1
|
Geetha S, Prashanth NV, Durga P, Jayaram K, Farooq M, Chandra S, Sushma. Comparison of nebulisation 0.75% ropivacaine with 2% lignocaine for attenuation of haemodynamic response due to intubation: A prospective randomised study. J Perioper Pract 2024:17504589241229906. [PMID: 38600632 DOI: 10.1177/17504589241229906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/12/2024]
Abstract
INTRODUCTION Laryngoscopy and intubation are associated with the reflex response of hypertension, tachycardia and other intraoperative complications. Nebulised route drug administration and entropy-guided induction enable optimal intubating conditions. AIMS To compare pre-induction nebulisation between 0.75% ropivacaine and 2% lignocaine in blunting the nasotracheal intubation response. MATERIALS AND METHODS A total of 100 patients undergoing elective faciomaxillary surgeries were prospectively randomised to receive pre-induction nebulisation: 5mL of 2% lignocaine (100mg) (Group L) or 5mL of 0.75% ropivacaine (37.5mg) (Group R). Patients were induced and intubated (nasotracheal) with entropy monitoring. Observed parameters included systolic blood pressure, diastolic blood pressure, mean arterial pressure, heart rate, entropy at baseline, induction, intubation, post-intubation one, three and five minutes, propofol induction dose, electrocardiogram changes and peri-intubation cough reflex. RESULTS Ropivacaine aerosol proved significantly better than lignocaine aerosol on haemodynamics (systolic blood pressure, diastolic blood pressure, mean arterial pressure, heart rate) and cough reflex (p < 0.05). Both groups experienced similar entropy changes and propofol induction dose requirements and no fresh electrocardiogram changes (compared with the baseline). CONCLUSION Pre-induction nebulised ropivacaine offers superior intubating conditions than lignocaine regarding haemodynamic response and cough reflex for faciomaxillary surgeries.
Collapse
Affiliation(s)
- Singam Geetha
- Nizam's Institute of Medical Sciences, Hyderabad, India
| | | | - Padmaja Durga
- Nizam's Institute of Medical Sciences, Hyderabad, India
| | | | | | | | - Sushma
- Nizam's Institute of Medical Sciences, Hyderabad, India
| |
Collapse
|
2
|
Pauchard JC, Hafiani EM, Bonnet L, Cabelguenne D, Carenco P, Cassier P, Garnier J, Lallemant F, Pons S, Sautou V, De Jong A, Caillard A. Guidelines for reducing the environmental impact of general anaesthesia. Anaesth Crit Care Pain Med 2023; 42:101291. [PMID: 37562688 DOI: 10.1016/j.accpm.2023.101291] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/12/2023]
Abstract
OBJECTIVE To provide guidelines for reducing the environmental impact of general anaesthesia. DESIGN A committee of ten experts from SFAR and SF2H and SFPC learned societies was set up. A policy of declaration of competing interests was applied and observed throughout the guideline-writing process. Likewise, it did not benefit from any funding from a company marketing a health product (drug or medical device). The committee followed the GRADE® method (Grading of Recommendations Assessment, Development and Evaluation) to assess the quality of the evidence on which the recommendations were based. METHODS We aimed to formulate recommendations according to the GRADE® methodology for three different fields: anaesthesia vapours and gases; intravenous drugs; medical devices and the working environment. Each question was formulated according to the PICO format (Population, Intervention, Comparator, Outcome). The literature review and recommendations were formulated according to the GRADE® methodology. RESULTS The experts' work on the synthesis and application of the GRADE® method led to the formulation of 17 recommendations. Since the GRADE® method could not be entirely applied to all of the questions, some of the recommendations were formulated as expert opinions. CONCLUSION Based on strong agreement between experts, we produced 17 recommendations designed to guide reducing the environmental impact of general anaesthesia.
Collapse
Affiliation(s)
- Jean-Claude Pauchard
- Ramsay Santé, Member of Société Française d'Anesthésie Réanimation (SFAR) Substainable Development Committee, Clinique Aguiléra, Biarritz, France.
| | - El-Madhi Hafiani
- Department of Anaesthesia, Resuscitation and Perioperative Medicine, DMU DREAM - Tenon Hospital, AP-HP Sorbonne University, Paris, France.
| | - Laure Bonnet
- Department of Anesthesia and Intensive Care, Centre Hospitalier Princess Grace, Monaco
| | | | - Philipe Carenco
- Hygiene Department CHU de Nice, Nice, France; CPias PACA, Marseille, France; AFNOR, La Plaine Saint-Denis, France; Comité Européen de Normalisation, Brussels, Belgium; Bureau de Normalisation de l'Industrie Textile et de l'Habillement (BNITH), domaine des textiles en santé, Paris, France
| | - Pierre Cassier
- Institute of Infectious Agents, Hospices Civils de Lyon, Lyon, France; CIRI, Centre International de Recherche en Infectiologie, Université de Lyon, Inserm, U1111, Université Claude Bernard Lyon 1, CNRS, UMR5308, ENS de Lyon, Lyon, France
| | - Jérémie Garnier
- Department of Anesthesia and Intensive Care Unit, CHU Amiens-Picardie, 1 Rond-Point du Pr Christian Cabrol, 80054 Amiens Cedex 1, France
| | - Florence Lallemant
- Department of Anesthesia and Intensive Care Unit, CHU Lille, F-59000 Lille, France; CHU Lille, Pôle des Urgences, F-59000 Lille, France
| | - Stéphanie Pons
- DMU DREAM, Department of Anesthesiology and Critical Care, Sorbonne University, GRC 29, AP-HP, Pitié-Salpêtrière, Paris, France
| | - Valérie Sautou
- Clermont Auvergne University, Clermont Auvergne INP, CNRS, CHU Clermont Ferrand, ICCF, F-63000 Clermont-Ferrand, France
| | - Audrey De Jong
- PhyMedExp, Montpellier University, INSERM, CNRS, CHU Montpellier, France; Department of Anesthesia and Intensive Care Unit, St-Eloi Hospital, France
| | - Anaïs Caillard
- Department of Anesthesia and Intensive Care Unit, CHU Brest, Cavale Blanche Hospital, France; ORPHY, EA 4324, France
| |
Collapse
|
3
|
He B, Zhang N, Peng M. Meta-analysis of the effect of entropy-assisted general anesthesia on the quality of postoperative recovery. Medicine (Baltimore) 2023; 102:e34091. [PMID: 37352057 PMCID: PMC10289486 DOI: 10.1097/md.0000000000034091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 02/27/2023] [Accepted: 04/06/2023] [Indexed: 06/25/2023] Open
Abstract
BACKGROUND To evaluate the effect of the quality of postoperative anesthetic resuscitation in patients with entropy index monitoring assisted general anesthesia versus standard clinical practice. METHODS The randomized controlled trials on the application of entropy index monitoring in general anesthesia were searched in PubMed, Web of Science, Embase, The Cochrane Library, CNKI, Wanfang, VIP, and other databases by computer. The data were collected from inception to January 2022. Two researchers independently screened the retrieved literature according to the inclusion and exclusion criteria and used Cochrane's risk-of-bias assessment criteria to evaluate the quality of the literature. The evaluation indicators included respiratory recovery time, extubation time, consciousness recovery time, emergence agitation, postoperative nausea and vomiting (PONV), and intraoperative awareness. The RevMan 5.4.1 software was used for the meta-analysis of the data. RESULTS A total of 860 patients from 10 eligible randomized controlled trials were included in this study. The results showed that compared with the control group, the respiratory recovery time (MD = -3.37, 95% CI: -5.09 to -1.85, P < .0001), extubation time (MD = -4.57, 95% CI: -6.08 to -3.95, P < .00001), and consciousness recovery time (MD = -4.95, 95% CI: -7.21 to -2.70, P < .00001) in the entropy index group were significantly shortened. The incidence of emergence agitation in the entropy index group (RR = 0.23, 95% CI: 0.11-0.47, P < .0001) decreased significantly. The incidence of PONV (RR = 0.46, 95% CI: 0.27-0.79, P = .004) was significantly reduced. However, the incidence of intraoperative awareness (RR = 0.33, 95% CI: 0.04-3.16, P = .34) wasn't significantly different. CONCLUSION The application of the entropy index can improve the recovery quality of patients under general anesthesia, not only shortening the postoperative recovery time but also reducing the occurrence of agitation and PONV. It does not affect the incidence of intraoperative awareness.
Collapse
Affiliation(s)
- Bingyuan He
- Yongchuan Hospital of Chongqing Medical University, Chongqing, China
| | - Na Zhang
- Yongchuan Hospital of Chongqing Medical University, Chongqing, China
| | - Mingqing Peng
- Yongchuan Hospital of Chongqing Medical University, Chongqing, China
| |
Collapse
|
4
|
Singh J, Pathania J, Bodh V, Sharma R, Kumar R, Sharma B. Etomidate-ketamine versus dexmedetomidine-ketamine for entropy-guided procedural sedation during endoscopic retrograde cholangiopancreatography procedures: A randomized single blind study. Indian J Gastroenterol 2023; 42:177-184. [PMID: 37103752 DOI: 10.1007/s12664-022-01326-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 12/18/2022] [Indexed: 04/28/2023]
Abstract
BACKGROUND AND AIMS The major challenge for the anesthetist in endoscopic retrograde cholangiopancreatography (ERCP) procedures is to provide moderate to deep levels of sedation in prone position with preservation of spontaneous respiratory efforts in shared airway scenario with an endoscopist. These patients have other comorbidities, making them vulnerable to complications during the routinely used sedation with propofol. We compared the entropy-guided efficacy of combination of etomidate-ketamine to dexmedetomidine-ketamine in patients undergoing ERCP. METHODS This prospective single blind randomized entropy-guided trial was conducted on 60 patients with etomidate-ketamine in group I (n = 30) and dexmedetomidine-ketamine in group II (n = 30). The purpose was to compare etomidate-ketamine versus dexmedetomidine-ketamine for ERCP in terms of intraprocedural hemodynamics with desaturation, onset of sedation, recovery time and endoscopist's satisfaction. RESULTS Hypotension was observed only in six (20%) patients of group II (p < 0.009). Two patients of group I and three in group II desaturated (Spo2 < 90) briefly during the procedure, but none of the patient required intubation (p > 0.05). The mean time in minutes of onset of sedation was 1.15 in group I and 5.6 in group II (p < 0.001). Endoscopists' satisfaction was better in group I (p ≤ 0.001) and length of recovery room stay was shorter in group I as compared to that in group II (p ≤ 0.007). CONCLUSION We conclude that entropy-guided intravenous procedural sedation with etomidate-ketamine combination provides faster onset of sedation, stable periprocedural hemodynamics, rapid recovery and fair to excellent endoscopist satisfaction compared to dexmedetomidine-ketamine combination for ERCP.
Collapse
Affiliation(s)
- Jagroop Singh
- Department of Anesthesia, Indira Gandhi Medical College, Ridge Sanjauli Road, Shimla, 171 001, India
| | - Jyoti Pathania
- Department of Anesthesia, Indira Gandhi Medical College, Ridge Sanjauli Road, Shimla, 171 001, India
| | - Vishal Bodh
- Department of Gastroenterology, Indira Gandhi Medical College, Ridge Sanjauli Road, Shimla, 171 001, India
| | - Rajesh Sharma
- Department of Gastroenterology, Indira Gandhi Medical College, Ridge Sanjauli Road, Shimla, 171 001, India
| | - Rajesh Kumar
- Department of Gastroenterology, Indira Gandhi Medical College, Ridge Sanjauli Road, Shimla, 171 001, India
| | - Brij Sharma
- Department of Gastroenterology, Indira Gandhi Medical College, Ridge Sanjauli Road, Shimla, 171 001, India.
| |
Collapse
|
5
|
Vazquez PM, Jensen EW. Different perspectives for monitoring nociception during general anesthesia. Korean J Anesthesiol 2022; 75:112-123. [PMID: 35172074 PMCID: PMC8980281 DOI: 10.4097/kja.22002] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Accepted: 02/15/2022] [Indexed: 11/30/2022] Open
Abstract
Safe anesthesia is achieved using objective methods that estimate the patient’s state during different phases of surgery. A patient’s state under anesthesia is characterized by three major aspects, which are linked to the main effects produced by each of the families of anesthetic agents administered: hypnosis, analgesia, and muscular relaxation. While quantification techniques designed to assess muscular relaxation under neuromuscular blocking agents have a relatively long history with a high degree of standardization and understanding (e.g., the train-of-four), the knowledge and techniques used to the depth of hypnosis assessment suffer from a lesser degree in both standardization and interpretation due to brain complexity. The problem of standardization and interpretation in the analgesia and nociception assessment increases since it involves more systems, the central nervous system, and the autonomic nervous system. This helps to explain why there are multiple a priori valid approaches to develop nociception monitoring from different interpretations and physiological bases of noxious stimuli processing. Thus, in this review, the current monitoring technologies clinically available for estimating a patient’s nociception under general anesthesia are described.
Collapse
Affiliation(s)
- Pablo Martinez Vazquez
- Deutsches Primaten Zentrum (DPZ), 37077 Goettingen, Germany.,R&D of Quantium Medical/Fresenius Kabi. Barcelona, Spain
| | - Erik Weber Jensen
- R&D of Quantium Medical/Fresenius Kabi. Barcelona, Spain.,Automatic Control and Information (ESAII) Department, CREB. UPC-Barcelonatech, Barcelona, Spain
| |
Collapse
|
6
|
|
7
|
Schonberger RB, Bardia A, Dai F, Michel G, Yanez D, Curtis JP, Vaughn MT, Burg MM, Mathis M, Kheterpal S, Akhtar S, Shah N. Variation in propofol induction doses administered to surgical patients over age 65. J Am Geriatr Soc 2021; 69:2195-2209. [PMID: 33788251 PMCID: PMC8373684 DOI: 10.1111/jgs.17139] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 02/26/2021] [Accepted: 03/07/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND/OBJECTIVES Advanced age is associated with increased susceptibility to acute adverse effects of propofol. The present study aimed to describe patterns of propofol dosing for induction of general anesthesia before endotracheal intubation in a nationwide sample of older adults presenting for surgery. DESIGN Retrospective observational study using the Multicenter Perioperative Outcomes Group data set. SETTING Thirty-six institutions across the United States. PARTICIPANTS A total of 350,766 patients aged over 65 years who received propofol for general anesthetic induction and endotracheal intubation between 2014 and 2018. INTERVENTION None. MEASUREMENTS Total induction bolus dose of propofol administered. RESULTS The mean (SD) weight-adjusted propofol dose was 1.7 (0.6) mg/kg. The mean prevalent propofol induction dose exceeded the upper bound of what has been described as the typical geriatric dose requirement across every age category examined. The percent of patients receiving propofol induction doses above the described typical geriatric range was 64.8% (95% CI 64.6-65.0), varying from 73.8% among patients aged 65-69 to 45.8% among patients aged 80 and older. CONCLUSION The present study of a large multicenter cohort demonstrates that prevalent propofol dosing commonly falls above the published typically required dose range for patients aged ≥65 in nationwide anesthetic practice. Widespread variability in induction dose administration remains incompletely explained by known patient variables. The nature and clinical consequences of these unexplained dosing decisions remain important topics for further study. Observed discordance between expected and actual induction dosing raises the question of whether there should be reconsideration of widespread provider practice or, alternatively, whether what is published as the typical propofol induction dose range should be revisited.
Collapse
Affiliation(s)
| | - Amit Bardia
- Department of Anesthesiology; Yale School of Medicine; New Haven, CT
| | - Feng Dai
- Yale Center for Analytical Sciences; New Haven, CT
| | - George Michel
- Department of Anesthesiology; Yale School of Medicine; New Haven, CT
| | - David Yanez
- Yale Center for Analytical Sciences; New Haven, CT
| | - Jeptha P. Curtis
- Section of Cardiology, Department of Internal Medicine; Yale School of Medicine; New Haven, CT
| | - Michelle T. Vaughn
- Department of Anesthesiology; University of Michigan School of Medicine; Ann Arbor, MI
| | - Matthew M. Burg
- Department of Anesthesiology; Yale School of Medicine; New Haven, CT
- Section of Cardiology, Department of Internal Medicine; Yale School of Medicine; New Haven, CT
| | - Michael Mathis
- Department of Anesthesiology; University of Michigan School of Medicine; Ann Arbor, MI
| | - Sachin Kheterpal
- Department of Anesthesiology; University of Michigan School of Medicine; Ann Arbor, MI
| | - Shamsuddin Akhtar
- Department of Anesthesiology; Yale School of Medicine; New Haven, CT
| | - Nirav Shah
- Department of Anesthesiology; University of Michigan School of Medicine; Ann Arbor, MI
| |
Collapse
|
8
|
Pal N, Butterworth J. Comment on: Variation in propofol induction doses administered to surgical patients over age 65. J Am Geriatr Soc 2021; 69:2678-2679. [PMID: 34185880 DOI: 10.1111/jgs.17328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 04/28/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Nirvik Pal
- Department of Anesthesiology, Virginia Commonwealth University, Richmond, Virginia, USA
| | - John Butterworth
- Department of Anesthesiology, Virginia Commonwealth University, Richmond, Virginia, USA
| |
Collapse
|
9
|
Elgebaly AS, El Mourad MB, Fathy SM. The role of entropy monitoring in reducing propofol requirements during open heart surgeries. A prospective randomized study. Ann Card Anaesth 2021; 23:272-276. [PMID: 32687081 PMCID: PMC7559947 DOI: 10.4103/aca.aca_184_18] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Background: Hypotension, which is commonly associated with propofol induction of general anesthesia in coronary artery bypass grafting (CABG) surgery, may cause adverse consequences in patients with coronary artery diseases undergoing this type of surgeries. The clinical absence of verbal response and eyelash reflex was used as an endpoint for hypnosis. Spectral entropy, as a novel monitoring method for the endpoint of hypnosis, affect the dose of required anesthetic agents for induction as well as the hemodynamic profile during general anesthesia in CABG surgery. Aims: We hypothesized that entropy monitoring might reduce the dose of propofol required for induction of anesthesia during CABG surgery and could maintain hemodynamic stability when compared with the conventional clinical monitoring. Materials and Methods: Sixty adult patients of both sexes, aged 30–60 years, ASA II and III, and scheduled for CABG surgery were enrolled in this prospective, controlled, randomized, double-blind study. These patients were randomly divided into two equal groups to receive intravenous propofol for induction of anesthesia guided by either the patients’ clinical response (Group I) or by entropy monitoring (Group II). The total dose of propofol used for induction of anesthesia was recorded. Hemodynamic parameters and entropy values were also recorded. Results: Propofol consumption was significantly reduced in Group II than Group I (P = 0.000*). Heart rate showed no statistical significance between the two groups, whereas the mean arterial pressure significantly decreased at induction in group I compared to Group II (P = 0.000*). The entropy values were significantly lower in Group I than Group II at induction (P = 0.036* for state entropy; 0.002* for response entropy). However, during intubation, and after 1 and 5 min, entropy indices displayed a significant increase in Group I than Group II. Conclusions: Entropy monitoring significantly reduced the dose of propofol required for induction of anesthesia and maintained hemodynamic stability compared to the conventional clinical monitoring during CABG surgeries.
Collapse
Affiliation(s)
- Ahmed Said Elgebaly
- Department of Anesthesia and PSICUD, Faculty of Medicine, Tanta University, Egypt
| | - Mona B El Mourad
- Department of Anesthesia and PSICUD, Faculty of Medicine, Tanta University, Egypt
| | - Sameh Mohamad Fathy
- Department of Anesthesia and PSICUD, Faculty of Medicine, Tanta University, Egypt
| |
Collapse
|
10
|
Christenson C, Martinez-Vazquez P, Breidenstein M, Farhang B, Mathews J, Melia U, Jensen EW, Mathews D. Comparison of the Conox (qCON) and Sedline (PSI) depth of anaesthesia indices to predict the hypnotic effect during desflurane general anaesthesia with ketamine. J Clin Monit Comput 2020; 35:1421-1428. [PMID: 33211251 DOI: 10.1007/s10877-020-00619-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Accepted: 11/09/2020] [Indexed: 11/30/2022]
Abstract
Comparison of two depth of anesthesia indices, qCON (Conox) and PSI (Sedline), during desflurane sedation and their sensitivity to random ketamine boluses in patients undergoing routine surgery. The performance of desflurane and ketamine on both indices was analyzed for 11 patients, and the ketamine sensitivity was compared with another group of 11 patients under sevoflurane and propofol.The MOAA/S was used to determine sedation level and pain. Different boluses of ketamine ranging from 10 to 30 mg where randomly administered in both groups and the effect on the indexes were measured after 4 min.The indices were recorded during the whole surgery, and their correlations with the desflurane concentration and the discrimination between awake and anesthetized states were evaluated with the prediction probability statistic (Pk). The Pk values, mean (se), discriminating between awake and anesthetized states were 0.974(0.016) for the qCON and 0.962(0.0123) for the PSI, while the 1-Pk statistic for the qCON and the PSI with respect to the desflurane concentration were 0.927(0.016) and 0.918(0.018), respectively, with no statistically significant differences.The agreement between both depth of hypnosis parameters was assessed under the Bland-Altman plot and the Spearman correlation, rs = 0.57(p < 0.001).During the sevoflurane-propofol anesthesia, which served as a control group, both indices experienced a similar behavior with a no significant change of their median values after ketamine. However, during desflurane anesthesia the qCON index did not change significantly after ketamine administration, qCON (before = 33 (4), after = 30 (17); Wilcoxon, p = 0.89), while the PSI experienced a significant increase, PSI (before = 31(6), after = 39(16) Wilcoxon, p = 0.013).This study shows that qCON and PSI have similar performance under desflurane with good discrimination between the awake and anesthetized states. While both indices exhibited similar behavior under ketamine boluses under a sevoflurane-propofol anesthesia, the qCON index had a better performance under ketamine during desflurane anesthesia.
Collapse
Affiliation(s)
| | - Pablo Martinez-Vazquez
- Quantium Medical, Mataro, Barcelona, Spain. .,Deutsches Primaten Zentrum (DPZ)GmbH, Gottingen, Germany.
| | | | - Borzoo Farhang
- University of Vermont Medical Center, Burlington, VT, USA
| | | | | | - Erik Weber Jensen
- Quantium Medical, Mataro, Barcelona, Spain.,Fresenius Kabi GmbH, Bad Homburg, Germany
| | - Donald Mathews
- University of Vermont Medical Center, Burlington, VT, USA
| |
Collapse
|
11
|
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.
Collapse
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
| |
Collapse
|
12
|
Xing Y, Xu D, Xu Y, Chen L, Wang H, Li S. Effects of Neuromuscular Blockages on Entropy Monitoring During Sevoflurane Anesthesia. Med Sci Monit 2019; 25:8610-8617. [PMID: 31729355 PMCID: PMC6873634 DOI: 10.12659/msm.917879] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Background There are no data available on the effects of different degrees of neuromuscular blockade on spectral entropy during sevoflurane anesthesia. This study aimed to observe the effects of different degrees of neuromuscular blockade on state and response entropy during sevoflurane anesthesia. Material/Methods Eighty-one female patients were randomized to 9 groups (n=9 per group) according to the concentration of sevoflurane and degree of neuromuscular blockade. Response and state entropy were monitored. The endpoints were: 1) impact of neuromuscular blockade on state entropy and response entropy, and the difference between response entropy and state entropy; and 2) the response of entropy after cutaneous tetanic electrical noxious stimulation to the ulnar nerve under different degrees of neuromuscular blockade and concentrations of sevoflurane. Results These were no significant differences in response entropy or state entropy, or differences between response entropy and state entropy among the groups in the awake state (P>0.05). Without noxious stimulation, sevoflurane concentrations and neuromuscular blockade had no significant effects on response entropy or state entropy, or on the difference between response entropy and state entropy (all P>0.05), but sevoflurane concentrations showed a significant effect on state entropy (P<0.05). After noxious stimulation, sevoflurane concentrations and neuromuscular blockade had significant effects on response entropy and state entropy, and on the difference between response entropy and state entropy. Conclusions Response entropy and state entropy decreased with increasing sevoflurane concentration. Neuromuscular blockade did not affect entropy without noxious stimulation. With stimulation, muscle relaxants significantly reduced the changes in entropy, and there were significant effects of neuromuscular blockade and sevoflurane on entropy.
Collapse
Affiliation(s)
- Yian Xing
- Department of Anesthesiology, Shanghai General Hospital of Nanjing Medical University, Shanghai, China (mainland)
| | - Dian Xu
- Department of Anesthesiology, Shanghai General Hospital of Nanjing Medical University, Shanghai, China (mainland)
| | - Yanyifang Xu
- Department of Anesthesiology, Shanghai General Hospital of Nanjing Medical University, Shanghai, China (mainland)
| | - Lianhua Chen
- Department of Anesthesiology, Shanghai General Hospital of Nanjing Medical University, Shanghai, China (mainland)
| | - Hong Wang
- Department of Anesthesiology, Shanghai General Hospital of Nanjing Medical University, Shanghai, China (mainland)
| | - Shitong Li
- Department of Anesthesiology, Shanghai General Hospital of Nanjing Medical University, Shanghai, China (mainland)
| |
Collapse
|
13
|
Escontrela Rodríguez B, Gago Martínez A, Merino Julián I, Martínez Ruiz A. Spectral entropy in monitoring anesthetic depth. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2016; 63:471-478. [PMID: 26431743 DOI: 10.1016/j.redar.2015.07.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2015] [Revised: 06/30/2015] [Accepted: 07/14/2015] [Indexed: 06/05/2023]
Abstract
Monitoring the brain response to hypnotics in general anesthesia, with the nociceptive and hemodynamic stimulus interaction, has been a subject of intense investigation for many years. Nowadays, monitors of depth of anesthesia are based in processed electroencephalogram by different algorithms, some of them unknown, to obtain a simplified numeric parameter approximate to brain activity state in each moment. In this review we evaluate if spectral entropy suitably reflects the brain electric behavior in response to hypnotics and the different intensity nociceptive stimulus effect during a surgical procedure.
Collapse
Affiliation(s)
- B Escontrela Rodríguez
- Servicio Anestesiología y Reanimación, Hospital Universitario de Cruces, Barakaldo, Vizcaya, España.
| | - A Gago Martínez
- Servicio Anestesiología y Reanimación, Hospital Universitario de Cruces, Barakaldo, Vizcaya, España
| | - I Merino Julián
- Servicio Anestesiología y Reanimación, Hospital Universitario de Cruces, Barakaldo, Vizcaya, España
| | - A Martínez Ruiz
- Servicio Anestesiología y Reanimación, Hospital Universitario de Cruces, Barakaldo, Vizcaya, España; Facultad de Medicina, Universidad del País Vasco, Leioa, Vizcaya, España
| |
Collapse
|
14
|
Chhabra A, Subramaniam R, Srivastava A, Prabhakar H, Kalaivani M, Paranjape S. Spectral entropy monitoring for adults and children undergoing general anaesthesia. Cochrane Database Syst Rev 2016; 3:CD010135. [PMID: 26976247 PMCID: PMC8769493 DOI: 10.1002/14651858.cd010135.pub2] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Anaesthetic drugs during general anaesthesia are titrated according to sympathetic or somatic responses to surgical stimuli. It is now possible to measure depth of anaesthesia using electroencephalography (EEG). Entropy, an EEG-based monitor can be used to assess the depth of anaesthesia using a strip of electrodes applied to the forehead, and this can guide intraoperative anaesthetic drug administration. OBJECTIVES The primary objective of this review was to assess the effectiveness of entropy monitoring in facilitating faster recovery from general anaesthesia. We also wanted to assess mortality at 24 hours, 30 days, and one year following general anaesthesia with entropy monitoring.The secondary objectives were to assess the effectiveness of the entropy monitor in: preventing postoperative recall of intraoperative events (awareness) following general anaesthesia; reducing the amount of anaesthetic drugs used; reducing cost of the anaesthetic as well as in reducing time to readiness to leave the postanaesthesia care unit (PACU). SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL; 2014, Issue 10), MEDLINE via Ovid SP (1990 to September 2014) and EMBASE via Ovid SP (1990 to September 2014). We reran the search in CENTRAL, MEDLINE via Ovid SP and EMBASE via Ovid SP in January 2016. We added one potential new study of interest to the list of 'Studies awaiting Classification' and we will incorporate this study into the formal review findings during the review update. SELECTION CRITERIA We included randomized controlled trials (RCTs) conducted in adults and children (aged greater than two years of age), where in one arm entropy monitoring was used for titrating anaesthesia, and in the other standard practice (increase in heart rate, mean arterial pressure, lacrimation, movement in response to noxious surgical stimuli) was used for titrating anaesthetic drug administration. We also included trials with an additional third arm, wherein another EEG monitor, the Bispectral index (BIS) monitor was used to assess anaesthetic depth. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. Two review authors independently extracted details of trial methodology and outcome data from trials considered eligible for inclusion. All analyses were made on an intention-to-treat basis. We used a random-effect model where there was heterogeneity. For assessments of the overall quality of evidence for each outcome that included pooled data from RCTs, we downgraded evidence from 'high quality' by one level for serious (or by two for very serious) study limitations (risk of bias, indirectness of evidence, serious inconsistency, imprecision of effect or potential publication bias). MAIN RESULTS We included 11 RCTs (962 participants). Eight RCTs (762 participants) were carried out on adults (18 to 80 years of age), two (128 participants) involved children (two to 16 years) and one RCT (72 participants) included patients aged 60 to 75 years. Of the 11 included studies, we judged three to be at low risk of bias, and the remaining eight RCTs at unclear or high risk of bias.Six RCTs (383 participants) estimated the primary outcome, time to awakening after stopping general anaesthesia, which was reduced in the entropy as compared to the standard practice group (mean difference (MD) -5.42 minutes, 95% confidence interval (CI) -8.77 to -2.08; moderate quality of evidence). We noted heterogeneity for this outcome; on performing subgroup analysis this was found to be due to studies that included participants undergoing major, long duration surgeries (off-pump coronary artery bypass grafting, major urological surgery). The MD for time to awakening with four studies on ambulatory procedures was -3.20 minutes (95% CI -3.94 to -2.45). No trial reported the second primary outcome, mortality at 24 hours, 30 days, and one year with the use of entropy monitoring.Eight trials (797 participants) compared the secondary outcome, postoperative recall of intraoperative events (awareness) in the entropy and standard practice groups. Awareness was reported by only one patient in the standard practice group, making meaningful estimation of benefit of entropy monitoring difficult; moderate quality of evidence.All 11 RCTs compared the amount of anaesthetic agent used between the entropy and standard practice groups. Six RCTs compared the amount of propofol, four compared the amount of sevoflurane and one the amount of isoflurane used between the groups. Analysis of three studies (166 participants) revealed that the MD of propofol consumption between the entropy group and control group was -11.56 mcg/kg/min (95% CI -24.05 to 0.92); low quality of evidence. Analysis of another two studies (156 participants) showed that the MD in sevoflurane consumption in the entropy group compared to the control group was -3.42 mL (95% CI -6.49 to -0.35); moderate quality of evidence.No trial reported on the secondary outcome of the cost of general anaesthesia.Three trials (170 participants) estimated MD in time to readiness to leave the PACU of the entropy group as compared to the control group (MD -5.94 minutes, 95% CI -16.08 to 4.20; low quality of evidence). Heterogeneity was noted, which was due to the difference in anaesthetic technique (propofol-based general anaesthesia) in one study. The remaining two studies had used volatile-based general anaesthesia. The MD in time to readiness to leave the PACU was -4.17 minutes (95% CI -6.84 to -1.51) with these two studies. AUTHORS' CONCLUSIONS The evidence as regards time to awakening, recall of intraoperative awareness and reduction in inhalational anaesthetic agent use was of moderate quality. The quality of evidence of as regards reduction in intravenous anaesthetic agent (propofol) use, as well as time to readiness to leave the PACU was found to be of low quality. As the data are limited, further studies consisting of more participants will be required for ascertaining benefits of entropy monitoring.Further studies are needed to assess the effect of entropy monitoring on focal issues such as short-term and long-term mortality, as well as cost of general anaesthesia.
Collapse
Affiliation(s)
- Anjolie Chhabra
- All India Institute of Medical SciencesDepartment of AnaesthesiologyAnsari NagarNew DelhiIndia110029
| | - Rajeshwari Subramaniam
- All India Institute of Medical SciencesDepartment of AnaesthesiologyAnsari NagarNew DelhiIndia110029
| | - Anurag Srivastava
- All India Institute of Medical SciencesDepartment of SurgeryAnsari NagarNew DelhiIndia110029
| | - Hemanshu Prabhakar
- All India Institute of Medical SciencesDepartment of NeuroanaesthesiologyAnsari NagarNew DelhiIndia110029
| | - Mani Kalaivani
- All India Institute of Medical SciencesDepartment of BiostatisticsAnsari NagarNew DelhiIndia
| | - Saloni Paranjape
- All India Institute of Medical SciencesDepartment of AnaesthesiologyAnsari NagarNew DelhiIndia110029
| | | |
Collapse
|
15
|
Rao AK, Gurajala I, Gopinath R. Comparison of electroencephalogram entropy versus loss of verbal response to determine the requirement of propofol for induction of general anaesthesia. Indian J Anaesth 2015. [PMID: 26195830 PMCID: PMC4481753 DOI: 10.4103/0019-5049.158738] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Background and Aims: Propofol causes dose-dependent reduction in blood pressure (BP). This study was done to evaluate the use of spectral entropy on the dose of propofol required and the haemodynamic stability during induction of general anaesthesia (GA). Methods: In this randomised controlled study, 72 American Society of Anesthesiologists’ physical status I and II patients undergoing general and orthopaedic surgeries were divided into Group S (n-36) and Group C (n-36). Patients in Group C were induced with propofol till loss of response to verbal commands and in Group S until the state entropy was <50 and state and response entropy difference was <10. The induction dose of propofol, haemodynamic parameters and the entropy values were recorded. Numerical data were expressed as a mean ± standard deviation and analysed using unpaired, two-tailed t-test. Categorical data were compared using Chi-square test. P < 0.05 value was considered significant. Results: The dose of propofol per kg was significantly more in the entropy group (1.80 ± 0.23 mg/kg in the Group C and 1.98 ± 0.217 mg/kg in the Group S [P < 0.05]). After induction, at intubation and 1 min after intubation, entropy values were lower in Group S than Group C (P < 0.05). The BP decreased significantly after induction compared with the baseline (P < 0.05), but there was no difference between the groups. Conclusion: Propofol required for induction of GA when guided by electroencephalogram entropy was significantly higher than the induction dose based on loss of verbal response. Both conventional induction and induction with entropy as the endpoint resulted in similar haemodynamic profile.
Collapse
Affiliation(s)
- Akasapu Karunakara Rao
- Department of Anaesthesiology, Rajiv Gandhi Institute of Medical Sciences, Srikakulam, Andhra Pradesh, India
| | - Indira Gurajala
- Department of Anaesthesiology and Critical Care, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Ramachandran Gopinath
- Department of Anaesthesiology and Critical Care, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
| |
Collapse
|
16
|
Shah SB, Chowdhury I, Bhargava AK, Sabbharwal B. Comparison of hemodynamic effects of intravenous etomidate versus propofol during induction and intubation using entropy guided hypnosis levels. J Anaesthesiol Clin Pharmacol 2015; 31:180-5. [PMID: 25948897 PMCID: PMC4411830 DOI: 10.4103/0970-9185.155145] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background and Aims: This study aimed to compare the hemodynamic responses during induction and intubation between propofol and etomidate using entropy guided hypnosis. Material and Methods: Sixty ASA I & II patients in the age group 20-60 yrs, scheduled for modified radical mastectomy were randomly allocated in two groups based on induction agent Etomidate or Propofol. Both groups received intravenous midazolam 0.03 mg kg-1 and fentanyl 2 μg kg-1 as premedication. After induction with the desired agent titrated to entropy 40, vecuronium 0.1 mg kg-1 was administered for neuromuscular blockade. Heart rate, systolic, diastolic and mean arterial pressures, response entropy [RE] and state entropy [SE] were recorded at baseline, induction and upto three minutes post intubation. Data was subject to statistical analysis SPSS (version 12.0) the paired and the unpaired Student's T-tests for equality of means. Results: Etomidate provided hemodynamic stability without the requirement of any rescue drug in 96.6% patients whereas rescue drug ephedrine was required in 36.6% patients in propofol group. Reduced induction doses 0.15mg kg-1 for etomidate and 0.98 mg kg-1 for propofol, sufficed to give an adequate anaesthetic depth based on entropy. Conclusion: Etomidate provides more hemodynamic stability than propofol during induction and intubation. Reduced induction doses of etomidate and propofol titrated to entropy translated into increased hemodynamic stability for both drugs and sufficed to give an adequate anaesthetic depth.
Collapse
Affiliation(s)
- Shagun Bhatia Shah
- Department of Anaesthesia, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Itee Chowdhury
- Department of Anaesthesia, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Ajay Kumar Bhargava
- Department of Anaesthesia, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Bhawnish Sabbharwal
- Department of Anaesthesia, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| |
Collapse
|
17
|
Dongare DH, Kale JV, Naphade RW. Comparison of vital capacity induction with sevoflurane to intravenous induction with propofol in adult patients. Anesth Essays Res 2015; 8:319-23. [PMID: 25886328 PMCID: PMC4258959 DOI: 10.4103/0259-1162.143122] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Various techniques exist for gaseous induction in adults. Vital capacity induction (VCI) is a special technique for gaseous induction of anesthesia. AIMS We compared the two methods for time of induction, vital parameters at induction, and suitability for laryngeal mask insertion and its effects, if any on the emergence and postoperative cognitive function tests. SETTINGS AND DESIGN A total of 60 adult American Society of Anesthesiologists grades I and II gynecological patients were randomly allocated into two groups of 30 each. MATERIALS AND METHODS Group "S" received VCI with 8% sevoflurane in 8 l/min oxygen and group "P" received intravenous induction with propofol after premedication. Laryngeal mask airway (LMA) was inserted and anesthesia maintained with oxygen, nitrous oxide, and sevoflurane in both groups. Induction time, corresponding entropy, vital parameters, and emergence time were noted. Postoperative cognitive and psychomotor functions were noted with P-deletion test, digit symbol substitution test, and finger nose test. STATISTICAL ANALYSIS USED Unpaired t-test and Fisher exact test. RESULTS Time for induction was 61 ± 32 s and 31 ± 10.8 s for VCI (group S) and propofol (group P), respectively. The difference was statistically significant (P = 0.001). About 70% patients in VCI had excellent conditions for LMA insertion when compared with 76% in propofol group (P = 0.3855). The incidence of airway complications, emergence times, and recovery of postoperative cognitive functions was not significantly different in both groups. CONCLUSIONS VCI provides an induction and recovery comparable to propofol induction.
Collapse
Affiliation(s)
- Dhanashree H Dongare
- Department of Anesthesia, Smt. Kashibai Navale Medical College and General Hospital, Pune, Maharashtra, India
| | - Jyothi V Kale
- Department of Anesthesia, Smt. Kashibai Navale Medical College and General Hospital, Pune, Maharashtra, India
| | - Ramesh W Naphade
- Department of Anesthesia, Smt. Kashibai Navale Medical College and General Hospital, Pune, Maharashtra, India
| |
Collapse
|
18
|
Musialowicz T, Lahtinen P. Current Status of EEG-Based Depth-of-Consciousness Monitoring During General Anesthesia. CURRENT ANESTHESIOLOGY REPORTS 2014. [DOI: 10.1007/s40140-014-0061-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
|
19
|
Harsoor SS, Rani DD, Lathashree S, Nethra SS, Sudheesh K. Effect of intraoperative Dexmedetomidine infusion on Sevoflurane requirement and blood glucose levels during entropy-guided general anesthesia. J Anaesthesiol Clin Pharmacol 2014; 30:25-30. [PMID: 24574589 PMCID: PMC3927287 DOI: 10.4103/0970-9185.125693] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Background: Dexmedetomidine has been shown to blunt the stress response to surgery. Hence a study was designed to evaluate the effect of intravenous (IV) Dexmedetomidine infusion during general anesthesia for abdominal surgeries on blood glucose levels and on Sevoflurane requirements during anesthesia. Materials and Methods: Forty patients scheduled for abdominal surgery under general anesthesia were divided into Dexmedetomidine (D) group and Placebo (P) group of 20 each. Group D received a loading dose of Inj. Dexmedetomidine at 1 μg/kg/10 min diluted to 20 mL, followed by maintenance with 0.5 μg/kg/h., till the end of surgery. Group P received similar volume of IV normal saline. Anesthesia was maintained with nitrous oxide in oxygen and Sevoflurane keeping entropy between 40 and 60. Data were analyzed using students t test, chi square test and Fisher Exact test as applicable. Results: During the first postoperative hour, Dexmedetomidine group showed blood glucose levels of 118.2 ± 16.24 mg/dL, compared to placebo group which was 136.95 ± 19.76 mg/dL and it was statistically significant (P < 0.01). Mean hourly Sevoflurane requirement in Group D was 11.10 ± 2.17 mL, compared to 15.45 ± 3.97 mL in placebo group. In peri-operative period, the heart rate and MAP were significantly lower in Group D, when compared to placebo. Patients in Group D were better sedated and post-operative pain score was better in Group D compared to Group P. Conclusion: IV Dexmedetomidine was effective in blunting stress response to surgical trauma as indicated by lower blood glucose levels, and reduces Sevoflurane requirements during entropy guided general anesthesia without affecting time for extubation.
Collapse
Affiliation(s)
- S S Harsoor
- Department of Anaesthesia, Bangalore Medical College and Research Institute, Bangalore, Karnataka, India
| | - Devika D Rani
- Department of Anaesthesia, Bangalore Medical College and Research Institute, Bangalore, Karnataka, India
| | - S Lathashree
- Department of Anaesthesia, Bangalore Medical College and Research Institute, Bangalore, Karnataka, India
| | - S S Nethra
- Department of Anaesthesia, Bangalore Medical College and Research Institute, Bangalore, Karnataka, India
| | - K Sudheesh
- Department of Anaesthesia, Bangalore Medical College and Research Institute, Bangalore, Karnataka, India
| |
Collapse
|
20
|
El Tahan MR, Khidr AM. Low Target Sufentanil Effect-Site Concentrations Allow Early Extubation After Valve Surgery. J Cardiothorac Vasc Anesth 2013; 27:63-70. [DOI: 10.1053/j.jvca.2012.01.023] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2011] [Indexed: 11/11/2022]
|
21
|
Preoperative pregabalin does not reduce propofol ED(50): a randomized controlled trial. Can J Anaesth 2013; 60:364-9. [PMID: 23334782 DOI: 10.1007/s12630-013-9885-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2012] [Accepted: 01/08/2013] [Indexed: 10/27/2022] Open
Abstract
BACKGROUND In many studies, gabapentinoids, such as pregabalin, have been shown to reduce preoperative anxiety. This anxiolysis is often accompanied by sedation, one of the most frequent side effects of pregabalin. We hypothesized that pregabalin taken preoperatively could reduce propofol requirements for induction of general anesthesia. METHODS A randomized double-blind placebo-controlled trial was conducted after approval by the local ethics committee. Fifty women aged 18-40 yr, American Anesthesiologists Society physical status I and II, and scheduled to undergo elective laparoscopic gynecologic procedures were enrolled after written consent. Treatment group patients were given pregabalin 150 mg po one hour before surgery while patients in the control group received a placebo. The primary outcome was the propofol dose required to achieve a targeted anesthetic depth in 50% of the population, i.e., effective dose (ED)50. The ED50 was estimated using Dixon's up-and-down methodology. The targeted anesthetic depth was defined based on predetermined entropy monitoring values (State Entropy [SE] < 50 and Response Entropy [RE]-SE < 10). As a secondary outcome, we tested if pregabalin reduced pre-induction anxiety levels which were measured on a 0-100 scale. RESULTS The propofol ED50 was not statistically different between the pregabalin group (mean 1.33 mg·kg(-1); 95% confidence interval [CI] 1.23 to 1.43) vs the placebo group (mean 1.37 mg·kg(-1); 95% CI 1.28 to 1.46); P = 0.19. Also, pre-induction anxiety level was not different between groups (median 31; interquartile range [IQR] [10-52] vs median 42; IQR [4-71], respectively; P = 0.41). CONCLUSIONS Preoperative pregabalin does not reduce propofol requirements in a population of healthy young women undergoing laparoscopic gynecologic procedures. This study failed to show a pre-induction anxiolytic effect of pregabalin in such a population. This trial was registered at www.clinicaltrials.gov (NCT01158859).
Collapse
|
22
|
El-Tahan M, Mowafi H, Al Sheikh I, Khidr A, Al-Juhaiman R. Efficacy of dexmedetomidine in suppressing cardiovascular and hormonal responses to general anaesthesia for caesarean delivery: a dose–response study. Int J Obstet Anesth 2012; 21:222-9. [DOI: 10.1016/j.ijoa.2012.04.006] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2012] [Revised: 04/23/2012] [Accepted: 04/24/2012] [Indexed: 11/16/2022]
|
23
|
Kertai MD, Whitlock EL, Avidan MS. Brain monitoring with electroencephalography and the electroencephalogram-derived bispectral index during cardiac surgery. Anesth Analg 2012; 114:533-46. [PMID: 22253267 DOI: 10.1213/ane.0b013e31823ee030] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Cardiac surgery presents particular challenges for the anesthesiologist. In addition to standard and advanced monitors typically used during cardiac surgery, anesthesiologists may consider monitoring the brain with raw or processed electroencephalography (EEG). There is strong evidence that a protocol incorporating the processed EEG bispectral index (BIS) decreases the incidence intraoperative awareness in comparison with standard practice. However, there is conflicting evidence that incorporating the BIS into cardiac anesthesia practice improves "fast-tracking," decreases anesthetic drug use, or detects cerebral ischemia. Recent research, including many cardiac surgical patients, shows that a protocol based on BIS monitoring is not superior to a protocol based on end-tidal anesthetic concentration monitoring in preventing awareness. There has been a resurgence of interest in the anesthesia literature in limited montage EEG monitoring, including nonproprietary processed indices. This has been accompanied by research showing that with structured training, anesthesiologists can glean useful information from the raw EEG trace. In this review, we discuss both the hypothesized benefits and limitations of BIS and frontal channel EEG monitoring in the cardiac surgical population.
Collapse
Affiliation(s)
- Miklos D Kertai
- Duke University Medical Center, 2301 Erwin Road, 5693 HAFS Bldg., DUMC 3094 Durham, NC 27710, USA.
| | | | | |
Collapse
|
24
|
Does hypocapnia before and during carbon dioxide insufflation attenuate the hemodynamic changes during laparoscopic cholecystectomy? Surg Endosc 2011; 26:391-7. [DOI: 10.1007/s00464-011-1884-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2011] [Accepted: 08/04/2011] [Indexed: 10/17/2022]
|
25
|
El Tahan MR. Effects of aminophylline on cognitive recovery after sevoflurane anesthesia. J Anesth 2011; 25:648-56. [PMID: 21755342 DOI: 10.1007/s00540-011-1190-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2011] [Accepted: 06/06/2011] [Indexed: 11/30/2022]
Abstract
PURPOSE Aminophylline accelerates the recovery from sevoflurane anesthesia. We studied the effects of escalating doses of aminophylline on cognitive and clinical recovery after sevoflurane anesthesia. METHODS After ethical approval and informed consent, 150 patients scheduled for elective surgery under sevoflurane-fentanyl anesthesia were randomly allocated to receive saline or 2, 3, 4 or 5 mg/kg of aminophylline (n = 30 for each) at the end of anesthesia (T (0)). Short Orientation Memory Concentration Test (SOMCT) scores, entropy values, end-tidal sevoflurane concentrations (EtSevo), times to eyes opening and extubation, respiratory rate (RR) and tidal volume (TV) were recorded. RESULTS Compared to placebo, patients receiving 2, 3, 4 and 5 mg/kg of aminophylline had higher SOMCT scores [median (25th percentile/75th percentile) 20.6 (19/23), 21.5 (21/22), 24.5 (24-25), 25.5 (25/26), respectively, vs. 13.5 (13/14) at 30 min after extubation, and 24 (22/26), 25 (24/26), 27.5 (27-28), 27.5 (27/28), respectively, vs. 18.5 (18/19) at 45 min after extubation], higher entropy values for the first 10 min after T (0), lower EtSevo for the first 4 min after T (0), shorter times to eyes opening [5 (4.0/6.0), 5 (4.0/6.0), 4 (2.0/5.5), and 4 (2.0/6.0), respectively, vs. 9.8 (8.0/11.0) min], shorter times to extubation, shorter times to home discharge (P < 0.001), and higher RR and larger TV values. Patients who received 4 and 5 mg/kg of aminophylline showed higher SOMCT scores, 6 min shorter times to eyes opening and to extubation, and 58 min shorter times to home discharge. CONCLUSION The administration of escalating doses of aminophylline accelerates postoperative cognitive recovery from sevoflurane anesthesia, as measured by the SOMCT, due to increased ventilatory elimination of sevoflurane.
Collapse
Affiliation(s)
- Mohamed R El Tahan
- Anesthesiology Department, College of Medicine, University of Dammam, P.O. 40289, Dammam, Al Khobar, 31952, Saudi Arabia.
| |
Collapse
|
26
|
|
27
|
Propofol and the electroencephalogram. Clin Neurophysiol 2010; 121:998-1006. [DOI: 10.1016/j.clinph.2009.12.016] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2009] [Revised: 12/01/2009] [Accepted: 12/13/2009] [Indexed: 11/15/2022]
|
28
|
Current world literature. Ageing: biology and nutrition. Curr Opin Clin Nutr Metab Care 2009; 12:95-100. [PMID: 19057195 DOI: 10.1097/mco.0b013e32831fd97a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
29
|
Use of Spectral Entropy Monitoring in Reducing the Quantity of Sevoflurane as Sole Inhalational Anesthetic and in Decreasing the Need for Antihypertensive Drugs in Total Knee Replacement Surgery. ACTA ACUST UNITED AC 2008; 46:106-11. [DOI: 10.1016/s1875-4597(08)60003-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
30
|
Current World Literature. Curr Opin Anaesthesiol 2008; 21:85-8. [DOI: 10.1097/aco.0b013e3282f5415f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|