3215 participants) reported POCD, and of these, six studies reported data that could not be pooled; we noted no difference in scores of POCD in four of these and in one study, data were at a time point incomparable to other studies. We excluded one large study from meta-analysis because study investigators had used non-standard anaesthetic management and this study was not methodologically comparable to other studies. We combined data for seven studies and found low-certainty evidence that TIVA may reduce POCD (OR 0.52, 95% CI 0.31 to 0.87; 869 participants).We found no evidence of a difference in mortality at 30 days (OR 1.21, 95% CI 0.33 to 4.45; 271 participants; three studies; very low-certainty evidence). Twelve studies reported intraoperative hypotension. We did not perform meta-analysis for 11 studies for this outcome. We noted visual inconsistencies in these data, which may be explained by possible variation in clinical management and medication used to manage hypotension in each study (downgraded to low-certainty evidence); one study reported data in a format that could not be combined and we noted little or no difference between groups in intraoperative hypotension for this study. Eight studies reported length of stay in the PACU, and we did not perform meta-analysis for seven studies. We noted visual inconsistencies in these data, which may be explained by possible differences in definition of time points for this outcome (downgraded to very low-certainty evidence); data were unclearly reported in one study. We found no evidence of a difference in length of hospital stay according to type of anaesthetic maintenance agent (mean difference (MD) 0 days, 95% CI -1.32 to 1.32; 175 participants; four studies; very low-certainty evidence).We used the GRADE approach to downgrade the certainty of the evidence for each outcome. Reasons for downgrading included: study limitations, because some included studies insufficiently reported randomization methods, had high attrition bias, or high risk of selective reporting bias; imprecision, because we found few studies; inconsistency, because we noted heterogeneity across studies. AUTHORS' CONCLUSIONS We are uncertain whether maintenance with propofol-based TIVA or with inhalational agents affect incidences of postoperative delirium, mortality, or length of hospital stay because certainty of the evidence was very low. We found low-certainty evidence that maintenance with propofol-based TIVA may reduce POCD. We were unable to perform meta-analysis for intraoperative hypotension or length of stay in the PACU because of heterogeneity between studies. We identified 11 ongoing studies from clinical trials register searches; inclusion of these studies in future review updates may provide more certainty for the review outcomes.
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Affiliation(s)
- David Miller
- North Cumbria University HospitalsAcademic UnitCumberland InfirmaryNewtown RoadCarlisleUKCA2 7HY
| | - Sharon R Lewis
- Royal Lancaster InfirmaryLancaster Patient Safety Research UnitPointer Court 1, Ashton RoadLancasterUKLA1 4RP
| | - Michael W Pritchard
- Royal Lancaster InfirmaryLancaster Patient Safety Research UnitPointer Court 1, Ashton RoadLancasterUKLA1 4RP
| | - Oliver J Schofield‐Robinson
- Royal Lancaster InfirmaryLancaster Patient Safety Research UnitPointer Court 1, Ashton RoadLancasterUKLA1 4RP
| | | | - Phil Alderson
- National Institute for Health and Care ExcellenceLevel 1A, City Tower,Piccadilly PlazaManchesterUKM1 4BD
| | - Andrew F Smith
- Royal Lancaster InfirmaryDepartment of AnaesthesiaAshton RoadLancasterLancashireUKLA1 4RP
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Kim TY, Kim DK, Yoon TG, Lim JA, Woo NS, Chee HK, Shin JK, Song MG, Kim SH. Myocardial Injury in Remifentanil-Based Anaesthesia for off-Pump Coronary Artery Bypass Surgery: An Equipotent Dose of Sevoflurane versus Propofol. Anaesth Intensive Care 2011; 39:418-25. [DOI: 10.1177/0310057x1103900312] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This randomised controlled trial compared the effect of equipotent anaesthetic doses of sevoflurane (S group) versus propofol (P group), during remifentanil-based anaesthesia for off-pump coronary artery bypass surgery, on myocardial injury. Either sevoflurane or propofol was titrated to maintain bispectral index values between 40 and 50. In both groups, a targeted concentration of remifentanil 20 ng.ml-1 was maintained during anaesthesia. The concentrations of creatine kinase MB and troponin I were measured before the start of surgery, on admission to the intensive care unit, and at 12 and 24 hours after intensive care unit admission. The postoperative values of creatine kinase MB (S group: 15.08±18.97, 20.78±20.92, 12.76±12.82 vs 2.09±1.54 ng.ml-1; P group: 10.99±13.15, 27.16±56.55, 11.88±18.80 vs 1.84±1.67 ng.ml-1) and troponin I (S group: 3.56±5.19, 5.66±7.89, 3.35±4.55 vs 0.52±1.90 ng.ml-1; P group: 2.42±3.33, 4.11±6.01, 3.04±5.31 vs 0.43±1.28 ng.ml-1) were significantly higher than preoperative values in both groups but there were no significant differences between the two groups. There were no significant differences in time to extubation (S group, 476±284 minutes; P group, 450±268 minutes) and intensive care unit length of stay (S group, 2775±1449 minutes; P group, 2797±1534 minutes) between the two groups. In conclusion, sevoflurane and propofol at equipotent doses guided by bispectral index with remifentanil 20 ng.ml-1 had similar creatine kinase MB and troponin I values.
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Affiliation(s)
- T.-Y. Kim
- Department of Anaesthesiology and Pain Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - D.-K. Kim
- Department of Anaesthesiology and Pain Medicine, Konkuk University School of Medicine, Seoul, Korea
- Department of Cardiovascular and Thoracic Surgery
| | - T.-G. Yoon
- Department of Anaesthesiology and Pain Medicine, Konkuk University School of Medicine, Seoul, Korea
- Department of Cardiovascular and Thoracic Surgery
| | - J.-A. Lim
- Department of Anaesthesiology and Pain Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - N.-S. Woo
- Department of Anaesthesiology and Pain Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - H.-K. Chee
- Department of Anaesthesiology and Pain Medicine, Konkuk University School of Medicine, Seoul, Korea
- Department of Anaesthesiology
| | - J.-K. Shin
- Department of Anaesthesiology and Pain Medicine, Konkuk University School of Medicine, Seoul, Korea
- Department of Anaesthesiology
| | - M.-G. Song
- Department of Anaesthesiology and Pain Medicine, Konkuk University School of Medicine, Seoul, Korea
- Department of Anaesthesiology
| | - S.-H. Kim
- Department of Anaesthesiology and Pain Medicine, Konkuk University School of Medicine, Seoul, Korea
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