Tetanic stimulus of ulnar nerve as a predictor of heart rate response to skin incision in propofol remifentanil anaesthesia

Size: px
Start display at page:

Download "Tetanic stimulus of ulnar nerve as a predictor of heart rate response to skin incision in propofol remifentanil anaesthesia"

Transcription

1 British Journal of Anaesthesia 99 (4): (2007) doi: /bja/aem200 Advance Access publication July 27, 2007 Tetanic stimulus of ulnar nerve as a predictor of heart rate response to skin incision in propofol remifentanil anaesthesia M. Rantanen 1 *, H. Yppärilä-Wolters 2, M. van Gils 2, A. Yli-Hankala 13, M. Huiku 4, M. Kymäläinen 4 and I. Korhonen 2 1 Department of Anaesthesia, Tampere University Hospital, PO Box 2000, FIN Tampere, Finland. 2 VTT Technical Research Centre of Finland, PO Box 1300, FIN Tampere, Finland. 3 University of Tampere Medical School, University of Tampere, FIN Tampere, Finland. 4 GE Healthcare Finland Oy, PO Box 900, FIN GE Helsinki, Finland *Corresponding author. markku.rantanen@pshp.fi Background. To study adequate antinociception during general anaesthesia, tetanic stimulus of 5 10 s duration has been used previously as a standardized nociceptive stimulus. However, such stimuli have been found to correlate poorly with intraoperative nociception. We hypothesized that an electrical tetanic stimulus of the ulnar nerve, lasting 30 s, would provide a reliable experimental pain model. Methods. Thirty-three patients, undergoing open abdominal surgery, were studied. Propofol and remifentanil were used for anaesthesia. Patients were randomized to receive remifentanil at three target-controlled infusion levels (1, 3, or 5 ng ml 21 ) during short (5 s, Tet5) and a long-lasting (30 s, Tet30) tetanic (50 ma, 50 Hz) stimulus and skin incision. RR intervals (RRI) were obtained from the ECG and the mean RRI before each stimulus (Tet5, Tet30, incision) was compared with that after the stimulus. Results. At remifentanil level 1 ng ml 21, the RRI responses to tetanic stimuli and skin incision were prominent but with higher concentrations (3 and 5 mg ml 21 ), responses were very small. Tet30 (r 2 ¼0.780) was the best predictor of the RRI response to skin incision when compared with Tet5 (r 2 ¼0.611), remifentanil level (r 2 ¼0.340), or propofol level (r 2 ¼0.036). Conclusions. Long-lasting tetanic stimulus of ulnar nerve may provide a better experimental pain model for surgical pain during general anaesthesia than shorter stimuli, which have been applied in earlier studies. Br J Anaesth 2007; 99: Keywords: anaesthetics i.v., propofol; analgesia; analgesics opioid, remifentanil; pain, experimental Accepted for publication: May 30, 2007 Adequate antinociception is mandatory during general anaesthesia. Antinociception, usually achieved by opioids, should relate to external stimuli, constituting relevant nociceptive antinociceptive balance. Estimation of such a balance has been commonly based on unspecific autonomic reactions, such as hypertension, tachycardia, involuntary movements, sweating, or presence of tears. Various approaches, such as processed encephalographic (EEG) variables, peripheral neurophysiological responses, or heart rate variability (HRV), have been taken for measuring the level of nociception of an unconscious surgical patient. 1 8 In clinical research, to evaluate the nociceptive antinociceptive balance of an anaesthetized patient, an experimental pain test, which correlates sufficiently to analgesic medication and intensity of surgical stimuli, is needed. 9 Such a test method should be non-invasive, harmless, specific to measure pain, sensitive, standardized, and repeatedly applicable Experimental pain stimuli Declaration of interest. This study was supported by funding from GE Healthcare Finland Oy. Dr Yli-Hankala is a medical advisor of GE Healthcare Finland. Dr Huiku and Ms Kymäläinen are employees of GE Healthcare Finland Oy. # The Board of Management and Trustees of the British Journal of Anaesthesia All rights reserved. For Permissions, please journals.permissions@oxfordjournals.org

2 Rantanen et al. can be electrical, thermal, mechanical, ischaemic, or chemical In the operating room, only the electrical pain model has potential clinical importance, because it is repeatable, non-invasive, and the strength of the stimulus is adjustable. Both single electrical stimulation and repeated electrical stimuli have been investigated. 17 Most pain models usually reflect only surface pain, whereas surgical tissue damage also involves deep structures response. 18 To describe those responses, electrical stimuli have to be sufficiently long lasting to activate both temporal and spatial nociceptive mechanisms Such an experimental pain test may simulate skin incision as a noxious stimulus. Tetanic stimulus of the ulnar nerve has been investigated as a standardized predictor of a patient s responsiveness to nociceptive stimuli Typically, stimuli lasting for 5 10 s have been used. 22 However, it has been shown recently that a response to 5 s electrical tetanic stimulus has no predictive value in clinical surgical anaesthesia. 23 In this study, we wanted to evaluate the physiological effects of short (5 s) and long-lasting (30 s) tetanic stimuli of the ulnar nerve. We hypothesized that a long-lasting tetanic stimulus is better related to analgesic drug concentration and patient s response to skin incision during propofol remifentanil anaesthesia than a short tetanic stimulus. Methods The ethics committee of Tampere University Hospital approved the study, and written informed consent was obtained from each patient. Thirty-six patients (ASA I II) were enrolled. Inclusion criteria were age between 18 and 65 yr and elective laparotomy under general anaesthesia. Exclusion criteria were known neurological disorders, history of head injury, any medication seriously affecting heart rate or the central nervous system, major cardiac problems, uncontrolled hypertension, disease of the thyroid, history of alcohol or drug abuse or BMI.30 kg m 22. All patients were premedicated with diazepam 5 10 mg orally 60 min before surgery. In the operating room, an i.v. catheter was inserted into a forearm vein and standard monitoring was started, including EEG spectral entropy (SE). Anaesthesia was induced and maintained with targetcontrolled infusions (TCI Orchestra Primea w, Fresenius, France) of propofol and remifentanil Tracheal intubation was facilitated with cisatracurium 0.15 mg kg 21. Neuromuscular block was monitored every 20 s until a train-of-four (TOF) response below 4/4 was reached (Datex-Ohmeda S/5 Anaesthesia Monitor, GE Healthcare Finland Oy, Helsinki, Finland), and the trachea of the patient was intubated. After tracheal intubation, propofol TCI was adjusted to maintain SE level between 35 and 60, the target being at 50 (adequate surgical level of hypnosis). 26 The lungs of patients were normoventilated with air oxygen mixture (FI O2 0.35). Two ECG electrodes (Kendall ARBO H99SG, Tyco Healthcare Deutschland GmbH, Noustadt/Donau, Germany) were placed over the ulnar nerve on the left wrist. Patients were randomly allocated according to computer-generated random numbers (Excel 2000, Microsoft Corp., Redmond, WA, USA) to receive remifentanil at three different TCI levels: 1, 3, or 5 ng ml 21 during intubation, tetanic testing, and skin incision. Patients were also randomized to receive first either a short tetanic stimulus (5 s, 50 ma, 50 Hz, square-wave, neurostimulator, Life Tech Inc., Houston, TX, USA) and thereafter the long-lasting tetanic stimulus (30 s, 50 ma, 50 Hz, square-wave), or vice versa. To ensure adequacy of the stimulus, neurostimulator pulse wave and current power were verified by a Tektronix A 6302 probe and Tektronix TM 502A Current probe amplifier (Tektronix Inc., Beaverton, Oregon, USA) before beginning the trial. Tetanic testing was started at steady-state anaesthesia after endotracheal intubation (minimum interval between intubation and testing was 10 min). The operating room was kept as quiet as possible and all external stimuli were minimized during the testing period. The time interval between each tetanic stimulus was 3 min. Surgery was allowed to start when 2 min elapsed after testing. Skin incision was annotated. The ECG was amplified and displayed on a Datex-Ohmeda S/5 monitor (GE Healthcare Finland Oy, Helsinki, Finland). Both ECG (sampling frequency 300 Hz) and tetanic stimuli annotations were recorded on a PC with S/5 Collect (software vers. 4.0) and analysed off-line. The R-waves of the ECG signal were automatically detected and visually verified and corrected afterwards when necessary. A beat-to-beat R-to-R interval (RRI) signal was constructed as a series of time differences between the successive heart beats. The RRI-signal was analysed off-line in each separate individual using Matlab w software (Matlab, version 6.5, Release 13, The Mathworks Inc., MA, USA). The analysis period before each stimulus was 60 s, and the post-stimulation periods were 20 s for the short tetanic stimulus, 45 s for the long tetanic stimulus, and 60 s for the first skin incision. The length of the analysis period was determined based on the length of RRI responses. The mean RRI values within the analysed periods were computed and the post-stimulus values were divided by their pre-stimulus values. The investigator was not blinded during the data collection. However, the investigator who made all analyses off-line was blinded and was never present in the operating room. The statistical analysis was performed with the SPSS w program (SPSS for Windows, SPSS Inc., Chicago, IL, USA). The general linear model for repeated measures was applied for studying the effect of remifentanil on RRI responses produced by different stimuli (Tet30, Tet5, and incision). One-way ANOVA and paired-sample t-test were used for post hoc analyses. Linear regression analysis was 510

3 Tetanic stimulus predicts response to skin incision used to predict the RRI response to the skin incision by pre-incision variables, that is, RRI responses to tetanic stimuli and drug (remifentanil and propofol) levels. Data are shown as mean (SD) or range, unless otherwise indicated. P-values of,0.05 (two-tailed) were considered statistically significant. Results Thirty-three patients (22 women and 11 men) were studied. Their mean age was 48 (12.3) yr (range yr) and BMI 26 (3.4) kg m 22. Three patients were excluded due to technical problems in the data collection. Tetanic stimuli and skin incision induced prominent RRI responses at remifentanil level of 1 ng ml 21 (Fig. 1A). Post/pre RRI ratios were 0.97 (0.04), 0.91 (0.07), and 0.90 (0.09) for Tet5, Tet30, and skin incision, respectively (P,0.01 between Tet5 and others; P¼0.407 between Tet30 and skin incision, Table 1). At 3 and 5 ng ml 21 remifentanil levels, all stimuli types were associated with very small RRI responses (Fig. 1B and C). The RRI response to Tet30 was the best predictor of the RRI response to the skin incision (r 2 ¼0.780) of all the measured variables (r 2 for remifentanil level 0.340, for propofol level 0.036, and for the Tet ) (Fig. 2). When all the variables were combined, the model predicted the RRI response to skin incision only slightly better (r 2 ¼0.811) than the RRI response to Tet30 alone. SE levels during tetanic testing and skin incision remained stable and unaltered. Significant hypotension did not occur and no vasoactive drugs were needed. The intensity of neuromuscular block was similar in all patients (fewer than 4/4 responses for TOF stimulation) throughout the study period. Discussion Our results show that RRI response to 30 s tetanic stimulus predicted the RRI response to skin incision. However, these findings were seen at the lowest remifentanil level only. With higher remifentanil concentrations, RRI remained unresponsive to all stimuli including skin incision. In this study, the responsiveness of RRI to stimuli correlated with the level of analgesic medication. In previous trials, rather short-lasting (5 or 10 s) tetanic stimuli have been used as an experimental non-invasive Fig 1 The mean RRI responses at remifentanil levels of 1, 3, and 5 mg ml 21 to different stimuli. Stimulation starts at 0 s. The RRI responses are normalized according to the pre-stimulus level. 511

4 Rantanen et al. Table 1 The post/pre-stimulus RRI ratios. Mean (SD) for different remifentanil levels and stimuli. At remifentanil level 1 ng ml 21, the RRI responses differed among the stimuli (P-value 1 ). The post hoc test (paired-sample test) revealed a significant difference between RRI Tet5 and RRI Tet30 (P¼0.003) and between RRI Tet5 and RRI incision (P¼0.006) (Up down comparison). At remifentanil level 1 ng ml 21, the RRI responses were also larger than at other remifentanil levels (P-value 2 ). Significant differences are marked in the table (*P,0.001; **P,0.05 in comparison with the RRI response at remifentanil level 1 ng ml 21 ) (Left right comparison) (1 ng ml 21 ) (3 ng ml 21 ) (5 ng ml 21 ) P-value 2 RRI Tet (0.072) 1.01 (0.027)* (0.022)*,0.001 RRI Tet (0.037) (0.011)** (0.012) RRI incision (0.091) (0.026)** 1.00 (0.035)**,0.001 P-value test stimulus to cause nociception during general anaesthesia. 27 Our study supports the previous finding that a short tetanic stimulus relatively poorly reflects the physiological response caused by a surgical stimulus. 21 It has been presumed that short electrical stimulus elicits mainly cutaneous pain mechanisms, whereas surgical tissue damage also contains deeper components. Petersen-Felix and Arendt-Nielsen 18 have suggested that a stimulus has to be long lasting or repeated to activate temporal or spatial summation mechanisms and, hence, to elicit intense pain sensation. A long-lasting electrical stimulus activates various afferent pathways, because C-fibres have a higher activation threshold than A-fibres. 28 Our results support the findings of Petersen-Felix and Arendt-Nielsen, that is, that the response to a long-lasting tetanic stimulus is qualitatively different to the response seen after a short stimulus. In a previous study, Luginbühl and colleagues 23 concluded that pulse plethysmography (PPG) response to a short-lasting (5 s) tetanic stimulus does not predict the responsiveness to endotracheal intubation at different levels of analgesia and anaesthesia, and thus the PPG response to Fig 2 A scatter plot of the mean postpre-stimulus RRI ratios: skin incision vs 30 s tetanic stimulus at different remifentanil levels. a short-lasting tetanic stimulus does not reflect the analgesic state accurately. This conflicts somewhat with our finding where RRI responses to tetanic stimuli (both 30 and 5 s, though the former with significantly better correlation) were significant predictors to RRI responses to skin incision clearly better predictors than the drug levels alone, which were the best predictors in a study by Luginbühl and colleagues. 23 We hypothesize that this difference may be at least partially related to the different nature of skin incision and tracheal intubation as a stimulus. The intubation causes a strong direct autonomic stimulus (e.g. through direct stimulation of baroreceptors), which is combined with the nociceptive stimulus, whereas in skin incision, the direct nociceptive stimulus dominates and no direct autonomic stimuli occur. Hence, at least part of the response to intubation may be related to the direct autonomic stimulus rather than pure nociception, making its prediction by use of experimental pain models less probable. In addition, though skin incision in different types of surgery is certainly neither a well-controlled nor a standardized clinical stimulus, intubation is even more prone to inter-individual variance in magnitude and duration of stimulation. Thus, we hypothesize that the use of skin incision as a reference of clinical pain has a better potential to give an accurate association between an experimental and clinical stimulus, and autonomic responses to skin incision better reflect the real nociceptive antinociceptive balance than those responses to tracheal intubation. Our results confirm a clear association between a longlasting tetanic stimulus and abdominal skin incision during propofol remifentanil anaesthesia. We did not study the later phases of surgery. The reliability of a tetanic stimulus to predict reflections caused by visceral manipulation or other nociceptive events remains to be evaluated. All patients were paralysed with cisatracurium, leading to significantly attenuated motor responses for tetanic stimuli. Theoretically, omitting the use of cisatracurium and consequent vigorous muscle contractions during tetanic testing would have led to stronger heart rate responses. However, we aimed at standardized study circumstances for both tetanic testing and skin incision. Our goal was not to study the effect of muscle relaxation on heart rate but to elucidate the association between the length of the tetanic stimulus and skin incision, without unnecessary confounding factors. Moreover, a long abdominal skin incision without neuromuscular block was considered potentially problematic and was therefore discarded. No harmful side-effects occurred in our study. Patients were interviewed later on by a trained research nurse for theoretically possible damage caused by tetanic stimuli. No tetanic stimulation associated symptoms or signs of ulnar nerve damage were noted. In conclusion, the RRI response to the long-lasting electrical tetanic (30 s, 50 ma, 50 Hz) was a better predictor of the RRI response to skin incision than a short tetanic 512

5 Tetanic stimulus predicts response to skin incision stimulus or drug (remifentanil and propofol) level. We suggest a tetanic stimulus lasting 30 s as a standardized, non-invasive, repeatable test method, which simulates the RRI response to skin incision in healthy individuals during propofol remifentanil anaesthesia. References 1 Guignard B. Monitoring analgesia. Best Pract Res Clin Anaesthesiol 2006; 20: Bouillon TW, Bruhn J, Radulescu L, et al. Pharmacodynamic interaction between propofol and remifentanil regarding hypnosis, tolerance of laryngoscopy and electroencephalographic approximate entropy. Anesthesiology 2004; 100: Kearse L, Manberg P, Chamoun N, et al. Bispectral analysis of the electroencephalogram correlates with patient movement to skin incision during propofol/nitrous oxide anesthesia. Anesthesiology 1994; 81: Baars JH, Kalisch D, Herold KF, et al. Concentration-dependent suppression of F-waves by sevoflurane does not predict immobility to painful stimuli in humans. Br J Anaesth 2005; 95: Schubert A, Palazzolo J, Brum J, et al. Heart rate, heart rate variability, and blood pressure during perioperative stressor events in abdominal surgery. J Clin Anesth 1997; 9: Ledowski T, Bein B, Hanss R, et al. Neuroendocrine stress response and heart rate variability: a comparison of total intravenous versus balanced anesthesia. Anesth Analg 2005; 101: Seitsonen ERJ, Korhonen IKJ, van Gils MJ, et al. EEG spectral entropy, heart rate, photoplethysmography and motor responses to skin incision during sevoflurane anaesthesia. Acta Anaesthesiol Scand 2005; 49: Rantanen M, Yli-Hankala A, van Gils M, et al. Novel multiparameter approach for measurement of nociception at skin incision during general anaesthesia. Br J Anaesth 2006; 96: Petersen K, Jones B, Segredo V, et al. Effect of remifentanil on pain and secondary hyperalgesia associated with the heat capsaicin sensitization model in healthy volunteers. Anesthesiology 2001; 94: Gracely RH. Studies of pain in normal man. In: Wall PD, Melzack R, eds. Textbook of Pain, 3rd Edn. Edinburgh: Churchill Livingstone, 1994; Arendt-Nielsen L. Induction and assessment of experimental pain from human skin, muscle and viscera. In: Jensen TS, Turner JA, Wiesenfeld-Hallin Z, eds. Proceedings of the 8th World Congress of Pain. Seattle: IASP Press, 1997; Arendt-Nielsen L, Petersen-Felix S, Fisher M, et al. The effect of N-methyl-D-aspartate agonist (ketamine) on single and repeated nociceptive stimuli: a placebo-controlled experimental human study. Anesth Analg 1995; 81: Yagi M, Mashimo T, Kawaguchi T, Yoshiya I. Analgesic and hypnotic effect of subanesthetic concentrations of xenon in human volunteers: comparison with nitrous oxide. Br J Anaesth 1995; 74: Petersen-Felix S, Arendt-Nielsen L, Bak P, et al. Ondansetron does not inhibit the analgesic effect of alfentanil. Br J Anaesth 1994; 73: Smith GA, Egbert LD, Markowitz RA, et al. An experimental pain method sensitive to morphine in man: the submaximum effort tourniquet technique. J Pharmacol Exp Ther 1966; 154: Maurset A, Skoglund LA, Hustveit O, et al. A new version of the ischemic tourniquet pain test. Methods Find Exp Clin Pharmacol 1991; 13: Petersen-Felix S, Arendt-Nielsen L, Bak P, et al. The effect of isoflurane on repeated nociceptive stimuli (dentral temporal summation). Pain 1996; 64: Petersen-Felix S, Arendt-Nielsen L. From pain research to pain treatment: the role of human experimental pain models. Best Pract Res Clin Anaesthesiol 2002; 16: Petersen-Felix S, Arendt-Nielsen L, Bak P, et al. The effect of isoflurane on repeated nociceptive stimuli (dentral temporal summation). Pain 1996; 64: Luginbühl M, Schnider T, Petersen-Felix S, et al. Comparison of five experimental pain tests to measure analgesic effects of alfentanil. Anesthesiology 2001; 95: Shimoda O, Ikuta Y, Sakamoto M, et al. Skin vasomotor reflex predicts circulatory responses to laryngoscopy and intubation. Anesthesiology 1998; 88: Cohen PJ, Heisterkamp DV, Skovsted P. The effect of general anaesthetics on the response to tetanic stimulus in man. Br J Anaesth 1970; 42: Luginbühl M, Rüfenacht M, Korhonen I, et al. Stimulation induced variability of pulse plethysmography does not discriminate responsiveness to intubation. Br J Anaesth 2006; 96: Schnider TW, Minto CF, Gambus PL, et al. The influence of method of administration and covariates on the pharmacokinetics of propofol in adult volunteers. Anesthesiology 1998; 88: Minto CF, Schnider TW, Shafer SL. Pharmacokinetics and pharmacodynamics of remifentanil. II. Model application. Anesthesiology 1997; 86: Vakkuri A, Yli-Hankala A, Talja P, et al. Time frequency balanced spectral entropy as a measure of anesthetic drug effect in central nervous system during sevoflurane, propofol and thiopental anesthesia. Acta Anaesthesiol Scand 2004; 48: Luginbühl M, Reichlin F, Sigurdsson GH, et al. Prediction of the haemodynamic response to tracheal intubation: comparison of laser-doppler skin vasomotor reflex and pulse wave reflex. Br J Anaesth 2002; 89: Curatolo M, Petersen-Felix S, Arendt-Nielsen L. Sensory assessment of regional analgesia in humans. Anesthesiology 2000; 93:

Influence of nociceptive stimulation on analgesia nociception index (ANI) during propofol remifentanil anaesthesia

Influence of nociceptive stimulation on analgesia nociception index (ANI) during propofol remifentanil anaesthesia British Journal of Anaesthesia 11 (6): 124 3 (213) Advance Access publication 6 March 213. doi:1.193/bja/aet19 Influence of nociceptive stimulation on analgesia nociception index () during propofol remifentanil

More information

Effect of remifentanil or esmolol on bispectral index and entropy to tracheal intubation during propofol anesthesia

Effect of remifentanil or esmolol on bispectral index and entropy to tracheal intubation during propofol anesthesia Anesth Pain Med 2010; 5: 304~309 Research Article Effect of remifentanil or esmolol on bispectral index and entropy to tracheal intubation during propofol anesthesia Department of Anesthesiology and Pain

More information

Effect of pain on autonomic nervous system indices derived from photoplethysmography in healthy volunteers

Effect of pain on autonomic nervous system indices derived from photoplethysmography in healthy volunteers British Journal of Anaesthesia 1 (5): 3 (1) Advance Access publication February 1. doi:1.193/bja/aes1 PAIN Effect of pain on autonomic nervous system indices derived from photoplethysmography in healthy

More information

Clinical Study The Effect of Tracheal Intubation-Induced Autonomic Response on Photoplethysmography

Clinical Study The Effect of Tracheal Intubation-Induced Autonomic Response on Photoplethysmography Hindawi Anesthesiology Research and Practice Volume 217, Article ID 7646541, 5 pages https://doi.org/1.1155/217/7646541 Clinical Study The Effect of Tracheal Intubation-Induced Autonomic Response on Photoplethysmography

More information

SSI reflects nociception during laparoscopy was that while keeping state entropy (SE) and arterial pressure at a predetermined level, SSI would be hig

SSI reflects nociception during laparoscopy was that while keeping state entropy (SE) and arterial pressure at a predetermined level, SSI would be hig British Journal of Anaesthesia 98 (4): 456 61 (27) doi:1.193/bja/aem35 Advance Access publication March 9, 27 Surgical stress index reflects surgical stress in gynaecological laparoscopic day-case surgery

More information

BIS Monitoring. ASSESSMENT OF DEPTH OF ANAESTHESIA. Why measure depth of anaesthesia? or how to avoid. awareness in one easy lesson

BIS Monitoring.   ASSESSMENT OF DEPTH OF ANAESTHESIA. Why measure depth of anaesthesia? or how to avoid. awareness in one easy lesson BIS Monitoring or how to avoid www.eurosiva.org awareness in one easy lesson ASSESSMENT MONITORING ANAESTHETIC DEPTH OF DEPTH OF ANAESTHESIA Why measure depth of anaesthesia? How do the various EEG monitors

More information

Effect of landiolol on bispectral index and spectral entropy responses to tracheal intubation during propofol anaesthesia

Effect of landiolol on bispectral index and spectral entropy responses to tracheal intubation during propofol anaesthesia British Journal of Anaesthesia 101 (2): 273 8 (2008) doi:10.1093/bja/aen162 Advance Access publication June 9, 2008 Effect of landiolol on bispectral index and spectral entropy responses to tracheal intubation

More information

THE cerebral effect of hypnotic drugs is frequently measured

THE cerebral effect of hypnotic drugs is frequently measured PERIOPERATIVE MEDICINE Anesthesiology 2010; 112:872 80 Copyright 2010, the American Society of Anesthesiologists, Inc. Lippincott Williams & Wilkins Noxious Stimulation Response Index A Novel Anesthetic

More information

Spectral entropy measurement of patient responsiveness during propofol and remifentanil. A comparison with the bispectral index {

Spectral entropy measurement of patient responsiveness during propofol and remifentanil. A comparison with the bispectral index { British Journal of Anaesthesia 93 (5): 5 5 () doi:.93/bja/aeh5 Advance Access publication August, Spectral entropy measurement of patient responsiveness during propofol and remifentanil. A comparison with

More information

Anesthesia depth: EEG or non-eeg derived or both?

Anesthesia depth: EEG or non-eeg derived or both? Anesthesia depth: EEG or non-eeg derived or both? P. L. Gambús Servei de Anestesia; Hospital CLINIC de Barcelona --- Adjunct Associate Professor Department of Anesthesia and Perioperative Care University

More information

The correlation of bispectral index with endtidal sevoflurane concentration and haemodynamic parameters in preschoolers

The correlation of bispectral index with endtidal sevoflurane concentration and haemodynamic parameters in preschoolers Paediatric Anaesthesia 2002 12: 519 525 The correlation of bispectral index with endtidal sevoflurane concentration and haemodynamic parameters in preschoolers MARY ELLEN MCCANN MD, JULIANNE BACSIK MD,

More information

Basic pharmacokinetics. Frédérique Servin APHP hôpital Bichat Paris, FRANCE

Basic pharmacokinetics. Frédérique Servin APHP hôpital Bichat Paris, FRANCE Basic pharmacokinetics Frédérique Servin APHP hôpital Bichat Paris, FRANCE DOSE CONCENTRATION EFFECT Pharmacokinetics What the body does to the drug Pharmacodynamics What the drug does to the body Transfer

More information

Ana Castro Lecture Series in Biomedical Signal and Image Processing MIM2013

Ana Castro Lecture Series in Biomedical Signal and Image Processing MIM2013 Ana Castro Lecture Series in Biomedical Signal and Image Processing MIM2013 Instituto de Telecomunicações Faculdade de Ciências da Universidade do Porto Porto, 16th March 2013 pain can be defined as an

More information

Original Article. * Received for Publication: September 2, 2006 * Revision Received: December 27, 2006 * Revision Accepted: April 4, 2007

Original Article. * Received for Publication: September 2, 2006 * Revision Received: December 27, 2006 * Revision Accepted: April 4, 2007 Original Article COMPARATIVE EVALUATION OF THE CEREBRAL STATE INDEX TM AND BISPECTRAL INDEX TM MONITORING DURING PROPOFOL -REMIFENTANIL ANESTHESIA FOR OPEN HEART SURGERY Shahrbanoo Shahbazi 1, Farid Zand

More information

Chapter 25. General Anesthetics

Chapter 25. General Anesthetics Chapter 25 1. Introduction General anesthetics: 1. Analgesia 2. Amnesia 3. Loss of consciousness 4. Inhibition of sensory and autonomic reflexes 5. Skeletal muscle relaxation An ideal anesthetic: 1. A

More information

British Journal of Anaesthesia 100 (1): (2008) doi: /bja/aem279 Advance Access publication November 23, 2007 Remifentanil target-controll

British Journal of Anaesthesia 100 (1): (2008) doi: /bja/aem279 Advance Access publication November 23, 2007 Remifentanil target-controll British Journal of Anaesthesia 100 (1): 125 30 (2008) doi:10.1093/bja/aem279 Advance Access publication November 23, 2007 Remifentanil target-controlled infusion vs propofol targetcontrolled infusion for

More information

Time to Lowest BIS after an Intravenous Bolus and an Adaptation of the Time-topeak-effect

Time to Lowest BIS after an Intravenous Bolus and an Adaptation of the Time-topeak-effect Adjustment of k e0 to Reflect True Time Course of Drug Effect by Using Observed Time to Lowest BIS after an Intravenous Bolus and an Adaptation of the Time-topeak-effect Algorithm Reported by Shafer and

More information

Akasapu Karunakara Rao, Indira Gurajala 1, Ramachandran Gopinath 1

Akasapu Karunakara Rao, Indira Gurajala 1, Ramachandran Gopinath 1 Clinical Investigation Comparison of electroencephalogram entropy versus loss of verbal response to determine the requirement of propofol for induction of general anaesthesia Address for correspondence:

More information

EUROANESTHESIA 2006 BASIC PHARMACOKINETICS FOR THE CLINICIAN INTRODUCTION BASIC PARAMETERS COMPARTMENTAL MODELS. Madrid, Spain, 3-6 June RC2

EUROANESTHESIA 2006 BASIC PHARMACOKINETICS FOR THE CLINICIAN INTRODUCTION BASIC PARAMETERS COMPARTMENTAL MODELS. Madrid, Spain, 3-6 June RC2 BASIC PHARMACOKINETICS FOR THE CLINICIAN EUROANESTHESIA 2006 Madrid, Spain, 3-6 June 2006 9RC2 THOMAS W. SCHNIDER Institute for Anesthesiology Kantonsspital St.Gallen, Switzerland CHARLES F. MINTO Department

More information

FENTANYL BY CONSTANT RATE I.V. INFUSION FOR POSTOPERATIVE ANALGESIA

FENTANYL BY CONSTANT RATE I.V. INFUSION FOR POSTOPERATIVE ANALGESIA Br. J. Anaesth. (1985), 5, 250-254 FENTANYL BY CONSTANT RATE I.V. INFUSION FOR POSTOPERATIVE ANALGESIA W. S. NIMMO AND J. G. TODD is a synthetic opioid analgesic 50 times more potent than morphine, with

More information

Entropy Publications Reference List June 2016

Entropy Publications Reference List June 2016 GE Healthcare Entropy Publications Reference List June 2016 Contents PEER-REVIEWED ARTICLES... 2 ARTICLES CATEGORIZED... 9 ABSTRACTS... 20 PEER-REVIEWED ARTICLES Abdelmageed, W.M, et al. Preoperative paracetamol

More information

British Journal of Anaesthesia 94 (2): (2005) doi: /bja/aei003 Advance Access publication October 29, 2004

British Journal of Anaesthesia 94 (2): (2005) doi: /bja/aei003 Advance Access publication October 29, 2004 British Journal of Anaesthesia 94 (2): 193 7 (2005) doi:10.1093/bja/aei003 Advance Access publication October 29, 2004 CLINICAL PRACTICE Effects of isoflurane and propofol on cortical somatosensory evoked

More information

Palmar skin conductance compared to a developed stress score and to noxious and awakening stimuli on patients in anaesthesia

Palmar skin conductance compared to a developed stress score and to noxious and awakening stimuli on patients in anaesthesia Acta Anaesthesiol Scand 2005; 49: 798 803 Copyright # Acta Anaesthesiol Scand 2005 Printed in UK. All rights reserved ACTA ANAESTHESIOLOGICA SCANDINAVICA doi: 10.1111/j.1399-6576.2005.00665.x Palmar skin

More information

Comparative randomized study of propofol target-controlled infusion versus sevoflurane anesthesia for third molar extraction

Comparative randomized study of propofol target-controlled infusion versus sevoflurane anesthesia for third molar extraction Original Article pissn 2383-9309 eissn 2383-9317 J Dent Anesth Pain Med 2018;18(3):169-175 https://doi.org/10.17245/jdapm.2018.18.3.169 Comparative randomized study of propofol target-controlled infusion

More information

Closed-Loop Control of General Anesthesia: My Clinical Experience

Closed-Loop Control of General Anesthesia: My Clinical Experience Closed-Loop Control of General Anesthesia: My Clinical Experience Ngai LIU, M.D. n.liu@hopital-foch.org 33(1)-46-25-27-67 Service d Anesthésie Hôpital Foch Suresnes France JAMA 195, 144 (13) 5 patients,

More information

The Effect of Bispectral Index Monitoring on Anesthetic Use and Recovery in Children Anesthetized with Sevoflurane in Nitrous Oxide

The Effect of Bispectral Index Monitoring on Anesthetic Use and Recovery in Children Anesthetized with Sevoflurane in Nitrous Oxide PEDIATRIC ANESTHESIA SECTION EDITOR WILLIAM J. GREELEY SOCIETY FOR PEDIATRIC ANESTHESIA The Effect of Bispectral Index Monitoring on Anesthetic Use and Recovery in Children Anesthetized with Sevoflurane

More information

Rauf et al. The evidence for this effect is equivocal. Studies of volunteers and non-cardiac surgery patients have concluded that there is no toleranc

Rauf et al. The evidence for this effect is equivocal. Studies of volunteers and non-cardiac surgery patients have concluded that there is no toleranc British Journal of Anaesthesia 95 (5): 611 15 (2005) doi:10.1093/bja/aei237 Advance Access publication September 9, 2005 Remifentanil infusion in association with fentanyl propofol anaesthesia in patients

More information

Tracheal intubation in children after induction of anesthesia with propofol and remifentanil without a muscle relaxant

Tracheal intubation in children after induction of anesthesia with propofol and remifentanil without a muscle relaxant Original Article Tracheal intubation in children after induction of anesthesia with propofol and remifentanil without a muscle relaxant Mirmohammad Taghi Mortazavi, 1 Masood Parish, 1 Naghi Abedini, 2

More information

Manual versus target-controlled infusions of propofol

Manual versus target-controlled infusions of propofol Manual versus target-controlled s of propofol D. S. Breslin, 1 R. K. Mirakhur, 2 J. E. Reid 3 and A. Kyle 4 1 Research Fellow, 2 Professor, 3 SpR, 4 Research Nurse, Department of Anaesthetics and Intensive

More information

Age-related requisite concentration of sevoflurane for adequate sedation with combined epidural-general anesthesia

Age-related requisite concentration of sevoflurane for adequate sedation with combined epidural-general anesthesia Clinical Research Article Korean J Anesthesiol 203 June 64(6): 489-493 http://dx.doi.org/0.4097/kjae.203.64.6.489 Age-related requisite concentration of sevoflurane for adequate sedation with combined

More information

Cover Page. The handle holds various files of this Leiden University dissertation.

Cover Page. The handle   holds various files of this Leiden University dissertation. Cover Page The handle http://hdl.handle.net/1887/2959 holds various files of this Leiden University dissertation. Author: Diepstraten, Jeroen Title: The influence of morbid obesity on the pharmacokinetics

More information

Effect-site concentration of remifentanil for laryngeal mask airway insertion during target-controlled infusion of propofol

Effect-site concentration of remifentanil for laryngeal mask airway insertion during target-controlled infusion of propofol doi:10.1111/j.1365-2044.2008.05707.x Effect-site concentration of remifentanil for laryngeal mask airway insertion during target-controlled infusion of propofol M. K. Kim, 1 J. W. Lee, 2 D. J. Jang, 3

More information

Monitoring for Unconsciousness During General Anaesthesia

Monitoring for Unconsciousness During General Anaesthesia Monitoring for Unconsciousness During General Anaesthesia TIM McCULLOCH, MB, BS, BSc(Med), FANZCA Staff Specialist, Dept of Anaesthetics, Royal Prince Alfred Hospital, Camperdown, NSW Tim McCulloch is

More information

Change in auditory evoked potential index and bispectral index during induction of anesthesia with anesthetic drugs

Change in auditory evoked potential index and bispectral index during induction of anesthesia with anesthetic drugs J Clin Monit Comput (2015) 29:621 626 DOI 10.1007/s10877-014-9643-x ORIGINAL RESEARCH Change in auditory evoked potential index and bispectral index during induction of anesthesia with anesthetic drugs

More information

Anesthesiology, V 105, No 6, Dec

Anesthesiology, V 105, No 6, Dec Anesthesiology 2006; 105:1122 34 Copyright 2006, the American Society of Anesthesiologists, Inc. Lippincott Williams & Wilkins, Inc. The Effects of Ketamine and Rocuronium on the A-Line Auditory Evoked

More information

Type of intervention Anaesthesia. Economic study type Cost-effectiveness analysis.

Type of intervention Anaesthesia. Economic study type Cost-effectiveness analysis. Comparison of the costs and recovery profiles of three anesthetic techniques for ambulatory anorectal surgery Li S T, Coloma M, White P F, Watcha M F, Chiu J W, Li H, Huber P J Record Status This is a

More information

COMPARISON OF LINEAR AND NON-LINEAR ANALYSIS OF HEART RATE VARIABILITY IN SEDATED CARDIAC SURGERY PATIENTS

COMPARISON OF LINEAR AND NON-LINEAR ANALYSIS OF HEART RATE VARIABILITY IN SEDATED CARDIAC SURGERY PATIENTS COMPARISON OF LINEAR AND NON-LINEAR ANALYSIS OF HEART RATE VARIABILITY IN SEDATED CARDIAC SURGERY PATIENTS I. Korhonen 1, L.T. Mainardi 2, H.Yppärilä 3, T. Musialowicz 4 1 VTT Information Technology, Tampere,

More information

Richard A. Beers, M.D. Professor, Anesthesiology SUNY Upstate Medical Univ VA Medical Center Syracuse, NY

Richard A. Beers, M.D. Professor, Anesthesiology SUNY Upstate Medical Univ VA Medical Center Syracuse, NY Richard A. Beers, M.D. Professor, Anesthesiology SUNY Upstate Medical Univ VA Medical Center Syracuse, NY beersr@verizon.net 2 Improvements in safety and advances in care are re-invested in older, sicker

More information

Xiaochong Fan, Minyu Ma, Zhisong Li, Shengkai Gong, Wei Zhang, Yuanyuan Wen

Xiaochong Fan, Minyu Ma, Zhisong Li, Shengkai Gong, Wei Zhang, Yuanyuan Wen Int J Clin Exp Med 2015;8(9):16369-16373 www.ijcem.com /ISSN:1940-5901/IJCEM0008198 Original Article The relationship between the target effective site concentration of rocuronium and the degree of recovery

More information

Antagonism of neuromuscular blockade but not muscle relaxation affects depth of anaesthesia

Antagonism of neuromuscular blockade but not muscle relaxation affects depth of anaesthesia British Journal of Anaesthesia 94 (6): 742 7 (2005) doi:10.1093/bja/aei120 Advance Access publication March 18, 2005 Antagonism of neuromuscular blockade but not muscle relaxation affects depth of anaesthesia

More information

Ketoprofen, diclofenac or ketorolac for pain after tonsillectomy in adults?

Ketoprofen, diclofenac or ketorolac for pain after tonsillectomy in adults? British Journal of Anaesthesia 82 (1): 56 60 (1999) Ketoprofen, diclofenac or ketorolac for pain after tonsillectomy in adults? P. Tarkkila* and L. Saarnivaara Department of Anaesthesia, Otolaryngological

More information

ATTENUATION OF HEMODYNAMIC RESPONSES FOLLOWING LARYNGOSCOPY AND TRACHEAL INTUBATION

ATTENUATION OF HEMODYNAMIC RESPONSES FOLLOWING LARYNGOSCOPY AND TRACHEAL INTUBATION ATTENUATION OF HEMODYNAMIC RESPONSES FOLLOWING LARYNGOSCOPY AND TRACHEAL INTUBATION - Comparative assessment of and Gabapentin Premedication Seyed Mojtaba. Marashi, Mohammad Hossein. Ghafari * and Alireza

More information

Pediatric Evaluation of the Bispectral Index (BIS) Monitor and Correlation of BIS with End-tidal Sevoflurane Concentration in Infants and Children

Pediatric Evaluation of the Bispectral Index (BIS) Monitor and Correlation of BIS with End-tidal Sevoflurane Concentration in Infants and Children Pediatric Evaluation of the Bispectral Index (BIS) Monitor and Correlation of BIS with End-tidal Sevoflurane Concentration in Infants and Children William T. Denman, MB, FRCA, Emily L. Swanson, MD, David

More information

Preliminary Intraoperative Validation of the Nociception Level Index

Preliminary Intraoperative Validation of the Nociception Level Index Preliminary Intraoperative Validation of the Nociception Level Index A Noninvasive Nociception Monitor Ruth Edry, M.D., Vasile Recea, M.D., Yuri Dikust, M.D., Daniel I. Sessler, M.D. ABSTRACT Background:

More information

The suppression of spinal F-waves by propofol does not predict immobility to painful stimuli in humansy

The suppression of spinal F-waves by propofol does not predict immobility to painful stimuli in humansy British Journal of Anaesthesia 96 (1): 118 26 (26) doi:1.193/bja/aei283 Advance Access publication November 29, 25 The suppression of spinal F-waves by propofol does not predict immobility to painful stimuli

More information

Optimization Methods to Minimize Emergence Time While Maintaining Adequate Post-Operative Analgesia

Optimization Methods to Minimize Emergence Time While Maintaining Adequate Post-Operative Analgesia Optimization Methods to Minimize Emergence Time While Maintaining Adequate ost-operative Analgesia arl Tams BS, Noah Syroid MS, Ken B. Johnson MD, Talmage D. Egan MD, Dwayne Westenskow hd ABSTAT A rapid

More information

Effect of preoperative oral amantadine on intraoperative anesthetic and analgesic requirements in female patients during abdominoplasty

Effect of preoperative oral amantadine on intraoperative anesthetic and analgesic requirements in female patients during abdominoplasty Egyptian Journal of Anaesthesia (2013) 29, 7 11 Egyptian Society of Anesthesiologists Egyptian Journal of Anaesthesia www.elsevier.com/locate/egja www.sciencedirect.com Research Article Effect of preoperative

More information

Sensory Assessment of Regional Analgesia in Humans

Sensory Assessment of Regional Analgesia in Humans REVIEW ARTICLE Dennis M. Fisher, M.D., Editor-in-Chief Anesthesiology 2000; 93:1517 30 2000 American Society of Anesthesiologists, Inc. Lippincott Williams & Wilkins, Inc. Sensory Assessment of Regional

More information

Bispectral index (Bis) guided comparison of control of haemodynamic responses by fentanyl and butorphanol during tracheal intubation in neurosurgical

Bispectral index (Bis) guided comparison of control of haemodynamic responses by fentanyl and butorphanol during tracheal intubation in neurosurgical Page 1 of 5 Pharmacology Bispectral index (Bis) guided comparison of control of haemodynamic responses by fentanyl and butorphanol during tracheal intubation in neurosurgical S Kumar 1, A Singh 3*, LD

More information

COMPARATIVE ANAESTHETIC PROPERTIES OF VARIOUS LOCAL ANAESTHETIC AGENTS IN EXTRADURAL BLOCK FOR LABOUR

COMPARATIVE ANAESTHETIC PROPERTIES OF VARIOUS LOCAL ANAESTHETIC AGENTS IN EXTRADURAL BLOCK FOR LABOUR Br.J. Anaesth. (1977), 49, 75 COMPARATIVE ANAESTHETIC PROPERTIES OF VARIOUS LOCAL ANAESTHETIC AGENTS IN EXTRADURAL BLOCK FOR LABOUR D. G. LITTLEWOOD, D. B. SCOTT, J. WILSON AND B. G. COVINO SUMMARY Various

More information

Midazolam premedication and thiopental induction of anaesthesia: interactions at multiple end-points

Midazolam premedication and thiopental induction of anaesthesia: interactions at multiple end-points British Journal of Anaesthesia 83 (4): 590 5 (1999) Midazolam premedication and thiopental induction of anaesthesia: interactions at multiple end-points O. H. G. Wilder-Smith 1 *, P. A. Ravussin 25, L.

More information

Increasing isoflurane concentration may cause paradoxical increases in the EEG bispectral index in surgical patients

Increasing isoflurane concentration may cause paradoxical increases in the EEG bispectral index in surgical patients British Journal of Anaesthesia 84 (1): 33 7 (2000) Increasing isoflurane concentration may cause paradoxical increases in the EEG bispectral index in surgical patients O. Detsch, G. Schneider, E. Kochs*,

More information

Posted: 11/27/2011 on Medscape; Published Br J Anaesth. 2011;107(2): Oxford University Press

Posted: 11/27/2011 on Medscape; Published Br J Anaesth. 2011;107(2): Oxford University Press Posted: 11/27/2011 on Medscape; Published Br J Anaesth. 2011;107(2):209-217. 2011 Oxford University Press Effect of Phenylephrine and Ephedrine Bolus Treatment on Cerebral Oxygenation in Anaesthetized

More information

HST-151 Clinical Pharmacology in the Operating Room

HST-151 Clinical Pharmacology in the Operating Room Harvard-MIT Division of Health Sciences and Technology HST.151: Principles of Pharmocology Instructors: Dr. Carl Rosow, Dr. David Standaert and Prof. Gary Strichartz 1 HST-151 Clinical Pharmacology in

More information

KATOH et al. 1 described the reduction of minimal

KATOH et al. 1 described the reduction of minimal Interaction between Nitrous xide, Sevoflurane, and pioids A Response Surface Approach Hugo E. M. Vereecke, M.D., Ph.D.,* Johannes H. Proost, Pharm.D., Ph.D., Bjorn Heyse, M.D., Douglas J. Eleveld, Ph.D.,

More information

General anesthesia. No single drug capable of achieving these effects both safely and effectively.

General anesthesia. No single drug capable of achieving these effects both safely and effectively. General anesthesia General anesthesia is essential to surgical practice, because it renders patients analgesic, amnesia, and unconscious reflexes, while causing muscle relaxation and suppression of undesirable

More information

Monitoring cortical electrical activity in anesthesia for obese patient

Monitoring cortical electrical activity in anesthesia for obese patient Monitoring cortical electrical activity in anesthesia for obese patient Gabriel M. Gurman, M.D. Division of Anesthesiology Soroka Medical Center and Faculty of Health Sciences, Ben Gurion University Beer

More information

INTUBATING CONDITIONS AND INJECTION PAIN

INTUBATING CONDITIONS AND INJECTION PAIN INTUBATING CONDITIONS AND INJECTION PAIN - Cisatracurium or Rocuronium versus Rocuronium-Cisatracurium Combination - AHED ZEIDAN *, NAZIH NAHLE *, HILAL MAALIKI ** AND ANIS BARAKA *** Summary The present

More information

Comparison of the qcon and qnox indexes for the assessment of unconsciousness level and noxious stimulation response during surgery.

Comparison of the qcon and qnox indexes for the assessment of unconsciousness level and noxious stimulation response during surgery. Comparison of the qcon and qnox indexes for the assessment of unconsciousness level and noxious stimulation response during surgery. Umberto Melia 1, Eva Gabarron 1, Mercé Agustí 2, Nuria Souto 2, Patricia

More information

The Influence of Injection Rate on the Hypnotic Effect of Propofol during Anesthesia: A Randomized Trial

The Influence of Injection Rate on the Hypnotic Effect of Propofol during Anesthesia: A Randomized Trial The Influence of Injection Rate on the Hypnotic Effect of Propofol during Anesthesia: A Randomized Trial Jasmin Blum, Eberhard Kochs, Nicole Forster, Gerhard Schneider * Department of Anesthesiology, Technische

More information

responses of the oculocardiac reflex during strabismus surgery

responses of the oculocardiac reflex during strabismus surgery Received: 30.6.2007 Accepted: 31.8.2007 Comparison of effects of thiopental, propofol or ketamine on the cardiovascular responses of the oculocardiac reflex during strabismus surgery Mohammadreza Safavi*,

More information

The effect of bispectral index monitoring on anaesthetic requirements in target-controlled infusion for lumbar microdiscectomy

The effect of bispectral index monitoring on anaesthetic requirements in target-controlled infusion for lumbar microdiscectomy ORIGINAL AND CLINICAL ARTICLES Anaesthesiology Intensive Therapy 2014, vol. 46, no 4, 284 288 ISSN 1642 5758 DOI: 10.5603/AIT.2014.046 www.ait.viamedica.pl The effect of bispectral index monitoring on

More information

Setting The setting was a hospital (tertiary care). The economic study was carried out in Ankara, Turkey.

Setting The setting was a hospital (tertiary care). The economic study was carried out in Ankara, Turkey. Inhalation versus total intravenous anesthesia for lumbar disc herniation: comparison of hemodynamic effects, recovery characteristics, and cost Ozkose Z, Ercan B, Unal Y, Yardim S, Kaymaz M, Dogulu F,

More information

Center for Sensory-Motor Interaction (SMI), Laboratory for Musculoskeletal Pain and Motor Control, Aalborg University, Denmark

Center for Sensory-Motor Interaction (SMI), Laboratory for Musculoskeletal Pain and Motor Control, Aalborg University, Denmark 14RC2 Assessment and mechanisms of musculo-skeletal pain Thomas Graven-Nielsen, Lars Arendt-Nielsen Center for Sensory-Motor Interaction (SMI), Laboratory for Musculoskeletal Pain and Motor Control, Aalborg

More information

Depth of anaesthesia monitors Bispectral Index (BIS), E-Entropy and Narcotrend-Compact M

Depth of anaesthesia monitors Bispectral Index (BIS), E-Entropy and Narcotrend-Compact M Depth of anaesthesia monitors Bispectral Index (BIS), E-Entropy and Narcotrend-Compact M Issued: November 2012 www.nice.org.uk/dg6 NICE 2012 Contents 1 Recommendations... 3 2 The technologies... 5 3 Clinical

More information

Emergence and early cognitive function in the elderly after xenon or desflurane anaesthesia: a double-blinded randomized controlled trial

Emergence and early cognitive function in the elderly after xenon or desflurane anaesthesia: a double-blinded randomized controlled trial British Journal of Anaesthesia 98 (6): 756 62 (2007) doi:10.1093/bja/aem103 Advance Access publication May 7, 2007 Emergence and early cognitive function in the elderly after xenon or desflurane anaesthesia:

More information

OBSTETRICS Magnesium sulphate has beneficial effects as an adjuvant during general anaesthesia for Caesarean section

OBSTETRICS Magnesium sulphate has beneficial effects as an adjuvant during general anaesthesia for Caesarean section British Journal of Anaesthesia 103 (6): 861 6 (2009) doi:10.1093/bja/aep265 Advance Access publication September 24, 2009 OBSTETRICS Magnesium sulphate has beneficial effects as an adjuvant during general

More information

Efficacy of the Valsalva Maneuver on Needle Projection Pain and Hemodynamic Responses During Spinal Puncture

Efficacy of the Valsalva Maneuver on Needle Projection Pain and Hemodynamic Responses During Spinal Puncture 156 Research Paper International Journal of Medical Sciences 2011; 8(2):156-160 Ivyspring International Publisher. All rights reserved. Efficacy of the Valsalva Maneuver on Needle Projection Pain and Hemodynamic

More information

JMSCR Vol 06 Issue 11 Page November 2018

JMSCR Vol 06 Issue 11 Page November 2018 www.jmscr.igmpublication.org Impact Factor (SJIF): 6.379 Index Copernicus Value: 79.54 ISSN (e)-2347-176x ISSN (p) 2455-0450 DOI: https://dx.doi.org/10.18535/jmscr/v6i11.98 IV Nalbuphine vs IV Fentanyl

More information

Differential effects of lidocaine and remifentanil on response to the tracheal tube during emergence from general anaesthesia

Differential effects of lidocaine and remifentanil on response to the tracheal tube during emergence from general anaesthesia British Journal of Anaesthesia 106 (3): 410 15 (2011) Advance Access publication 2 January 2011. doi:10.1093/bja/aeq396 Differential effects of lidocaine and remifentanil on response to the tracheal tube

More information

Hemodynamic Effects of Co-administration of Midazolam during Anesthesia Induction with Propofol and Remifentanil in Hypertensive Patients

Hemodynamic Effects of Co-administration of Midazolam during Anesthesia Induction with Propofol and Remifentanil in Hypertensive Patients https://doi.org/10.7180/kmj.2017.32.1.36 KMJ Original Article Hemodynamic Effects of Co-administration of Midazolam during Anesthesia Induction with Propofol and Remifentanil in Hypertensive Patients Ju

More information

BJA Advance Access published December 5, 2012

BJA Advance Access published December 5, 2012 British Journal of Anaesthesia Page 1 of 7 doi:10.1093/bja/aes426 BJA Advance Access published December 5, 2012 Surgical pleth index-guided remifentanil administration reduces remifentanil and propofol

More information

Toyoaki Maruta 1*, Yoshihumi Kodama 2, Ishie Tanaka 3, Tetsuro Shirasaka 1 and Isao Tsuneyoshi 1

Toyoaki Maruta 1*, Yoshihumi Kodama 2, Ishie Tanaka 3, Tetsuro Shirasaka 1 and Isao Tsuneyoshi 1 Maruta et al. BMC Anesthesiology (2016) 16:110 DOI 10.1186/s12871-016-0275-1 RESEARCH ARTICLE Open Access Comparison of the effect of continuous intravenous infusion and two bolus injections of remifentanil

More information

BIS Technology Enabling safety and quality improvements in the cardiac operating room

BIS Technology Enabling safety and quality improvements in the cardiac operating room BIS Technology Enabling safety and quality improvements in the cardiac operating room BIS technology backs you up with proven brain monitoring. Using the BIS monitor has made me more of a scientist and

More information

POST-TETANIC COUNT AND PROFOUND NEUROMUSCULAR BLOCKADE WITH ATRACURIUM INFUSION IN PAEDIATRIC PATIENTS

POST-TETANIC COUNT AND PROFOUND NEUROMUSCULAR BLOCKADE WITH ATRACURIUM INFUSION IN PAEDIATRIC PATIENTS Br. J. Anaesth. (9), 60, 3-35 POST-TETANIC COUNT AND PROFOUND NEUROMUSCULAR BLOCKADE WITH ATRACURIUM INFUSION IN PAEDIATRIC PATIENTS S. A. RIDLEY AND D. J. HATCH Atracurium degrades rapidly and, because

More information

A comparison of the Glidescope R to the McGrath R videolaryngoscope in patients

A comparison of the Glidescope R to the McGrath R videolaryngoscope in patients Clinical Research Article Korean J Anesthesiol 2011 July 61(1): 19-23 DOI: 10.4097/kjae.2011.61.1.19 A comparison of the Glidescope R to the McGrath R videolaryngoscope in patients Woo Jae Jeon, Kyoung

More information

P V Praveen Kumar 1*, P. Archana 2. Original Research Article. Abstract

P V Praveen Kumar 1*, P. Archana 2. Original Research Article. Abstract Original Research Article Comparative clinical study of attenuation of cardiovascular responses to laryngoscopy intubation diltiazem, lignocaine and combination of diltiazem and lignocaine P V Praveen

More information

Mark D. Antoszyk, CRNA, BS Director Anesthesia Services Department of Anesthesiology Carolina s Medical Center Northeast Concord, North Carolina

Mark D. Antoszyk, CRNA, BS Director Anesthesia Services Department of Anesthesiology Carolina s Medical Center Northeast Concord, North Carolina Mark D. Antoszyk, CRNA, BS Director Anesthesia Services Department of Anesthesiology Carolina s Medical Center Northeast Concord, North Carolina Mark D. Antoszyk, CRNA, BS, is director of anesthesia services

More information

RESPIRATION AND THE AIRWAY Comparison of two induction regimens using or not using muscle relaxant: impact on postoperative upper airway discomfort

RESPIRATION AND THE AIRWAY Comparison of two induction regimens using or not using muscle relaxant: impact on postoperative upper airway discomfort RESPIRATION AND THE AIRWAY Comparison of two induction regimens using or not using muscle relaxant: impact on postoperative upper airway discomfort X. Combes 1 *, L. Andriamifidy 2, E. Dufresne 2, P. Suen

More information

Closed-loop Control of Mean Arterial Blood Pressure during Surgery with Alfentanil

Closed-loop Control of Mean Arterial Blood Pressure during Surgery with Alfentanil Anesthesiology 2006; 105:462 70 Copyright 2006, the American Society of Anesthesiologists, Inc. Lippincott Williams & Wilkins, Inc. Closed-loop Control of Mean Arterial Blood Pressure during Surgery with

More information

Comparative study of effective-site target controlled infusion with standard bolus induction of propofol for laryngeal mask airway insertion

Comparative study of effective-site target controlled infusion with standard bolus induction of propofol for laryngeal mask airway insertion Asian Biomedicine Vol. 4 No. 1 February 2010; 177-182 Brief communication (Original) Comparative study of effective-site target controlled infusion with standard bolus induction of propofol for laryngeal

More information

Post-operative nausea and vomiting after gynecologic laparoscopic surgery: comparison between propofol and sevoflurane

Post-operative nausea and vomiting after gynecologic laparoscopic surgery: comparison between propofol and sevoflurane Clinical Research Article Korean J Anesthesiol 2011 January 60(1): 36-40 DOI: 10.4097/kjae.2011.60.1.36 Post-operative nausea and vomiting after gynecologic laparoscopic surgery: comparison between propofol

More information

Bio Anesthetic Monitor

Bio Anesthetic Monitor Cerebral State Index Bio Anesthetic Monitor Electroencephalogram (EEG) Monitor Brain Monitoring CSI Index BA-1000A Provide an objective measure of patient s depth of consciousness and optimal anesthesia

More information

Effects of thiopental sodium, ketamine, and propofol on the onset time of rocuronium in children

Effects of thiopental sodium, ketamine, and propofol on the onset time of rocuronium in children Anesth Pain Med 2017; 12: 47-51 https://doi.org/10.17085/apm.2017.12.1.47 Clinical Research http://crossmark.crossref.org/dialog/?doi=10.17085/apm.2017.12.1.47&domain=pdf&date_stamp=2017-1-25 pissn 1975-5171

More information

Efficacy of a single-dose ondansetron for preventing post-operative nausea and vomiting

Efficacy of a single-dose ondansetron for preventing post-operative nausea and vomiting European Review for Medical and Pharmacological Sciences 2001; 5: 59-63 Efficacy of a single-dose ondansetron for preventing post-operative nausea and vomiting after laparoscopic cholecystectomy with sevoflurane

More information

Patient state index vs bispectral index as measures of the electroencephalographic effects of propofol

Patient state index vs bispectral index as measures of the electroencephalographic effects of propofol British Journal of Anaesthesia 15 (2): 172 8 (21) Advance Access publication 29 June 21. doi:1.193/bja/aeq155 NEUROSCIENCES AND NEUROANAESTHESIA Patient state index vs bispectral index as measures of the

More information

Research Article. Shital S. Ahire 1 *, Shweta Mhambrey 1, Sambharana Nayak 2. Received: 22 July 2016 Accepted: 08 August 2016

Research Article. Shital S. Ahire 1 *, Shweta Mhambrey 1, Sambharana Nayak 2. Received: 22 July 2016 Accepted: 08 August 2016 International Journal of Research in Medical Sciences Ahire SS et al. Int J Res Med Sci. 2016 Sep;4(9):3838-3844 www.msjonline.org pissn 2320-6071 eissn 2320-6012 Research Article DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20162824

More information

Mr David A McDonald Service Improvement Manager Whole System patient Flow Improvement Programme Scottish Government

Mr David A McDonald Service Improvement Manager Whole System patient Flow Improvement Programme Scottish Government Mr David A McDonald Service Improvement Manager Whole System patient Flow Improvement Programme Scottish Government Introduction Brief update Two main topics Use of Gabapentin Local Infiltration Analgesia

More information

Hypotension after induction, corrected with 20 mg ephedrine x cc LR EBL 250cc Urine output:

Hypotension after induction, corrected with 20 mg ephedrine x cc LR EBL 250cc Urine output: Terry C. Wicks, CRNA, MHS Catawba Valley Medical Center Hickory, North Carolina 63 y.o., 5 2, 88 kg female for hand assisted laparoscopic tranversecolectomy Co-morbidities include: Hypertension controlled

More information

Droperidol has comparable clinical efficacy against both nausea and vomiting

Droperidol has comparable clinical efficacy against both nausea and vomiting British Journal of Anaesthesia 103 (3): 359 63 (2009) doi:10.1093/bja/aep177 Advance Access publication July 15, 2009 has comparable clinical efficacy against both nausea and vomiting C. C. Apfel 1 *,

More information

JMSCR Vol 04 Issue 01 Page January 2016

JMSCR Vol 04 Issue 01 Page January 2016 www.jmscr.igmpublication.org Impact Factor 3.79 Index Copernicus Value: 5.88 ISSN (e)-2347-176x ISSN (p) 2455-0450 DOI: http://dx.doi.org/10.18535/jmscr/v4i1.04 Haemodynamic Effects during Induction in

More information

British Journal of Anaesthesia 101 (5): (2008) doi: /bja/aen272 Advance Access publication September 26, 2008

British Journal of Anaesthesia 101 (5): (2008) doi: /bja/aen272 Advance Access publication September 26, 2008 British Journal of Anaesthesia 101 (5): 627 31 (2008) doi:10.1093/bja/aen272 Advance Access publication September 26, 2008 CLINICAL PRACTICE Effect of prewarming on post-induction core temperature and

More information

OBJECTIVES OF TRAINING FOR THE ANAESTHESIA TERM

OBJECTIVES OF TRAINING FOR THE ANAESTHESIA TERM College of Intensive Care Medicine of Australia and New Zealand ABN: 16 134 292 103 Document type: Training Date established: 2007 Date last reviewed: 2014 OBJECTIVES OF TRAINING FOR THE ANAESTHESIA TERM

More information

The Sparing Effect of Low-dose Esmolol on Sevoflurane during Laparoscopic Gynaecological Surgery

The Sparing Effect of Low-dose Esmolol on Sevoflurane during Laparoscopic Gynaecological Surgery The Journal of International Medical Research 2011; 39: 1861 1869 [first published online as 39(5) 4] The Sparing Effect of Low-dose Esmolol on Sevoflurane during Laparoscopic Gynaecological Surgery YE

More information

Inhalation of Isoflurane or Sevoflu. Citation Acta medica Nagasakiensia. 1996, 41

Inhalation of Isoflurane or Sevoflu. Citation Acta medica Nagasakiensia. 1996, 41 NAOSITE: Nagasaki University's Ac Title Author(s) Hemodynamic and Catecholamine Respo Inhalation of Isoflurane or Sevoflu Tomiyasu, Shiro; Hara, Tetsuya; Mor Sumikawa, Koji Citation Acta medica Nagasakiensia.

More information

Postgraduate Course of Anesthesiology What does anesthesia do with the brain? September 23, 2013 UZ Leuven

Postgraduate Course of Anesthesiology What does anesthesia do with the brain? September 23, 2013 UZ Leuven Postgraduate Course of Anesthesiology What does anesthesia do with the brain? September 23, 2013 UZ Leuven Vincent Bonhomme CHU Liege and CHR Citadelle MONITORING DEPTH OF ANESTHESIA: WHY? WHEN? WHY? 1.

More information

Optimizing intravenous drug administration by applying pharmacokinetic/pharmacodynamic concepts

Optimizing intravenous drug administration by applying pharmacokinetic/pharmacodynamic concepts British Journal of Anaesthesia 107 (1): 38 47 (2011) Advance Access publication 30 May 2011. doi:10.1093/bja/aer108 Optimizing intravenous drug administration by applying pharmacokinetic/pharmacodynamic

More information

INTRODUCTION. Although propofol is an intravenous anesthe tic commonly used for anesthesia in morbidly obese. (Acta Anaesth. Belg.

INTRODUCTION. Although propofol is an intravenous anesthe tic commonly used for anesthesia in morbidly obese. (Acta Anaesth. Belg. (Acta Anaesth. Belg., 211, 62, 73-82) Maintenance of anesthesia in morbidly obese patients using propofol with continuous BIS-monitoring : a comparison of propofol-remifentanil and propofol-epidural anesthesia

More information

Pharmacokinetics of drug infusions

Pharmacokinetics of drug infusions SA Hill MA PhD FRCA Key points The i.v. route provides the most predictable plasma concentrations. Pharmacodynamic effects of a drug are related to plasma concentration. Both plasma and effect compartments

More information