Ultimo Aggiornamento: 31 Dicembre 2002

Anaesthesist 2001 Dec;50(12):921-5

The Narcotrend--a new EEG monitor designed to measure the depth of anaesthesia. A comparison with bispectral index monitoring during propofol-remifentanil-anaesthesia.

Kreuer S, Biedler A, Larsen R, Schoth S, Altmann S, Wilhelm W

Klinik fur Anaesthesiologie und Intensivmedizin, Universitatskliniken des Saarlandes, 66421 Homburg/Saar.

[Medline record in process]

INTRODUCTION: The Narcotrend is a new EEG monitor designed to measure the depth of anaesthesia based on a 6-letter classification from A (awake) to F (general anaesthesia with increasing burst suppression) and divided into 14 substages (A, B0-2, C0-2, D0-2, E0,1, F0,1). This study was designed to investigate the assessment of the depth of anaesthesia as measured by the Narcotrend in comparison with bispectral index monitoring (BIS). METHODS: Both BIS and Narcotrend EEG electrodes were positioned on the patient's forehead as recommended by the manufacturers. All patients were premedicated with diazepam 0.15 mg/kg orally in the evening and on the morning before surgery. Induction of anaesthesia was started with a remifentanil infusion at 0.4 microgram/kg/min; 5 min later propofol was given for hypnosis using a target-controlled infusion initially started at 3.5 micrograms/ml. After loss of consciousness patients received 1.2 mg/kg of suxamethonium. Immediately after intubation, remifentanil was reduced to 0.2 microgram/kg/min, and the depth of anaesthesia was adjusted according to clinical needs by regulating the propofol target-controlled-infusion. BIS values and Narcotrend stages were recorded as data pairs in intervals of 1 min during anaesthetic induction and emergence, and in intervals of 5 min during maintenance of anaesthesia. RESULTS: Fifty patients undergoing orthopaedic surgery were studied and 2031 data pairs were o Abtained. An increasing depth of anaesthesia as indicated by the Narcotrend was associated with significantly lower mean BIS values. With BIS values between 100 and 85 (representing awake patients), 95.5% of all data pairs indicated a Narcotrend stage A or B. In case the BIS was found to be 65-40 (representing general anaesthesia) the corresponding Narcotrend stages were measured as D (52.4%) or E (41.1%). No patient complained of intraoperative recall when interviewed on the 1st and 3rd postoperative day. CONCLUSIONS: We could demonstrate that an increase of the hypnotic component of anaesthesia as indicated by BIS is accompanied by corresponding effects as displayed by the Narcotrend during propofol-remifentanil anaesthesia. The Narcotrend stages D or E are assumed equivalent to BIS values between 64 and 40 indicating general anaesthesia.

PMID: 11824075, UI: 21682721

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Anesthesiology 2002 Jan;96(1):256-7

Pulse oximetry and BIS monitoring.

Gage JS

Publication Types:

• Letter

PMID: 11753035, UI: 21621200

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Anesthesiology 2002 Jan;96(1):255-6

BIS monitoring: there's more to it than awareness.

Spackman TN, Abel MD

Publication Types:

• Letter

PMID: 11753034, UI: 21621199

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Anesthesiology 2002 Jan;96(1):252

The steep dose-response curves of anesthesia.

Ueda I

Publication Types:

• Letter

PMID: 117 A53030, UI: 21621195

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Anesthesiology 2002 Jan;96(1):241-3

Detection of awareness with the bispectral index: two case reports.

Luginbuhl M, Schnider TW

Department of Anestesiology, University Hospital of Bern, Switzerland. martin.luginbuehl@dfk2.unibe.ch

PMID: 11753025, UI: 21621190

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Anesthesiology 2002 Jan;96(1):232-7

Testing for malignant hyperthermia.

Rosenberg H, Antognini JF, Muldoon S

Department of Anesthesiology, Thomas Jefferson University, Jefferson Medical College, Philadelphia, Pennsylvania 19107, USA. Henry.Rosenberg@mail.tju.edu

PMID: 11753023, UI: 21621188

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Can J Anaesth 2001 Dec;48(11):1117-21

The laryngeal mask airway is effective (and probably safe) in selected healthy parturients for elective Cesarean section: a prospective study of 1067 cases.

Han TH, Brimacombe J, Lee EJ, Yang HS

Department of Anesthesiology Samsung Medical Center, SungKyunKwan University School of Medicine, Seoul, Korea.

PURPOSE: To report on the use of the laryngeal mask airway (LMA) for elective Cesarean section in 1067 consecutive ASA I-II patients preferring general anesthesia. METHODS: Patients were excluded if they had pharyngeal reflux, a pre-pregnancy body mass index >30, or had a known/predicted difficult airway. Patients were fasted for six hours and given ranitidine/sodium citrate. A rapid sequence induction was performed with thiopentone and suxamethonium. The LMA was inserted by experienc Aed users. Anesthesia was maintained with N(2)O and 50% O(2) and a volatile agent. Cricoid pressure was maintained until delivery, but was relaxed if insertion/ventilation was difficult. Patients were intubated if an effective airway was not obtained within 90 sec, or SpO(2) <94%, or end-tidal CO(2) >45 mmHg. Postdelivery, vecuronium and fentanyl were administered. RESULTS: An effective airway was obtained in 1060 (99%) patients, 1051 (98%) at the first attempt and nine (1%) at the second or third attempt. Air leakage or partial airway obstruction occurred in 22 (21%) patients, and seven (0.7%) patients required intubation. There were no episodes of hypoxia (SpO(2) <90%), aspiration, regurgitation, laryngospasm, bronchospasm or gastric insufflation. Surgical conditions were satisfactory and all APGAR scores were >/=7 after five minutes. CONCLUSION: We conclude that the LMA is effective and probably safe for elective Cesarean section in healthy, selected patients when managed by experienced LMA users.

Publication Types:

• Clinical trial

PMID: 11744589, UI: 21610109

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Can J Anaesth 2001 Dec;48(11):1102-8

Intraoperative single-shot "3-in-1" femoral nerve block with ropivacaine 0.25%, ropivacaine 0.5% or bupivacaine 0.25% provides comparable 48-hr analgesia after unilateral total knee replacement.

Ng HP, Cheong KF, Lim A, Lim J, Puhaindran ME

Department of Anaesthesiology, and Hand and Reconstructive Surgery, National University Hospital Singapore.

PURPOSE: To compare analgesia after intraoperative single shot "3-in-1" femoral nerve block (FNB) in combination with general anesthesia using ropivacaine 0.25%, ropivacaine 0.5% with bupivacaine 0.25% for A total knee replacement (TKR). METHODS: We performed a randomized, double-blind study in 48 patients for elective TKR under general anesthesia. Patients were randomized to one of four groups (C: sham block, R1: "3-in-1" FNB using 30 mL of ropivacaine 0.25%, R2: "3-in-1" FNB using 30 mL of ropivacaine 0.5%, B: "3-in-1" FNB using 30 mL of bupivacaine 0.25%). Verbal pain score (VPS) both at rest and movement were assessed for 48 hr after TKR (0=none; 1=mild; 2=moderate; 3=severe). Total morphine consumption and its associated side effects, duration of hospitalization after operation were also compared. RESULTS: There were no differences in patients' physical characteristics, intraoperative morphine usage, operation time, tourniquet time or length of hospitalization between the four groups. When compared with group C, the VPS was significantly lower in groups R1, R2 and B at one, four, eight, 24 and 48 hr after TKR (P <0.05). The morphine requirement of groups R1, R2 and B were also significantly lower when comparing with group C up to 48 hr postoperatively (P <0.05). There were no significant differences in VPS and postoperative morphine requirement at any time between groups R1, R2 and B. CONCLUSION: "3-in-1" FNB with ropivacaine provided analgesia that was clinically comparable to that of bupivacaine up to 48 hr after TKR. Increasing the concentration of ropivacaine from 0.25% to 0.5% failed to improve the postoperative analgesia of "3-in-1" FNB.

Publication Types:

• Clinical trial
• Randomized controlled trial

PMID: 11744586, UI: 21610106

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Can J Anaesth 2001 Dec;48(11):1091-101

Preemptive analgesia II: recent advances and current trends. A

Kelly DJ, Ahmad M, Brull SJ

Department of Anaesthesia, Cork University Hospital, Wilton, Cork, Ireland.

PURPOSE: This two-part review summarizes the current knowledge of physiological mechanisms, pharmacological modalities and controversial issues surrounding preemptive analgesia. SOURCE: Articles from 1966 to present were obtained from the MEDLINE databases. Search terms included analgesia, preemptive; neurotransmitters; pain, postoperative; hyperalgesia; sensitization, central nervous system; pathways, nociception; anesthetic techniques; analgesics, agents. Principal findings: In Part I of this review article, techniques and agents that attenuate or prevent central and peripheral sensitization were reviewed. In Part II, the conditions required for effective preemptive techniques are evaluated. Specifically, preemptive analgesia may be defined as an antinociceptive treatment that prevents establishment of altered central processing of afferent input from sites of injury. The most important conditions for establishment of effective preemptive analgesia are the establishment of an effective level of antinociception before injury, and the continuation of this effective analgesic level well into the post-injury period to prevent central sensitization during the inflammatory phase. Although single-agent therapy may attenuate the central nociceptive processing, multi-modal therapy is more effective, and may be associated with fewer side effects compared with the high-dose, single-agent therapy. CONCLUSION: The variable patient characteristics and timing of preemptive analgesia in relation to surgical noxious input require individualization of the technique(s) chosen. Multi-modal analgesic techniques appear more effective.

Publication Types:

• Review
• Review, tutorial

PMID: 11744585, UI: 21610105

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Can J Anaesth 2001 Dec;48(11):1084-90

Equi-lasting doses of rocuronium, compared to mivacurium, result in improved neuromuscular blockade in patients undergoing gynecological laparoscopy : [Des doses de duree equivalente de rocuronium, compare au mivacurium, ameliorent la curarisation chez des patientes qui subissent une laparoscopie gynecologique].

Dahaba AA, Schweitzer E, Fitzgerald RD, Schwarz S

Department of Anaesthesia, Lainz Hospital, Vienna, Austria. Ashraf.Dahaba@kfunigraz.ac.at

PURPOSE: To compare equi-lasting doses of a short-acting (mivacurium) to an intermediate-acting (rocuronium) neuromuscular relaxant, with regard to intubating conditions, efficacy, number of maintenance doses, hemodynamic alterations, adverse events and costs, in patients undergoing laparoscopic gynecological surgery. METHODS: Sixty patients were randomly allocated to receive either 0.2 mg*kg(-1) (3 x ED(95)) mivacurium or 0.5 mg*kg(-1) (1.7 x ED(95)) rocuronium, under propofol/fentanyl anesthesia. T1, first twitch of the train-of-four (TOF) and TOF ratio (T4:T1) were used to evaluate neuromuscular block using the Relaxometer(R) mechanomyograph. The trachea was intubated when T1 was maximally suppressed. Neuromuscular block was maintained at 25% T1 with equi-lasting doses of 0.075 mg*kg(-1) mivacurium or 0.15 mg*kg(-1) rocuronium. RESULTS: Mean (min) +/- SD mivacurium onset time (1.9 +/- 0.4) was longer than that of rocuronium (1.3 +/- 0.3). This did not yield a statistical difference in intubating conditions between the two groups. Interval 25-75% T1 recovery and time to 0.8 TOF recovery were prolonged following rocuronium (11.9 +/- 3.9, 52.6 +/- 15.5 respectively) compared to mivacurium (6.7 +/- 2.3, 39.2 +/- 8.1 respectively). More patients, A 22/30, required mivacurium maintenance doses compared to 14/30 patients in the rocuronium group. Arterial blood pressure declined and 13/30 patients manifested erythema following mivacurium administration. The acquisition costs of rocuronium (6.93 Euro/patient) were 23% lower compared to mivacurium (8.96 Euro/patient). CONCLUSION: Equi-lasting doses of rocuronium resulted in favourable intubating conditions more rapidly, improved hemodynamic stability, required less frequent administration of maintenance doses and were not associated with erythema, compared to mivacurium.

Publication Types:

• Clinical trial
• Randomized controlled trial

PMID: 11744584, UI: 21610104

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Can J Anaesth 2001 Dec;48(11):1080-3

Transdermal ketoprofen mitigates the severity of postoperative sore throat : [Le ketoprofene transdermique reduit le mal de gorge postoperatoire].

Ozaki M, Minami K, Sata T, Shigematsu A

Department of Anesthesiology, University of Occupational and Environmental Health, School of Medicine, Fukuoka, Japan.

PURPOSE: To evaluate prospectively the incidence and severity of postoperative sore throat in 63 orotracheally intubated patients undergoing general anesthesia for various surgical procedures and to determine whether postoperative sore throat could be attenuated by treatment with the transdermal nonsteroidal anti-inflammatory drug ketoprofen applied on the anterior skin of the neck during operation. METHOD: Patients were randomly assigned to have treatment with ketoprofen (ketoprofen group) or to have placebo tape treatment (control group). Postoperative analgesia was obtained by continuous epidural infusion of local anesthetics, and no narcotics were administered intraopera Atively or postoperatively. All patients were interviewed postoperatively after 12-20 hr using a scoring scale questionnaire. Sore throat was scored as 0=no sore throat, 1=minimal, 2=mild, 3=moderate, 4=severe. RESULTS: In the control group, 16 of 32 patients had a sore throat. In the ketoprofen group, less patients (ten of 31 patients) had a sore throat (not significant). The severity of sore throat was alleviated significantly in the ketoprofen group (P <0.05). CONCLUSION: This study suggests the pain caused by tracheal intubation is relieved by intraoperative topical use of transdermal ketoprofen.

Publication Types:

• Clinical trial
• Randomized controlled trial

PMID: 11744583, UI: 21610103

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Can J Anaesth 2001 Dec;48(11):1061-5

The evolving role of the laryngeal mask airway in obstetrics.

Preston R

Publication Types:

• Comment
• Editorial

PMID: 11744579, UI: 21610099

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Pediatrics 2002 Feb;109(2):236-43

Risk reduction in pediatric procedural sedation by application of an American Academy of Pediatrics/American Society of Anesthesiologists process model.

Hoffman GM, Nowakowski R, Troshynski TJ, Berens RJ, Weisman SJ

Department of Anesthesiology, Children's Hospital of Wisconsin, Milwaukee, Wisconsin 53226, USA. ghoffman@mcw.edu

[Medline record in process]

OBJECTIVE: Guidelines for risk reduction during procedural sedation from the American Academy of Pediatrics (AAP) and the American Society of Anesthesiologists (ASA) rely on expert opinion and consensus. In this a Article, we tested the hypothesis that application of an AAP/ASA-structured model would reduce the risk of sedation-related adverse events. METHODS: Prospectively coded sedation records were abstracted by a hospital quality improvement specialist with practical and administrative experience in pediatric sedation. Process variables included notation of nulla per os (NPO) status, performance of a guided risk assessment, assignment of ASA physical status score, obtaining informed consent, generation of a sedation plan, and assessment of sedation level using a quantitative scoring system. Content variables included adherence to AAP NPO guidelines, ASA class, target sedation level, actual sedation level, age, procedure, and drugs used. Complication risk was assessed by logistic regression and Mantel-Haenszel odds ratios (OR). RESULTS: Complications were identified in 40 of 960 records (4.2%). The complication rate was 34 of 895 (3.8%) with planned conscious sedation and 6 of 65 (9.2%) with planned deep sedation ([DS]; OR: 2.6). Complications were reduced by performance of structured risk assessment (OR: 0.10), adherence to all process guidelines (OR: 0), and avoiding actual DS (OR: 0.4). The only drug associated with higher risk was chloral hydrate (OR: 2.1). Failure to adhere to NPO guidelines did not increase risk in this assessment; however, the adverse event rate was 0 if all process guidelines were followed. CONCLUSIONS: Presedation assessment reduces complications of DS. Repeated assessment of sedation score reduces the risk of inadvertent DS. The data provide direct evidence that AAP/ASA guidelines can reduce the risk of pediatric procedural sedation.

PMID: 11826201, UI: 21684049