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Corner H, Barley M, Metodiev Y. The use of processed electroencephalography (pEEG) in obstetric anaesthesia: a narrative review. Int J Obstet Anesth 2023; 54:103650. [PMID: 36934515 DOI: 10.1016/j.ijoa.2023.103650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 02/16/2023] [Accepted: 02/28/2023] [Indexed: 03/08/2023]
Abstract
Accidental awareness under general anaesthesia (AAGA) remains a major complication of anaesthesia. The incidence of AAGA during obstetric anaesthesia is high relative to other specialities. The use of processed electroencephalography (pEEG) in the form of "depth of anaesthesia" monitoring has been shown to reduce the incidence of AAGA in the non-obstetric population. The evidence for using pEEG to prevent AAGA in the obstetric population is poor and requires further exploration. Furthermore, pregnancy and disease states affecting the central nervous system, such as pre-eclampsia, may alter the interpretation of pEEG waveforms although this has not been fully characterised. National guidelines exist for pEEG monitoring with total intravenous anaesthesia and for "high-risk" cases regardless of technique, including the obstetric population. However, none of the currently available guidelines relates specifically to obstetric anaesthesia. Using pEEG monitoring for obstetric anaesthesia may also provide additional benefits beyond a reduction in risk of AAGA. These potential benefits include reduced postoperative nausea and vomiting, reduced anaesthetic agent use, a shorter post-anaesthetic recovery stay. In addition, pEEG acts as a surrogate marker of cerebral perfusion, and thus as an additional monitor for impending cardiovascular collapse, as seen in amniotic fluid embolism. The subtle physiological and pathological changes in EEG activity that may occur during pregnancy are an unexplored research area in the context of anaesthetic pEEG monitors. We believe that the direction of clinical practice is moving towards greater use of pEEG monitoring and individualisation of anaesthesia.
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Affiliation(s)
- H Corner
- Department of Anaesthesia, Leicester Royal Infirmary, Leicester, UK.
| | - M Barley
- Department of Anaesthesia, Queens Medical Centre, Nottingham, UK
| | - Y Metodiev
- Department of Anaesthesia, University Hospital of Wales, Cardiff, UK
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Ibrahim EEA, Amer MM, Abuelnaga ME, Abd-Elaal WI. Dexmedetomidine infusion during caesarean section under general anaesthesia: Evaluation of maternal awareness using BIS, maternal and neonatal outcomes. EGYPTIAN JOURNAL OF ANAESTHESIA 2018. [DOI: 10.1016/j.egja.2018.08.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Emad Eldeen A. Ibrahim
- Suez Canal University, Egypt
- Department of Anaesthesia and Intensive Care, Faculty of Medicine, Suez Canal University, Egypt
| | - Mokhtar M. Amer
- Suez Canal University, Egypt
- Department of Anaesthesia and Intensive Care, Faculty of Medicine, Suez Canal University, Egypt
| | - Mohamed E. Abuelnaga
- Suez Canal University, Egypt
- Department of Anaesthesia and Intensive Care, Faculty of Medicine, Suez Canal University, Egypt
| | - Wafaa I. Abd-Elaal
- Suez Canal University, Egypt
- Department of Anaesthesia and Intensive Care, Faculty of Medicine, Suez Canal University, Egypt
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Abstract
Awareness during general anesthesia for cesarean delivery continues to be a major problem. The key to preventing awareness is strict attention to anesthetic technique. The prevalence and implications of aortocaval compression have been firmly established. Compression of the vena cava is a real occurrence when assuming the supine position. Relief of this compression most likely does not occur until the patient is turned 30°, which is not feasible for performing cesarean delivery. Although it is still wise to tilt the patient, the benefit of this tilt may not be as great as once thought.
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Shaylor R, Ginosar Y, Avidan A, Eventov-Friedman S, Amison N, Weiniger CF. Pre-delivery remifentanil infusion for placenta accreta cesarean delivery under general anesthesia: an observational study. J Matern Fetal Neonatal Med 2015; 29:2793-7. [PMID: 26527226 DOI: 10.3109/14767058.2015.1104297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE General anesthesia may be required for placenta accreta cesarean delivery. Intrauterine fetal anesthetic exposure should be minimized to avoid neonatal respiratory depression; opioids are often delayed until post-delivery. METHODS In this observational study, we compared neonatal outcome using pre-delivery remifentanil versus post-delivery (deferred) opioids for placenta accreta cesarean delivery. Choice of anesthesia was discretionary. The primary outcome was Apgar score at 5 min comparing women who received pre-delivery remifentanil versus deferred opioid administration. We recorded maternal/obstetric characteristics, surgical characteristics, maternal hemodynamic data, neonatal outcomes: Apgar scores, umbilical vein pH and respiratory interventions at birth. RESULTS Between February 2007 and April 2014 we identified 40 general anesthesia placenta accreta cesarean deliveries. The remifentanil dose rate ranged from 0.06 to 0.46 mcg kg(-1 )min(-1). Obstetric and maternal characteristics were similar. Neonatal Apgar, umbilical pH and respiratory intervention outcomes were similar in both groups; Apgar scores median (interquartile range IQR [range]) at 5 min were 9 (8-10) for pre-delivery remifentanil versus 9 (9-10) for deferred opioid administration, p = 0.18. CONCLUSIONS We did not observe a significant effect on neonatal Apgar scores at 1 and 5 min, or respiratory interventions at birth when remifentanil infusion was administered pre-delivery.
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Affiliation(s)
- R Shaylor
- a Department of Anesthesiology and Critical Care Medicine , Hadassah Hebrew University Medical Center , Jerusalem , Israel and
| | - Y Ginosar
- a Department of Anesthesiology and Critical Care Medicine , Hadassah Hebrew University Medical Center , Jerusalem , Israel and
| | - A Avidan
- a Department of Anesthesiology and Critical Care Medicine , Hadassah Hebrew University Medical Center , Jerusalem , Israel and
| | - S Eventov-Friedman
- b Department of Neonatology , Hadassah Hebrew University Medical Center , Jerusalem , Israel
| | - N Amison
- a Department of Anesthesiology and Critical Care Medicine , Hadassah Hebrew University Medical Center , Jerusalem , Israel and
| | - C F Weiniger
- a Department of Anesthesiology and Critical Care Medicine , Hadassah Hebrew University Medical Center , Jerusalem , Israel and
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Noskova P, Blaha J, Bakhouche H, Kubatova J, Ulrichova J, Marusicova P, Smisek J, Parizek A, Slanar O, Michalek P. Neonatal effect of remifentanil in general anaesthesia for caesarean section: a randomized trial. BMC Anesthesiol 2015; 15:38. [PMID: 25821405 PMCID: PMC4377196 DOI: 10.1186/s12871-015-0020-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Accepted: 03/09/2015] [Indexed: 02/06/2023] Open
Abstract
Background Remifentanil has been suggested for its short duration of action to replace standard opioids for induction of general anaesthesia in caesarean section. While the stabilizing effect of remifentanil on maternal circulation has been confirmed, its effect on postnatal adaptation remains unclear, as currently published studies are not powered sufficiently to detect any clinical effect of remifentanil on the newborn. Methods Using a double-blinded randomized design, a total of 151 parturients undergoing caesarean delivery under general anaesthesia were randomized into two groups – 76 patients received a bolus of remifentanil prior to induction, while 75 patients were assigned to the control group. Remifentanil 1 μg/kg was administered 30 seconds before the standard induction of general anaesthesia. The primary outcome measure was an assessment of neonatal adaptation using the Apgar score, while secondary outcomes included the need for respiratory support after delivery and differences in umbilical blood gas analysis (Astrup). Results The incidence of lower Apgar scores between 0 and 7 was significantly higher in the remifentanil group at one minute (25% vs. 9.3% of newborns, p = 0.017); whilst at five minutes and later no Apgar score differences were observed. There was no difference in the need for moderate (nasal CPAP) or intensive (intubation) respiratory support, but significantly more neonates in the remifentanil group required tactile stimulation for breathing support (21% vs. 7% of newborns, p = 0.017). There was no difference in the parameters from umbilical cord blood gas analysis between the groups. Conclusion At a dose of 1 μg/kg, remifentanil prior to induction of general anaesthesia increases the risk of neonatal respiratory depression during first minutes after caesarean delivery but duration of clinical symptoms is short. Trial registration ClinicalTrials.gov: NCT01550640.
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Affiliation(s)
- Pavlina Noskova
- Department of Anaesthesiology, Resuscitation and Intensive Medicine, 1st Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, U Nemocnice 2, 128 08 Praha 2, Czech Republic
| | - Jan Blaha
- Department of Anaesthesiology, Resuscitation and Intensive Medicine, 1st Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, U Nemocnice 2, 128 08 Praha 2, Czech Republic
| | - Hana Bakhouche
- Institute of Pharmacology, 1st Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Albertov 4, 128 00 Praha 2, Czech Republic
| | - Jana Kubatova
- Department of Anaesthesiology, Resuscitation and Intensive Medicine, 1st Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, U Nemocnice 2, 128 08 Praha 2, Czech Republic
| | - Jitka Ulrichova
- Department of Anaesthesiology, Resuscitation and Intensive Medicine, 1st Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, U Nemocnice 2, 128 08 Praha 2, Czech Republic
| | - Patricia Marusicova
- Department of Anaesthesiology, Resuscitation and Intensive Medicine, 1st Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, U Nemocnice 2, 128 08 Praha 2, Czech Republic
| | - Jan Smisek
- Neonatology, Department of Gynaecology and Obstetrics, 1st Faculty of Medicine, Charles University and General University Hospital in Prague, Apolinarska 18, 128 51 Praha 2, Czech Republic
| | - Antonin Parizek
- Department of Gynaecology and Obstetrics, 1st Faculty of Medicine, Charles University and General University Hospital in Prague, Apolinarska 18, 128 51 Praha 2, Czech Republic
| | - Ondrej Slanar
- Institute of Pharmacology, 1st Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Albertov 4, 128 00 Praha 2, Czech Republic
| | - Pavel Michalek
- Department of Anaesthesiology, Resuscitation and Intensive Medicine, 1st Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, U Nemocnice 2, 128 08 Praha 2, Czech Republic
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Girgirah K, Quinn A. Reliability of bispectral index analysis in patients undergoing Caesarean section. Br J Anaesth 2015; 114:530. [PMID: 25694570 DOI: 10.1093/bja/aev018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Khanjani S, Naghibi K, Azarnoush H. Awareness and apgar score in elective Cesarean section under general anesthesia with propofol or Isoflurane: A prospective, randomized, double-blinded clinical trial study. Adv Biomed Res 2014; 3:234. [PMID: 25538920 PMCID: PMC4260274 DOI: 10.4103/2277-9175.145735] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2013] [Accepted: 02/03/2014] [Indexed: 12/05/2022] Open
Abstract
Background: Awareness is a postoperative recall of events experienced under general anesthesia. In this study, we compared the incidence of awareness between two routine methods used, inhalation (Isoflurane) and intravenous protocol (Propofol), in elective Cesarean section, and also evaluated the effect of these two different methods on the apgar score of newborns. Materials and Methods: In this prospective, clinical trial study, 90 pregnant women candidates for elective Cesarean section were randomly enrolled, after taking written consent. Induction of anesthesia in both groups was provided by propofol and succinylcholine in the same manner, and maintenance of anesthesia in Group 1 was provided by propofol 100 μg/kg/minute and in Group 2 with isoflurane 1 MAC, to maintain the bispectral index (BIS) between 45 and 60. Blood pressure, heart rate, electrocardiography (ECG), and also Etco2 and o2sat were recorded throughout the surgery and finally analyzed and compared. Results: From 90 patients, four cases of confirmed awareness were found in the propofol group and three cases in the Isoflurane group (8/9% vs. 6/7%), but the apgar scores were comparable between the two groups. Meanwhile there were no significant differences between the two groups in basic information, neonatal apgar scores, hemodynamic changes, and BIS, Electromyography (EMG), and signal quality index (SQI) values. Conclusion: According to the patient's state, diagnosis of the anesthesiologist, and other criteria like price and its availability, we could use these drugs in general anesthesia during Cesarean section, although it is recommended that more studies be done to compare the effect of these two drugs in larger groups.
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Affiliation(s)
- Somayeh Khanjani
- Department of Obstetrics and Gynecology, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Khosrou Naghibi
- Department of Anesthesiology and Intensive Care, Isfahan University of Medical Sciences, Isfahan, Iran
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Poma S, Delmonte MP, Gigliuto C, Imberti R, Delmonte M, Arossa A, Iotti GA. Management of posterior reversible syndrome in preeclamptic women. Case Rep Obstet Gynecol 2014; 2014:928079. [PMID: 25506009 PMCID: PMC4254080 DOI: 10.1155/2014/928079] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2014] [Revised: 10/30/2014] [Accepted: 11/01/2014] [Indexed: 11/17/2022] Open
Abstract
Posterior reversible encephalopathy syndrome (PRES) is a neurological syndrome associated with a number of conditions including preeclampsia. It is characterized by seizures, alteration of consciousness, visual disturbances, and symmetric white matter abnormalities, typically in the posterior parietooccipital regions of the cerebral hemispheres, at computed tomography (CT) and magnetic resonance (MRI). We report three new cases of PRES in preeclamptic patients and describe the management of these patients. We present a brief review of other cases in the literature, with particular attention to the anesthetic management.
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Affiliation(s)
- S. Poma
- Unit of Obstetric Anesthesia, Department of Anesthesia and Intensive Care, Fondazione Policlinico San Matteo Hospital, Viale Golgi 19, 27100 Pavia, Italy
| | - M. P. Delmonte
- Unit of Obstetric Anesthesia, Department of Anesthesia and Intensive Care, Fondazione Policlinico San Matteo Hospital, Viale Golgi 19, 27100 Pavia, Italy
| | - C. Gigliuto
- Department of Anesthesia and Intensive Care, Fondazione Policlinico San Matteo Hospital, Viale Golgi 19, 27100 Pavia, Italy
| | - R. Imberti
- Direzione Scientifica, Fondazione Policlinico San Matteo, Viale Golgi 19, 27100 Pavia, Italy
| | - M. Delmonte
- Dipartimento di Medicina Diagnostica e Servizi, Servizio di Radiodiagnostica, Fondazione Policlinico San Matteo, Viale Golgi 19, 27100 Pavia, Italy
| | - A. Arossa
- Department of Obstetrics and Gynecology, Fondazione Policlinico San Matteo, Viale Golgi 19, 27100 Pavia, Italy
| | - G. A. Iotti
- Department of Anesthesia and Intensive Care, Fondazione Policlinico San Matteo Hospital, Viale Golgi 19, 27100 Pavia, Italy
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Pulse perfusion value predicts eye opening after sevoflurane anaesthesia: an explorative study. J Clin Monit Comput 2014; 29:461-5. [PMID: 25273626 DOI: 10.1007/s10877-014-9623-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2014] [Accepted: 09/24/2014] [Indexed: 10/24/2022]
Abstract
The variables measured in modern pulse oximetry apparatuses include a graphical pulse curve and a specified perfusion value (PV) that could be a sensitive marker for detecting differences in sympathetic activity. We hypothesized that there is a correlation between a reduction of PV and the time to eye opening after general anaesthesia. The objective was to investigate whether PV can predict eye opening after sevoflurane anaesthesia. Prospective, explorative clinical study included 20 patients, ASA physical status 1 or 2, at Skåne University Hospital, Lund, Sweden, from November 2012 to January 2013 scheduled for elective breast tumour surgery. A general anaesthesia was delivered with inhalation of oxygen, nitrous oxide and sevoflurane anaesthesia to a depth of 1.2 minimal alveolar concentration. Sevoflurane inspiratory and expiratory concentrations were measured. Bispectral index monitoring, PV as measured by pulse oximeter, heart rate and carbon dioxide were registered at before anaesthesia, 15 min after induction (at 1.2 minimal alveolar concentration), at end of surgery and at eye opening at the end of anaesthesia. PV values were lower before anaesthesia and at eye opening compared to at 15 min after induction and at end of surgery (P < 0.05). The reduction of PV between end of surgery and eye opening was 0.76. We conclude that the pulse oximeter PV could be a useful variable to assess the timing of recovery, in terms of eye opening after a general anaesthesia.
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Ueki R, Tatara T, Kariya N, Shimode N, Hirose M, Tashiro C. Effect of decreased fetal perfusion on placental clearance of volatile anesthetics in a dual perfused human placental cotyledon model. J Anesth 2014; 28:635-8. [PMID: 24384731 DOI: 10.1007/s00540-013-1777-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2013] [Accepted: 12/16/2013] [Indexed: 11/29/2022]
Abstract
Placental transfer of volatile anesthetics is a critical issue in managing fetal distress during cesarean section under general anesthesia. Using dual perfused human placental cotyledons obtained from parturients undergoing elective cesarean section (n = 5), we investigated the effect of decreased fetal perfusion on placental clearance of sevoflurane and isoflurane. Keeping the maternal flow rate fixed, fetal flow rate was consecutively decreased from 3 ml/min (control perfusion) to 2 ml/min (intermediate perfusion) and to 1 ml/min (hypoperfusion). Placental transfer was assessed by the clearance of anesthetics by the placenta, defined by the ratio of anesthetic concentration in fetal vein and maternal artery, multiplied by fetal flow rate. Placental clearance was compared between different fetal perfusion states and anesthetics. Hypoperfusion resulted in a lower clearance of sevoflurane and isoflurane compared with control (P = 0.002, P < 0.001) and intermediate (P = 0.04, P = 0.018) perfusion. Clearances of sevoflurane and isoflurane were comparable during control perfusion (P = 0.93), intermediate perfusion (P = 1.00), and hypoperfusion (P = 0.88). Thus, maintenance of volatile anesthetics at a marginally low concentration may not be necessary when fetal distress is observed during emergency cesarean delivery because placental transfer of volatile anesthetics decreases with decreasing fetal perfusion.
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Affiliation(s)
- Ryusuke Ueki
- Department of Anesthesiology, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan,
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Bispectral index and cerebral oximetry in low-flow and high-flow rate anaesthesia during laparoscopic cholecystectomy - a randomized controlled trial. Wideochir Inne Tech Maloinwazyjne 2012; 6:226-30. [PMID: 23255984 PMCID: PMC3516945 DOI: 10.5114/wiitm.2011.26256] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2010] [Revised: 10/13/2010] [Accepted: 09/02/2011] [Indexed: 11/17/2022] Open
Abstract
Introduction The need to reduce pollution emissions in the operating room and to reduce treatment costs motivates more frequent use of general anaesthesia with a small or minimal fresh gas flow rate. Nevertheless, the reduction of the delivery of fresh gases should not influence the quality and safety of the anaesthesia. Material and methods A total of 105 elective laparoscopic cholecystectomy patients were included in the study. There were 72 female (68.6%) and 33 male (31.4%) patients. Patients were randomized by a ‘closed envelope’ method into two groups. Group I included patients with low-flow anaesthesia and group II included patients with high-flow anaesthesia. In all patients the cerebral oximetry was measured separately for each cerebral hemisphere; the bispectral index (BIS), heart rate, blood pressure, end-tidal carbon dioxide concentration and haemoglobin oxygen saturation were monitored. Results Heart rate, blood pressure, end-tidal carbon dioxide concentration and saturation were similar in both groups and the differences between them were statistically insignificant. The BIS values were similar in both groups and indicated that patients who underwent low-flow anaesthesia were not exposed to a higher risk of awakening during the procedure than the high-flow anaesthesia patients. The changes in brain oximetry values were similar in both low-flow and high-flow anaesthesia. Conclusions Use of both low-flow and high-flow rate general anaesthesia provided patients undergoing laparoscopic cholecystectomy proper oxygenation of the central nervous system, adequate sleep depth and haemodynamic stability.
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Choi WJ, Kim SH, Koh WU, Hwang DI, Cho SK, Park PH, Han SM, Shin JW. Effect of pre-exposure to sevoflurane on the bispectral index in women undergoing Caesarean delivery under general anaesthesia. Br J Anaesth 2012; 108:990-7. [PMID: 22434266 DOI: 10.1093/bja/aes036] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Patients undergoing Caesarean delivery under inhalation anaesthesia are at a high risk of awareness, especially in the period before delivery. We assessed the effects of pre-exposure to sevoflurane on the bispectral index (BIS) in the interval before delivery. METHODS Sixty-four patients undergoing elective Caesarean delivery were randomly assigned to receive 1.0-1.1 vol% (control 1) or 1.2-1.3 vol% (control 2) end-tidal sevoflurane, or the same concentrations of end-tidal sevoflurane combined with pre-exposure to 1 vol% sevoflurane for the last 1 min of the preoxygenation period (the preSevo 1 and preSevo 2 groups, respectively). We assessed BIS values, arterial pressure, and heart rate at the time of induction; before intubation; and upon skin incision, uterine incision, and delivery. We also determined the maternal incidence of intraoperative awareness and the neonatal Apgar scores, and conducted umbilical blood gas analysis. RESULTS At skin incision, BIS values were significantly lower in the preSevo 1 group than in the control 1 group [50 (13) vs 72 (8), P<0.001] and in the preSevo 2 group than in the control 2 group [44 (11) vs 67 (10), P<0.001]. The mean BIS values in the preSevo 1 and 2 groups were maintained below 60 in the period before delivery. No other parameter differed among groups, and no patient exhibited intraoperative awareness. CONCLUSIONS Pre-exposure to low concentrations of sevoflurane reduced BIS values in the interval before delivery, suggesting that this approach may reduce the risk of maternal awareness. Clinical Research Information Service (code KCT0000069, http://cris.cdc.go.kr).
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Affiliation(s)
- W J Choi
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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Wong C. General anesthesia is unacceptable for elective cesarean section. Int J Obstet Anesth 2010; 19:209-12. [DOI: 10.1016/j.ijoa.2009.10.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2009] [Accepted: 10/01/2009] [Indexed: 11/16/2022]
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Role of potassium and calcium channels in sevoflurane-mediated vasodilation in the foeto-placental circulation. BMC Anesthesiol 2009; 9:4. [PMID: 19515255 PMCID: PMC2702293 DOI: 10.1186/1471-2253-9-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2008] [Accepted: 06/10/2009] [Indexed: 11/24/2022] Open
Abstract
Background Sevoflurane has been demonstrated to vasodilate the foeto-placental vasculature. We aimed to determine the contribution of modulation of potassium and calcium channel function to the vasodilatory effect of sevoflurane in isolated human chorionic plate arterial rings. Methods Quadruplicate ex vivo human chorionic plate arterial rings were used in all studies. Series 1 and 2 examined the role of the K+ channel in sevoflurane-mediated vasodilation. Separate experiments examined whether tetraethylammonium, which blocks large conductance calcium activated K+ (KCa++) channels (Series 1A+B) or glibenclamide, which blocks the ATP sensitive K+ (KATP) channel (Series 2), modulated sevoflurane-mediated vasodilation. Series 3 – 5 examined the role of the Ca++ channel in sevoflurane induced vasodilation. Separate experiments examined whether verapamil, which blocks the sarcolemmal voltage-operated Ca++ channel (Series 3), SK&F 96365 an inhibitor of sarcolemmal voltage-independent Ca++ channels (Series 4A+B), or ryanodine an inhibitor of the sarcoplasmic reticulum Ca++ channel (Series 5A+B), modulated sevoflurane-mediated vasodilation. Results Sevoflurane produced dose dependent vasodilatation of chorionic plate arterial rings in all studies. Prior blockade of the KCa++ and KATP channels augmented the vasodilator effects of sevoflurane. Furthermore, exposure of rings to sevoflurane in advance of TEA occluded the effects of TEA. Taken together, these findings suggest that sevoflurane blocks K+ channels. Blockade of the voltage-operated Ca++channels inhibited the vasodilator effects of sevoflurane. In contrast, blockade of the voltage-independent and sarcoplasmic reticulum Ca++channels did not alter sevoflurane vasodilation. Conclusion Sevoflurane appears to block chorionic arterial KCa++ and KATP channels. Sevoflurane also blocks voltage-operated calcium channels, and exerts a net vasodilatory effect in the in vitro foeto-placental circulation.
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Ok SJ, Kim WY, Lee YS, Kim KG, Shin HW, Chang MS, Kim JH, Park YC. The effects of midazolam on the bispectral index after fetal expulsion in caesarean section under general anaesthesia with sevoflurane. J Int Med Res 2009; 37:154-62. [PMID: 19215685 DOI: 10.1177/147323000903700118] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The effects of midazolam used with low concentration inhaled anaesthetics on the bispectral index (BIS) was investigated after fetal expulsion during caesarean section. Forty-five patients undergoing caesarean section received either normal saline (control, n = 15), or an intravenous bolus of 0.03 mg/kg (n = 15) or 0.05 mg/kg (n = 15) midazolam. Changes in BIS and maternal haemodynamics were monitored before induction, on intubation, at uterine incision, on delivery, at 3, 5 and 10 min after fetal expulsion, at subcutaneous tissue closure, at skin closure, on eye opening and at extubation. BIS values in the group that received 0.05 mg/kg midazolam were significantly lower than in the other two groups at 3, 5 and 10 min after fetal expulsion, and at subcutaneous tissue closure and skin closure. Values of BIS < 60 could only be maintained with 0.05 mg/kg midazolam and there was no delay in maternal emergence or recovery.
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Affiliation(s)
- S-J Ok
- Department of Anaesthesiology and Pain Medicine, Korea University Ansan Hospital, Ansan, Korea
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Farragher R, Maharaj CH, Higgins BD, Crowe S, Burke P, Laffey CD, Flynn NM, Laffey JG. Sevoflurane and the feto-placental vasculature: the role of nitric oxide and vasoactive eicosanoids. Anesth Analg 2008; 107:171-7. [PMID: 18635485 DOI: 10.1213/ane.0b013e318173465e] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND The effects and mechanisms of action of volatile anesthetics on the feto-placental vasculature are not known. We aimed to quantify the vasoactive effects of sevoflurane and determine the role of nitric oxide (NO) and of vasoactive eicosanoids in mediating these effects in isolated human chorionic plate arterial rings. METHODS Quadruplicate ex vivo human chorionic plate arterial rings were used in all studies. Series 1 quantified the vasodilation produced by sevoflurane in rings preconstricted with the thromboxane analog U46619. Series 2A-C examined the role of NO in sevoflurane-mediated vasodilation. In separate experiments, we examined the potential for the nonspecific NO inhibitors, L-NAME, L-nMMA, and the inactive D-NAME, to modulate the vasodilation produced by sevoflurane. Series 2D determined whether sevoflurane altered vascular smooth muscle sensitivity to exogenous NO. Series 3A-D examined the role of vasoactive eicosanoids in sevoflurane-mediated vasodilation. In separate experimental series, we examined whether the nonspecific cyclooxygenase inhibitor, indomethacin, or the 5-lipoxygenase inhibitor, nordihydroguaiaretic acid, modulated sevoflurane-mediated vasodilation. RESULTS Sevoflurane produced dose-dependent vasodilation of preconstricted chorionic plate arterial rings, with mean ring vasodilation increasing from 15 +/- 7% at 2% sevoflurane to 67 +/- 17% (mean +/- sd) at 8% sevoflurane. Blockade of NO synthase did not attenuate the vasodilator effects of sevoflurane. Sevoflurane did not alter smooth muscle sensitivity to NO. Indomethacin augmented sevoflurane vasodilation at 10(-5) M, but not at 10(-6) M. Conversely, nordihydroguaiaretic acid attenuated sevoflurane-mediated vasodilation at 3 x 10(-6) M but not at 3 x 10(-7) M. CONCLUSIONS Sevoflurane was a vasodilator in the feto-placental vasculature in this in vitro model. Sevoflurane-mediated vasodilation is NO and cyclooxygenase-independent and appears to be mediated in part via a lipoxygenase generated vasodilator eicosanoid.
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Affiliation(s)
- Rachel Farragher
- Department of Anaesthesia, Clinical Sciences Institute, National University of Ireland
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Allahyary E, Zand F, Tabatabaee HR. Evaluation of the Adequacy of General Anesthesia in Cesarean Section by Auditory Evoked Potential Index: An Observational Study. ACTA ACUST UNITED AC 2008; 46:16-24. [DOI: 10.1016/s1875-4597(08)60015-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Lee IH, Kim DY, Chung RK, Kim CH. Maternal and neonatal effects of sevoflurane and desflurane in cesarean section. Korean J Anesthesiol 2008. [DOI: 10.4097/kjae.2008.55.4.446] [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)
- In Hwa Lee
- Department of Anesthesiology and Pain Medicine, Ewha Womans University School of Medicine, Seoul, Korea
| | - Dong Yeon Kim
- Department of Anesthesiology and Pain Medicine, Ewha Womans University School of Medicine, Seoul, Korea
| | - Rack Kyung Chung
- Department of Anesthesiology and Pain Medicine, Ewha Womans University School of Medicine, Seoul, Korea
| | - Chi Hyo Kim
- Department of Anesthesiology and Pain Medicine, Ewha Womans University School of Medicine, Seoul, Korea
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Chun EH, Kim JH, Baik HJ, Kim YJ. The Effect of Isoflurane and Sevoflurane on Maternal Awareness under General Anesthesia for Cesarean Section. Korean J Anesthesiol 2008. [DOI: 10.4097/kjae.2008.54.5.524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- Eun Hee Chun
- Department of Anesthesiology and Pain Medicine, School of Medicine, Ewha Womans University, Seoul, Korea
| | - Jong Hak Kim
- Department of Anesthesiology and Pain Medicine, School of Medicine, Ewha Womans University, Seoul, Korea
| | - Hee Jung Baik
- Department of Anesthesiology and Pain Medicine, School of Medicine, Ewha Womans University, Seoul, Korea
| | - Yun Jin Kim
- Department of Anesthesiology and Pain Medicine, School of Medicine, Ewha Womans University, Seoul, Korea
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Banks A, Levy D. General anaesthesia for operative obstetrics. ANAESTHESIA AND INTENSIVE CARE MEDICINE 2007. [DOI: 10.1016/j.mpaic.2007.05.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Kang MY, Yoo KY, Kim SJ, Chung ST. Bispectral Index Values at a Sevoflurane Concentration of 1% in Patients Undergoing Lower Segment Cesarean Delivery: A Comparison between Painful Labor and Painless Labor. Korean J Anesthesiol 2007. [DOI: 10.4097/kjae.2007.53.6.709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- Myung Yoo Kang
- Department of Anesthesiology and Pain Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Kyung Yeon Yoo
- Department of Anesthesiology and Pain Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Seok Jai Kim
- Department of Anesthesiology and Pain Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Sung Tae Chung
- Department of Anesthesiology and Pain Medicine, Chonnam National University Medical School, Gwangju, Korea
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Lee HJ, Kim JB, Choi HJ. Effect of Administration Method of Isoflurane on Bispectral Index Values in the Early Period of Cesarean Section: A Comparison of End-Tidal or Vaporizer Concentration using Overpressure. Korean J Anesthesiol 2007. [DOI: 10.4097/kjae.2007.52.2.143] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- Hae Jin Lee
- Department of Anesthesiology and Pain Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jong Bun Kim
- Department of Anesthesiology and Pain Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - He Jin Choi
- Department of Anesthesiology and Pain Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Abstract
The use of processed electroencephalography (EEG) using a simple frontal lead system has been made available for assessing the impact of anesthetic medications during surgery. This review discusses the basic principles behind these devices. The foundations of anesthesia monitoring rest on the observations of Guedel with ether that the depth of anesthesia relates to the cortical, brainstem and spinal effects of the anesthetic agents. Anesthesiologists strive to have a patient who is immobile, is unconscious, is hemodynamically stable and who has no intraoperative awareness or recall. These anesthetic management principles apply today, despite the absence of ether from the available anesthetic medications. The use of the EEG as a supplement to the usual monitoring techniques rests on the observation that anesthetic medications all alter the synaptic function which produces the EEG. Frontal EEG can be viewed as a surrogate for the drug effects on the entire central nervous system (CNS). Using mathematical processing techniques, commercial EEG devices create an index usually between 0 and 100 to characterize this drug effect. Critical aspects of memory formation occur in the frontal lobes making EEG monitoring in this area a possible method to assess risk of recall. Integration of processed EEG monitoring into anesthetic management is evolving and its ability to characterize all of the anesthetic effects on the CNS (in particular awareness and recall) and improve decision making is under study.
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Affiliation(s)
- Leslie C Jameson
- Anesthesiology, University of Colorado at Denver and Health Sciences Center, 4200 East 9th Ave, Campus Box B113, Denver, CO 80262, USA.
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Abstract
Good multidisciplinary communication is crucial to the safe management of women requiring non-elective Caesarean section. Anaesthetists should participate actively in resuscitation of the fetus in utero; relief of aortocaval compression is paramount. Epidural top-up with levobupivacaine 0.5% is the anaesthetic of choice for women who have been receiving labour epidural analgesia. If epidural top-up fails to provide bilateral light touch anaesthesia from S5 - T5, a combined spinal-epidural technique with small intrathecal dose of local anaesthetic is a useful approach. Pre-eclampsia is not a contra-indication to single-shot spinal anaesthesia, which is the technique of choice for most women presenting for Caesarean section without an epidural catheter in situ. Induction and maintenance doses of drugs for general anaesthesia should not be reduced in the belief that the baby will be harmed. Early postoperative observations are geared towards the detection of overt or covert haemorrhage.
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Affiliation(s)
- D M Levy
- Nottingham University Hospitals NHS Trust, Queen's Medical Centre, Nottingham NG7 2UH, UK.
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Fletcher JE, Hinn AR, Heard CM, Georges LS, Freid EB, Keifer A, Brooks SD, Bailey AG, Valley RD. The Effects of Isoflurane and Desflurane Titrated to a Bispectral Index of 60 on the Cortical Somatosensory Evoked Potential During Pediatric Scoliosis Surgery. Anesth Analg 2005; 100:1797-1803. [PMID: 15920216 DOI: 10.1213/01.ane.0000152193.90756.4e] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
In this study, we compared the effect of isoflurane and desflurane on the posterior tibial somatosensory evoked potential recorded by scalp electrodes during correction of idiopathic scoliosis in pediatric patients. Depth of sedation was controlled by maintaining bispectral index (BIS) at 60 throughout the study. Comparison of patients breathing desflurane and isoflurane showed an evoked cortical amplitude (N37-P45) of 0.53 +/- 0.3 microV versus 1.3 +/- 0.8 microV (P = 0.014), respectively. In addition to this comparison, a crossover design was included whereby the desflurane or isoflurane received in the first part of the study was changed to the other anesthetic. Substituting one anesthetic for another confirmed our initial finding that the cortical evoked amplitude is greater with isoflurane than with desflurane. No differential effect was found between desflurane and isoflurane on the evoked subcortical (N31-P34) amplitude or the P37 latency.
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Affiliation(s)
- James E Fletcher
- *Department of Anesthesiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; and †Department of Anesthesiology, Children's Hospital Buffalo, Buffalo, New York
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