1
|
Kim K, Lee E, Jung SM, Baek J. 50% effective concentration of sevoflurane for immobility in cerebral palsy children undergoing botulinum toxin injection. Medicine (Baltimore) 2022; 101:e30928. [PMID: 36281165 PMCID: PMC9592399 DOI: 10.1097/md.0000000000030928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND This prospective study aimed to determine the optimum end-tidal sevoflurane concentration required for immobility during botulinum toxin injection in spontaneously breathing children with cerebral palsy (CP). METHODS Twenty-three children with spastic CP, aged 3 to 12 years, with American Society of Anesthesiologists (ASA) physical status I and II, scheduled to receive botulinum toxin type A injection were enrolled in the study. After induction of deep sedation using pre-filled 8% sevoflurane in oxygen and maintenance of the predetermined end-tidal sevoflurane concentration, the botulinum toxin was injected in spontaneously breathing children. The response to the botulinum toxin injection was classified as "movement" or "no movement" by an independent investigator who was blinded to the predetermined end-tidal sevoflurane concentration and bispectral index (BIS) value. The end-tidal sevoflurane concentration was predetermined, initiating at 2.0% with 0.2% as a step size in the next patient depending on the previous patient's response using the modified Dixon's up-and-down method. RESULTS Of 21 children, 12 (57.1%) showed "no movement" in response to the botulinum toxin injection. By Dixon's up-and-down method, the 50% effective end-tidal concentration (EC50) of sevoflurane for successful botulinum toxin injection was 1.76 ± 0.15% (95% CI 1.62-1.90). Based on the dose-response curve using probit analysis, the predicted EC50 and 95% effective end-tidal concentrations (EC95) of sevoflurane without movement were 1.77% (95% CI 1.59-2.35) and 2.09% (95% CI 1.89-5.80), respectively. CONCLUSION Botulinum toxin injection can be successfully accomplished at an end-tidal sevoflurane concentration of 1.76 ± 0.15% in 50% of spontaneously breathing children with CP aged 3-12 years.
Collapse
Affiliation(s)
- Kanghui Kim
- Department of Anesthesiology and Pain Medicine, Yeungnam University College of Medicine, Daegu, Republic of Korea
| | - Eunhee Lee
- Department of Anesthesiology and Pain Medicine, Yeungnam University College of Medicine, Daegu, Republic of Korea
| | - Sung Mee Jung
- Department of Anesthesiology and Pain Medicine, Yeungnam University College of Medicine, Daegu, Republic of Korea
- * Correspondence: Sung Mee Jung, Department of Anesthesiology and Pain Medicine Yeungnam University College of Medicine, 170 Hyeonchung-ro, Nam-gu, Daegu 42415, Republic of Korea (e-mail: )
| | - Jongyoon Baek
- Department of Anesthesiology and Pain Medicine, Yeungnam University College of Medicine, Daegu, Republic of Korea
| |
Collapse
|
2
|
Kandil AI, Ok MS, Baroch KA, Subramanyam R, Mahmoud MA, McAuliffe JJ. Why a Propofol Infusion Should Be the Anesthetic of Choice for Auditory Brainstem Response Testing in Children. Anesth Analg 2021; 134:802-809. [PMID: 35113042 DOI: 10.1213/ane.0000000000005693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Auditory brainstem response (ABR) testing is considered to be relatively resistant to effects of volatile anesthetics. The impact of newer anesthetics on interpretability of ABR testing is unknown. This study compared sevoflurane versus propofol anesthesia on qualitative interpretability of ABR click-testing in children. METHODS This prospective double-blind crossover study enrolled children (≤18 years old) receiving general anesthesia for elective ABR testing. All subjects received both sevoflurane and propofol anesthesias in the same ABR testing session. Deidentified ABR data were reviewed by 5 audiologists (blinded to anesthetic and patient) to determine threshold levels for hearing loss. The primary outcome was qualitative interpretability (false positive) of ABR click-testing. RESULTS Each patient was tested at 4 different intensities in each ear: generating 624 records under each anesthetic, for a total of 1248 records. A few patients were tested at 5 different intensities in a single ear accounting for the additional 11 records, yielding 1259 records. Under sevoflurane anesthesia, 21 of the same patients (37 ears) were identified with abnormal ABR levels consistent with hearing loss (one or both ears). The probability of a patient being diagnosed with hearing "loss" in one or both ears was significantly less with propofol versus sevoflurane anesthesia (mid P =.0312). If patients with bilateral loss are compared, the mid P value is 0.0098. The effect size based on patients was medium to large, with a minimum value of Cohen w = 0.320. CONCLUSIONS Sevoflurane produced more false positives for hearing loss and suggested more severe hearing loss than propofol. False-positive ABR tests, produced by certain anesthetic agents, can have significant life-long impact and negative psychosocial and developmental implications. Use of the intravenous anesthetic propofol is superior to sevoflurane for ABR testing in children.
Collapse
Affiliation(s)
- Ali I Kandil
- From the Department of Anesthesiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.,Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Michale S Ok
- From the Department of Anesthesiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.,Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Kelly A Baroch
- Division of Audiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Rajeev Subramanyam
- From the Department of Anesthesiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.,Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Mohamed A Mahmoud
- From the Department of Anesthesiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.,Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio
| | - John J McAuliffe
- From the Department of Anesthesiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.,Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio
| |
Collapse
|
3
|
Shen Y, Wang YT, Peng ZZ, Bai J, Zheng JJ, Zhang MZ, Sun Y. Comparison of the ED50 propofol requirements during the insertion of laryngeal mask airway Ambu AuraFlex with Ambu AuraOnce in children undergoing strabismus surgery. J Clin Pharm Ther 2021; 46:1629-1635. [PMID: 34339536 DOI: 10.1111/jcpt.13506] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 07/01/2021] [Accepted: 07/25/2021] [Indexed: 11/30/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVE Optimal airway management is crucial in strabismus surgery due to the inaccessibility of the airway throughout the procedure. Laryngeal mask airway offers advantages over tracheal intubation in ophthalmic surgery as it does not increase the intraocular pressure. The purpose of this study was to determine the median effective dose of propofol required, when combined with 0.2 µg/kg of sufentanil, for smooth insertion of Ambu AuraFlex in the first attempt in children undergoing strabismus surgery, and to compare it with that for Ambu AuraOnce. METHODS Forty-three paediatric patients undergoing strabismus surgery under general anaesthesia were recruited. For induction, the initial dosage of propofol was 2 mg/kg in the AuraOnce group or 3 mg/kg in the AuraFlex group. In accordance with Dixon's up-and-down method, the dose of propofol for consecutive patients in each group was adjusted in increments or decrements of 0.25 mg/kg based on the previous patient's "three-point, six-category scale" response to the first attempt of insertion of the randomized device. Insertion of the device was attempted when the bispectral index was ≤60 for 5 s after propofol administration without the use of neuromuscular blocking agents. RESULTS AND DISCUSSION The median effective dose (95% confidence interval) of propofol was significantly lower in the Ambu AuraOnce group than in the Ambu AuraFlex group (1.92 [1.50-2.32] mg/kg vs. 2.98 [2.49-3.94] mg/kg; p = 0.002). The incidence of dislodgement of the device was significantly higher with the use of the Ambu AuraOnce than with the use of AuraFlex (p = 0.023), whereas insignificant differences were observed between the two groups in the incidence of other perioperative adverse events. WHAT IS NEW AND CONCLUSION Ambu AuraFlex requires a significantly higher dose of propofol for insertion and provides more effective and stable airway management in strabismus surgery than AuraOnce.
Collapse
Affiliation(s)
- Yang Shen
- Department of Anesthesiology, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yan-Ting Wang
- Department of Anesthesiology, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Zhe-Zhe Peng
- Department of Anesthesiology, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Jie Bai
- Department of Anesthesiology, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Ji-Jian Zheng
- Department of Anesthesiology, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Ma-Zhong Zhang
- Department of Anesthesiology, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Ying Sun
- Department of Anesthesiology, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| |
Collapse
|
4
|
Sethi S, Goel N, Ghai B, Sharma MN, Ram J. EC 50 of sevoflurane for classic laryngeal mask airway insertion in children at different time points: A randomized blind trial. J Anaesthesiol Clin Pharmacol 2021; 36:489-493. [PMID: 33840929 PMCID: PMC8022070 DOI: 10.4103/joacp.joacp_108_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 08/28/2019] [Accepted: 12/20/2019] [Indexed: 12/02/2022] Open
Abstract
Background and Aims: Literature documents EC50 (End-tidal) of sevoflurane for CLMA (Classic Laryngeal Mask airway) insertion between 1.5 and 2% and most of these studies suggest maintaining the required end-tidal sevoflurane concentration for 10-25 minutes before LMA insertion. Waiting for this long interval for blood brain sevoflurane equilibration may not be feasible in children especially during failed ventilation. We aimed to estimate EC50 of sevoflurane for CLMA insertion at equilibration time points of 2.5 min and 5.0 min. Material and Methods: In this randomized trial, children aged 2_8 years of either sex having American Society of Anesthesiologists status I undergoing elective cataract surgery were included. After inhalational induction of general anesthesia with 8% sevoflurane and 100% oxygen, intravenous cannulation was secured. The sevoflurane vaporizer was finely adjusted to maintain an end-tidal sevoflurane concentration at 2% for 2.5 min for first child in group 2.5 and 5 min in group 5.0. This was followed by LMA insertion which was considered to be unsuccessful if there was “movement” and successful if “no movement” occurred. End-tidal concentration was increased/decreased (step-size 0.2%) using Dixon and Massey up and down method in the next patient depending upon the previous patient's response. Results: EC50 of sevoflurane for insertion of classic LMA in children aged 2-8 yrs in 100% oxygen was 1.1% (0.9-1.2) at 2.5 min and 1.6% (1.5-1.7) at 5.0 min. Derived EC95 (95% CI) at 2.5 min was 1.8% (1.5-9.2) and at 5.0 min was 1.8% (1.4-8.8) respectively. Conclusion: We suggest maintaining end-tidal sevoflurane of 1.6% for 2.5 min and 1.8% for 5 min for successful CLMA insertion.
Collapse
Affiliation(s)
- Sameer Sethi
- Department of Anaesthesia, PGIMER, Chandigarh, India
| | - Nitika Goel
- Department of Anaesthesia, PGIMER, Chandigarh, India
| | - Babita Ghai
- Department of Anaesthesia, PGIMER, Chandigarh, India
| | | | - Jagat Ram
- Department of Ophthalmology, PGIMER, Chandigarh, India
| |
Collapse
|
5
|
Xiao J, Chen Z, Yu B. A Potential Mechanism of Sodium Channel Mediating the General Anesthesia Induced by Propofol. Front Cell Neurosci 2020; 14:593050. [PMID: 33343303 PMCID: PMC7746837 DOI: 10.3389/fncel.2020.593050] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Accepted: 11/10/2020] [Indexed: 12/19/2022] Open
Abstract
General anesthesia has revolutionized healthcare over the past 200 years and continues to show advancements. However, many phenomena induced by general anesthetics including paradoxical excitation are still poorly understood. Voltage-gated sodium channels (NaV) were believed to be one of the proteins targeted during general anesthesia. Based on electrophysiological measurements before and after propofol treatments of different concentrations, we mathematically modified the Hodgkin–Huxley sodium channel formulations and constructed a thalamocortical model to investigate the potential roles of NaV. The ion channels of individual neurons were modeled using the Hodgkin–Huxley type equations. The enhancement of propofol-induced GABAa current was simulated by increasing the maximal conductance and the time-constant of decay. Electroencephalogram (EEG) was evaluated as the post-synaptic potential from pyramidal (PY) cells. We found that a left shift in activation of NaV was induced primarily by a low concentration of propofol (0.3–10 μM), while a left shift in inactivation of NaV was induced by an increasing concentration (0.3–30 μM). Mathematical simulation indicated that a left shift of NaV activation produced a Hopf bifurcation, leading to cell oscillations. Left shift of NaV activation around a value of 5.5 mV in the thalamocortical models suppressed normal bursting of thalamocortical (TC) cells by triggering its chaotic oscillations. This led to irregular spiking of PY cells and an increased frequency in EEG readings. This observation suggests a mechanism leading to paradoxical excitation during general anesthesia. While a left shift in inactivation led to light hyperpolarization in individual cells, it inhibited the activity of the thalamocortical model after a certain depth of anesthesia. This finding implies that high doses of propofol inhibit the network partly by accelerating NaV toward inactivation. Additionally, this result explains why the application of sodium channel blockers decreases the requirement for general anesthetics. Our study provides an insight into the roles that NaV plays in the mechanism of general anesthesia. Since the activation and inactivation of NaV are structurally independent, it should be possible to avoid side effects by state-dependent binding to the NaV to achieve precision medicine in the future.
Collapse
Affiliation(s)
- Jinglei Xiao
- Department of Anesthesiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhengguo Chen
- College of Computer, National University of Defence Technology, Changsha, China
| | - Buwei Yu
- Department of Anesthesiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| |
Collapse
|
6
|
A vertebrate model to reveal neural substrates underlying the transitions between conscious and unconscious states. Sci Rep 2020; 10:15789. [PMID: 32978423 PMCID: PMC7519646 DOI: 10.1038/s41598-020-72669-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 08/28/2020] [Indexed: 12/16/2022] Open
Abstract
The field of neuropharmacology has not yet achieved a full understanding of how the brain transitions between states of consciousness and drug-induced unconsciousness, or anesthesia. Many small molecules are used to alter human consciousness, but the repertoire of underlying molecular targets, and thereby the genes, are incompletely understood. Here we describe a robust larval zebrafish model of anesthetic action, from sedation to general anesthesia. We use loss of movement under three different conditions, spontaneous movement, electrical stimulation or a tap, as a surrogate for sedation and general anesthesia, respectively. Using these behavioral patterns, we find that larval zebrafish respond to inhalational and IV anesthetics at concentrations similar to mammals. Additionally, known sedative drugs cause loss of spontaneous larval movement but not to the tap response. This robust, highly tractable vertebrate model can be used in the detection of genes and neural substrates involved in the transition from consciousness to unconsciousness.
Collapse
|
7
|
Monteserín-Matesanz C, González T, Anadón-Baselga MJ, Zaballos M. Supreme™ laryngeal mask airway insertion requires a lower concentration of sevoflurane than ProSeal™ laryngeal mask airway insertion during target-controlled remifentanil infusion: a prospective randomised controlled study. BMC Anesthesiol 2020; 20:5. [PMID: 31910822 PMCID: PMC6945475 DOI: 10.1186/s12871-019-0921-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Accepted: 12/23/2019] [Indexed: 11/27/2022] Open
Abstract
Background ProSeal (PLMA) and Supreme (SLMA) laryngeal mask airways are effective ventilator devices with distinctive designs that may require different anaesthetics for insertion. Sevoflurane induction provides acceptable conditions for laryngeal mask insertion, and remifentanil significantly decreases the minimum alveolar concentration of sevoflurane required for that insertion. The study aimed to evaluate the optimal end-tidal (ET) sevoflurane concentration for successful insertion of PLMA versus SLMA in patients receiving a remifentanil infusion without a neuromuscular blocking agent. Methods Altogether, 45 patients ASA (American Society Anaesthesiologists) physical status I–II, aged 18–60 years were scheduled for elective ambulatory surgery. Exclusion criteria were a difficult airway, recent respiratory infection, reactive airway, obstructive sleep apnoea syndrome, gastric aspiration’s risk factors, pregnancy, and lactation. Patients were randomly allocated to receive the SLMA or the PLMA. Sevoflurane induction with co-administration of remifentanil was performed at an effect-site concentration of 4 ng mL− 1. ET50 was calculated with a modified Dixon’s up-and-down method (starting at 2.5% in steps of 0.5%). Predetermined sevoflurane concentration was kept constant during the 10 min before LMA insertion. Patient’s response to LMA insertion was classified as “movement” or “no movement”. Sevoflurane ET50 was determined as the midpoint concentration of all the independent pairs that manifested crossover from “movement” to “no movement”. Results The ET50 sevoflurane concentration co-administered with remifentanil required for PLMA insertion was 1.20 ± 0.41% (95% confidence interval 0.76 to 1.63%). For SLMA insertion, it was 0.55 ± 0.38% (95% confidence interval 0.14 to 0.95%) (p = 0.019). Conclusions The end-tidal sevoflurane concentration with co-administered remifentanil required to allow insertion of the SLMA was 54% lower than that needed for inserting the PLMA. Trial registration Clinicaltrials.gov identifier: NCT03003377. Retrospectively registered. Date of registration: December 28, 2016.
Collapse
Affiliation(s)
- Cristina Monteserín-Matesanz
- Anaesthesia department, Hospital General Universitario Gregorio Marañón, C/ Doctor Esquerdo, N° 46, 28007, Madrid, Spain
| | - Tatiana González
- Anaesthesia department, Hospital General Universitario Gregorio Marañón, C/ Doctor Esquerdo, N° 46, 28007, Madrid, Spain
| | | | - Matilde Zaballos
- Anaesthesia department, Hospital General Universitario Gregorio Marañón, C/ Doctor Esquerdo, N° 46, 28007, Madrid, Spain. .,Department of Legal Medicine, Psychiatry and Pathology Universidad Complutense, Madrid, Spain.
| |
Collapse
|
8
|
Goel N, Jain D, Ghai B. Sevoflurane EC50 for intravenous cannulation attempt and movement in children. Acta Anaesthesiol Scand 2019; 63:842-846. [PMID: 30908587 DOI: 10.1111/aas.13363] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 02/25/2019] [Accepted: 03/01/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Intravenous cannulation at lighter planes of anaesthesia can lead to adverse respiratory and haemodynamic events. So far, there is no consensus on optimum end tidal sevoflurane concentration required for intravenous cannulation in children. We aimed to evaluate the optimum end tidal concentration at which an intravenous cannulation can be successfully attempted without movements in paediatric patients after inhalational induction of general anaesthesia. MATERIAL AND METHODS In this clinical trial, paediatric subjects of either sex aged 1-3 years, weighing 7-15 kg having American Society of Anaesthesiologists physical status I/II of undergoing elective cataract surgery were included. After inhalational induction of general anaesthesia with 8% sevoflurane and 100% oxygen, end tidal sevoflurane concentration was maintained at 2% for 4 minutes for the first child. This was followed by intravenous cannulation attempted by an experienced anesthesiologist. The intravenous cannulation was considered to be unsuccessful if there was "movement" and successful if there was "no movement" in response to the stimuli of cannulation. End-tidal concentration was increased/decreased (step-size 0.2% for sevoflurane) using Dixon and Massey up and down method in the next patient depending upon previous patient's response. RESULTS The sevoflurane EC50 for successful intravenous cannulation is 1.32% ± 1.0%. Pearson correlation (r) between weight of the child and response to intravenous cannulation was found to be 0.40 with P value of 0.008. CONCLUSION Intravenous cannulation can be accomplished without movements at end tidal sevoflurane of 1.3% in children aged 1-3 years in 50% of children.
Collapse
Affiliation(s)
- Nitika Goel
- Department of Anaesthesia and Critical Care Postgraduate Institute of Medical Education and Research Chandigarh India
| | - Divya Jain
- Department of Anaesthesia and Critical Care Postgraduate Institute of Medical Education and Research Chandigarh India
| | - Babita Ghai
- Department of Anaesthesia and Critical Care Postgraduate Institute of Medical Education and Research Chandigarh India
| |
Collapse
|
9
|
Wan L, Shao LJZ, Liu Y, Wang HX, Xue FS, Tian M. Dexmedetomidine reduces sevoflurane EC 50 for supraglottic airway device insertion in spontaneously breathing morbidly obese patients. Ther Clin Risk Manag 2019; 15:627-635. [PMID: 31118650 PMCID: PMC6504637 DOI: 10.2147/tcrm.s199440] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2018] [Accepted: 03/20/2019] [Indexed: 01/08/2023] Open
Abstract
Purpose: This study aimed to assess the effect of intravenous dexmedetomidine (DEX) on sevoflurane EC50 for supraglottic airway device (SAD) insertion in spontaneously breathing morbidly obese patients. Patients and methods: Thirty-eight morbidly obese patients with a body mass index 40–57 kg/m2 who were scheduled for bariatric surgery under general anesthesia requiring tracheal intubation were randomly allocated to two groups receiving the different treatments: group S, saline was given intravenously, and group D, a bolus dose of DEX 1 μg/kg was administered intravenously over 10 mins, followed by intravenous DEX infusion at a rate of 0.5 μg/kg/h. Five percent sevoflurane was initially inhaled for anesthesia induction and then end-tidal expiratory sevoflurane concentration (ETsev) was adjusted to a target value as to the modified Dixon’s up-and-down method. Patients’ response to SAD insertion was classified as “movement” or “no movement”. The average of the midpoints of all crossover points was defined as calculated sevoflurane EC50 for successful SAD insertion. Furthermore, the probit regression analysis was used to determine sevoflurane end-tidal concentrations where 50% (EC50) and 95% (EC95) insertions of SAD were successful. After the observation was completed, flexible bronchoscope-guided intubation was performed through the SAD. Results: The calculated sevoflurane EC50 for successful SAD insertion was significantly lower in group D than in group S (1.75±0.32% vs 2.92±0.26%, p<0.001). By the probit regression analysis, EC50 and EC95 of sevoflurane for successful SAD insertion were 1.59% (95% CI, 1.22–1.90%) and 2.15% (95% CI, 1.86–3.84%) in group D, respectively, and 2.81% (95% CI, 2.35–3.29%) and 3.32% (3.02–6.74%) in group S. Conclusion: When sevoflurane inhalational induction is performed in spontaneous breathing morbidly obese patients, intravenous DEX can reduce sevoflurane EC50 for successful SAD insertion by about 40%. Chinese Clinical Trial Registry: No. ChiCTR1800016868
Collapse
Affiliation(s)
- Lei Wan
- Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Liu-Jia-Zi Shao
- Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Yang Liu
- Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Hai-Xia Wang
- Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Fu-Shan Xue
- Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Ming Tian
- Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, Beijing, People's Republic of China
| |
Collapse
|
10
|
Choudhary J, Prabhudesai A, Datta C. Dexmedetomidine with propofol versus fentanyl with propofol for insertion of Proseal laryngeal mask airway: A randomized, double-blinded clinical trial. J Anaesthesiol Clin Pharmacol 2019; 35:368-372. [PMID: 31543587 PMCID: PMC6748008 DOI: 10.4103/joacp.joacp_104_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Background and Aims: Successful insertion of the proseal laryngeal mask airway (PLMA) requires much greater doses of propofol as compared to classic laryngeal mask (CLMA). Dexmedetomidine and fentanyl are equally effective adjuvants for CLMA insertion. We designed this study to compare the efficacy of these two drugs as sole adjuvant in PLMA insertion. Material and Methods: Seventy four American Society of Anesthesiologists (ASA) I and II patients were randomly allocated to receive either dexmedetomidine 1 μg/kg [Group PD] or fentanyl 1 μg/kg [Group PF]. Study drugs were diluted in 10 ml NS and administered over 10 min prior to induction of anesthesia with 2.5 mg/kg propofol. PLMA insertion condition was measured according to the Muzi scoring system. Score ≤2 was considered optimal for PLMA insertion. Patient's cardio-respiratory parameters, emergence time, and postoperative pain were also recorded. Results: In our study 83.8% patients in the group PF and 91.9% in the group PD achieved optimal insertion condition (not significant). Hemodynamic stability was maintained in both the groups but the incidence of apnea was significantly higher in the PF group (P = 0.011). We also observed that emergence time was prolonged but postoperative pain scores were significantly lower in the PD group (P < 0.001). Conclusion: We conclude that both dexmedetomidine and fentanyl in a dose of 1 μg/kg when used before induction with propofol provide comparable conditions for successful PLMA insertion. Dexmedetomidine has additional advantage of preserving spontaneous respiration and providing better analgesia.
Collapse
Affiliation(s)
- Jaya Choudhary
- Department of Anesthesia and Pain Medicine, Medica Superspecialty Hospital, Kolkata, West Bengal, India
| | - Aaditya Prabhudesai
- Department of Anesthesia and Pain Medicine, Medica Superspecialty Hospital, Kolkata, West Bengal, India
| | - Chumki Datta
- Department of Anesthesia and Pain Medicine, Medica Superspecialty Hospital, Kolkata, West Bengal, India
| |
Collapse
|
11
|
Wang H, Gao X, Wei W, Miao H, Meng H, Tian M. The optimum sevoflurane concentration for supraglottic airway device Blockbuster™ insertion with spontaneous breathing in obese patients: a prospective observational study. BMC Anesthesiol 2017; 17:156. [PMID: 29179689 PMCID: PMC5704385 DOI: 10.1186/s12871-017-0449-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Accepted: 11/19/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Airway management of the obese patient presenting for surgery is more likely to be a challenging problem. Supraglottic airway device has been adopted as a bridge to connect ventilation and tracheal intubation in obese patients who would be suffered with difficult intubation. The optimum sevoflurane concentration for supraglottic airway device insertion allowing spontaneous breathing in 50% of obese patients (ED50) is not known. The purpose of this study was to determine the ED50 of sevoflurane for supraglottic airway device Blockbuster™ insertion with spontaneous breathing in obese patients requiring general anesthesia. METHODS Thirty elective obese patients (body mass index 30-50 kg/m2) undergoing bariatric surgery were recruited in this study. The predetermined target sevoflurane concentration (initiating at 2.5% with 0.5% as a step size) was sustained for >5 min using a modified Dixon's up-and-down method, and then the supraglottic airway device Blockbuster™ was inserted. The patient's response to supraglottic airway device insertion was classified as either 'movement' or 'no-movement'. The ED50 of sevoflurane were determined by calculating the midpoint concentration of crossover point from 'movement' or 'no-movement' response. RESULTS The ED50 of sevoflurane for supraglottic airway device Blockbuster™ insertion in obese patients calculated using up-and-down method were 2.50 ± 0.60%. The ED50 and ED95 (95% confidence interval) obtained by probit regression analysis were 2.35 (1.28-3.42) % and 4.03 (3.16-17.83) % for supraglottic airway device Blockbuster™ insertion, respectively. CONCLUSION We conclude that the optimum end-tidal sevoflurane concentration required for the supraglottic airway device Blockbuster™ insertion allowing spontaneous breathing in 50% of obese patients (ED50) is 2.5 ± 0.6%. TRIAL REGISTRATION Chinese Clinical Trial Registry, ChiCTR-IPR-16009071 , Registered on 24 August 2016.
Collapse
Affiliation(s)
- Haixia Wang
- Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Xue Gao
- Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Wei Wei
- Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Huihui Miao
- Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Hua Meng
- Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Ming Tian
- Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China.
| |
Collapse
|
12
|
Wang HX, Miao HH, Gao X, Wei W, Ding GN, Zhang Y, Tian M. Optimum end-tidal concentration of sevoflurane to facilitate supraglottic airway device insertion with propofol at induction allowing spontaneous respiration in obese patients: A prospective observational study. Medicine (Baltimore) 2017; 96:e8902. [PMID: 29382022 PMCID: PMC5709021 DOI: 10.1097/md.0000000000008902] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Obese patients are more likely to encounter with difficult airway management, and supraglottic airway device has been adopted to facilitate tracheal intubation. The optimum anesthetic concentration for obese patients to insert a supraglottic airway device with spontaneous respiration has not been investigated. This study was designed to determine the end-tidal concentration of sevoflurane that would provide acceptable condition for supraglottic airway device insertion with propofol at induction in obese patients without using neuromuscular blockade.Thirty elective obese patients [body mass index (BMI) 30-50 kg/m] scheduled for bariatric surgery were enrolled in this study. Sevoflurane was inhaled at a concentration of 5% after infusion of 1 mg/kg propofol (within 1 minute) according to lean body weight. The target concentration of sevoflurane was initiated at 2.5% with 0.5% as a step size using a modified Dixon up-and-down method. Five minutes after target concentration achieved, the insertion of supraglottic airway device was attempted.The minimum alveolar concentration of sevoflurane for successful insertion of supraglottic airway device calculated using up-and-down method were 2.25 (0.53) % for obese patients. The values of the effective concentration of sevoflurane for successful supraglottic airway device insertion in 50% (EC50) and 95% (EC95) of the obese patients obtained by probit regression analysis were 2.09% (95% confidence interval 1.48-2.68) and 3.31% (95% confidence interval 2.70-8.12), respectively.We conclude that sevoflurane at a minimum alveolar concentration of 2.25% can provide optimal conditions for insertion of supraglottic airway device with spontaneous respiration in obese patients with 1 mg/kg propofol at induction.
Collapse
|
13
|
Abrich VA, Ramakrishna H, Mehta A, Mookadam F, Srivathsan K. The possible role of propofol in drug-induced torsades de pointes: A real-world single-center analysis. Int J Cardiol 2017; 232:243-246. [DOI: 10.1016/j.ijcard.2017.01.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Revised: 12/30/2016] [Accepted: 01/03/2017] [Indexed: 11/15/2022]
|
14
|
Ghai B, Jain K, Bansal D, Bhatia N. End-tidal sevoflurane concentration for ProSeal(TM) versus Classic(TM) laryngeal mask airway insertion in unpremedicated anaesthetised adult females. Anaesth Intensive Care 2016; 44:221-6. [PMID: 27029654 DOI: 10.1177/0310057x1604400208] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
The optimal end-tidal sevoflurane concentration for successful ProSealTM (Teleflex, Morrisville, NC, USA) laryngeal mask airway (PLMA) versus ClassicTM (Teleflex, Morrisville, NC, USA) laryngeal mask airway (CLMA) insertion in unpremedicated anaesthetised adults is unknown. We determined end-tidal sevoflurane concentrations for successful insertion in fifty percent of anaesthetised adults. This randomised, prospective, double-blind study was conducted in the operating theatre of a government tertiary care hospital. Forty-four unpremedicated American Society of Anesthesiologists physical status I and II women with cervical carcinoma (aged 30 to 60 years), scheduled for intracavity caesium implantation under general anaesthesia with a laryngeal mask airway (LMA) were included in the study. The participants were randomised to one of the two groups, to receive either a PLMA or CLMA. After anaesthetic induction with sevoflurane, a predetermined end-tidal sevoflurane concentration (starting at 2.5%) was sustained for 10 minutes before LMA insertion was attempted. End-tidal sevoflurane concentration was increased/decreased (step-size 0.25%) using Dixon and Massey's up-and-down method for the next patient based on the previous patient's response. Placement without clenching, movement, coughing or biting within one minute was considered successful insertion. The end-tidal sevoflurane concentration required for successful LMA insertion in fifty percent of anaesthetised adults was calculated as the mean of the crossover pairs' midpoints in each group and further confirmed by probit regression analysis. The end-tidal sevoflurane concentration (95% confidence interval) required for successful PLMA insertion in 50% of anaesthetised adults (3.15% [3.12% to 3.18%]) was significantly higher than that for CLMA insertion (2.71% [2.66% to 2.76%], P<0.001). These findings suggest that deeper anaesthesia is required for placement of a PLMA in comparison to a CLMA.
Collapse
Affiliation(s)
- B Ghai
- Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - K Jain
- Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - D Bansal
- National Institute of Pharmaceutical Education and Research, Punjab, India
| | - N Bhatia
- Postgraduate Institute of Medical Education and Research, Chandigarh, India
| |
Collapse
|
15
|
Zaballos M, Bastida E, Agustí S, Portas M, Jiménez C, López-Gil M. Effect-site concentration of propofol required for LMA-Supreme™ insertion with and without remifentanil: a randomized controlled trial. BMC Anesthesiol 2015; 15:131. [PMID: 26438179 PMCID: PMC4595052 DOI: 10.1186/s12871-015-0115-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Accepted: 09/24/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A new supraglottic device, the LMA-Supreme™, has recently become available for clinical use. Information on anaesthetic and co-adjuvant requirements for insertion of the LMA-Supreme™ is limited. The present study aimed to evaluate the optimal effect-site concentration of propofol in 50 % (EC50) of adults necessary for successful insertion of the LMA-Supreme™ and to examine remifentanil's effect on propofol requirements. METHODS Fifty-eight elective patients (aged 18-60 years; ASA (American Society Anaesthesiologists) physical status classification I and II) scheduled for day surgery were randomly assigned to one of two groups: propofol with saline or propofol with remifentanil. Anaesthesia was induced by target-controlled infusion according to predetermined effect-site concentrations of propofol and remifentanil (5 ng.mL(-1)). The EC50 was calculated using Dixon's up-and-down method. Ten minutes following drug administration, LMA-Supreme™ insertion was attempted without the use of muscle relaxant drugs. RESULTS In the propofol + saline group, the EC50 of propofol required for LMA-Supreme™ insertion was 6.32 ± 0.67 μg.mL(-1) (95 % CI, 5.69-6.94 μg.mL(-1)). With the addition of remifentanil at an effect-site concentration of 5 ng.mL(-1), the EC50 of propofol required for LMA-Supreme™ insertion was 2.50 ± 0.80 μg.mL(-1) (95 % CI, 1.82-3.17 μg.mL(-1); p < 0.0001). CONCLUSIONS The propofol requirement for smooth insertion of the LMA-Supreme™ was 60 % less when remifentanil (5 ng.mL(-1)) was co-administered. CLINICAL TRIAL REGISTRATION Identified as NCT01974648 at www.clinicaltrials.gov .
Collapse
Affiliation(s)
- Matilde Zaballos
- Department of Toxicology, Faculty of Medicine, Complutense University, Madrid, Spain. .,Department of Anaesthesiology, Hospital Universitario Gregorio Marañón, Madrid, Spain.
| | - Emilia Bastida
- Department of Anaesthesiology, Hospital Universitario Gregorio Marañón, Madrid, Spain.
| | - Salomé Agustí
- Department of Anaesthesiology, Hospital Universitario Gregorio Marañón, Madrid, Spain.
| | - Maite Portas
- Department of Anaesthesiology, Hospital Universitario Gregorio Marañón, Madrid, Spain.
| | - Consuelo Jiménez
- Department of Anaesthesiology, Hospital Universitario Gregorio Marañón, Madrid, Spain.
| | - Maite López-Gil
- Department of Anaesthesia, Head Department of Anaesthesiology, Hospital Universitario Gregorio Marañón, Madrid, Spain.
| |
Collapse
|
16
|
Ashay NA, Wasim S, Anil TB. Propofol requirement for insertion of I-gel versus laryngeal mask airway: A comparative dose finding study using Dixon's up-and-down method. J Anaesthesiol Clin Pharmacol 2015; 31:324-8. [PMID: 26330709 PMCID: PMC4541177 DOI: 10.4103/0970-9185.161666] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Background and Aims: Propofol is the drug of choice when used as sole anesthetic agent for placement of supraglottic airway devices. We aimed to find and compare the propofol dose required for smooth first attempt insertion of I-gel versus the classic laryngeal mask airway (cLMA) using Dixon's up-and-down method. Material and Methods: Prospective randomized controlled trial (n-60) was planned. I-gel or cLMA was inserted 60 s after propofol injection whose dose was calculated based on previous patients response as per Dixon's up-and-down method. Propofol requirements for successful placement of devices was noted and compared. Difference between the groups was measured by ANOVA. A P < 0.05 was considered as statistically significant. Results: Significantly lower (P < 0.001) propofol dose was required for I-gel (2.02 ± 0.26 mg/kg) insertion than cLMA (2.70 ± 0.28 mg/kg). Conclusions: I-gel requires significantly lower dose of propofol for insertion when compared to cLMA.
Collapse
Affiliation(s)
- Nerurkar Aparna Ashay
- Department of Anaesthesiology, Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai, Maharashtra, India
| | - Shaikh Wasim
- Department of Anaesthesiology, Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai, Maharashtra, India
| | - Tendolkar Bharati Anil
- Department of Anaesthesiology, Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai, Maharashtra, India
| |
Collapse
|
17
|
Ghai B, Jain K, Bansal D, Wig J. End-tidal concentrations of sevoflurane and desflurane for ProSeal laryngeal mask airway removal in anaesthetised adults: a randomised double-blind study. Eur J Anaesthesiol 2014; 31:274-9. [PMID: 24231668 DOI: 10.1097/eja.0b013e328365cad7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND The optimal end-tidal sevoflurane and desflurane concentration for successful ProSeal laryngeal mask airway (PLMA) removal in unpremedicated anaesthetised adults has not been determined. OBJECTIVES We determined end-tidal sevoflurane and desflurane concentration in 50% of anaesthetised adults (EC50: concentration at which there is 50% chance of patients showing 'no movement' response) for smooth PLMA removal. DESIGN Randomised controlled double blind study. SETTING Operating theatre of a government tertiary care institute. The study period was December 2011 to January 2013. PATIENTS Thirty nine unpremedicated American Society of Anesthesiologists (ASA) physical status I and II women with cervical carcinoma (aged 30 to 60 years) scheduled for implantation of intracavity caesium under general anaesthesia with PLMA as an airway device were included in the study. INTERVENTIONS The participants were randomised to one of the two groups receiving either desflurane or sevoflurane for anaesthesia maintenance. Anaesthesia induction was performed with intravenous propofol. Predetermined end-tidal sevoflurane concentration (initiating at 2%) or desflurane (initiating at 4%) was sustained for 10 min before PLMA removal was attempted. End-tidal concentrations were increased/decreased (step-size 0.2% for sevoflurane and 0.5% for desflurane) using Dixon and Massey up and down method in the next patient depending upon previous patient's response. Patient responses to PLMA removal were classified as 'movement' or 'no movement'. MAIN OUTCOME MEASURES EC50 was calculated as the mean of the crossover pairs' midpoints in each group and further confirmed by probit regression analysis. RESULTS EC50 (95% confidence interval) of sevoflurane and desflurane for PLMA removal were 1.58% (0.669 to 2.060) and 2.79% (2.733 to 2.841), respectively. CONCLUSION Predicted EC50 and EC95 of sevoflurane and desflurane for smooth removal for the PLMA were 1.58 (0.669 to 2.060), 2.27 (1.859 to 21.16), 2.79 (2.733.2.841) and 3.27% (3.173 to 3.395), respectively. TRIAL REGISTRATION Registered with Clinical Trial Registry of India (URL: http://www.ctri.in), Registry ref no: CTRI/2012/12/004285.
Collapse
Affiliation(s)
- Babita Ghai
- From the Department of Anaesthesia and Intensive Care, Post Graduate Institute of Medical Education and Research, Chandigarh (BG, KJ, JW), Clinical Research Unit, National Institute of Pharmaceutical Education and Research, Mohali (DB), Punjab, India
| | | | | | | |
Collapse
|
18
|
Jang YE, Kim YC, Yoon HK, Jeon YT, Hwang JW, Kim E, Park HP. A randomized controlled trial of the effect of preoperative dexmedetomidine on the half maximal effective concentration of propofol for successful i-gel insertion without muscle relaxants. J Anesth 2014; 29:338-345. [PMID: 25394762 DOI: 10.1007/s00540-014-1949-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2014] [Accepted: 10/30/2014] [Indexed: 11/26/2022]
Abstract
BACKGROUND Dexmedetomidine is a useful anesthetic adjuvant for general anesthesia. We determined whether preoperative dexmedetomidine administration could reduce the half maximal effective concentration (EC50) of propofol for successful i-gel insertion without muscle relaxants. METHODS Thirty-seven patients were randomly allocated to one of two groups. In the dexmedetomidine group (n = 19), dexmedetomidine (1 µg/kg) was loaded for 10 min preoperatively. In the control group (n = 20), the same volume of 0.9% normal saline was administered in the same manner. The EC50 of propofol for successful i-gel insertion was determined using Dixon's up-and-down method. The EC50 of propofol was calculated as the midpoint concentration after at least six crossover points had been obtained. For successful i-gel insertion, all of the following four factors were required—(1) no major movement of the body within 1 min of insertion, (2) no significant resistance to mouth opening, (3) cough ≤2, and (4) visible square wave capnogram without air leakage at a peak airway pressure of <10 cmH2O. Mean blood pressure (MBP) and heart rate (HR) were monitored during the peri-insertion period of i-gel. RESULTS The EC50 of propofol for successful i-gel insertion was 3.18 μg/mL in the dexmedetomidine group and 6.75 μg/mL in the control group (p < 0.001). The incidence of hypotension (MBP <80% of the baseline) during the peri-insertion period of i-gel was higher in the control group (p = 0.001), whereas the incidence of bradycardia (HR <80% of the baseline) was higher in the dexmedetomidine group (p = 0.001). CONCLUSIONS Preoperative dexmedetomidine reduced the EC50 of propofol for successful i-gel insertion without muscle relaxants.
Collapse
Affiliation(s)
- Young-Eun Jang
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, South Korea
| | - Yong-Chul Kim
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, South Korea
| | - Hyun-Kyu Yoon
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, South Korea
| | - Young-Tae Jeon
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, South Korea
| | - Jung-Won Hwang
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, South Korea
| | - Eugene Kim
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, South Korea
| | - Hee-Pyoung Park
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, South Korea.
| |
Collapse
|
19
|
Savla JR, Ghai B, Bansal D, Wig J. Effect of intranasal dexmedetomidine or oral midazolam premedication on sevoflurane EC50 for successful laryngeal mask airway placement in children: a randomized, double-blind, placebo-controlled trial. Paediatr Anaesth 2014; 24:433-9. [PMID: 25229980 DOI: 10.1111/pan.12358] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/30/2013] [Indexed: 10/25/2022]
Abstract
INTRODUCTION This study was conducted to determine the effect of oral midazolam (OM) or intranasal dexmedetomidine (IND) on the EC50 of sevoflurane for successful laryngeal mask airway placement in children. We hypothesize that premedication with either agent might reduce the sevoflurane EC50 for laryngeal mask airway placement in children to a similar extent. METHODS Fifty-two American Society of Anesthesiologists (ASA) I children (aged 1-6 years) scheduled for general anesthesia with laryngeal mask airway were randomized to one of the three groups: group M received 0.5 mg · kg(-1) OM with honey and intranasal saline, group D received 2 μg · kg(-1) IND along with oral honey, and group P received oral honey and intranasal saline at least 30 min prior to induction of anesthesia. Anesthesia was induced with incremental sevoflurane up to 8% in 100% O2 . A predetermined target endtidal sevoflurane (ETsevo ) concentration (2% in the first child of all three groups) was sustained for 10 min before the attempt of laryngeal mask airway insertion by adjusting dial concentration. No intravenous anesthetic or neuromuscular blockade was used. ETsevo was increased/decreased (step size 0.2%) using Dixon's and Massey's up and down method in next patient depending upon previous patient's response. Placement of the laryngeal mask airway without movement, coughing, biting, or bucking was considered as successful. EC50 of sevoflurane was calculated as the average of the crossover midpoints in each group, which was further confirmed by probit analysis. RESULTS The EC50 of sevoflurane for laryngeal mask airway placement after OM (1.66 ± 0.31) and IND (1.57 ± 0.14) premedications was significantly lower than the placebo group (2.00 ± 0.17, P < 0.0001). The EC95 (95% CI) derived from probit regression analysis was 2.34% (2.22-2.51%) with OM, 1.88% (1.77-2.04%) with IND, and 2.39% (2.25-2.35%) with placebo group. CONCLUSIONS Oral midazolam and IND premedications significantly reduce the sevoflurane EC50 for laryngeal mask airway insertion in children by 17% and 21%, respectively.
Collapse
Affiliation(s)
- Jyothi R Savla
- Department of Anaesthesia and Intensive Care, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | | | | | | |
Collapse
|
20
|
Zaballos M, Bastida E. Reply to: ED50 of sevoflurane for LMA Supreme insertion: reliability! Eur J Anaesthesiol 2014; 31:54-55. [PMID: 23884405 DOI: 10.1097/eja.0b013e32836456b5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Affiliation(s)
- Matilde Zaballos
- From the Department of Toxicology, Complutense University (MZ) and Department of Anaesthesiology, Hospital Universitario Gregorio Marañón, Madrid, Spain (MZ, EB)
| | | |
Collapse
|
21
|
Makkar JK, Singh NP. ED50 of sevoflurane for LMA Supreme insertion: reliability! Eur J Anaesthesiol 2014; 31:54. [PMID: 23877025 DOI: 10.1097/eja.0b013e328363944a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Affiliation(s)
- Jeetinder K Makkar
- From the Department of Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research (JKM), Alchemist Hospital (NPS), Chandigarh, India
| | | |
Collapse
|
22
|
Kennedy R, McKellow M, French R, Sleigh J. Sevoflurane End-Tidal to Effect-Site Equilibration in Women Determined by Response to Laryngeal Mask Airway Insertion. Anesth Analg 2013; 117:786-791. [DOI: 10.1213/ane.0b013e3182a46d4e] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|
23
|
Predicted end-tidal sevoflurane concentration for insertion of a Laryngeal Mask Supreme: a prospective observational study. Eur J Anaesthesiol 2013; 30:170-4. [PMID: 23274620 DOI: 10.1097/eja.0b013e32835c5512] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
CONTEXT The single-use Laryngeal Mask Airway (LMA) Supreme is a new supraglottic airway device. It has been reported to be reliable and easy-to-use in clinical practice; however, the anaesthetic techniques for its insertion are not standardised. OBJECTIVES The purpose of this study was to determine the ED50 of end-tidal sevoflurane concentration for successful LMA Supreme insertion without the use of neuromuscular blockade. DESIGN A prospective observational study. SETTING A single tertiary care surgical centre. PATIENTS Thirty-one consecutive elective patients scheduled for minor elective surgery under general anaesthesia. INTERVENTION Patients were preoxygenated with 100% oxygen and anaesthetised using normal tidal volume inhalation of sevoflurane. The target sevoflurane concentration was determined using a modified Dixon's 'up-and-down' method (starting at 2.5% with 0.5% as the step size). After the predetermined end-tidal concentration had been established and maintained for 10 min, LMA Supreme insertion was attempted. MAIN OUTCOME MEASURE The main outcome measure was the patient's response to LMA Supreme insertion, classified as either 'movement' or 'no movement'. The mean of the concentrations of seven cross-overs from 'movement' to 'no movement' was used to estimate the ED50. RESULTS The estimated sevoflurane concentration for successful LMA Supreme insertion in 50% of adults was 3.03 ± 0.75% (95% confidence interval 2.3 to 3.7%). The values of the ET50 and ET95 obtained by logistic regression were 2.83 and 5.30%, respectively. CONCLUSION Sevoflurane alone can provide acceptable conditions for insertion of the LMA Supreme in adults, at an estimated minimum alveolar anaesthetic concentration of 3% with minimal adverse effects.
Collapse
|
24
|
Kim SH, Choi EM, Chang CH, Kim HK, Chung MH, Choi YR. Comparison of the effect-site concentrations of remifentanil for Streamlined Liner of the Pharynx Airway (SLIPA) versus laryngeal mask airway SoftSealTM insertion during target-controlled infusion of propofol. Anaesth Intensive Care 2011; 39:611-7. [PMID: 21823378 DOI: 10.1177/0310057x1103900412] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This study was designed to determine the optimal dose of remifentanil required for the successful insertion of Streamlined Liner of the Pharynx Airway (SLIPA) and to compare it to that required for laryngeal mask airway (LMA) insertion in patients receiving a propofol infusion at a standard effect-site concentration. Fifty-eight patients scheduled to undergo general anaesthesia were randomly assigned to either the SLIPA (n = 29) or LMA (n = 29) group. All patients were premedicated with midazolam 0.05 mg x kg(-1) and glycopyrrolate 0.004 mg x kg(-1) intramuscularly. After the administration of lignocaine 1 mg x kg(-1) intravenously, a propofol infusion was started at an effect-site concentration of 3.5 microg x ml(-1) with a remifentanil infusion without a neuromuscular blocking agent. The remifentanil dose was determined by the modified up-and-down method starting in each group at 4 ng x ml(-1). Six minutes after induction, the airway device was inserted. Airway device insertion was classified as 'success' or 'failure' based on patient response. From the isotonic regression analysis and bootstrap distribution, the EC50 of remifentanil for SLIPA and LMA were 0.93 ng x ml(-1) (95% confidence interval [CI] 0.81 to 1.50 ng x ml(-1) and 1.36 ng x ml(-1) (95% CI 1.19 to 2.06 ng x ml(-1)) respectively, and the EC95 for SLIPA and LMA insertions were 1.90 ng x ml(-1) (95% CI 1.39 to 1.95) and 2.43 ng x ml(-1) (95% CI 1.80 to 2.46 ng x ml(-1)) respectively. Using the 83% CIs from the bootstrap distribution, EC50 for SLIPA was significantly less than that of LMA (0.83 to 1.23 vs 1.26 to 2.00, respectively) (P < 0.05). These findings suggest that the insertion of SLIPA needs about a 32% lower depth of anaesthesia than LMA insertion.
Collapse
Affiliation(s)
- S H Kim
- Department of Anesthesiology and Pain Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea
| | | | | | | | | | | |
Collapse
|
25
|
Kim MK, Lee JW, Jang DJ, Shin OY, Nam SB. Effect-site concentration of remifentanil for laryngeal mask airway insertion during target-controlled infusion of propofol. Anaesthesia 2009; 64:136-40. [PMID: 19143689 DOI: 10.1111/j.1365-2044.2008.05707.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The purpose of this study was to determine the effect-site concentration of remifentanil that would provide optimal conditions for successful laryngeal mask airway insertion during a target-controlled infusion (TCI) of propofol at 3.5 microg.ml(-1) without the use of neuromuscular blockade. Five minutes after propofol infusion, remifentanil was infused at a dose determined by a modified Dixon's up-and-down method. Five minutes after remifentanil infusion, the laryngeal mask was inserted. The effect-site concentration of remifentanil for successful laryngeal mask insertion in 50% of adults (EC(50)) was 3.04 (SD 0.49) ng.ml(-1) during a TCI of 3.5 microg.ml(-1) propofol without neuromuscular blockade. From the probit analysis, the EC(50) and EC(95) of remifentanil were 2.84 ng.ml(-1) (95% CI 2.09-3.57 ng.ml(-1)) and 3.79 ng.ml(-1) (95% CI 3.26-9.25 ng.ml(-1)), respectively.
Collapse
Affiliation(s)
- M K Kim
- Department of Anaesthesiology and Pain Medicine, College of Medicine, Kyung Hee University, Seoul, Korea
| | | | | | | | | |
Collapse
|
26
|
Xu Z, Liu F, Yue Y, Ye T, Zhang B, Zuo M, Xu M, Hao R, Xu Y, Yang N, Che X. C50 for Propofol-Remifentanil Target-Controlled Infusion and Bispectral Index at Loss of Consciousness and Response to Painful Stimulus in Chinese Patients: A Multicenter Clinical Trial. Anesth Analg 2009; 108:478-83. [DOI: 10.1213/ane.0b013e31818f8a30] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
|
27
|
Cook TM, Gibbison B. Analysis of 1000 consecutive uses of the ProSeal laryngeal mask airway by one anaesthetist at a district general hospital. Br J Anaesth 2007; 99:436-9. [PMID: 17604305 DOI: 10.1093/bja/aem172] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The ProSeal laryngeal mask airway (PLMA), introduced to UK practice in late 2001, offers potential performance and safety benefits over other airways such as the classic laryngeal mask airway. There are no large series reporting its use. METHODS Data from a prospective, consecutive series of 1000 size 3-5 PLMA uses, by one anaesthetist, were analysed to examine whether performance in routine and advanced practice is similar to that reported in formal trials. RESULTS Patients were female in 52% of cases, median age 52 (range 8-101) yr, median weight 78 kg (10% over 100 kg, 24% over 90 kg). Procedures included 12% laparoscopic and 5% open abdominal surgery. Overall insertion success was 99.4%, (first and second attempt success 85% and 12%, respectively). Median insertion time was 12 s (93% <30 s). Insertion success did not differ between genders, or between mask sizes. Median airway seal was 32 cm H(2)O (range 8-40, 94% seal >20 cm H(2)O). Specific tests confirmed correct positioning in 98.5% of cases. Of six failures, two occurred during management of difficult airways. Minor airway obstruction occurred in 2.7%. Blood was visible on 8% of removed PLMAs and more commonly after more than one insertion attempt (38 vs 4.7%, chi(2) P < 0.0001). In three cases minor regurgitation without aspiration occurred. CONCLUSIONS In the hands of a regular user, the PLMA was associated with a high rate of insertion success during routine and advanced use in relatively unselected patients. Correct placement rates approached 100%. The incidence of complications was low.
Collapse
Affiliation(s)
- T M Cook
- Royal United Hospital, Combe Park, Bath BA1 3NG, UK.
| | | |
Collapse
|
28
|
Pace NL, Stylianou MP. Advances in and limitations of up-and-down methodology: a précis of clinical use, study design, and dose estimation in anesthesia research. Anesthesiology 2007; 107:144-52. [PMID: 17585226 DOI: 10.1097/01.anes.0000267514.42592.2a] [Citation(s) in RCA: 287] [Impact Index Per Article: 16.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Sequential design methods for binary response variables exist for determination of the concentration or dose associated with the 50% point along the dose-response curve; the up-and-down method of Dixon and Mood is now commonly used in anesthesia research. There have been important developments in statistical methods that (1) allow the design of experiments for the measurement of the response at any point (quantile) along the dose-response curve, (2) demonstrate the risk of certain statistical methods commonly used in literature reports, (3) allow the estimation of the concentration or dose-the target dose-associated with the chosen quantile without the assumption of the symmetry of the tolerance distribution, and (4) set bounds on the probability of response at this target dose. This article details these developments, briefly surveys current use of the up-and-down method in anesthesia research, reanalyzes published reports using the up-and-down method for the study of the epidural relief of pain during labor, and discusses appropriate inferences from up-and-down method studies.
Collapse
Affiliation(s)
- Nathan L Pace
- Department of Anesthesiology, University of Utah, Salt Lake City, Utah 84132-2304, USA.
| | | |
Collapse
|
29
|
Kim JY, Park SY, Moon BK, Kim DW, Kim JS. Predicted Effect-site Concentration of Remifentanil for Facilitating Laryngeal Mask Airway Insertion with Propofol Target-Controlled Infusion. Korean J Anesthesiol 2007. [DOI: 10.4097/kjae.2007.52.4.381] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- Jong Yeop Kim
- Department of Anesthesiology and Pain Medicine, College of Medicine, Ajou University, Suwon, Korea
| | - Sung Yong Park
- Department of Anesthesiology and Pain Medicine, College of Medicine, Ajou University, Suwon, Korea
| | - Bong Ki Moon
- Department of Anesthesiology and Pain Medicine, College of Medicine, Ajou University, Suwon, Korea
| | - Do Wan Kim
- Department of Anesthesiology and Pain Medicine, College of Medicine, Ajou University, Suwon, Korea
| | - Jin Soo Kim
- Department of Anesthesiology and Pain Medicine, College of Medicine, Ajou University, Suwon, Korea
| |
Collapse
|
30
|
Richebé P, Rivalan B, Baudouin L, Sesay M, Sztark F, Cros AM, Maurette P. Comparison of the anaesthetic requirement with target-controlled infusion of propofol to insert the laryngeal tube vs. the laryngeal mask. Eur J Anaesthesiol 2006; 22:858-63. [PMID: 16225722 DOI: 10.1017/s0265021505001456] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND OBJECTIVE The target effect-site concentration of propofol to insert a laryngeal mask airway was recently reported as almost 5 microg mL(-1). The present study aimed to determine the target effect-site concentration with target-controlled infusion of propofol to place classical larnygeal mask airway or current laryngeal tube in adult patients. METHODS We included 40 patients scheduled for short gynaecological and radiological procedures under general anaesthesia in a randomized, double-blind manner using the Dixon's up-and-down statistical method. Monitoring included standard cardiorespiratory monitors, and bispectral index monitoring was used for all patients. Anaesthesia was conducted with a target-controlled infusion system: Diprifusor. The initial target plasma concentration of propofol was 5 microg mL(-1), and was changed stepwise by 0.5 microg mL(-1) increments according to Dixon's up-and-down method. Criteria for acceptable insertion were: Muzi's score < or = 2, and mean arterial blood pressure, heart rate or bispectral index variation <20% the baseline values. RESULTS Target effect-site concentration of propofol required to insert laryngeal tube was 6.3 +/- 0.3 microg mL(-1) with Dixon method and ED50 was 6.1 microg mL(-1) (5.9-6.4) with logistic regression method. In the case of larnygeal mask airway they were 7.3 +/- 0.2 microg mL(-1) (Dixon method) and 7.3 microg mL(-1) (7.1-7.5; with logistic regression) respectively (P < 0.05). ED95 (logistic regression) was 6.8 microg mL(-1) (5.9-7.6) for laryngeal tube and 7.7 microg mL(-1) (7.3-8.0) for larnygeal mask airway (P < 0.05). Haemodynamic incidents were 55% in the larnygeal mask airway group vs. 30% in the laryngeal tube group (P < 0.05). CONCLUSIONS The target effect-site concentration of propofol for insertion of laryngeal tube was lower than for larnygeal mask airway (P < 0.05), with a consequent reduction of the propofol induced haemodynamic side-effects.
Collapse
Affiliation(s)
- P Richebé
- Centre Hospitalier et Universitaire de Bordeaux, Département d'Anesthésie et Réanimation III, Bordeaux Cedex, France.
| | | | | | | | | | | | | |
Collapse
|
31
|
Handa-Tsutsui F, Kodaka M. Propofol concentration requirement for laryngeal mask airway insertion was highest with the ProSeal, next highest with the Fastrach, and lowest with the Classic type, with target-controlled infusion. J Clin Anesth 2005; 17:344-7. [PMID: 16102683 DOI: 10.1016/j.jclinane.2004.08.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2004] [Accepted: 08/17/2004] [Indexed: 10/25/2022]
Abstract
STUDY OBJECTIVE To determine propofol concentration of plasma 50% (Cp50, concentration at which there is a 50% chance that patients show no movement in response) for the Classic-, Fastrach-, and ProSeal-type laryngeal mask airway (LMA) insertion using target-controlled infusion (TCI) technique. DESIGN Prospective, randomized, comparative study. SETTING University-affiliated hospital. PATIENTS Sixty American Society of Anesthesiologists physical status I and II women scheduled for minor gynecologic operations. INTERVENTIONS Propofol TCI (Diprifusor pharmacokinetic model) was started at target concentration using an anesthesia pump. After reaching target effect-site concentration of propofol, 1 of the 3 types of LMA was inserted. We recorded patient responses to LMA insertion as "movement" or "no movement." Test propofol concentrations started from a dosage of 4 microg/mL. Concentrations were then predetermined by a modified Dixon's up-and-down method with 0.4 microg/mL step size. MEASUREMENTS Patient response to LMA insertion was classified as either of "no movement" or "movement." The midpoint was defined as the average concentration value of crossover (movement/no movement) response. The Cp50 value was defined as the average of the crossover midpoints in each group, and it was estimated from calculating the midpoints. MAIN RESULTS Cp50 of the Classic, Fastrach, and ProSeal LMA insertion were 3.2+/-0.34, 4.0+/-0.22, and 4.9+/-0.20 microg/mL (mean+/-SD), respectively. CONCLUSION Required propofol TCI concentrations for LMA insertion were significantly highest for the ProSeal, second highest for the Fastrach, and lowest for the Classic LMA.
Collapse
Affiliation(s)
- Fumi Handa-Tsutsui
- Department of Anesthesia, Saitama Medical Center, Saitama Medical School, Saitama 350-8550, Japan.
| | | |
Collapse
|
32
|
Cook TM, Lee G, Nolan JP. The proseal™laryngeal mask airway: a review of the literature. Can J Anaesth 2005; 52:739-60. [PMID: 16103390 DOI: 10.1007/bf03016565] [Citation(s) in RCA: 187] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
PURPOSE To analyze and summarize the published literature relating to the ProSeal LMA (PLMA): a modification of the "classic LMA" (cLMA) with an esophageal drain tube (DT), designed to improve controlled ventilation, airway protection and diagnosis of misplacement. SOURCE Articles identified through Medline and EMBASE searches using keywords "Proseal", "ProSeal" and "PLMA". Hand searches of these articles and major anesthetic journals from January 1998 to March 2005. PRINCIPAL FINDINGS Searches identified 59 randomized controlled trials or clinical studies and 79 other publications. Compared to the cLMA, PLMA insertion takes a few seconds longer. First attempt insertion success for the PLMA is lower, but overall success is equivalent. Airway seal is improved by 50%. The DT enables early diagnosis of mask misplacement, allows gastric drainage, reduces gastric inflation and may vent regurgitated stomach contents. Evidence suggests, but does not prove, that the correctly placed PLMA reduces aspiration risk compared with the cLMA. PLMA use is associated with less coughing and less hemodynamic disturbance than use of a tracheal tube (TT). Comparative trials of the PLMA with other supraglottic airways favour the PLMA. Clinicians have extended the use of the PLMA inside and outside the operating theatre including use for difficult airway management and airway rescue. CONCLUSIONS The PLMA has similar insertion characteristics and complications to other laryngeal masks. The DT enables rapid diagnosis of misplacement. The PLMA offers significant benefits over both the cLMA and TT in some clinical circumstances. These and clinical experience with the PLMA are discussed.
Collapse
Affiliation(s)
- Tim M Cook
- Department of Anaesthesia, Royal United Hospital, Combe Park, Bath BA1 3NG, UK.
| | | | | |
Collapse
|
33
|
Iannuzzi M, Iannuzzi E, Rossi F, Berrino L, Chiefari M. Relationship between Bispectral Index, electroencephalographic state entropy and effect-site EC 50 for propofol at different clinical endpoints. Br J Anaesth 2005; 94:613-6. [PMID: 15734785 DOI: 10.1093/bja/aei097] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND State entropy (SE) is a newly available monitor for depth of anaesthesia. We investigated whether the relationship between predicted effect-site propofol concentration and both bispectral index (BIS) and SE values is useful for predicting loss of verbal contact and loss of consciousness during steady-state conditions. METHODS Twenty unpremedicated patients undergoing elective major abdominal surgery were recruited. A target-controlled infusion of propofol was administered using Schneider's pharmacokinetic model. The propofol infusion was set at an initial site-effect concentration of 1.0 microg ml(-1), and increased by 1.0 microg ml(-1) steps every 4 min, up to 6.0 microg ml(-1). A 4-min interval was chosen to ensure that steady-state site-effect concentrations were obtained. Propofol site-effect concentrations and BIS and SE values were recorded at loss of verbal contact (LVC) and loss of consciousness (LOC). Population values for predicted effect-site concentrations at the clinical endpoints were estimated and correlated with BIS and SE values. RESULTS For LVC, the effect-site concentration for 90% of patients was 1.1 (1.1-3.2) microg ml(-1) and for LOC 2.8 (2.8-5.65) microg ml(-1). LVC occurred in 90% of patients at a BIS value of 70.2 (70.2-90.2) and an SE value of 60.3 (60.3-75.5) and LOC occurred at a BIS value of 38.2 (38.2-70.4) and an SE value of 42.2 (42.2-60.4). CONCLUSIONS LVC and LOC occurred within a defined range of predicted effect-site concentrations. SE had a smaller range than BIS and higher correlation with effect-site concentration and may be more useful than BIS in predicting both LVC and LOC.
Collapse
Affiliation(s)
- M Iannuzzi
- Department of Anaesthesiological, Surgical and Emergency Sciences, Second Service of Anaesthesia, Second University of Naples, Naples, Italy.
| | | | | | | | | |
Collapse
|
34
|
Iannuzzi M, Iannuzzi E, Rossi F, Berrino L, Chiefari M. Relationship between Bispectral Index, electroencephalographic state entropy and effect-site EC 50 for propofol at different clinical endpoints. Br J Anaesth 2005; 94:492-5. [PMID: 15665070 DOI: 10.1093/bja/aei075] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND State entropy (SE) is a newly available monitor for depth of anaesthesia. We investigated whether the relationship between predicted effect-site propofol concentration and Bispectral Index (BIS) and SE values is useful for predicting loss of verbal contact and loss of consciousness during steady-state conditions. METHODS Twenty unpremedicated patients undergoing elective major abdominal surgery were recruited. A target-controlled infusion of propofol was administered using Schneider's pharmacokinetic model. The propofol infusion was set at an initial site effect concentration of 1.0 microg ml(-1) and increased by 1.0 microg ml(-1) steps every 4 min up to 6.0 microg ml(-1). A 4-min interval was chosen to ensure that steady-state effect-site concentrations were obtained. Propofol site effect concentrations and BIS and SE values were recorded at loss of verbal contact (LVC) and loss of consciousness (LOC). Population values for predicted effect-site concentrations at the clinical endpoints were estimated and correlated with BIS and SE values. RESULTS For LVC, the effect-site concentration for 90% of patients was 1.1 (1.1-3.2) microg ml(-1) and for LOC it was 2.8 (2.8-5.65) microg ml(-1). LVC occurred in 90% of patients at a BIS value of 70.2 (70.2-90.2) and an SE value of 60.3 (60.3-75.5), and LOC occurred at a BIS value of 38.2 (38.2-70.4) and an SE value of 42.2 (42.2-60.4). CONCLUSIONS LVC and LOC occurred within a defined range of predicted effect-site concentrations. SE had a smaller range than BIS and greater correlation with effect-site concentration and may be more useful than BIS in predicting both LVC and LOC.
Collapse
Affiliation(s)
- M Iannuzzi
- Department of Anaesthesiological, Surgical and Emergency Sciences, Second Service of Anaesthesia and Department of Experimental Medicine, Second University of Naples, Naples, Italy.
| | | | | | | | | |
Collapse
|
35
|
Filipovic M, Wang J, Michaux I, Hunziker P, Skarvan K, Seeberger MD. Effects of halothane, sevoflurane and propofol on left ventricular diastolic function in humans during spontaneous and mechanical ventilation. Br J Anaesth 2004; 94:186-92. [PMID: 15556965 DOI: 10.1093/bja/aei028] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND There is limited knowledge of the effects of anaesthetics on left ventricular (LV) diastolic function in humans. Our aim was to evaluate these effects in humans free from cardiovascular disease. METHODS Sixty patients (aged 18-47 yr) who had no history or signs of cardiovascular disease were randomized to receive general anaesthesia with halothane, sevoflurane or propofol. Echocardiography was performed at baseline and during spontaneous respiration at 1 minimum alveolar concentration (MAC) of the inhalational agents or propofol 4 microg ml(-1) (step 1), and repeated during positive-pressure ventilation with 1 and 1.5 MAC of the inhalational agents or with propofol 4 and 6 microg ml(-1) (steps 2a and 2b). Analysis of echocardiographic measurements focused on heart rate corrected isovolumic relaxation time (IVRT(c)) and early diastolic peak velocity of the lateral mitral annulus (E(a)). RESULTS IVRT(c) decreased from baseline to step 1 in the halothane group (82 [95% CI, 76-88] ms and 74 [95% CI, 68-80] ms respectively; P=0.02), remained stable in the sevoflurane group (78 [95% CI, 72-83] ms and 73 [95% CI, 67-81] ms; n.s.) and increased in the propofol group (80 [95% CI, 74-86] ms and 92 [95% CI, 84-102] ms; P=0.02). E(a) decreased in the propofol group only (18.8 [95% CI, 16.5-19.9] cm s(-1) and 16.0 [95% CI, 14.9-17.9] cm s(-1); P=0.003). From step 2a to step 2b, IVRT(c) increased further in the propofol group (109 [95% CI, 99-121] ms and 119 [95% CI, 99-135] ms; P=0.04) but remained stable in the other two groups. E(a) did not change from step 2a to step 2b. CONCLUSIONS Halothane and sevoflurane did not impair LV relaxation, whereas propofol caused a mild impairment. However, the impairment by propofol was of a magnitude that is unlikely to cause clinical diastolic dysfunction.
Collapse
Affiliation(s)
- M Filipovic
- Department of Anaesthesia and Medical Intensive Care Unit, University of Basel/Kantonsspital, CH-4031 Basel, Switzerland.
| | | | | | | | | | | |
Collapse
|