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Lan JY, Shieh JS, Yeh JR, Fan SZ. Fractal Properties of Heart Rate Dynamics: A New Biomarker for Anesthesia-Biphasic Changes in General Anesthesia and Decrease in Spinal Anesthesia. SENSORS (BASEL, SWITZERLAND) 2022; 22:9258. [PMID: 36501959 PMCID: PMC9740393 DOI: 10.3390/s22239258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 11/10/2022] [Accepted: 11/25/2022] [Indexed: 06/17/2023]
Abstract
Processed electroencephalogram (EEG) has been considered a useful tool for measuring the depth of anesthesia (DOA). However, because of its inability to detect the activities of the brain stem and spinal cord responsible for most of the vital signs, a new biomarker for measuring the multidimensional activities of the central nervous system under anesthesia is required. Detrended fluctuation analysis (DFA) is a new technique for detecting the scaling properties of nonstationary heart rate (HR) behavior. This study investigated the changes in fractal properties of heart rate variability (HRV), a nonlinear analysis, under intravenous propofol, inhalational desflurane, and spinal anesthesia. We compared the DFA method with traditional spectral analysis to evaluate its potential as an alternative biomarker under different levels of anesthesia. Eighty patients receiving elective procedures were randomly allocated different anesthesia. HRV was measured with spectral analysis and DFA short-term (4-11 beats) scaling exponent (DFAα1). An increase in DFAα1 followed by a decrease at higher concentrations during propofol or desflurane anesthesia is observed. Spinal anesthesia decreased the DFAα1 and low-/high-frequency ratio (LF/HF ratio). DFAα1 of HRV is a sensitive and specific method for distinguishing changes from baseline to anesthesia state. The DFAα1 provides a potential real-time biomarker to measure HRV as one of the multiple dimensions of the DOA.
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Affiliation(s)
- Jheng-Yan Lan
- Department of Anesthesiology, Taipei Veterans General Hospital, Yuli Branch, Hualian 98142, Taiwan
| | - Jiann-Shing Shieh
- Department of Mechanical Engineering, Yuan Ze University, Taoyuan 320, Taiwan
| | - Jia-Rong Yeh
- Department of Anesthesiology, National Taiwan University Hospital, Taipei 10002, Taiwan
| | - Shou-Zen Fan
- Department of Anesthesiology, National Taiwan University Hospital, Taipei 10002, Taiwan
- Department of Anesthesiology, En Chu Kong Hospital, New Taipei City 237, Taiwan
- College of Medicine, National Taiwan University, Taipei 10002, Taiwan
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Scoping review of the association between postsurgical pain and heart rate variability parameters. Pain Rep 2021; 6:e977. [PMID: 35155967 PMCID: PMC8824397 DOI: 10.1097/pr9.0000000000000977] [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: 08/23/2021] [Revised: 10/07/2021] [Accepted: 10/13/2021] [Indexed: 11/26/2022] Open
Abstract
Supplemental Digital Content is Available in the Text. This scoping review provides some evidence of a possible association between heart rate variability and postsurgical pain, although significant variability exists among included studies. Surgical interventions can elicit neuroendocrine and sympathovagal responses, leading to cardiac autonomic imbalance. Cardiac complications account for approximately 30% of postoperative complications. Altered heart rate variability (HRV) was initially described in the 1970s as a predictor of acute coronary syndromes and has more recently been shown to be an independent predictor of postoperative morbidity and mortality after noncardiac surgery. In general, HRV reflects autonomic balance, and altered HRV measures have been associated with anesthetic use, chronic pain conditions, and experimental pain. Despite the well-documented relationship between altered HRV and postsurgical outcomes and various pain conditions, there has not been a review of available evidence describing the association between postsurgical pain and HRV. We examined the relationship between postsurgical pain and HRV. MEDLINE and EMBASE databases were searched until December 2020 and included all studies with primary data. Two reviewers independently assessed risk of bias for each study using the criteria outlined in the Cochrane Handbook for Systematic Review of Interventions. A total of 8 studies and 1002 participants were included. Studies examined the association of postsurgical pain and HRV or analgesia nociception index derived from HRV. There was a statistically significant association between HRV measures and postsurgical pain in 6 of 8 studies. Heterogeneity of studies precluded meta-analyses. No studies reported cardiovascular outcomes. There is a potential association between postsurgical pain and HRV or analgesia nociception index, although results are likely impacted by confounding variables. Future studies are required to better delineate the relationship between postsurgical pain and HRV and impacts on cardiovascular outcomes.
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So V, Klar G, Leitch J, McGillion M, Devereaux PJ, Arellano R, Parlow J, Gilron I. Association between postsurgical pain and heart rate variability: protocol for a scoping review. BMJ Open 2021; 11:e044949. [PMID: 33849852 PMCID: PMC8051399 DOI: 10.1136/bmjopen-2020-044949] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 03/29/2021] [Accepted: 03/30/2021] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION Surgical interventions can elicit neuroendocrine responses and sympathovagal imbalance, ultimately affecting cardiac autonomic function. Cardiac complications account for 30% of postoperative complications and are the leading cause of morbidity and mortality following non-cardiac surgery. One cardiovascular parameter, heart rate variability (HRV), has been found to be predictive of postoperative morbidity and mortality. HRV is defined as variation in time intervals between heartbeats and is affected by cardiac autonomic balance. Furthermore, altered HRV has been shown to predict cardiovascular events in non-surgical settings. In multiple studies, experimentally induced pain in healthy humans leads to reduced HRV suggesting a causal relationship. In a different studies, chronic pain has been associated with altered HRV, however, in the setting of clinical pain conditions, it remains unclear how much HRV impairment is due to pain itself versus autonomic changes related to analgesia. We aim to review the available evidence describing the association between postsurgical pain and HRV alterations in the early postoperative period. METHODS AND ANALYSIS We will conduct a scoping review of relevant studies using detailed searches of MEDLINE and EMBASE, in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis. Included studies will involve participants undergoing non-cardiac surgery and investigate outcomes of (1) measures of pain intensity; (2) measures of HRV and (3) statistical assessment of association between #1 and #2. As secondary review outcomes included studies will also be examined for other cardiovascular events and for their attempts to control for analgesic treatment and presurgical HRV differences among treatment groups in the analysis. This work aims to synthesise available evidence to inform future research questions related to postsurgical pain and cardiac complications. ETHICS AND DISSEMINATION Ethics review and approval is not required for this review. The results will be submitted for publication in peer-reviewed journals.
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Affiliation(s)
- Vincent So
- Anesthesiology and Perioperative Medicine, Queen's University, Kingston, Ontario, Canada
| | - Gregory Klar
- Anesthesiology and Perioperative Medicine, Queen's University, Kingston, Ontario, Canada
| | - Jordan Leitch
- Anesthesiology and Perioperative Medicine, Queen's University, Kingston, Ontario, Canada
| | - Michael McGillion
- School of Nursing, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - P J Devereaux
- Division of Cardiology, Medicine, McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada
| | - Ramiro Arellano
- Anesthesiology and Perioperative Medicine, Queen's University, Kingston, Ontario, Canada
| | - Joel Parlow
- Anesthesiology and Perioperative Medicine, Queen's University, Kingston, Ontario, Canada
- Departments of Biomedical and Molecular Sciences, Queen's University Faculty of Health Sciences, Kingston, Ontario, Canada
| | - Ian Gilron
- Anesthesiology and Perioperative Medicine, Queen's University, Kingston, Ontario, Canada
- Departments of Biomedical and Molecular Sciences, Centre for Neuroscience Studies, Queen's University Faculty of Health Sciences, Kingston, Ontario, Canada
- School of Policy Studies, Queen's University, Kingston, Ontario, Canada
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Fares KM, Mohamed SAB, Abd El-Rahman AM, AbdeLemam RM, Osman AMM. Analgesic Effect of Intrathecal Fentanyl vs Dexmedetomidine as Adjuvants to Bupivacaine Following Abdominal Surgery for Cancer in Children, a Randomized Trial. PAIN MEDICINE 2020; 21:2634-2641. [DOI: 10.1093/pm/pnaa259] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
AbstractBackgroundIntrathecal fentanyl in spinal anesthesia improves intra- and postoperative analgesia. Dexmedetomidine is a fascinating adjuvant with regards to neuraxial anesthesia in children experiencing surgery for abdominal malignancy.Patients and MethodsAfter endorsement by the institutional reviewing board (IRB) and guardians’ written informed consent, this research was carried out on 60 pediatric malignancy patients scheduled for major abdominal surgery. Children were randomly distributed into three groups (20 patients each): Group C: given 2 mL of bupivacaine 0.5% (0.4 mg/kg) intrathecally, injected gradually over 20 seconds. Group F: the same as group C, plus fentanyl 0.2 μg/kg. Group D: the same as group C, plus dexmedetomidine 0.2 μg/kg. Pain at zero, two, four, six, 12, 18, and 24 hours postoperatively was evaluated by Face, Legs, Activity, Crying, and Consolability (FLACC) score. First analgesic request and postoperative unfavorable effects were recorded for 24 hours postoperatively.ResultsA significant decrease was recognized in the mean FLACC score in groups D and F at six, eight, and 12 hours postoperatively, in contrast to group C (P ≤ 0.05). First analgesic request was significantly prolonged in group D (7.67 ± 0.57 hours), in contrast to groups F and C (5.40 ± 1.09 hours and 4.23 ± 3.27 hours, respectively, P < 0.04). Paracetamol utilization was significantly decreased in group D (316.67 ± 28.86 mg), in contrast to group C (391.00 ± 52.00 mg, P < 0.03), without a significant difference between group F (354.44 ± 46.67 mg) and groups D and C (P > 0.05).ConclusionsAdding dexmedetomidine and fentanyl to intrathecal bupivacaine improved postoperative analgesia following abdominal surgery for cancer in children, with better overall analgesia of dexmedetomidine compared with fentanyl.
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Affiliation(s)
- Khaled Mohamed Fares
- Anesthesia, Intensive Care and Pain Management, South Egypt Cancer Institute, Assiut University, Assiut, Egypt
| | - Sahar Abdel-Baky Mohamed
- Anesthesia, Intensive Care and Pain Management, South Egypt Cancer Institute, Assiut University, Assiut, Egypt
| | | | - Rania Mohammed AbdeLemam
- Anesthesia, Intensive Care and Pain Management, South Egypt Cancer Institute, Assiut University, Assiut, Egypt
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Hofhuizen C, Lemson J, Snoeck M, Scheffer GJ. Spinal anesthesia-induced hypotension is caused by a decrease in stroke volume in elderly patients. Local Reg Anesth 2019; 12:19-26. [PMID: 30881108 PMCID: PMC6404676 DOI: 10.2147/lra.s193925] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Background Hypotension is common during spinal anesthesia (SA) and is caused by a decrease in systemic vascular resistance (SVR) and/or cardiac output (CO). The effect of the dose of bupivacaine administered intrathecally on the changes in CO in elderly patients is largely unknown. This study investigated the hemodynamic effect of SA in elderly patients by studying the effect of two different dosages of intrathecal bupivacaine. Methods This prospective cohort study included 64 patients aged >65 years scheduled for procedures under SA; the patients received either 15 mg bupivacaine (the medium dose [MD] group) or 10 mg bupivacaine and 5 μg sufentanil (the low dose [LD] group). Blood pressure and CO were monitored throughout the procedure using Nexfin™, a noninvasive continuous monitoring device using a finger cuff. Results Thirty-three patients received MD and 31 received LD and there was no mean difference in baseline hemodynamics between the groups. On an average, the CO decreased 11.6% in the MD group and 10.0 % in the LD group. There was no significant change in SVR. Incidence of a clinically relevant decrease in stroke volume (SV) (>15% from baseline) was 67% in the MD and 45% in the LD groups (P<0.05). Conclusion CO and blood pressure decreased significantly after the onset of SA in elderly patients. This is mainly caused by a decrease in SV and not by a decrease in SVR. There was no difference in CO and blood pressure change between dosages of 10 or 15 mg bupivacaine.
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Affiliation(s)
- Charlotte Hofhuizen
- Department of Critical Care, Radboud University Medical Center, Nijmegen, The Netherlands,
| | - Joris Lemson
- Department of Critical Care, Radboud University Medical Center, Nijmegen, The Netherlands,
| | - Marc Snoeck
- Department of Anesthesia, Canisius-Wilhelmina Ziekenhuis, Nijmegen, The Netherlands
| | - Gert-Jan Scheffer
- Department of Anesthesia, Radboud University Medical Center, Nijmegen, The Netherlands
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Uchida S, Kadoi Y, Saito S. Effect of Low Dose Remifentanil on Postoperative Pain Relief and Heart Rate Variability in Post-Anaesthesia Care Unit. Turk J Anaesthesiol Reanim 2017; 45:297-302. [PMID: 29114415 DOI: 10.5152/tjar.2017.34341] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/01/2017] [Indexed: 11/22/2022] Open
Abstract
Objective Several reports have shown the negligible adverse effects of low-dose remifentanil on the autonomic nervous system. We propose that the administration of low-dose remifentanil would be beneficial without adverse respiratory and hemodynamic effects. This study aimed to examine the effects of low-dose remifentanil on postoperative pain relief and heart rate variability (HRV) after surgery. Methods In total, 20 patients, who underwent breast cancer surgery, were analysed for HRV in the post-anaesthesia care unit (PACU). A sedative dose of remifentanil was continuously infused if patients experienced pain while in PACU. The remifentanil infusion dose was determined by achieving analgesia with no adverse effects on hemodynamics and/or respiration. Variables of low-frequency power, high-frequency power and low-frequency power/high-frequency power ratio were measured before and after the administration of remifentanil. Pain score was expressed as the numeric rating scale (NRS) from 0 to 10. Results The mean dosage of remifentanil administered as a continuous infusion was 0.029±0.0042 μg kg-1 min-1. After remifentanil administration, the value of the NRS decreased from 4.2±2.9 to 2.7±2.6. In addition, the value of high-frequency power increased from 35.6±14.3 to 49.4±3.0. Conclusion The continuous infusion of low-dose remifentanil may reduce post-operative pain scores and trigger the relative activation of the parasympathetic nervous system in post-surgical patients. This indicates that continuous infusion of low-dose remifentanil may be a useful option for postoperative pain relief in cases where postoperative pain control proves inadequate even with the application of regional block technique.
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Affiliation(s)
- Shynma Uchida
- Department of Anesthesia, Gunma Cancer Center, Maebahsi, Japan
| | - Yuji Kadoi
- Department of Anesthesiology, Gunma University Hospital, Maebahsi, Japan
| | - Shigeru Saito
- Department of Anesthesiology, Gunma University Hospital, Maebahsi, Japan
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Liu XB, Pan S, Yang XG, Li ZW, Sun QS, Zhao Z, Ma HC, Cui CR. Effect of penehyclidine hydrochloride on heart rate variability in hysteroscopy. Exp Ther Med 2015; 10:181-186. [PMID: 26170932 DOI: 10.3892/etm.2015.2497] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2014] [Accepted: 12/23/2014] [Indexed: 11/06/2022] Open
Abstract
In order to evaluate the effect of different doses of penehyclidine hydrochloride (penehyclidine) on heart rate (HR) and HR variability (HRV) in hysteroscopy, 180 patients (American Society of Anesthesiologists grade I-II) were randomized equally to three groups: 0.5 mg penehyclidine and intravenous anesthesia (group I), 1.0 mg penehyclidine and intravenous anesthesia (group II) and saddle anesthesia combined with intravenous anesthesia (control group). HR and HRV, including total power (TP), low-frequency power (LF), high-frequency power (HF) and the LF to HF ratio (LF/HF), were recorded prior and subsequent to the induction of anesthesia (T0 and T1, respectively), following the start of surgery (T2) and following completion of surgery (T3). HR was lower at T2 than at T0 in the control patients, but no differences were observed in groups I and II. The HR at T2 was increased in group II compared with that in group I. TP in group II was significantly higher compared with that in group I at T2. At T1 and at T2, the LF and HF values were lower in group I than those in the controls. Patients in group II also had higher LF and HF at T2 than patients in group I. The HF was higher at T2 than that at T0 in the controls; however, the HF and LF did not change significantly within groups I and II. No significant differences were observed in the LF/HF ratio among the three groups. At a dose of 0.5 mg, penehyclidine stabilized HRV and did not alter the autonomic nervous modulation of HR. A penehyclidine dose of 1.0 mg may be superior to a dose of 0.5 mg in maintaining HR, but is less effective at balancing sympathetic and parasympathetic activity.
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Affiliation(s)
- Xiao-Bo Liu
- Department of Anesthesiology, First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| | - Shu Pan
- Department of Anesthesiology, First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| | - Xi-Ge Yang
- Department of Anesthesiology, First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| | - Zhi-Wen Li
- Department of Anesthesiology, First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| | - Qing-Shan Sun
- Department of Anesthesiology, First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| | - Zhuang Zhao
- Department of Anesthesiology, First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| | - Hai-Chun Ma
- Department of Anesthesiology, First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| | - Cheng-Ri Cui
- Department of Anesthesiology, First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
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Chatzimichali A, Zoumprouli A, Metaxari M, Apostolakis I, Daras T, Tzanakis N, Askitopoulou H. Heart rate variability may identify patients who will develop severe bradycardia during spinal anaesthesia. Acta Anaesthesiol Scand 2011; 55:234-41. [PMID: 21058941 DOI: 10.1111/j.1399-6576.2010.02339.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND OBJECTIVES The reported incidence of cardiac arrest during spinal anaesthesia is 6.4+1.2 per 10,000 patients. Many of these arrests occurred in healthy young patients during minor surgery. This raises the question of whether some of them were avoidable. We investigated the value of Heart Rate Variability (HRV) to identify patients prone to developing severe bradycardia during spinal anaesthesia. METHODS Eighty ASA I-II patients, 21-60 years of age, undergoing elective surgery under spinal anaesthesia were studied. The HRV was assessed for 25 min before the spinal block. Two spectral components of HRV were calculated: a low-frequency (LF) and a high-frequency (HF) component. Patients were grouped according to whether bradycardia did or did not develop during spinal anaesthesia. RESULTS Nineteen patients developed severe bradycardia (<45 b.p.m.). The mean value of HF before spinal anaesthesia was significantly increased in the bradycardic group (P<0.05). The correlation between baseline heart rate (HR(baseline)) and minimum heart rate and LF, HF during spinal anaesthesia was significant (P<0.01). A receiver operator curve characteristic analysis showed a sensitivity and specificity of HF and HR(baseline) of 65% and 74%, respectively, to predict bradycardia <45 b.p.m. after spinal anaesthesia. CONCLUSIONS The present study shows that HF and clinical factors such as patient's HR(baseline) could identify patients prone to developing severe bradycardia during spinal anaesthesia.
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Affiliation(s)
- A Chatzimichali
- Department of Anaesthesiology, University Hospital of Heraklion, Crete, Greece.
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Nishiyama T. Recent advance in patient monitoring. Korean J Anesthesiol 2010; 59:144-59. [PMID: 20877698 PMCID: PMC2946031 DOI: 10.4097/kjae.2010.59.3.144] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2010] [Revised: 07/23/2010] [Accepted: 07/23/2010] [Indexed: 11/10/2022] Open
Abstract
Recent advance in technology has developed a lot of new aspects of clinical monitoring. We can monitor sedation levels during anesthesia using various electroencephalographic (EEG) indices, while it is still not useful for anesthesia depth monitoring. Some attempts are made to monitor the changes in sympathetic nerve activity as one of the indicators of stress, pain/analgesia, or anesthesia. To know the balance of sympathetic and parasympathetic activity, heart rate or blood pressure variability is investigated. For trend of cardiac output, low invasive monitors have been investigated. Improvement of ultrasound enables us to see cardiac structure and function continuously and clearer, increases success rate and decreases complication of central venous puncture and various kinds of nerve blocks. Without inserting an arterial catheter, trends of arterial oxygen tension or carbon dioxide tension can be monitored. Indirect visualization of the airway decreases difficult intubation and makes it easier to teach tracheal intubation. The changes in blood volume can be speculated non-invasively. Cerebral perfusion and metabolism are not ordinary monitored yet, but some studies show their usefulness in management of critically ill. This review introduces recent advances in various monitors used in anesthesia and critical care including some studies of the author, especially focused on EEG and cardiac output. However, the most important is that these new monitors are not almighty but should be used adequately in a limited situation where their meaning is confirmed.
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Affiliation(s)
- Tomoki Nishiyama
- Department of Anesthesiology and Critical Care, Higashi Omiya General Hospital, Saitama, Japan
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Duman A, Apiliogullari S, Duman I. Effects of intrathecal fentanyl on quality of spinal anesthesia in children undergoing inguinal hernia repair. Paediatr Anaesth 2010; 20:530-6. [PMID: 20456062 DOI: 10.1111/j.1460-9592.2010.03315.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The effect of intrathecal fentanyl on the characteristics of spinal anesthesia has not been investigated in children undergoing inguinal hernia repair. The purpose of this study was to assess whether the incidence and severity of pain during peritoneal sac traction is decreased by addition of fentanyl to bupivacaine in children undergoing inguinal hernia repair with spinal anesthesia. METHODS Children (6-14 years) were randomized into two groups. Group F (n = 25): hyperbaric bupivacaine plus 0.2 microg.kg(-1) of fentanyl. Group P (n = 25): hyperbaric bupivacaine plus 0.9% NaCl (placebo). The dose of bupivacaine was 0.4 mg.kg(-1). The primary variable was the incidence and severity of pain during peritoneal sac traction. Spinal block characteristics, duration of spinal anesthesia assessed by recovery of hip flexion and duration of analgesia were the secondary variables measured, and the side effects were noted. RESULTS There were significant differences in incidence of pain and pain scores during sac traction with lower incidence and scores in the fentanyl group (P = 0.009). Two groups were similar regarding the level of sensory block during sac traction and duration of spinal anesthesia. Duration of spinal analgesia was prolonged significantly in the fentanyl group (P = 0.025). CONCLUSION Intrathecal fentanyl at a dose of 0.2 microg.kg(-1) added to bupivacaine significantly improves the quality of intraoperative analgesia and prolongs postoperative analgesia in children undergoing inguinal hernia repair with spinal anesthesia.
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Affiliation(s)
- Ates Duman
- Department of Anesthesia and Intensive Care, Medical Faculty, Faculty of Dentistry, Selcuk University, Konya, Turkey
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