1
|
Ajayan N, Christudas J, Morris L, Hrishi AP. An Entropy-Based Prospective Randomized Controlled Trial to Evaluate the Analgesic and Hypnotic Effects of Equipotent Doses of Sevoflurane and Isoflurane in Patients Presenting for Spine Surgeries. J Neurosci Rural Pract 2022; 13:376-381. [PMID: 35946024 PMCID: PMC9357483 DOI: 10.1055/s-0042-1744228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objectives
Minimal alveolar concentration (MAC) of anesthetic agents has been considered a suitable measure of the potency of inhalational anesthetics. Furthermore, it is assumed that equi-MAC concentrations of different anesthetic agents have a similar potency in suppressing responses to painful stimuli. Isoflurane and sevoflurane are two commonly used volatile anesthetic agents in spine surgeries. Therefore, these agents' hypnotic and analgesic potencies should be distinguished and comprehended for the optimal administration of anesthesia. Consequently, we undertook this study to compare the analgesic and hypnotic potencies between these agents at equi-MAC concentrations, using the entropy monitor.
Materials and Methods
Forty patients undergoing lumbar spine surgery were randomly assigned to two groups receiving either isoflurane (
n
= 20) or sevoflurane (
n
= 20). After induction, maintenance of anesthesia was done with age-corrected 1.0 MAC of either isoflurane or sevoflurane. A standardized noxious stimulus was provided to all the patients after achieving a steady state of 1.0 MAC. The state entropy (SE), response entropy (RE), and RE–SE were recorded at baseline, prestimulus, and poststimulus time points in both groups.
Statistical Analyses
Data are presented as frequency and percentages for categorical variables and mean ± standard deviation for continuous variables. The comparison of categorical variables between the two groups was made using the Fisher's exact test, and the Student's
t
-test was used for continuous variables. A
p
-value of < 0.05 was considered to be statistically significant.
Results
At age-corrected 1.0 MAC, there was no significant difference in the SE, RE, and RE–SE in both the groups at any time point.
Conclusion
Our study shows that during a steady state of age-corrected 1.0 MAC single-agent anesthesia, sevoflurane and isoflurane have comparable analgesic and hypnotic potencies as measured by entropy indices when a standardized nociceptive stimulus is provided.
Collapse
Affiliation(s)
- Neeraja Ajayan
- Department of Neurocritical Care, Cambridge University Hospitals, Cambridge, United Kingdom
| | - Jayakumar Christudas
- Department of Anaesthesia, Medical College Thiruvananthapuram, Thiruvananthapuram, Kerala, India
| | - Linette Morris
- Department of Anaesthesia, Medical College Thiruvananthapuram, Thiruvananthapuram, Kerala, India
| | - Ajay Prasad Hrishi
- Division of Neuroanesthesia, Department of Anesthesiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| |
Collapse
|
2
|
Shukla U, Yadav U, Yadav JBS, Agrawal S. Comparison of End-Tidal Anesthetic Gas Concentration versus Bispectral Index-Guided Protocol as Directing Tool on Time to Tracheal Extubation for Sevoflurane-Based General Anesthesia. Anesth Essays Res 2021; 14:600-604. [PMID: 34349327 PMCID: PMC8294427 DOI: 10.4103/aer.aer_25_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 03/01/2021] [Accepted: 03/15/2021] [Indexed: 11/23/2022] Open
Abstract
Background: Modalities for titrating anesthetic drug-like bispectral index (BIS) and end-tidal anesthetic gas (ETAG) concentration in predicting early extubation had been studied with old anesthetic agents such as isoflurane. Aim: The aim of this study is to compare the effect of ETAG concentration versus BIS-guided protocol as directing tool on time to tracheal extubation for sevoflurane-based general anesthesia. Materials and Methods: This prospective, randomized, double-blind trial studied sixty patients with American Society of Anesthesiologists physical status classes I and II who received sevoflurane-based general anesthesia and were allocated to either BIS–guided anesthesia group (n = 30) or ETAG–guided anesthesia group (n = 30). Time to tracheal extubation was measured. BIS value was kept between 40 and 60 in BIS group, whereas minimum alveolar concentration value was kept between 0.7 and 1.3 in ETAG group. The two groups were compared using Student's t-test, and P < 0.05 was considered statistically significant. The statistical analysis was performed using the open source “R” programming language. Results: Mean time to tracheal extubation was significantly shorter in BIS group (308.77 ± 20.48 s) as compared to ETAG group (377.90 ± 25.06 s) (P < 0.001). The sevoflurane concentration used was also significantly less in group BIS than group ETAG at multiple time intervals (P = 0.001). Conclusion: Prediction of extubation was significantly early with BIS monitoring as compared to ETAG monitoring in sevoflurane-based general anesthesia.
Collapse
Affiliation(s)
- Usha Shukla
- Department of Anaesthesiology, Uttar Pradesh University of Medical Sciences, Saifai, Etawah, Uttar Pradesh, India
| | - Urvashi Yadav
- Department of Anaesthesiology, Uttar Pradesh University of Medical Sciences, Saifai, Etawah, Uttar Pradesh, India
| | - Jay Brijesh Singh Yadav
- Department of Anaesthesiology, Uttar Pradesh University of Medical Sciences, Saifai, Etawah, Uttar Pradesh, India
| | - Sanket Agrawal
- Department of Anaesthesiology, Uttar Pradesh University of Medical Sciences, Saifai, Etawah, Uttar Pradesh, India
| |
Collapse
|
3
|
Abdelzaam E, Abd Allazeem ES, Elbarbary DH. The effect of bispectral index guided anesthesia versus standard practice on recovery after sevoflurane anesthesia in children: a prospective randomized double-blind clinical trial. EGYPTIAN JOURNAL OF ANAESTHESIA 2020. [DOI: 10.1080/11101849.2020.1838750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Affiliation(s)
- Elsayed Abdelzaam
- Department of Anesthesiology, Faculty of Medicine, Benha University, Benha, Egypt
| | | | - Dina H. Elbarbary
- Department of Anesthesiology, Faculty of Medicine, Benha University, Benha, Egypt
| |
Collapse
|
4
|
Görges M, West NC, Cooke EM, Pi S, Brant RF, Dumont GA, Ansermino JM, Merchant RN. Evaluating NeuroSENSE for assessing depth of hypnosis during desflurane anesthesia: an adaptive, randomized-controlled trial. Can J Anaesth 2020; 67:324-335. [PMID: 31691253 DOI: 10.1007/s12630-019-01522-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 08/12/2019] [Accepted: 10/28/2019] [Indexed: 02/07/2023] Open
Abstract
PURPOSE Processed electroencephalography (EEG) monitors support depth-of-hypnosis assessment during anesthesia. This randomized-controlled trial investigated the performance of the NeuroSENSE electroencephalography (EEG) monitor to determine whether its wavelet anesthetic value for central nervous system (WAVCNS) index distinguishes consciousness from unconsciousness during induction of anesthesia (as assessed by the anesthesiologist) and emergence from anesthesia (indicated by patient responsiveness), and whether it correlates with changes in desflurane minimum alveolar concentration (MAC) during maintenance of anesthesia. METHODS EEG was collected using a fronto-temporal bilateral montage. The WAVCNS was continuously recorded by the NeuroSENSE monitor, to which the anesthesiologist was blinded. Anesthesia was induced with propofol/remifentanil and maintained with desflurane, with randomized changes of -0.4, 0, or +0.4 MAC every 7.5 min within the 0.8-1.6 MAC range, if clinically acceptable to the anesthesiologist. During emergence from anesthesia, desflurane was stepped down by 0.2 MAC every five minutes. RESULTS Data from 75 patients with a median [interquartile range] age of 41[35-52] yr were obtained. The WAVCNS distinguished consciousness from unconsciousness as assessed by the anesthesiologist, with area under the receiver operating characteristic curve of 99.5% (95% confidence interval [CI], 98.5 to 100.0) at loss of consciousness and 99.4% (95% CI, 98.5 to 100.0) at return of consciousness. Bilateral WAVCNS changes correlated with desflurane concentrations, with -8.0 and -8.6 WAVCNS units, respectively, per 1 MAC change in the 0.8-1.6 MAC range during maintenance of anesthesia and -10.0 and -10.5 WAVCNS units, respectively, in the 0.4-1.6 MAC range including emergence from anesthesia. CONCLUSION The NeuroSENSE monitor can reliably discriminate between consciousness and unconsciousness, as assessed by the anesthesiologist, during induction of anesthesia and with a lower level of reliability during emergence from anesthesia. The WAVCNS correlates with desflurane concentration but plateaus at higher concentrations, similar to other EEG monitors, which suggests limited utility to titrate higher concentrations of anesthetic vapour. TRIAL REGISTRATION clinicaltrials.gov, NCT02088671; registered 17 March, 2014.
Collapse
Affiliation(s)
- Matthias Görges
- Department of Anesthesiology, Pharmacology & Therapeutics, University of British Columbia, Vancouver, BC, Canada.
- BC Children's Hospital Research Institute, 950 West 28th Avenue, Vancouver, BC, V5Z 4H4, Canada.
| | - Nicholas C West
- Department of Anesthesiology, Pharmacology & Therapeutics, University of British Columbia, Vancouver, BC, Canada
| | - Erin M Cooke
- Department of Anesthesiology, Pharmacology & Therapeutics, University of British Columbia, Vancouver, BC, Canada
- BC Children's Hospital Research Institute, 950 West 28th Avenue, Vancouver, BC, V5Z 4H4, Canada
| | - Shanshan Pi
- Department of Statistics, University of British Columbia, Vancouver, BC, Canada
| | - Rollin F Brant
- BC Children's Hospital Research Institute, 950 West 28th Avenue, Vancouver, BC, V5Z 4H4, Canada
- Department of Statistics, University of British Columbia, Vancouver, BC, Canada
| | - Guy A Dumont
- BC Children's Hospital Research Institute, 950 West 28th Avenue, Vancouver, BC, V5Z 4H4, Canada
- Department of Electrical Engineering, University of British Columbia, Vancouver, BC, Canada
| | - J Mark Ansermino
- Department of Anesthesiology, Pharmacology & Therapeutics, University of British Columbia, Vancouver, BC, Canada
- BC Children's Hospital Research Institute, 950 West 28th Avenue, Vancouver, BC, V5Z 4H4, Canada
| | - Richard N Merchant
- Department of Anesthesiology, Pharmacology & Therapeutics, University of British Columbia, Vancouver, BC, Canada
- Department of Anesthesia, Royal Columbian Hospital, Fraser Health Authority, New Westminster, BC, Canada
| |
Collapse
|
5
|
Ryu K, Song K, Kim J, Kim E, Kim SH. Comparison of the Analgesic Properties of Sevoflurane and Desflurane Using Surgical Pleth Index at Equi-Minimum Alveolar Concentration. Int J Med Sci 2017; 14:994-1001. [PMID: 28924371 PMCID: PMC5599923 DOI: 10.7150/ijms.20291] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Accepted: 06/18/2017] [Indexed: 11/28/2022] Open
Abstract
Background: Traditionally, minimum alveolar concentration (MAC) has been used as the standard measure to compare the potencies of volatile anesthetics. However, it reflects the spinal mechanism of immobility rather than the subcortical mechanism of analgesia. Recently, the surgical pleth index (SPI) derived from photoplethysmographic waveform was shown to reflect the intraoperative analgesic component. This study was designed to compare the SPI values produced by equi-MAC of two commonly used volatile anesthetics, sevoflurane and desflurane. Methods: Seventy-two patients undergoing arthroscopic shoulder surgery were randomly assigned to two groups receiving either sevoflurane (n = 36) or desflurane (n = 36). General anesthesia was maintained with the respective volatile anesthetic only. A vaporizer was adjusted to maintain end-tidal anesthetic concentration at age-corrected 1.0 MAC throughout the study period. The SPI value as an analgesic estimate and the bispectral index (BIS) value as a hypnotic estimate were recorded at predefined time points during the standardized surgical procedure. Results: During the steady state of age-corrected 1.0 MAC, mean SPI values throughout the entire study period were significantly higher in the sevoflurane group than in the desflurane group (38.1 ± 12.8 vs. 30.7 ± 8.8, respectively, P = 0.005), and mean BIS values were significantly higher in the sevoflurane group than in the desflurane group (40.7 ± 5.8 vs. 36.8 ± 6.2, respectively, P = 0.008). Conclusions: Equi-MAC of sevoflurane and desflurane did not produce similar surgical pleth index values. Therefore, sevoflurane and desflurane may have different analgesic properties at equipotent concentrations.
Collapse
Affiliation(s)
- Kyoungho Ryu
- Department of Anesthesiology and Pain Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Keulame Song
- Department of Anesthesiology and Pain Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jia Kim
- Department of Anesthesiology and Pain Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Eugene Kim
- Department of Orthopedic Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Seong-Hyop Kim
- Department of Anesthesiology and Pain medicine, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Republic of Korea.,Department of Infection and Immunology, Konkuk University School of Medicine, Seoul, Korea.,Department of Medicine, Institute of Biomedical Science and Technology, Konkuk University School of Medicine, Seoul, Korea
| |
Collapse
|
6
|
Chatrath V, Khetarpal R, Bansal D, Kaur H. Sevoflurane in low-flow anesthesia using "equilibration point". Anesth Essays Res 2016; 10:284-90. [PMID: 27212762 PMCID: PMC4864709 DOI: 10.4103/0259-1162.172343] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
CONTEXT While giving low-flow anesthesia, it is a routine practice to give fixed duration of initial high-flow. This study was conducted to show the use of equilibration point as changeover point from initial high-flow to low-flow. AIMS It was to compare the use of equilibration point, hemodynamics, end-tidal agent concentration, recovery time, and recovery score between isoflurane and sevoflurane. SETTINGS AND DESIGN It was a prospective randomized study conducted on 100 patients who were admitted for elective surgery expected to be < 2 h duration. MATERIALS AND METHODS Patients were randomly assigned to one of the two groups of 50 each. Group I received isoflurane and Group S sevoflurane as an inhalational agent. STATISTICAL ANALYSIS The observations obtained in both the groups were recorded and compared. Analysis was done using unpaired t-test and Chi-square test. RESULTS Hemodynamic parameters were comparable in both the groups. The mean equilibration times obtained for sevoflurane and isoflurane were 8.22 ± 1.060 min and 17.24 ± 10.2 min, respectively. The drift in end-tidal agent concentration over time was less in sevoflurane group. Mean recovery time was 7.92 ± 1.56 min in the sevoflurane group and 12.89 ± 3.45 min in the isoflurane group (P = 0.001). There was no significant difference between intraoperative and postoperative complications. CONCLUSION Use of equilibration time of the volatile anesthetic agent as a changeover point, from high-flow to low-flow, can help us to use circle system with low-flow anesthesia in a more efficient way, especially with newer anesthetics such as sevoflurane.
Collapse
Affiliation(s)
- Veena Chatrath
- Department of Anaesthesia and Critical Care, Government Medical College, Amritsar, Punjab, India
| | - Ranjana Khetarpal
- Department of Anaesthesia and Critical Care, Government Medical College, Amritsar, Punjab, India
| | - Divya Bansal
- Department of Anaesthesia and Critical Care, Government Medical College, Amritsar, Punjab, India
| | - Harjinder Kaur
- Department of Anaesthesia and Critical Care, Government Medical College, Amritsar, Punjab, India
| |
Collapse
|
7
|
Jain N, Mathur PR, Khan S, Khare A, Mathur V, Sethi S. Effect of bispectral index versus end-tidal anesthetic gas concentration-guided protocol on time to tracheal extubation for halothane-based general anesthesia. Anesth Essays Res 2016; 10:591-596. [PMID: 27746557 PMCID: PMC5062220 DOI: 10.4103/0259-1162.186600] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND AND AIMS Early extubation is a desirable goal after general anesthesia. Very few studies have compared the effect of bispectral index (BIS) monitoring versus standard end-tidal anesthetic gas (ETAG) concentration monitoring on tracheal extubation time for halothane-based anesthesia. The aim of this study was to compare the effect of BIS versus ETAG-guided anesthesia on time to tracheal extubation for halothane-based anesthesia in general surgical setting. METHODS This was a randomized, controlled double-blind study. Sixty patients with the American Society of Anesthesiologists physical status Class 1 or 2, receiving halothane-based general anesthesia were randomized to BIS-guided (n = 30) and ETAG-guided anesthesia (n = 30). Time to tracheal extubation was measured. In BIS group, BIS value was kept between 40 and 60 while in ETAG group; ETAG value was kept between 0.7 and 1.3 minimum alveolar concentration. The two groups were compared using Student's t-test, and P < 0.05 was considered statistically significant. Data were processed and analyzed using SPSS version 17 software. RESULTS Mean time to tracheal extubation was significantly longer in BIS group (9.63 ± 3.02 min) as compared to ETAG group (5.29 ± 1.51 min), mean difference 4.34 min with 95% confidence interval (3.106, 5.982) (P < 0.05). CONCLUSION In our study, the extubation time was significantly longer in BIS-guided anesthesia as compared to ETAG-guided anesthesia. ETAG monitoring promotes earlier extubation of patients as compared to BIS monitoring during halothane anesthesia.
Collapse
Affiliation(s)
- Neena Jain
- Department of Anaesthesiology, Jawaharlal Nehru Medical College, Ajmer, Rajasthan, India
| | - Pooja Rawat Mathur
- Department of Anaesthesiology, Jawaharlal Nehru Medical College, Ajmer, Rajasthan, India
| | - Shoyeb Khan
- Department of Anaesthesiology, Jawaharlal Nehru Medical College, Ajmer, Rajasthan, India
| | - Arvind Khare
- Department of Anaesthesiology, Jawaharlal Nehru Medical College, Ajmer, Rajasthan, India
| | - Veena Mathur
- Department of Anaesthesiology, Jawaharlal Nehru Medical College, Ajmer, Rajasthan, India
| | - Surendra Sethi
- Department of Anaesthesiology, Jawaharlal Nehru Medical College, Ajmer, Rajasthan, India
| |
Collapse
|
8
|
Zhang DX, Jiang S, Yu LN, Zhang FJ, Zhuang Q, Yan M. The effect of sevoflurane on the cognitive function of rats and its association with the inhibition of synaptic transmission. Int J Clin Exp Med 2015; 8:20853-20860. [PMID: 26885010 PMCID: PMC4723855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Accepted: 10/27/2015] [Indexed: 06/05/2023]
Abstract
To observe the effects of different concentrations of sevoflurane on synaptotagmin 1 (Syt1) expression, synaptic long term depression (LTD), and paired pulse depression (PPD) in the rat hippocampus as well as to investigate the association between these effects and the cognitive function of rats. A total of 24 male Sprague-Dawley (SD) rats were selected and randomly divided into 3 groups: the control group (group A), which inhaled air; group B, which inhaled 0.65 minimum alveolar concentration (MAC) sevoflurane for 2 h; and group C, which inhaled 1.30 MAC sevoflurane for 2 h. The subsequent experiments were performed after one day. (1) Y maze tests were performed, and the expression of Syt1 in hippocampal tissues was detected using western blot. (2) The changes in LTD and PPD in rat hippocampal slices were examined using electrophysiological techniques. Compared to the control group, the cognitive function was decreased and Syt1 expression in the hippocampus was significantly decreased in rats in the 1.30 MAC sevoflurane inhalation group. After 60 min of low frequency stimulation, the amplitudes of population spike (PS) potentials in rat hippocampal slices were significantly decreased. After induction of PPD, the P2/P1 ratio was significantly increased. No indicators in the 0.65 MAC sevoflurane inhalation group showed any significant changes. Inhalation of high concentrations of sevoflurane significantly reduced Syt1 protein levels in the rat hippocampus, significantly inhibited the release of presynaptic neurotransmitters, and reduced the efficiency of synaptic transmission, thus causing memory impairment.
Collapse
Affiliation(s)
- Deng-Xin Zhang
- Department of Anesthesiology, The Second Affiliated Hospital, College of Medicine, Zhejiang UniversityHangzhou 310009, P. R. China
- Department of Anesthesiology, The Affiliated Hospital of Jiangnan University (Wuxi 4th People’s Hospital)Wuxi 214000, P. R. China
| | - Shan Jiang
- Lianyungang Branch of Traditional Chinese Medicine, Jiangsu Union Technical InstituteLianyungang 222007, P. R. China
| | - Li-Na Yu
- Department of Anesthesiology, The Second Affiliated Hospital, College of Medicine, Zhejiang UniversityHangzhou 310009, P. R. China
| | - Feng-Jiang Zhang
- Department of Anesthesiology, The Second Affiliated Hospital, College of Medicine, Zhejiang UniversityHangzhou 310009, P. R. China
| | - Qing Zhuang
- Department of Anesthesiology, The Affiliated Hospital of Jiangnan University (Wuxi 4th People’s Hospital)Wuxi 214000, P. R. China
| | - Min Yan
- Department of Anesthesiology, The Second Affiliated Hospital, College of Medicine, Zhejiang UniversityHangzhou 310009, P. R. China
| |
Collapse
|