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Geetha S, Prashanth NV, Durga P, Jayaram K, Farooq M, Chandra S, Sushma. Comparison of nebulisation 0.75% ropivacaine with 2% lignocaine for attenuation of haemodynamic response due to intubation: A prospective randomised study. J Perioper Pract 2024:17504589241229906. [PMID: 38600632 DOI: 10.1177/17504589241229906] [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: 04/12/2024]
Abstract
INTRODUCTION Laryngoscopy and intubation are associated with the reflex response of hypertension, tachycardia and other intraoperative complications. Nebulised route drug administration and entropy-guided induction enable optimal intubating conditions. AIMS To compare pre-induction nebulisation between 0.75% ropivacaine and 2% lignocaine in blunting the nasotracheal intubation response. MATERIALS AND METHODS A total of 100 patients undergoing elective faciomaxillary surgeries were prospectively randomised to receive pre-induction nebulisation: 5mL of 2% lignocaine (100mg) (Group L) or 5mL of 0.75% ropivacaine (37.5mg) (Group R). Patients were induced and intubated (nasotracheal) with entropy monitoring. Observed parameters included systolic blood pressure, diastolic blood pressure, mean arterial pressure, heart rate, entropy at baseline, induction, intubation, post-intubation one, three and five minutes, propofol induction dose, electrocardiogram changes and peri-intubation cough reflex. RESULTS Ropivacaine aerosol proved significantly better than lignocaine aerosol on haemodynamics (systolic blood pressure, diastolic blood pressure, mean arterial pressure, heart rate) and cough reflex (p < 0.05). Both groups experienced similar entropy changes and propofol induction dose requirements and no fresh electrocardiogram changes (compared with the baseline). CONCLUSION Pre-induction nebulised ropivacaine offers superior intubating conditions than lignocaine regarding haemodynamic response and cough reflex for faciomaxillary surgeries.
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Affiliation(s)
- Singam Geetha
- Nizam's Institute of Medical Sciences, Hyderabad, India
| | | | - Padmaja Durga
- Nizam's Institute of Medical Sciences, Hyderabad, India
| | | | | | | | - Sushma
- Nizam's Institute of Medical Sciences, Hyderabad, India
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Fang Y, Xu Y, Cao S, Sun X, Zhang H, Jing Q, Tian L, Li C. Incidence and Risk Factors for Hypoxia in Deep Sedation of Propofol for Artificial Abortion Patients. Front Med (Lausanne) 2022; 9:763275. [PMID: 35572953 PMCID: PMC9092022 DOI: 10.3389/fmed.2022.763275] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 04/04/2022] [Indexed: 11/15/2022] Open
Abstract
Background Respiratory depression is a life-threatening adverse effect of deep sedation. This study aimed to investigate the factors related to hypoxia caused by propofol during intravenous anesthesia. Methods Three hundred and eight patients who underwent painless artificial abortion in the outpatient department of Shanghai Tenth People’s Hospital between November 1, 2019 and June 30, 2020 were divided into two groups according to whether the patients experienced hypoxia (SpO2 < 95%). Preoperative anxiety assessments, anesthesia process, and operation-related information of the two groups were analyzed. The univariate analysis results were further incorporated into logistic regression analysis for multivariate analysis to determine the independent risk factors affecting hypoxia. Results Univariate analysis revealed that body mass index (BMI) (21.80 ± 2.94 vs. 21.01 ± 2.39; P = 0.038, 95% confidence interval (CI) = [−1.54, −0.04]), propofol dose (15.83 ± 3.21 vs. 14.39 ± 3.01; P = 0.002, CI = [−2.34, −0.53]), menopausal days (49.64 ± 6.03 vs. 52.14 ± 5.73; P = 0.004, CI = [0.79, 4.21]), State Anxiety Inventory score (51.19 ± 7.55 vs. 44.49 ± 8.96; P < 0.001, CI = [−9.26, −4.15]), and Self-rating Anxiety Scale score (45.86 ± 9.48 vs. 42.45 ± 9.88; P = 0.021, CI = [−6.30, −0.53]) were statistically significant risk factors for hypoxia during the operation. Logistic regression analysis showed that propofol dosage, menopausal days, and State Anxiety Inventory score were independent risk factors for hypoxia. Conclusion Patient anxiety affects the incidence of hypoxia when undergoing deep intravenous anesthesia with propofol. We can further speculate that alleviating patient anxiety can reduce the incidence of hypoxia. Clinical Trial Registration [http://www.chictr.org.cn], identifier [ChiCTR2000032167].
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Affiliation(s)
- Yiling Fang
- Department of Anesthesiology and Perioperative Medicine, School of Medicine, Shanghai Fourth People's Hospital, Tongji University, Shanghai, China.,School of Medicine, Shanghai Fourth People's Hospital, Translational Research Institute of Brain and Brain-Like Intelligence, Tongji University, Shanghai, China.,Clinical Research Center for Anesthesiology and Perioperative Medicine, Tongji University, Shanghai, China.,Department of Anesthesiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China.,Department of General Practice, Zhangjiagang First People's Hospital, Affiliated to Soochow University School of Medicine, Zhangjiagang, China
| | - Yaru Xu
- Department of Anesthesiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Silu Cao
- Department of Anesthesiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Xiaoru Sun
- Department of Anesthesiology and Perioperative Medicine, School of Medicine, Shanghai Fourth People's Hospital, Tongji University, Shanghai, China.,School of Medicine, Shanghai Fourth People's Hospital, Translational Research Institute of Brain and Brain-Like Intelligence, Tongji University, Shanghai, China.,Clinical Research Center for Anesthesiology and Perioperative Medicine, Tongji University, Shanghai, China
| | - Hui Zhang
- Department of Anesthesiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Qi Jing
- Department of Anesthesiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Li Tian
- Department of Anesthesiology and Perioperative Medicine, School of Medicine, Shanghai Fourth People's Hospital, Tongji University, Shanghai, China.,School of Medicine, Shanghai Fourth People's Hospital, Translational Research Institute of Brain and Brain-Like Intelligence, Tongji University, Shanghai, China.,Clinical Research Center for Anesthesiology and Perioperative Medicine, Tongji University, Shanghai, China
| | - Cheng Li
- Department of Anesthesiology and Perioperative Medicine, School of Medicine, Shanghai Fourth People's Hospital, Tongji University, Shanghai, China.,School of Medicine, Shanghai Fourth People's Hospital, Translational Research Institute of Brain and Brain-Like Intelligence, Tongji University, Shanghai, China.,Clinical Research Center for Anesthesiology and Perioperative Medicine, Tongji University, Shanghai, China
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Rogobete AF, Bedreag OH, Papurica M, Popovici SE, Bratu LM, Rata A, Barsac CR, Maghiar A, Garofil DN, Negrea M, Petcu LB, Toma D, Dumbuleu CM, Rimawi S, Sandesc D. Multiparametric Monitoring of Hypnosis and Nociception-Antinociception Balance during General Anesthesia-A New Era in Patient Safety Standards and Healthcare Management. ACTA ACUST UNITED AC 2021; 57:medicina57020132. [PMID: 33540844 PMCID: PMC7913052 DOI: 10.3390/medicina57020132] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 01/27/2021] [Accepted: 01/28/2021] [Indexed: 11/16/2022]
Abstract
The development of general anesthesia techniques and anesthetic substances has opened new horizons for the expansion and improvement of surgical techniques. Nevertheless, more complex surgical procedures have brought a higher complexity and longer duration for general anesthesia, which has led to a series of adverse events such as hemodynamic instability, under- or overdosage of anesthetic drugs, and an increased number of post-anesthetic events. In order to adapt the anesthesia according to the particularities of each patient, the multimodal monitoring of these patients is highly recommended. Classically, general anesthesia monitoring consists of the analysis of vital functions and gas exchange. Multimodal monitoring refers to the concomitant monitoring of the degree of hypnosis and the nociceptive-antinociceptive balance. By titrating anesthetic drugs according to these parameters, clinical benefits can be obtained, such as hemodynamic stabilization, the reduction of awakening times, and the reduction of postoperative complications. Another important aspect is the impact on the status of inflammation and the redox balance. By minimizing inflammatory and oxidative impact, a faster recovery can be achieved that increases patient safety. The purpose of this literature review is to present the most modern multimodal monitoring techniques to discuss the particularities of each technique.
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Affiliation(s)
- Alexandru Florin Rogobete
- Faculty of Medicine, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (A.F.R.); (O.H.B.); (M.P.); (C.R.B.); (A.M.); (D.S.)
- Anaesthesia and Intensive Care Research Center, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (D.T.); (C.M.D.)
- Clinic of Anaesthesia and Intensive Care, Emergency County Hospital “Pius Brinzeu”, 300723 Timisoara, Romania;
| | - Ovidiu Horea Bedreag
- Faculty of Medicine, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (A.F.R.); (O.H.B.); (M.P.); (C.R.B.); (A.M.); (D.S.)
- Anaesthesia and Intensive Care Research Center, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (D.T.); (C.M.D.)
- Clinic of Anaesthesia and Intensive Care, Emergency County Hospital “Pius Brinzeu”, 300723 Timisoara, Romania;
| | - Marius Papurica
- Faculty of Medicine, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (A.F.R.); (O.H.B.); (M.P.); (C.R.B.); (A.M.); (D.S.)
- Anaesthesia and Intensive Care Research Center, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (D.T.); (C.M.D.)
- Clinic of Anaesthesia and Intensive Care, Emergency County Hospital “Pius Brinzeu”, 300723 Timisoara, Romania;
| | - Sonia Elena Popovici
- Faculty of Medicine, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (A.F.R.); (O.H.B.); (M.P.); (C.R.B.); (A.M.); (D.S.)
- Anaesthesia and Intensive Care Research Center, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (D.T.); (C.M.D.)
- Clinic of Anaesthesia and Intensive Care, Emergency County Hospital “Pius Brinzeu”, 300723 Timisoara, Romania;
- Correspondence: (S.E.P.); (L.M.B.); Tel.: +40-728-001-971
| | - Lavinia Melania Bratu
- Faculty of Medicine, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (A.F.R.); (O.H.B.); (M.P.); (C.R.B.); (A.M.); (D.S.)
- Correspondence: (S.E.P.); (L.M.B.); Tel.: +40-728-001-971
| | - Andreea Rata
- Department of Vascular Surgery, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania;
- Clinic of Vascular Surgery, Emergency County Hospital “Pius Brinzeu”, 300723 Timisoara, Romania
| | - Claudiu Rafael Barsac
- Faculty of Medicine, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (A.F.R.); (O.H.B.); (M.P.); (C.R.B.); (A.M.); (D.S.)
- Anaesthesia and Intensive Care Research Center, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (D.T.); (C.M.D.)
- Clinic of Anaesthesia and Intensive Care, Emergency County Hospital “Pius Brinzeu”, 300723 Timisoara, Romania;
| | - Andra Maghiar
- Faculty of Medicine, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (A.F.R.); (O.H.B.); (M.P.); (C.R.B.); (A.M.); (D.S.)
- Anaesthesia and Intensive Care Research Center, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (D.T.); (C.M.D.)
| | - Dragos Nicolae Garofil
- Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania;
| | - Mihai Negrea
- Faculty of Political, Administrative and Communication Sciences, Babes-Bolyai University, 400376 Cluj Napoca, Romania;
| | - Laura Bostangiu Petcu
- Faculty of Management, The Bucharest University of Economic Studies, 020021 Bucharest, Romania;
| | - Daiana Toma
- Anaesthesia and Intensive Care Research Center, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (D.T.); (C.M.D.)
- Clinic of Anaesthesia and Intensive Care, Emergency County Hospital “Pius Brinzeu”, 300723 Timisoara, Romania;
| | - Corina Maria Dumbuleu
- Anaesthesia and Intensive Care Research Center, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (D.T.); (C.M.D.)
- Clinic of Anaesthesia and Intensive Care, Emergency County Hospital “Pius Brinzeu”, 300723 Timisoara, Romania;
| | - Samir Rimawi
- Clinic of Anaesthesia and Intensive Care, Emergency County Hospital “Pius Brinzeu”, 300723 Timisoara, Romania;
| | - Dorel Sandesc
- Faculty of Medicine, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (A.F.R.); (O.H.B.); (M.P.); (C.R.B.); (A.M.); (D.S.)
- Anaesthesia and Intensive Care Research Center, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (D.T.); (C.M.D.)
- Clinic of Anaesthesia and Intensive Care, Emergency County Hospital “Pius Brinzeu”, 300723 Timisoara, Romania;
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