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Ellerkmann R, Söhle M. EEG-Messung in Narkose. Anasthesiol Intensivmed Notfallmed Schmerzther 2023; 58:626-638. [PMID: 38056442 DOI: 10.1055/a-2006-9907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/08/2023]
Abstract
Based on the existing literature, the application of designated, processed EEG-monitors to measure anesthetic depth and the associated clinical implications are explained. EEG-monitors quantify the hypnotic portion of anesthesia, but not the nociceptive properties of anesthetics. Depth of anesthesia monitoring is common practice in many German hospitals and helps to visualize the interindividual variability of anesthetics, especially of propofol. Although deep anesthesia is associated with increased long-term mortality, this relation seems not to be causally related. Nevertheless, depth of anesthesia monitors help to identify patients being especially susceptible to anesthetics. Moreover, they have shown to reduce the incidence of intraoperative awareness and postoperative delirium. The application of processed EEG-monitors to reduce the incidence of postoperative delirium is currently recommended by the European Society of Anaesthesiology and Intensive Care.
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Hampton CE, da Cunha A, Desselle A, Queiroz-Williams P, Hofmeister EH. The effect of age on the induction dose of propofol for general anesthesia in dogs. PLoS One 2023; 18:e0288088. [PMID: 37399166 DOI: 10.1371/journal.pone.0288088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 06/19/2023] [Indexed: 07/05/2023] Open
Abstract
OBJECTIVE In people, the dose of propofol (DOP) required for procedural sedation and anesthesia decreases significantly with age. The objective of this study was to determine if the DOP required to perform endotracheal intubation decreases with age in dogs. STUDY DESIGN Retrospective case series. ANIMALS 1397 dogs. METHODS Data from dogs anesthetized at referral center (2017-2020) were analyzed with three multivariate linear regression models with backward elimination using a combination of either absolute age, physiologic age, or life expectancy (ratio between age at the time of anesthetic event and expected age of death for each breed obtained from previous literature) as well as other factors as independent variables, and DOP as the dependent variable. The DOP for each quartile of life expectancy (<25%, 25-50%, 50-75%, 75-100%, >100%) was compared using one-way ANOVA. Significance was set at alpha = 0.025. RESULTS Mean age was 7.2 ± 4.1 years, life expectancy 59.8 ± 33%, weight 19 ± 14 kg, and DOP 3.76 ± 1.8 mg kg-1. Among age models, only life expectancy was a predictor of DOP (-0.37 mg kg-1; P = 0.013) but of minimal clinical importance. The DOP by life age expectancy quartile was 3.9 ± 2.3, 3.8 ± 1.8, 3.6 ± 1.8, 3.7 ± 1.7, and 3.4 ± 1.6 mg kg-1, respectively (P = 0.20). Yorkshire Terrier, Chihuahua, Maltese, mixed breed dogs under 10 kg, and Shih Tzu required higher DOP. Status of neutered male, ASA E, and Boxer, Labrador and Golden Retriever breeds decreased DOP, along with certain premedication drugs. CONCLUSIONS AND CLINICAL RELEVANCE In contrast to what is observed in people, an age cut-off predictive of DOP does not exist. Percentage of elapsed life expectancy along with other factors such as breed, premedication drug, emergency procedure, and reproductive status significantly alter DOP. In older dogs, the dose of propofol can be adjusted based on their elapsed life expectancy.
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Affiliation(s)
- Chiara E Hampton
- School of Veterinary Medicine, Department of Veterinary Medical Science, Louisiana State University, Baton Rouge, Louisiana, United States of America
- College of Veterinary Medicine, University of Tennessee, Knoxville, Tennessee, United States of America
| | - Anderson da Cunha
- College of Veterinary Medicine, Midwestern University, Glendale, Arizona, United States of America
| | - Amber Desselle
- School of Veterinary Medicine, Department of Veterinary Medical Science, Louisiana State University, Baton Rouge, Louisiana, United States of America
| | - Patricia Queiroz-Williams
- School of Veterinary Medicine, Department of Veterinary Medical Science, Louisiana State University, Baton Rouge, Louisiana, United States of America
| | - Erik H Hofmeister
- College of Veterinary Medicine, Department of Clinical Sciences, Auburn University, Auburn, Alabama, United States of America
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Asahi Y, Kubota K, Omichi S. Dose Requirements for Propofol Anaesthesia for Dental Treatment for Autistic Patients Compared with Intellectually Impaired Patients. Anaesth Intensive Care 2019; 37:70-3. [DOI: 10.1177/0310057x0903700101] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Y. Asahi
- Department of Dentistry, Bobath Memorial Hospital, Osaka, Japan
- Department of Dentistry, Morinomiya Hospital and Bobath Memorial Hospital
| | - K. Kubota
- Department of Dentistry, Morinomiya Hospital and Graduate School of Management Development and Information Sciences, Nihon Fukushi University, Aichi
| | - S. Omichi
- Department of Dentistry, Bobath Memorial Hospital and Part-time Dentist, Department of Dentistry, Morinomiya Hospital
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Rüsch D, Arndt C, Eberhart L, Tappert S, Nageldick D, Wulf H. Bispectral index to guide induction of anesthesia: a randomized controlled study. BMC Anesthesiol 2018; 18:66. [PMID: 29902969 PMCID: PMC6003112 DOI: 10.1186/s12871-018-0522-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Accepted: 05/22/2018] [Indexed: 02/07/2023] Open
Abstract
Background It is unknown to what extent hypotension frequently observed following administration of propofol for induction of general anesthesia is caused by overdosing propofol. Unlike clinical signs, electroencephalon-based cerebral monitoring allows to detect and quantify an overdose of hypnotics. Therefore, we tested whether the use of an electroencephalon-based cerebral monitoring will cause less hypotension following induction with propofol. Methods Subjects were randomly assigned to a bispectral index (BIS)-guided (target range 40–60) or to a weight-related (2 mg.kg− 1) manual administration of propofol for induction of general anesthesia. The primary endpoint was the incidence of hypotension following the administration of propofol. Secondary endpoints included the degree of hypotension and correlations between BIS and drop in mean arterial pressure (MAP). Incidences were analyzed with Fisher’s Exact-test. Results Of the 240 patients enrolled into this study, 235 predominantly non-geriatric (median 48 years, 25th – 75th percentile 35–61 years) patients without severe concomitant disease (88% American Society of Anesthesiology physical status 1–2) undergoing ear, nose and throat surgery, ophthalmic surgery, and dermatologic surgery were analyzed. Patients who were manually administered propofol guided by BIS (n = 120) compared to those who were given propofol by weight (n = 115) did not differ concerning the incidence of hypotension (44% vs. 45%; p = 0.87). Study groups were also similar regarding the maximal drop in MAP compared to baseline (33% vs. 30%) and the proportion of hypotensive events related to all measurements (17% vs. 19%). Final propofol induction doses in BIS group and NON-BIS group were similar (1.93 mg/kg vs. 2 mg/kg). There was no linear correlation between BIS and the drop in MAP at all times (r < 0.2 for all) except for a weak one at 6 min (r = 0.221). Conclusion Results of our study suggest that a BIS-guided compared to a weight-adjusted manual administration of propofol for induction of general anesthesia in non-geriatric patients will not lower the incidence and degree of arterial hypotension. Trial registration German Registry of Clinical Trials (DRKS00010544), retrospectively registered on August 4, 2016. Electronic supplementary material The online version of this article (10.1186/s12871-018-0522-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Dirk Rüsch
- Department of Anesthesia and Intensive Care, University Hospital Giessen-Marburg, Marburg Campus, Baldingerstraße, 35033, Marburg, Germany.
| | - Christian Arndt
- Department of Anesthesia and Intensive Care, University Hospital Giessen-Marburg, Marburg Campus, Baldingerstraße, 35033, Marburg, Germany
| | - Leopold Eberhart
- Department of Anesthesia and Intensive Care, University Hospital Giessen-Marburg, Marburg Campus, Baldingerstraße, 35033, Marburg, Germany
| | - Scarlett Tappert
- Department of Anesthesia and Intensive Care, University Hospital Giessen-Marburg, Marburg Campus, Baldingerstraße, 35033, Marburg, Germany
| | - Dennis Nageldick
- Department of Anesthesia and Intensive Care, University Hospital Giessen-Marburg, Marburg Campus, Baldingerstraße, 35033, Marburg, Germany
| | - Hinnerk Wulf
- Department of Anesthesia and Intensive Care, University Hospital Giessen-Marburg, Marburg Campus, Baldingerstraße, 35033, Marburg, Germany
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Abstract
Aging involves changes in several physiologic processes that lead to decreased volumes of distribution, slowed metabolism, and increased end-organ sensitivity to anesthetics. These changes generally result in increased potency. Elderly patients require less anesthetic medication, but the true extent of reduction is underappreciated and less uniformly practiced. The impact of potential anesthetic drug overdosing on intermediate and long-term outcomes is not fully appreciated. It may be necessary to consider age as a continuous variable for anesthetic drug dosing in older patients rather than treating adult versus elderly patients. Further pharmacologic studies are required in people more than 85 years old.
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Affiliation(s)
- Shamsuddin Akhtar
- Department of Anesthesiology, Yale University School of Medicine, 333 Cedar Street, Tompkins # 3, New Haven, CT 06520, USA.
| | - Ramachandran Ramani
- Department of Anesthesiology, Yale University School of Medicine, 333 Cedar Street, Tompkins # 3, New Haven, CT 06520, USA
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7
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Chan SM, Lee MS, Lu CH, Cherng CH, Huang YS, Yeh CC, Kuo CY, Wu ZF. Confounding factors to predict the awakening effect-site concentration of propofol in target-controlled infusion based on propofol and fentanyl anesthesia. PLoS One 2015; 10:e0124343. [PMID: 25938415 PMCID: PMC4418734 DOI: 10.1371/journal.pone.0124343] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Accepted: 02/28/2015] [Indexed: 11/24/2022] Open
Abstract
We conducted a large retrospective study to investigate the confounding factors that predict Ce ROC under propofol-based TIVA with TCI. We recorded sex, age, height, weight, Ce LOC, Ce ROC, total propofol and fentanyl consumption dose, and anesthetic time. Simple linear regression models were used to identify potential predictors of Ce ROC, and multiple linear regression models were used to identify the confounding predictors of Ce ROC. We found that Ce ROC correlated with age, sex, Ce LOC, and both total fentanyl and propofol consumption dose. The prediction formula was: Ce ROC = 0.87 - 0.06 × age + 0.18 × Ce LOC + 0.04 (if fentanyl consumption > 150 μg; if not, ignore this value) + 0.07 × (1 or 2, according to the total propofol consumption dose, 1 for a propofol amount 1000-2000 mg and 2 for a propofol amount > 2000 mg). We simplified the formula further as Ce ROC = 0.87 - 0.06 × age + 0.18 × Ce LOC. In conclusion, Ce ROC can be predicted under TCI with propofol- and fentanyl-based TIVA. The confounding factors that predicted propofol Ce ROC are age, sex, Ce LOC, and total consumption dose of propofol and fentanyl.
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Affiliation(s)
- Shun-Ming Chan
- Department of Anesthesiology, Tri-Service General Hospital and National Defense Medical Center, Taipei, Taiwan, Republic of China
- Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan, Republic of China
| | - Meei-Shyuan Lee
- School of Public Health, National Defense Medical Center, Taipei, Taiwan, Republic of China
| | - Chueng-He Lu
- Department of Anesthesiology, Tri-Service General Hospital and National Defense Medical Center, Taipei, Taiwan, Republic of China
| | - Chen-Hwan Cherng
- Department of Anesthesiology, Tri-Service General Hospital and National Defense Medical Center, Taipei, Taiwan, Republic of China
| | - Yuan-Shiou Huang
- Department of Anesthesiology, Tri-Service General Hospital and National Defense Medical Center, Taipei, Taiwan, Republic of China
| | - Chun-Chang Yeh
- Department of Anesthesiology, Tri-Service General Hospital and National Defense Medical Center, Taipei, Taiwan, Republic of China
| | - Chan-Yang Kuo
- Department of Anesthesiology, Tri-Service General Hospital and National Defense Medical Center, Taipei, Taiwan, Republic of China
| | - Zhi-Fu Wu
- Department of Anesthesiology, Tri-Service General Hospital and National Defense Medical Center, Taipei, Taiwan, Republic of China
- Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan, Republic of China
- * E-mail:
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Ellerkmann RK, Soehle M, Kreuer S. Brain monitoring revisited: What is it all about? Best Pract Res Clin Anaesthesiol 2013; 27:225-33. [DOI: 10.1016/j.bpa.2013.06.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2013] [Revised: 05/07/2013] [Accepted: 06/12/2013] [Indexed: 10/26/2022]
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Patanwala AE, Christich AC, Jasiak KD, Edwards CJ, Phan H, Snyder EM. Age-related Differences in Propofol Dosing for Procedural Sedation in the Emergency Department. J Emerg Med 2013; 44:823-8. [DOI: 10.1016/j.jemermed.2012.07.090] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2011] [Revised: 04/10/2012] [Accepted: 07/13/2012] [Indexed: 11/27/2022]
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Torbic H, Papadopoulos S, Manjourides J, Devlin JW. Impact of a Protocol Advocating Dexmedetomidine Over Propofol Sedation After Robotic-Assisted Direct Coronary Artery Bypass Surgery on Duration of Mechanical Ventilation and Patient Safety. Ann Pharmacother 2013; 47:441-6. [DOI: 10.1345/aph.1s156] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Controversy remains whether propofol or dexmedetomidine is the preferred sedative following cardiac surgery. Dexmedetomidine may offer advantages over propofol among patients undergoing robotic-assisted, minimally invasive, direct coronary artery bypass (MIDCAB) surgery given the rapidity with which this population is usually extubated after surgery. OBJECTIVE To measure the impact of a surgery protocol advocating use of dexmedetomidine rather than propofol after MIDCAB surgery on discontinuation of mechanical ventilation and patient safety. METHODS The records on consecutive adults undergoing MIDCAB surgery who received postoperative sedation with propofol or dexmedetomidine at a 508-bed academic medical center were analyzed before and after implementation of a post-MIDCAB surgery protocol advocating dexmedetomidine use. RESULTS Seventy-three propofol patients were compared with 53 dexmedetomidine patients. The groups were similar, except propofol patients were older (p = 0.002) and more likely to have underlying heart failure that was either moderate or severe (New York Heart Association class III or IV) (p = 0.0001). Time (median [interquartile range]) to extubation (hours) was shorter in the dexmedetomidine group (5.0 [3.6–7.0] vs 9.8 [5.0–16.3]; p = 0.0001). A Cox proportional hazards model revealed that patient age (p = 0.001) and duration of surgery (p = 0.003) influenced time to extubation between the dexmedetomidine and propofol groups but the presence of moderate or severe heart failure (p = 0.438), the number of coronary vessels operated on (p = 0.130), use of an opioid (p = 0.791), or the total dose of morphine administered (p = 0.215) did not. During sedation administration, more propofol-treated patients experienced 1 or more episodes of hypotension (systolic blood pressure ≤80 mm Hg, 11.6% vs 0%; p = 0.02), tachycardia (heart rate ≥120 beats/min, 8.6% vs 0%; p = 0.04), and unarousability (Sedation Agitation Scale score ≤2, 30.0% vs 9.4%; p = 0.03). CONCLUSIONS Use of a protocol promoting dexmedetomidine, rather than propofol sedation, after MIDCAB surgery facilitates faster discontinuation of mechanical ventilation and is associated with greater hemodynamic stability and arousability.
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Affiliation(s)
- Heather Torbic
- Heather Torbic PharmD BCPS, Department of Pharmacy, Brigham and Women's Hospital, Boston, MA
| | - Stella Papadopoulos
- Stella Papadopoulos PharmD BCPS, Department of Pharmacy, Boston Medical Center, Boston
| | - Justin Manjourides
- Justin Manjourides PhD, Department of Health Sciences, Bouve College, Northeastern University, Boston
| | - John W Devlin
- John W Devlin PharmD FCCM FCCP, School of Pharmacy, Northeastern University
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11
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Sheth SA, Eckhardt CA, Walcott BP, Eskandar EN, Simon MV. Factors Affecting Successful Localization of the Central Sulcus Using the Somatosensory Evoked Potential Phase Reversal Technique. Neurosurgery 2013; 72:828-34; discussion 834. [DOI: 10.1227/neu.0b013e3182897447] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
BACKGROUND:
Perirolandic surgery is associated with an increased risk of postoperative neurological deficit that can be reduced by accurate recognition of the location of sensorimotor cortex. The median somatosensory evoked potential (MSSEP) phase reversal technique (PRT) reliably identifies the central sulcus (CS) intraoperatively, but does require additional surgical time. Awareness of factors that lengthen the time required for MSSEP PRT has important implications for surgical planning.
OBJECTIVE:
To identify factors that affect the time required for CS localization via MSSEP PRT.
METHODS:
Multivariate Cox regression analysis, applied in 100 consecutive cases of perirolandic surgery at a single institution from 2005 to 2010, during which CS localization was attempted via a standardized MSSEP PRT.
RESULTS:
The CS was reliably identified in 77 cases. The mean time to identification was 5 minutes (SD = 5; range, 1–20 minutes). Lesion location either very close to the CS (within the postcentral gyrus) or at an intermediate distance (with edema extending very close to the CS) independently decreased the rate at which the CS was identified by 73% (hazard ratio: 0.27, P < .001) and 55% (hazard ratio: 0.45, P = .007), respectively. Highly destructive pathology reduced this rate by 42% (hazard ratio: 0.58, P = .03), after adjusting for other important factors. Epidural recording, age, and the presence of a burst suppression pattern on the electroencephalogram had no effect.
CONCLUSION:
MSSEP PRT is an effective method for CS identification and only marginally lengthens the operative time. However, difficulty in CS localization can be expected in the presence of postcentral gyrus lesions, edema distorting perirolandic anatomy, and with highly destructive pathology.
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Affiliation(s)
| | | | | | | | - Mirela V. Simon
- Departments of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
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The variability of stimulus thresholds in electrophysiologic cortical language mapping. J Clin Neurophysiol 2011; 28:210-6. [PMID: 21399523 DOI: 10.1097/wnp.0b013e3182121827] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
The aim of this study was to investigate the variability of electrical stimulation threshold in cortical language mapping in relationship to the lobar location of the mapped eloquent cortex and the distance between the latter and the location of the cortical lesion. A multivariate linear regression analysis was performed in a sample of 39 patients who underwent standardized successful language cortical mapping. Estimated stimulus threshold for temporal language cortex was 1.45 times higher than the estimated threshold for frontal language cortex, after adjusting for the other variables (P = 0.017). Stimulation of the mapped cortex in close proximity to the lesion or to the lesional edema increased the estimated threshold 2.6 or 1.8 times, respectively, compared with stimulation in other areas, after adjusting for the other variables (P < 0.0001, P = 0.0017). In concordance with prior findings, our results show that stimulus threshold in cortical language mapping is dependent on the lobar location of the mapped cortex. In addition, stimulus threshold is increased when the mapped cortex is in close proximity to the location of the lesion or perilesional edema.
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The effects of EEG suppression and anesthetics on stimulus thresholds in functional cortical motor mapping. Clin Neurophysiol 2010; 121:784-92. [DOI: 10.1016/j.clinph.2010.01.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2008] [Revised: 12/13/2009] [Accepted: 01/03/2010] [Indexed: 11/19/2022]
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Büttner N, Schultz B, Grouven U, Schultz A. EEG-adaptierte „target-controlled infusion“. Anaesthesist 2010; 59:126-34. [DOI: 10.1007/s00101-009-1666-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Abstract
Elderly patients have medical and psychological problems affecting all major organ systems. These problems may alter the pharmacokinetics and/or pharmacodynamics of medications, or expose previous neurologic deficits simply as a result of sedation. Delayed arousal, therefore, may arise from structural problems that are pre-existent or new, or metabolic or functional disorders such as convulsive or nonconvulsive seizures. Determining the cause of delayed arousal may require clinical, chemical, and structural tests. Structural problems that impair consciousness arise from a small number of focal lesions to specific areas of the central nervous system, or from pathology affecting the cerebrum. In general, focal or multifocal lesions can be identified by computerized tomography, or diffusion-weighted imaging. An algorithm is presented that outlines a workup for an elderly patient with delayed arousal.
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Affiliation(s)
- Zirka H Anastasian
- Division of Neurosurgical Anesthesiology, Department of Anesthesiology, Columbia University, New York, NY 10032, USA.
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Voulgaris DA, Hofmeister EH. Multivariate analysis of factors associated with post-anesthetic times to standing in isoflurane-anesthetized horses: 381 cases. Vet Anaesth Analg 2009; 36:414-20. [DOI: 10.1111/j.1467-2995.2009.00472.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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17
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Tak YJ, Shin HJ, Kim ES, Koo BW, Shin YD, Kim ST. What is the optimal effect-site concentration of remifentanil for minimizing the cardiovascular changes to endotracheal intubation during induction with propofol in elderly patients? Korean J Anesthesiol 2009; 56:392-397. [PMID: 30625759 DOI: 10.4097/kjae.2009.56.4.392] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The addition of remifentanil during propofol TCI (target controlled infusion) attenuates the hemodynamic changes induced by endotracheal intubation. This study examined the optimal effect-site concentration of remifentanil to minimize the cardiovascular changes to endotracheal intubation in elderly patients. METHODS Fifty ASA 1 or 2 elderly patients scheduled for elective surgery under general anesthesia were assigned randomly to one of two groups according to the effect-site concentration of remifentanil. Each group was administered 4 microgram/ml of propofol TCI with 1 ng/ml (group R1) or 3 ng/ml (group R3) of remifentanil. The heart rate (HR), systolic (SAP), mean (MAP) and diastolic arterial pressure (DAP) were measured at pre-induction, before and after endotracheal intubation. RESULTS After intubation, the HR, SAP, MAP and DAP increased significantly in the two groups compared with the pre-intubation values. However, the HR, SAP, MAP and DAP for group R3 were lower than group R1 for 5 min after intubation. CONCLUSIONS In elderly patients administered 4 microg/ml of propofol TCI, we suggest that the optimal effect-site concentration of remifentanil to minimize the cardiovascular changes to endotracheal intubation is 3 ng/ml rather than 1 ng/ml.
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Affiliation(s)
- Yang Ju Tak
- Department of Anesthesiology and Pain Medicine, College of Medicine, Chungbuk National University, Cheongju, Korea.
| | - Hyun Jung Shin
- Department of Anesthesiology and Pain Medicine, College of Medicine, Chungbuk National University, Cheongju, Korea.
| | - Eun Seok Kim
- Department of Anesthesiology and Pain Medicine, College of Medicine, Chungbuk National University, Cheongju, Korea.
| | - Bon Wook Koo
- Department of Anesthesiology and Pain Medicine, College of Medicine, Chungbuk National University, Cheongju, Korea.
| | - Young Duck Shin
- Department of Anesthesiology and Pain Medicine, College of Medicine, Chungbuk National University, Cheongju, Korea.
| | - Sang Tae Kim
- Department of Anesthesiology and Pain Medicine, College of Medicine, Chungbuk National University, Cheongju, Korea.
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Buchanan FF, Myles PS, Cicuttini F. Patient Sex and its Influence on General Anaesthesia. Anaesth Intensive Care 2009; 37:207-18. [DOI: 10.1177/0310057x0903700201] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Physiological and pharmacological differences exist between men and women. Women wake faster than men following general anaesthesia. Women also differ from men in their postoperative recovery as reflected by differences in postoperative pain, nausea and vomiting and overall quality of recovery. These gender differences seem to be more pronounced in premenopausal women, suggesting hormonal mechanisms are a major contributing factor.
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Affiliation(s)
- F. F. Buchanan
- Department of Anaesthesia and Perioperative Medicine, Alfred Hospital and Academic Board of Anaesthesia and Perioperative Medicine, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Department of Anaesthesia and Perioperative Medicine, Alfred Hospital
| | - P. S. Myles
- Department of Anaesthesia and Perioperative Medicine, Alfred Hospital and Academic Board of Anaesthesia and Perioperative Medicine, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Department of Anaesthesia and Perioperative Medicine, Alfred Hospital, Academic Board of Anaesthesia and Perioperative Medicine, Monash University and NHMRC Practitioner Fellow
| | - F. Cicuttini
- Department of Anaesthesia and Perioperative Medicine, Alfred Hospital and Academic Board of Anaesthesia and Perioperative Medicine, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Rheumatology Unit, Alfred Hospital and Department of Epidemiology and Monash University
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Lee IH, Culley DJ, Baxter MG, Xie Z, Tanzi RE, Crosby G. Spatial memory is intact in aged rats after propofol anesthesia. Anesth Analg 2008; 107:1211-5. [PMID: 18806029 DOI: 10.1213/ane.0b013e31817ee879] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND We have previously demonstrated that aged rats have persistent impairment of spatial memory after sedation with nitrous oxide or general anesthesia with isoflurane-nitrous oxide. Propofol has different receptor mechanisms of action and a favorable short-term recovery profile, and it has been proposed that propofol is devoid of enduring effects on cognitive performance. No studies have investigated this question in aged subjects, however, so we designed an experiment to examine the long-term effects of propofol anesthesia on spatial working memory. METHODS Eighteen-mo-old rats were randomized to 2 h of 100% oxygen-propofol anesthesia (n=11) or to a control group that breathed 100% oxygen (n=10). Propofol was administered by continuous infusion via a tail vein catheter. Rats breathed spontaneously and rectal temperature was maintained. Mean arterial blood pressure was measured noninvasively and a venous blood gas was obtained just before discontinuation of propofol. After a 2-day recovery, spatial working memory was assessed for 14 days using a 12-arm radial maze. The number of total errors, number of correct choices to first error, and time to complete the maze was recorded and analyzed using a repeated measure analysis of variance (ANOVA), with P<0.05 being considered statistically significant. RESULTS The average propofol infusion rate was 0.6+/-0.1 mg.kg (-1).min(-1), a rate corresponding to a 50% effective concentration dose in adult rats. Mean arterial blood pressure during anesthesia was 100+/-2 mm Hg and venous blood gases remained in the normal range. There was no difference between the control and previously anesthetized rats on any measure of radial arm maze performance, indicating propofol anesthesia produces no lasting impairment in spatial working memory in aged rats. CONCLUSIONS In aged rats, propofol anesthesia is devoid of the persistent memory effects observed with other general anesthetics in this model. Thus, while it appears that the state of general anesthesia is neither necessary nor sufficient for development of postanesthetic memory impairment, the choice of anesthetics may play a role in late cognitive outcome in the aged.
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Affiliation(s)
- In Ho Lee
- Department of Anesthesiology, Korea University Guro Hospital, Seoul, Republic of Korea
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Target-controlled infusion (TCI). Anaesthesist 2008; 57:221-2. [DOI: 10.1007/s00101-008-1332-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Cho JE, Kim WO, Jun NH, Yang SY, Kil HK. Comparison of Maintenance and Emergence of Anesthesia in Total Intravenous Anesthesia with Propofol and Remifentanil for Thyroidectomy and Mastectomy. Korean J Anesthesiol 2007. [DOI: 10.4097/kjae.2007.53.2.169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- Jang Eun Cho
- Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Won Oak Kim
- Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, Korea
- Anesthesiology and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Na Hyung Jun
- Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - So Young Yang
- Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Hae Keum Kil
- Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, Korea
- Anesthesiology and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea
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