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Jun MR, Kim MG, Han KS, Park JE, Cho HB, Park SY, Song S, Yoo JH, Chung JW, Kim SH. Potency of propofol for inducing loss of consciousness in end-stage kidney disease patients. PLoS One 2021; 16:e0254520. [PMID: 34383773 PMCID: PMC8360375 DOI: 10.1371/journal.pone.0254520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 06/02/2021] [Indexed: 11/18/2022] Open
Abstract
It can be difficult for anesthesiologists to determine the optimal dose of propofol for end-stage kidney disease (ESKD) patients due to changes in drug disposition. The purpose of this study was to evaluate the potency of propofol for inducing loss of consciousness in ESKD patients. Patients with normal kidney function (Control group, n = 15), those with ESKD (ESKD group, n = 15), and those with ESKD undergoing cervical epidural anesthesia (ESKD-CEB group, n = 15) were administered propofol by target-controlled infusion (TCI) using the Schneider model. The effect-site concentration (Ce) of propofol started at 0.5 μg/ml and increased in increments of 0.5 μg/ml until the patient did not respond to verbal commands. The relationship between the probability (P) of loss of consciousness and the Ce of propofol was analyzed in each group using logistic regression. The Ce values of propofol at the time of loss of consciousness were 4.3 ± 0.9, 3.7 ± 0.9, and 3.3 ± 1.0 μg/ml for the Control, ESKD, and ESKD-CEB* groups, respectively (*significant difference vs. control, P < 0.05). The estimated Ce50 values for lost ability to respond to verbal command were 4.56, 3.75, and 3.21 μg/ml for the Control, ESKD, and ESKD-CEB groups, respectively. In conclusion, when inducing anesthesia in ESKD patients, we recommend using an initial dose similar to that of patients with normal kidney function, or rather starting with a lower dose.
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Affiliation(s)
- Mi Roung Jun
- Department of Anesthesiology and Pain Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Republic of Korea
| | - Mun Gyu Kim
- Department of Anaesthesiology and Pain Medicine, Soonchunhyang University Hospital Seoul, Seoul, Republic of Korea
| | - Ki Seob Han
- Department of Anesthesiology and Pain Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Republic of Korea
| | - Ji Eun Park
- Department of Anesthesiology and Pain Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Republic of Korea
| | - Ho Bum Cho
- Department of Anaesthesiology and Pain Medicine, Soonchunhyang University Hospital Seoul, Seoul, Republic of Korea
| | - Sun Young Park
- Department of Anaesthesiology and Pain Medicine, Soonchunhyang University Hospital Seoul, Seoul, Republic of Korea
- * E-mail:
| | - Sanghoon Song
- Department of Anaesthesiology and Pain Medicine, Soonchunhyang University Hospital Seoul, Seoul, Republic of Korea
| | - Jae Hwa Yoo
- Department of Anaesthesiology and Pain Medicine, Soonchunhyang University Hospital Seoul, Seoul, Republic of Korea
| | - Ji Won Chung
- Department of Anaesthesiology and Pain Medicine, Soonchunhyang University Hospital Seoul, Seoul, Republic of Korea
| | - Sang Ho Kim
- Department of Anaesthesiology and Pain Medicine, Soonchunhyang University Hospital Seoul, Seoul, Republic of Korea
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Sitsen E, Olofsen E, Dahan A, Vuyk J. Effect of lumbar epidural blockade and propofol on mean arterial pressure, cardiac output and bispectral index: A randomised controlled and pharmacodynamic modelling study. Eur J Anaesthesiol 2021; 38:S121-S129. [PMID: 33876784 DOI: 10.1097/eja.0000000000001516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND It is generally accepted that a neuraxial blockade strengthens the sedative effects of propofol. Deafferentation caused by neuraxial blockade is thought to play a key role. OBJECTIVES The objective is to determine whether epidural blockade affects the bispectral index (BIS) of propofol and two other pharmacodynamic endpoints, mean arterial pressure (MAP) and cardiac output (CO). DESIGN Randomised, placebo-controlled study. SETTING University hospital. PATIENTS Patients scheduled for surgery needing epidural analgesia. INTERVENTION 28 ASA one or two patients received 0, 50, 100 or 150 mg of epidural ropivacaine. After stabilisation of the epidural blockade, propofol was given by target-controlled infusion. The propofol plasma target concentrations were increased at 6-min intervals from 0 to 1, 2.5, 4 and 6 μg ml-1. The study was performed before surgery. MAIN OUTCOME MEASURES Three endpoints, BIS, mean arterial blood pressure and CO were measured from baseline (prior to the administration of epidural ropivacaine) until 2 h after the start of propofol infusion. The propofol concentration-effect data were analysed to determine the interaction between epidural blockade and propofol sedation. RESULTS In the absence of propofol, the increase in number of epidural blocked segments from 0 to 15.5 (range 6 to 21) reduced the MAP by 30%, without affecting BIS or CO. In the absence of epidural blockade, the increase in propofol concentration to 6 μg ml-1 reduced BIS, MAP and CO. When combined, epidural anaesthesia and intravenous propofol exhibited no pharmacodynamic interaction on any of the three endpoints. In addition, epidural blockade did not affect the propofol effect-site equilibration half-life for its haemodynamic effects (11.5 ± 0.5 min) or for its effects on the BIS (4.6 ± 0.4 min). CONCLUSION Epidural blockade reduces the propofol requirements for sedative end points. This is not the result of a pharmacodynamic interaction. TRIAL REGISTRATION Dutch trial register CCMO, Central Committee on Research Involving Human Subjects, trial number NL 32295.058.10.
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Affiliation(s)
- Elske Sitsen
- From the Department of Anaesthesiology, Leiden University Medical Centre (LUMC), Leiden, The Netherlands (ES, EO, AD, JV)
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3
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Ding W, Chen Y, Li D, Wang L, Liu H, Wang H, Zeng X. Investigation of single-dose thoracic paravertebral analgesia for postoperative pain control after thoracoscopic lobectomy - A randomized controlled trial. Int J Surg 2018; 57:8-14. [PMID: 30056127 DOI: 10.1016/j.ijsu.2018.07.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 06/07/2018] [Accepted: 07/23/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Thoracoscopic lobectomy is less painful than normal thoracotomy, but pain management is still an issue in the postoperative period. Thoracic epidural analgesia (TEA) is considered as the gold standard for post-thoracotomy pain control, but is associated with numerous risks. METHODS A total of 114 patients undergoing thoracoscopic lobectomy were randomly divided into three groups. Patients in the PVB-R group received a single-dose 0.5% ropivacaine paravertebral block (PVB), combined with patient-controlled intravenous analgesia (PCIA) after extubation during the 48-h postoperative period; those in the PVB-RD group received a single-dose 0.5% ropivacaine and dexmedetomidine (1 μg/kg) PVB, combined with the same PCIA scheme; and those in the TEA group received intraoperative thoracic epidural anesthesia with 0.5% ropivacaine, and a single dose of epidural morphine (0.03 mg/kg) after extubation combined with the same PCIA scheme. The dose and first time of postoperative analgesia, verbal rating score (VRS), change in catecholamine, cortisol and cytokine levels, change in hemodynamic parameters, and side effects during the postoperative period were recorded. RESULTS Compared to the PVB-R group, the dose of postoperative analgesia and VRS were lower and the first time of postoperative analgesia were longer in the PVB-RD and TEA group. Patients in the PVB-RD group had a lower incidence of side effects compared to those in the TEA group. CONCLUSIONS Single-dose 0.5% ropivacaine combined with dexmedetomidine (1 μg/kg) PVB provides satisfactory postoperative pain control after thoracoscopic lobectomy, and can reduce the incidence of postoperative side effects.
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Affiliation(s)
- Wengang Ding
- Department of Anaesthesiology, Second Hospital of Harbin Medical University, 246 Xuefu Road, Harbin 150001, Heilongjiang, China.
| | - Yannan Chen
- Department of Anaesthesiology, Second Hospital of Harbin Medical University, 246 Xuefu Road, Harbin 150001, Heilongjiang, China.
| | - Dongmei Li
- Department of Anaesthesiology, Second Hospital of Harbin Medical University, 246 Xuefu Road, Harbin 150001, Heilongjiang, China.
| | - Lu Wang
- Department of Anaesthesiology, Second Hospital of Harbin Medical University, 246 Xuefu Road, Harbin 150001, Heilongjiang, China.
| | - Haopan Liu
- Department of Anaesthesiology, Second Hospital of Harbin Medical University, 246 Xuefu Road, Harbin 150001, Heilongjiang, China.
| | - Hongyan Wang
- Department of Anaesthesiology, Second Hospital of Harbin Medical University, 246 Xuefu Road, Harbin 150001, Heilongjiang, China.
| | - Xianzhang Zeng
- Department of Anaesthesiology, Second Hospital of Harbin Medical University, 246 Xuefu Road, Harbin 150001, Heilongjiang, China.
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4
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Zhao L, Zhang Y, Yang F, Zhu D, Li N, Zhao L, Li N, Yu J, Ma H. Effects of intrathecal bupivacaine on the NR2B/CaMKIIα/CREB signaling pathway in the rat lumbar spinal cord. Mol Med Rep 2018; 17:4508-4514. [PMID: 29344649 PMCID: PMC5802227 DOI: 10.3892/mmr.2018.8448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Accepted: 12/12/2017] [Indexed: 11/08/2022] Open
Abstract
Neuraxial anesthesia produces an anesthetic-sparing, sedative effect. The mechanism underlying this effect potentially involves decreased spinal afferent input. However, the neurochemical mechanisms at the spinal level remain unknown. The N-methyl-D-aspartate receptor 2B subunit/calcium-calmodulin-dependent protein kinase II α/cAMP response element-binding protein (NR2B/CaMKIIα/CREB) signaling pathway serves an important role in regulating the transmittance of peripheral noxious stimulation to supraspinal regions in the process of nociception. The present study investigated the effects of intrathecal bupivacaine on the NR2B/CaMKIIα/CREB signaling pathway. Following catheterization, 36 male Sprague-Dawley rats were randomly assigned to a normal saline (NS) or bupivacaine treatment group, in which each rat intrathecally received 20 µl normal saline or 0.5% bupivacaine, respectively. The expression levels of NR2B, CaMKIIα/p-CaMKIIα, and CREB/phosphorylated (p)-CREB in the lumbar spinal cord were investigated by western blotting, reverse transcription-quantitative polymerase chain reaction and immunohistochemistry (IHC). Following bupivacaine treatment, western blot analysis demonstrated that the protein expression levels of NR2B, p-CaMKIIα, and p-CREB in the spinal cord were reduced by approximately 54, 56 and 33%, respectively, compared with NS control rats. Similar alterations in expression were observed by IHC analysis. Additionally, mRNA expression levels of NR2B, CaMKIIα, and CREB were also downregulated following the intrathecal administration of bupivacaine. Therefore, the sedative effect of subarachnoid blockade with bupivacaine possibly occurs through de-afferentation, which may reduce cortical arousal by downregulating the spinal NR2B/CaMKIIα/CREB pathway in vivo, however further investigation is required in order to verify this.
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Affiliation(s)
- Liyan Zhao
- Department of Anesthesiology, Ningxia Medical University, Yinchuan, Ningxia 750004, P.R. China
| | - Yonghai Zhang
- Department of Anesthesiology, General Hospital of Ningxia Medical University, Yinchuan, Ningxia 750004, P.R. China
| | - Fan Yang
- Department of Anesthesiology, General Hospital of Ningxia Medical University, Yinchuan, Ningxia 750004, P.R. China
| | - Di Zhu
- Department of Anesthesiology, Ningxia Medical University, Yinchuan, Ningxia 750004, P.R. China
| | - Ningkang Li
- Department of Anesthesiology, Ningxia Medical University, Yinchuan, Ningxia 750004, P.R. China
| | - Li Zhao
- Department of Anesthesiology, General Hospital of Ningxia Medical University, Yinchuan, Ningxia 750004, P.R. China
| | - Na Li
- Department of Anesthesiology, Ningxia Medical University, Yinchuan, Ningxia 750004, P.R. China
| | - Jianqiang Yu
- Department of Pharmacology, Ningxia Hui Medicine Modern Engineering Research Center and Collaborative Innovation Center, Ningxia Medical University, Yinchuan, Ningxia 750004, P.R. China
| | - Hanxiang Ma
- Department of Anesthesiology, General Hospital of Ningxia Medical University, Yinchuan, Ningxia 750004, P.R. China
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Dumans-Nizard V, Le Guen M, Sage E, Chazot T, Fischler M, Liu N. Thoracic Epidural Analgesia With Levobupivacaine Reduces Remifentanil and Propofol Consumption Evaluated by Closed-Loop Titration Guided by the Bispectral Index. Anesth Analg 2017; 125:635-642. [DOI: 10.1213/ane.0000000000001996] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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6
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Ri HS, Baek SH, Yoon JU, Byeon GJ, Kim HY, Yoon JP. Optimal dose of dexmedetomidine for sedation during epidural anesthesia. Anesth Pain Med (Seoul) 2017. [DOI: 10.17085/apm.2017.12.3.261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Hyun-Su Ri
- Department of Anesthesia and Pain Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Seung Hoon Baek
- Department of Anesthesia and Pain Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Ji-Uk Yoon
- Department of Anesthesia and Pain Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Gyeong-Jo Byeon
- Department of Anesthesia and Pain Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Hee-Young Kim
- Department of Anesthesia and Pain Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Jung Pil Yoon
- Department of Anesthesia and Pain Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
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7
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Zeng X, Jiang J, Yang L, Ding W. Epidural Dexmedetomidine Reduces the Requirement of Propofol during Total Intravenous Anaesthesia and Improves Analgesia after Surgery in Patients undergoing Open Thoracic Surgery. Sci Rep 2017. [PMID: 28638060 PMCID: PMC5479811 DOI: 10.1038/s41598-017-04382-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
The aim of this study was to assess the systemic and analgesic effects of epidural dexmedetomidine in thoracic epidural anaesthesia (TEA) combined with total intravenous anaesthesia during thoracic surgery. Seventy-one patients undergoing open thoracotomy were included in this study and randomly divided into three groups: Control group (Group C): patients received TEA with levobupivacaine alone and were intravenously infused with saline; Epidural group (Group E): patients received TEA with levobupivacaine and dexmedetomidine, and were intravenously infused with saline; Intravenous group (group V): patients received TEA with levobupivacaine alone and were intravenously infused with dexmedetomidine. The doses of propofol used in the induction and maintenance of general anaesthesia, cardiovascular response, dose and first time of postoperative analgesia and verbal rating scale were recorded. The induction and maintenance were significantly lower in the Groups E and V. Verbal rating scale and postoperative analgesic requirements were significantly lower in Group E than in Groups C and V. Patients in Group C had more severe cardiovascular responses, as compared with Groups E and V. Epidural administration of dexmedetomidine reduced the induction and maintenance of propofol, and inhibited the cardiovascular response after intubation and extubation. Moreover, epidural dexmedetomidine provided better analgesia after open thoracotomy.
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Affiliation(s)
- Xianzhang Zeng
- Department of Anaesthesiology, Second Hospital of Harbin Medical University, 246 Xuefu Road, Harbin, 150001, Heilongjiang, China
| | - Jingjing Jiang
- Department of Anaesthesiology, Second Hospital of Harbin Medical University, 246 Xuefu Road, Harbin, 150001, Heilongjiang, China
| | - Lingling Yang
- Department of Anaesthesiology, Second Hospital of Harbin Medical University, 246 Xuefu Road, Harbin, 150001, Heilongjiang, China
| | - Wengang Ding
- Department of Anaesthesiology, Second Hospital of Harbin Medical University, 246 Xuefu Road, Harbin, 150001, Heilongjiang, China.
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8
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Wink J, de Wilde RBP, Wouters PF, van Dorp ELA, Veering BT, Versteegh MIM, Aarts LPHJ, Steendijk P. Thoracic Epidural Anesthesia Reduces Right Ventricular Systolic Function With Maintained Ventricular-Pulmonary Coupling. Circulation 2016; 134:1163-1175. [DOI: 10.1161/circulationaha.116.022415] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Accepted: 09/02/2016] [Indexed: 11/16/2022]
Abstract
Background:
Blockade of cardiac sympathetic fibers by thoracic epidural anesthesia may affect right ventricular function and interfere with the coupling between right ventricular function and right ventricular afterload. Our main objectives were to study the effects of thoracic epidural anesthesia on right ventricular function and ventricular-pulmonary coupling.
Methods:
In 10 patients scheduled for lung resection, right ventricular function and its response to increased afterload, induced by temporary, unilateral clamping of the pulmonary artery, was tested before and after induction of thoracic epidural anesthesia using combined pressure-conductance catheters.
Results:
Thoracic epidural anesthesia resulted in a significant decrease in right ventricular contractility (ΔESV
25
: +25.5 mL,
P
=0.0003; ΔEes: -0.025 mm Hg/mL,
P
=0.04). Stroke work, dP/dt
MAX
, and ejection fraction showed a similar decrease in systolic function (all
P
<0.05). A concomitant decrease in effective arterial elastance (ΔEa: -0.094 mm Hg/mL,
P
=0.004) yielded unchanged ventricular-pulmonary coupling. Cardiac output, systemic vascular resistance, and mean arterial blood pressure were unchanged. Clamping of the pulmonary artery significantly increased afterload (ΔEa: +0.226 mm Hg/mL,
P
<0.001). In response, right ventricular contractility increased (ΔESV
25
: -26.6 mL,
P
=0.0002; ΔEes: +0.034 mm Hg/mL,
P
=0.008), but ventricular-pulmonary coupling decreased (Δ(Ees/Ea) = -0.153,
P
<0.0001). None of the measured indices showed significant interactive effects, indicating that the effects of increased afterload were the same before and after thoracic epidural anesthesia.
Conclusions:
Thoracic epidural anesthesia impairs right ventricular contractility but does not inhibit the native positive inotropic response of the right ventricle to increased afterload. Right ventricular-pulmonary arterial coupling was decreased with increased afterload but not affected by the induction of thoracic epidural anesthesia.
Clinical Trial Registration:
URL:
http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=2844
. Unique identifier: NTR2844.
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Affiliation(s)
- Jeroen Wink
- From the Department of Anesthesiology (J.W., E.L.A.v.D., B.T.V., L.P.H.J.A.), Department of Intensive Care (R.B.P.d.W.), Department of Cardiothoracic Surgery (M.I.M.V.), and Department of Cardiology (P.S.), Leiden University Medical Center, The Netherlands; and the Department of Anesthesia, University Hospitals Ghent, Belgium (P.F.W.)
| | - Rob B. P. de Wilde
- From the Department of Anesthesiology (J.W., E.L.A.v.D., B.T.V., L.P.H.J.A.), Department of Intensive Care (R.B.P.d.W.), Department of Cardiothoracic Surgery (M.I.M.V.), and Department of Cardiology (P.S.), Leiden University Medical Center, The Netherlands; and the Department of Anesthesia, University Hospitals Ghent, Belgium (P.F.W.)
| | - Patrick F. Wouters
- From the Department of Anesthesiology (J.W., E.L.A.v.D., B.T.V., L.P.H.J.A.), Department of Intensive Care (R.B.P.d.W.), Department of Cardiothoracic Surgery (M.I.M.V.), and Department of Cardiology (P.S.), Leiden University Medical Center, The Netherlands; and the Department of Anesthesia, University Hospitals Ghent, Belgium (P.F.W.)
| | - Eveline L. A. van Dorp
- From the Department of Anesthesiology (J.W., E.L.A.v.D., B.T.V., L.P.H.J.A.), Department of Intensive Care (R.B.P.d.W.), Department of Cardiothoracic Surgery (M.I.M.V.), and Department of Cardiology (P.S.), Leiden University Medical Center, The Netherlands; and the Department of Anesthesia, University Hospitals Ghent, Belgium (P.F.W.)
| | - Bernadette Th. Veering
- From the Department of Anesthesiology (J.W., E.L.A.v.D., B.T.V., L.P.H.J.A.), Department of Intensive Care (R.B.P.d.W.), Department of Cardiothoracic Surgery (M.I.M.V.), and Department of Cardiology (P.S.), Leiden University Medical Center, The Netherlands; and the Department of Anesthesia, University Hospitals Ghent, Belgium (P.F.W.)
| | - Michel I. M. Versteegh
- From the Department of Anesthesiology (J.W., E.L.A.v.D., B.T.V., L.P.H.J.A.), Department of Intensive Care (R.B.P.d.W.), Department of Cardiothoracic Surgery (M.I.M.V.), and Department of Cardiology (P.S.), Leiden University Medical Center, The Netherlands; and the Department of Anesthesia, University Hospitals Ghent, Belgium (P.F.W.)
| | - Leon P. H. J. Aarts
- From the Department of Anesthesiology (J.W., E.L.A.v.D., B.T.V., L.P.H.J.A.), Department of Intensive Care (R.B.P.d.W.), Department of Cardiothoracic Surgery (M.I.M.V.), and Department of Cardiology (P.S.), Leiden University Medical Center, The Netherlands; and the Department of Anesthesia, University Hospitals Ghent, Belgium (P.F.W.)
| | - Paul Steendijk
- From the Department of Anesthesiology (J.W., E.L.A.v.D., B.T.V., L.P.H.J.A.), Department of Intensive Care (R.B.P.d.W.), Department of Cardiothoracic Surgery (M.I.M.V.), and Department of Cardiology (P.S.), Leiden University Medical Center, The Netherlands; and the Department of Anesthesia, University Hospitals Ghent, Belgium (P.F.W.)
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Atalan HK, Gucyetmez B, Donmez R, Berktas M, Kargi A, Erturer A, Sozenoglu İR, Denizalti TB, Polat KY. The effects of high lumbar epidural analgesia on postoperative pulmonary function tests in liver transplant donor patients. Intensive Care Med Exp 2015. [PMCID: PMC4797765 DOI: 10.1186/2197-425x-3-s1-a693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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10
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Xiang Y, Chen CQ, Chen HJ, Li M, Bao FP, Sheng-mei Z. The effect of epidural lidocaine administration on sedation of propofol general anesthesia: a randomized trial. J Clin Anesth 2014; 26:523-9. [DOI: 10.1016/j.jclinane.2014.03.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2012] [Revised: 03/10/2014] [Accepted: 03/11/2014] [Indexed: 10/24/2022]
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Yang W, Geng Y, Liu Y, Li A, Liu J, Xing J, Li W. Comparison of Effects of Thoracic Epidural and Intravenous Administration of Lidocaine on Target-Controlled Infusion of Propofol and Tracheal Intubation Response During Induction of Anesthesia. J Cardiothorac Vasc Anesth 2013; 27:1295-300. [DOI: 10.1053/j.jvca.2012.12.020] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2012] [Indexed: 11/11/2022]
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12
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YOO KY, JEONG CW, JEONG HJ, LEE SH, NA JH, KIM SJ, JEONG ST, LEE J. Thiopental dose requirements for induction of anaesthesia and subsequent endotracheal intubation in patients with complete spinal cord injuries. Acta Anaesthesiol Scand 2012; 56:770-6. [PMID: 22288930 DOI: 10.1111/j.1399-6576.2011.02640.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/14/2011] [Indexed: 11/28/2022]
Abstract
BACKGROUND Dose requirements of thiopental depend on patient characteristics and infusion rate. We determined thiopental dose requirements for induction of anaesthesia, and the effects of remifentanil on cardiovascular and bispectral index (BIS) responses to tracheal intubation in spinal cord-injured (SCI) patients undergoing general anaesthesia. METHODS Twenty patients with traumatic complete SCI undergoing elective surgery were enrolled. Twenty patients without SCI served as control. Anaesthesia was induced with thiopental, followed by remifentanil 1 μg/kg and rocuronium 0.8 mg/kg, and maintained with 2% sevoflurane and 50% nitrous oxide in oxygen after tracheal intubation. Thiopental was administered at a rate of 50 mg/15 s until abolition of the eyelash reflex. Thiopental doses, BIS values, systolic arterial blood pressure (SAP), heart rate (HR) and plasma catecholamine concentrations were measured. RESULTS Total thiopental dose required to abolish the eyelash reflex based on total body weight (BW) (5.26 ± 0.87 vs. 3.91 ± 1.07 mg/kg, P < 0.001) or lean BW (6.56 ± 1.37 vs. 5.24 ± 1.36 mg/kg, P < 0.01) were significantly smaller in the SCI group than in the control. SAP was decreased by induction of anaesthesia with thiopental and remifentanil, and increased by tracheal intubation in both groups. However, the peak SAP after intubation was smaller in the SCI patients. HR increased significantly above baseline values following intubation in both groups with no significant intergroup differences. Hypertension was more frequent in the control group. Norepinephrine concentrations remained unaltered following intubation in both groups. CONCLUSIONS These results suggest that the dose requirements of thiopental for induction of general anaesthesia and subsequent tracheal intubation are reduced in the SCI patients.
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Affiliation(s)
- K. Y. YOO
- Department of Anaesthesiology and Pain Medicine; Chonnam National University Medical School; Gwangju; South Korea
| | - C. W. JEONG
- Department of Anaesthesiology and Pain Medicine; Chonnam National University Medical School; Gwangju; South Korea
| | - H. J. JEONG
- Department of Anaesthesiology and Pain Medicine; Chonnam National University Medical School; Gwangju; South Korea
| | - S. H. LEE
- Department of Anaesthesiology and Pain Medicine; Chonnam National University Medical School; Gwangju; South Korea
| | - J. H. NA
- Department of Anaesthesiology; Seonam University Hospital; Gwangju; South Korea
| | - S. J. KIM
- Department of Anaesthesiology and Pain Medicine; Chonnam National University Medical School; Gwangju; South Korea
| | - S. T. JEONG
- Department of Anaesthesiology and Pain Medicine; Chonnam National University Medical School; Gwangju; South Korea
| | - J. LEE
- Department of Physiology; Chonnam National University Medical School; Gwangju; South Korea
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Kim SH, Chun DH, Chang CH, Kim TW, Kim YM, Shin YS. Effect of caudal block on sevoflurane requirement for lower limb surgery in children with cerebral palsy. Paediatr Anaesth 2011; 21:394-8. [PMID: 21299684 DOI: 10.1111/j.1460-9592.2011.03530.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Caudal block is a widely used technique for providing perioperative pain management in children. In this randomized double-blinded study, we evaluated the effects of preoperative caudal block on sevoflurane requirements in children with cerebral palsy (CP) undergoing lower limb surgery while bispectral index (BIS) values were maintained between 45 and 55. METHODS 52 children undergoing Achilles-tendon lengthening were randomized to receive combined general-caudal anesthesia (caudal group, n = 27) or general anesthesia alone (control group, n = 25). Caudal block was performed with a single dose of 0.7 ml·kg(-1) of 1.0% lidocaine containing epinephrine at 5 μg·ml(-1). The control group received no preoperative caudal block. The endtidal sevoflurane concentrations (ET(sev)) were adjusted every minute to maintain the BIS values between 45 and 55. RESULTS The ET(sev) required to maintain the BIS values were not significantly different between the control and caudal groups after induction of anesthesia [2.1 (0.2) vs 2.2 (0.4); P = 0.773]. However, significantly higher ET(sev) was observed in the control group before surgical incision [2.0 (0.2) vs 1.8 (0.3); P = 0.013] and during the first 20 min after surgical incision [2.2 (0.3) vs 1.4 (0.3); P < 0.001]. There was no significant difference in BIS values between the control and caudal groups throughout the study period (P > 0.05). In the caudal group, the caudal block was successful in 25 of 27 (92.6%) patients. CONCLUSIONS Caudal block effectively reduced sevoflurane requirements by 36% compared to general anesthesia alone in children with CP undergoing lower limb surgery while BIS values were maintained between 45 and 55.
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Affiliation(s)
- Soo Hwan Kim
- Department of Anesthesiology and Pain Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
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Current World Literature. Curr Opin Anaesthesiol 2009; 22:822-7. [DOI: 10.1097/aco.0b013e328333ec47] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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