Closed-Loop Control of General Anesthesia: My Clinical Experience
|
|
- Eunice Kelly
- 5 years ago
- Views:
Transcription
1 Closed-Loop Control of General Anesthesia: My Clinical Experience Ngai LIU, M.D. 33(1) Service d Anesthésie Hôpital Foch Suresnes France
2 JAMA 195, 144 (13) 5 patients, ETHER Major Surgical procedures varying age, both sexes Without untoward effect
3 Feasibility of Feedback control of Propofol During GA Maintenance Using the BIS monitor -Mortier/Struys: Anaesthesia 1998 Closed-loop controlled administration of propofol using BIS -Morley: Anaesthesia 2 Closed-loop control of anaesthesia: An assessment of the BIS -Struys: Anesthesiology 21 Comparison of closed-loop controlled administration of propofol.. -Leslie/Absalom: Anaesthesia 22 Closed-loop colonoscopy using the BIS -Absalom: Anesthesiology 22 Closed-loop control under combined general and regional anesthesia -Absalom : BJA 23 Closed-loop control of propofol using the BIS minor surgery -Ihmsen/ Naguib: BJA 27 Teletherapeutic drug administration by long distance closed-loop control of propofol -Puri: Anaesth. Intensive Care 27 Closed-loop anaesthesia delivery system using bispectral index -Haddad : IEEE Neural Network 27 Neural Network Adaptive Output Feedback for Intraoperative Anesthesia
4 Proportional-Differential + TCI propofol (Schnider) + Feed-forward
5 June 26, pp Prospective randomized study 2 patients/group Manual vs Automated induction
6 We wanted to compare our closed-loop controller to the manual TCI Titration in varying conditions of routine clinical anesthesia. Including minor and major surgery. The titration of remifentanil TCI during the surgical procedure was decided by the physician in charge of the patient in both groups. End point : 4 < BIS < 6 during maintenance.
7 Percentage BIS Manual (n=81) Closed-loop (n=83) ± 21 vs 89 ± 9, p =.1 Adequate anesthesia was more frequent in the Closed-loop group 9 1
8 Gray Br Med J 1952 Hypnotic Hypnosis Opioid Surgery? Analgesia Dynamic Balance Paralysis HR, MAP, Pupillometry NMBA
9 Case report Male 72 years History of coronary disease (CABG and Angioplasty) Beta-blocker Tympanoplasty General Anesthesia Closed-loop Propofol Manual TCI of Remifentanil Bolus of Atracurium
10 TI draping Arousal Incision Instability! Oscillation! Propofol Target Remi (ng/ml)
11 Movement Your hypothesis?
12 Anesthesia depth Dynamic Balance between Hypnosis and Analgesia Poor Analgesia BIS Instability (oscillation)!
13 GA = LOC + Inhibition of noxious stimuli P. Glass Anesthesiology 1998, 88; 5-6 T. Bouillon et al Anesthesiology 24 With a Closed-loop BIS-Propofol system, we obtain a stable level of hypnosis and the BIS can also reflect the degree of inhibition of response to noxious stimuli. If BIS suddenly increases in response to noxious stimuli, this could be a deficit in the analgesic component of anesthesia, and this requires an increase of analgesia. We have implemented a second closed-loop controller between Remifentanil and BIS using a Proportionaldifferential algorithm
14 GA = LOC + Inhibition of noxious stimuli P. Glass Anesthesiology 1998, 88; 5-6 T. Bouillon et al Anesthesiology 24 With a Closed-loop BIS-Propofol system, we obtain a stable level of hypnosis and the BIS can also reflect learnoffrom failure the degree ofwe inhibition response to noxious stimuli. Not from success. If BIS suddenly increases in response to noxious stimuli, this could be a deficit in the analgesic component of anesthesia, and this requires to increase analgesia. We have implemented a second closed-loop controller between Remifentanil and BIS using a Proportionaldifferential algorithm
15 Male 27 years, Kidney Transplantation, HTA grefferénale Kidney Tx 12 1 Bis Time (secondes)
16 Male 27 years, Kidney Transplantation, HTA grefferénale Bis Time (Seconds) propofol
17 Male 27 years, Kidney Transplantation, HTA Incision Retractor grefferénale Bis Temps (en secondes) propofol
18 Male, Kidney Transplantation, HTA Incision Retractor grefferénale Titre du graphique Bis Temps (en secondes) remifentanil propofol
19 Propofol and Remifentanil guided solely by the BIS : Manual vs Closed-loop Prospective Randomized, Multicenter After informed consent Ethical Committee and AFSSAPS approval Foch, Argenteuil, Angers, Besançon. Manuel vs Dual-loop 1 patients per group End points Percentage 4-6 Movement, HD Behavior of the controller during all types of surgery ASA IV A854 ASA Meeting Chicago 26
20 Manual Dual-loop ASA Meeting Chicago 26
21 Percentage of Time Number of patients 4 3 Dual-loop (n=83) Manual (n=84) % 71 % ± 19 vs 82 % ± 12 (p <.1)
22 ASA Meeting San Francisco 27 A 1881 Feedback control of Propofol-SE State Entropy : irregularity (1-32 Hz) : Depth of hypnosis Response Entropy (1-47 Hz) Remifentanil-(RE-SE) (RE-SE) represents (32-47 Hz) : Facial EMG activity or adequacy of anti-nociception
23 Manual (n=31) SE RE % of patients Dual-loop (n=27) minutes
24 Dual-loop in ICU, Prospective randomized study (E. Bourgeois SFAR 27) Manual (n=14) vs Dual-loop sedation (n=15) 2D Graph 12 nombre de modifications de cibles/h 1 % 67 ± 22 vs 38 % ± % 4 2 Propofol 1 Dual-loop 2 Manual 4 < BIS < 6 BIS < 4 BIS > 6
25 What did the Closed-loop controller teach me?
26 16 Entropy 14 BIS Female 2 years, 1.7 m, 5 kg, PK Schnider Closed-loop propofol, Remi fixed (4 ng/ml) ::7 AM 12:5:12 AM 12:1:12 AM 12:15:12 AM 12:2:12 AM 12:25:12 AM Tim e 12:3:12 AM 12:36:7 AM 12:41:7 AM 12:46:7 AM 12:51:7 AM
27 16 Entropy 14 BIS Female 2 years, 1.7 m, 5 kg, PK Schnider Closed-loop propofol (1%), Remi fixed (4 ng/ml) ::7 AM 12:5:12 AM 12:1:12 AM 12:15:12 AM 12:2:12 AM 12:25:12 AM Tim e 12:3:12 AM 12:36:7 AM 12:41:7 AM 12:46:7 AM 12:51:7 AM
28 16 Entropy 14 BIS Female 2 years, 1.7 m, 5Piglet kg, PK Schnider 22 Kg Closed-loop propofol, Remi fixed (4 ng/ml) 3 month! ::7 AM 12:5:12 AM 12:1:12 AM 12:15:12 AM 12:2:12 AM 12:25:12 AM Tim e 12:3:12 AM 12:36:7 AM 12:41:7 AM 12:46:7 AM 12:51:7 AM
29 16 Entropy 14 BIS Propofol 2 % ::7 :5:12 :1:12 :15:12 :2:12 :25:12 :3:12 temps :36:7 :41:7 :46:7 :51:7
30 Paediatr Anaesth. 27 Sep;17(9): years-old boy 25 kg Giant lobar emphysema SpO2 = 85 % with 1 l/min O2 Dual-loop Propofol-Remifentanil Induction and Maintenance Intrathecal morphine Right postero-lateral thoracotomy Middle lobectomy Lower lobe atypical resection
31 Closed-loop administration of propofol and remifentanil guided by the Bispectral Index for transsphenoidal surgery in a patient with extreme gigantism Age : 24 Weight : 125 kg Height : 2.48 m! Blade # 6
32 Induction Propofol.9 mg/kg Remifentanil 1.9 µg/kg Maintenance 5.2 mg/kg/h.3 µg/kg/min Bis 4-6 : 83 % < 4 : 15 % > 6 : 2 % GS : 23 Extubation : 7 min
33 Female, 69 years, 1.6 m, 85 kg Aortic Stenosis Aortic valve repair Bis Bis :: :5:11 :1:22 :15:33 :2:44 :25:55 :31:6
34 Female, 69 years, 1.6 m, 85 kg Aortic Stenosis Aortic valve repair Bis Sys :: :5:11 :1:22 :15:33 :2:44 :25:55 :31:6
35 Propofol :.8 mg/kg Remifentanil : 2.6 µg/kg Female, 69 years, 1.6 m, 85 kg Aortic Stenosis Aortic valve repair Bis propofol remifentanil :: Sys :5:11 :1:22 :15:33 :2:44 :25:55 :31:6
36 Feedback control Continuous Titration to effect compensates for most of PK Errors! Model Concentration Drug Safety +++ The impact of the PK model in a controller is low
37 Safety Closed-loop controller during cardiac arrest Propofol Concentration (ng/ml) BIS 1 2,5 8 2, 6 1,5 4 1, 2, Minutes
38 Safety Closed-loop controller during cardiac arrest Propofol Concentration (ng/ml) BIS 1 2,5 8 2, 6 1,5 4 1, 2, Minutes
39 Conclusion Feasibility of Dual-loop Reliable and safe Closed-loop controller could fundamentally change the practice of Anesthesia!!! The clinician will always hold the ultimate responsibility for patient safety O Hara Anesthesiology 92 n.liu@hopital-foch.org Service d Anesthésie Hôpital Foch Suresnes France
40 Open loop TCI Semi-closed loop TCI Closed-loop What is the best for the physician?
41 Emergence Manual TCI (n = 81) Closed-loop (n = 83) p 1 ± 7 7±4.17 Extubation Time (min) Manual TCI 5 4 Closed-loop group min Greater predictability and better planning of the recovery phase
42 Prof. Manfred MORARI
43 Case male 59 y Norepinephrine (mg/h) Main events nursing nursing Fibero TEE %<4 %<45 %>6 %>7 %3 5 %45 6 % BIS 5 6 SR propofol remifentanil Time (h)
44 # Closed-loop Anesthesia decreases #the incidence of Too Deep Anesthesia % 1 Manual TCI Weldon Anesthesiology 22 : A : A33 Lennmarken ASA Monk, ASA 24 : A1361 Closed-loop # 6 Prolonged deep anesthesia was associated with increased 4 risk of one year mortality! <45 < 4 >6 Figure 3. Efficiency of the system during maintenance of anesthesia. 4 < BIS < 6 = percentage of time in which the BIS value was between 4 and 6 during the maintenance. BIS < 45 = percentage of time in which the Bispectral index (BIS) value was below 45. BIS < 4 = percentage of time in which the BIS value was below a value of 4. BIS > 6 = percentage of time in which the BIS value was greater a value of 6. Manual TCI: Manual TCI group guided by the BIS. Closed-loop: Closed-loop group. # p <.1, ns: not significant.
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 informationBIS 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 informationTitration of Propofol for Anesthetic Induction and Maintenance Guided by the Bispectral Index: Closed-loop versus Manual Control
Anesthesiology 2006; 104:686 95 2006 American Society of Anesthesiologists, Inc. Lippincott Williams & Wilkins, Inc. Titration of Propofol for Anesthetic Induction and Maintenance Guided by the Bispectral
More informationClinical Evaluation of Closed-Loop Administration of Propofol Guided by the NeuroSENSE Monitor in Children
Clinical Evaluation of Closed-Loop Administration of Propofol Guided by the van Heusden, Klaske; Dumont, Guy A.; Soltesz, Kristian; Petersen, Christian; West, Nicholas; Umedaly, Aryannah; Ansermino, J.
More informationSeries 2 dexmedetomidine, tramadol, fentanyl, intellectually disabled patients:
Series 2 dexmedetomidine, tramadol, fentanyl, intellectually disabled patients: Read the following published scientific articles and answer the questions at the end: Abstract We get a substantial number
More informationApplications for Anaesthesia. arcomed syringe and infusion pumps
Applications for Anaesthesia arcomed syringe and infusion pumps TIVA TCI PCA PCEA PCS PIEB Anaesthesia programs and applications for arcomed Infusion Devices TIVA TCI PCA PCEA PCS PIEB (Total Intravenous
More informationBasic 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 informationClosed Loop Anaesthesia Delivery System (CLADS) - Anaesthesia Robot
Closed Loop Anaesthesia Delivery System (CLADS) - Anaesthesia Robot Prof. G. D. Puri Keywords: Anaesthesia, closed loop anaesthesia, propofol, EEG, BIS Anaesthesia practice in operating room primarily
More informationManual 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 informationEffect 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 informationAUSTRALIAN PRODUCT INFORMATION REMIFENTANIL APOTEX (REMIFENTANIL HYDROCHLORIDE) POWDER FOR INJECTION
AUSTRALIAN PRODUCT INFORMATION REMIFENTANIL APOTEX (REMIFENTANIL HYDROCHLORIDE) POWDER FOR INJECTION 1 NAME OF THE MEDICINE Remifentanil (as hydrochloride) 2 QUALITATIVE AND QUANTITATIVE COMPOSITION Each
More informationEffect 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 informationOriginal Article Awakening from anesthesia using propofol or sevoflurane with epidural block in radical surgery for senile gastric cancer
Int J Clin Exp Med 2015;8(10):19412-19417 www.ijcem.com /ISSN:1940-5901/IJCEM0012605 Original Article Awakening from anesthesia using propofol or sevoflurane with epidural block in radical surgery for
More informationSedation For Cardiac Procedures A Review of
Sedation For Cardiac Procedures A Review of Sedative Agents Dr Simon Chan Consultant Anaesthesiologist Department of Anaesthesia and Intensive Care Prince of Wales Hospital Hong Kong 21 February 2009 Aims
More informationAna 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 informationThe 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 informationTotal Intravenous Anesthesia (TIVA) and Target Controlled Infusions (TCI) in Children
Curr Anesthesiol Rep (2013) 3:37 41 DOI 10.1007/s40140-012-0005-2 PEDIATRIC ANESTHESIA (J LERMAN, SECTION EDITOR) Total Intravenous Anesthesia (TIVA) and Target Controlled Infusions (TCI) in Children Neil
More informationRichard 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 informationContributions to an Advisory System for Changes Detection in Depth of Anesthesia Signals
Contributions to an Advisory System for Changes Detection in Depth of Anesthesia Signals Raquel Sebastião, Margarida M. Silva, João Gama, and Teresa Mendonça 1 LIAAD-INESC Porto, L.A., Universidade do
More informationCLINICAL PRACTICE. Editor s key points
British Journal of Anaesthesia 11 (): 5 1 (15) Advance Access publication 1 December 1. doi:1.193/bja/aeu1 CLINICAL PRACTICE Feasibility of closed-loop co-administration of propofol and remifentanil guided
More informationRobust closed-loop control of induction and maintenance of propofol anesthesia in children
Robust closed-loop control of induction and maintenance of propofol anesthesia in children West, Nicholas; Dumont, Guy A.; van Heusden, Klaske; Petersen, Christian; Khosravi, Sara; Soltesz, Kristian; Umedaly,
More informationMark 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 informationThe Vigileo monitor by Edwards Lifesciences supports both the FloTrac Sensor for continuous cardiac output and the PreSep oximetry catheter for
1 2 The Vigileo monitor by Edwards Lifesciences supports both the FloTrac Sensor for continuous cardiac output and the PreSep oximetry catheter for continuous central venous oximetry (ScvO2) 3 The Vigileo
More informationTotal. Intravenous. ANAESTHESIA using target contro. Elderly. MAC Critica ill. Obese. Col Acad. College of Anaesthesiologists,
Total Intravenous ANAESTHESIA using target contro controlled infusion A pocket p reference Elderly MAC Critically Critica ill O Obese College of Anaesthesiologists, Col Acad Academy of Medicine of Malaysia
More informationBio 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 informationFor deep sedation in spontaneously breathing patients,
Ambulatory Anesthesiology Section Editor: Peter S. A. Glass Manual Versus Target-Controlled Infusion Remifentanil Administration in Spontaneously Breathing Patients Annelies T. Moerman, MD* Luc L. Herregods,
More informationBIS 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 informationComparative 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 informationPostoperative cognitive dysfunction a neverending story
Postoperative cognitive dysfunction a neverending story Adela Hilda Onuţu, MD, PhD Cluj-Napoca, Romania adela_hilda@yahoo.com No conflict of interest Contents Postoperative cognitive dysfunction (POCD)
More informationPain & Sedation Management in PICU. Marut Chantra, M.D.
Pain & Sedation Management in PICU Marut Chantra, M.D. Pain Diseases Trauma Procedures Rogers Textbook of Pediatric Intensive Care, 5 th ed, 2015 Emotional Distress Separation from parents Unfamiliar
More informationMonitoring Consciousness Using the Bispectral Index During Anesthesia
Monitoring Consciousness Using the Bispectral Index During Anesthesia A Pocket Guide for Clinicians COVIDIEN, COVIDIEN with logo, Covidien logo and positive results for life are U.S. and/or internationally
More informationSEDATION FOR SMALL PROCEDURES
SEDATION FOR SMALL PROCEDURES Sinno Simons Erasmus MC Sophia Children s Hospital Rotterdam, the Netherlands s.simons@erasmusmc.nl SEDATION in newborns How and when How to evaluate How to dose Why to use
More informationSatisfactory Analgesia Minimal Emesis in Day Surgeries. (SAME-Day study) A Randomized Control Trial Comparing Morphine and Hydromorphone
Satisfactory Analgesia Minimal Emesis in Day Surgeries (SAME-Day study) A Randomized Control Trial Comparing Morphine and Hydromorphone HARSHA SHANTHANNA ASSISTANT PROFESSOR ANESTHESIOLOGY MCMASTER UNIVERSITY
More informationCover Page. The handle holds various files of this Leiden University dissertation.
Cover Page The handle http://hdl.handle.net/1887/20616 holds various files of this Leiden University dissertation. Author: Lichtenbelt, Bart Jan Title: PK-PD modelling of the interaction of propofol and
More informationPostgraduate 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 informationCover 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 informationMonitoring 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 informationCan Depth of Anesthesia Monitoring Alter the Incidence of Mortality, POCD or Delirium?
Can Depth of Anesthesia Monitoring Alter the Incidence of Mortality, POCD or Delirium? John C. Drummond, M.D., FRCPC Professor of Anesthesiology, University of California, San Diego; Staff Anesthesiologist,
More informationTable 1. Relevant Publications by Company Investigators and Colleagues
Table 1. Relevant Publications by Company Investigators and Colleagues Study Objective Results Conclusions To determine Mean peak count frequency before whether OMT can administration of propofol determine
More informationMay 2006 Page 1 / 5 Danmeter A/S
May 2006 Page 1 / 5 Danmeter A/S The CSM story Introduction The Danmeter level of consciousness (LOC) technology was commercially introduced in 2000 a after research, development and clinical validation
More informationSpectral 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 informationImpact of perioperative lidocaine infusion and bis monitorization on remifentanil dosage in hypotensive anesthesia
European Review for Medical and Pharmacological Sciences S. UZUN, Y. YUCE 1, A. ERDEN, U. AYPAR 2014; 18: 559-565 Impact of perioperative lidocaine infusion and bis monitorization on remifentanil dosage
More informationInfluence 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 informationNothing to Disclose. Severe Pulmonary Hypertension
Severe Ronald Pearl, MD, PhD Professor and Chair Department of Anesthesiology Stanford University Rpearl@stanford.edu Nothing to Disclose 65 year old female Elective knee surgery NYHA Class 3 Aortic stenosis
More informationASSESSMENT OF THE PAEDIATRIC NEEDS ANAESTHESIOLOGY DISCLAIMER
European Medicines Agency Evaluation of Medicines for Human Use ASSESSMENT OF THE PAEDIATRIC NEEDS ANAESTHESIOLOGY London, October 2006 Doc. Ref: EMEA/405166/2006 DISCLAIMER The Paediatric Working Party
More informationBeta Blockers for ENT Surgery
Beta Blockers for ENT Surgery Dr. Giuliano Michelagnoli U.O. Anestesia e Rianimazione Nuovo Ospedale di Prato Perioperative Beta-Blockade 1. Reduction of perioperative cardiovascular risk 2. Multimodal
More informationInteraction between Sedation and Weaning: How to Balance Them? Guillermo Castorena MD Fundacion Clinica Medica Sur Mexico
Interaction between Sedation and Weaning: How to Balance Them? Guillermo Castorena MD Fundacion Clinica Medica Sur Mexico Balance is not that easy! Weaning Weaning is the liberation of a patient from
More informationRegional Anaesthesia for Caesarean Section Warwick D. Ngan Kee
Regional Anaesthesia for Caesarean Section Warwick D. Ngan Kee Chair, Department of Anesthesiology Sidra Medicine Doha, Qatar D I S C L O S U R E S No financial disclosures No industry affiliations No
More informationThe legally binding text is the original French version TRANSPARENCY COMMITTEE OPINION. 24 June 2009
The legally binding text is the original French version TRANSPARENCY COMMITTEE OPINION 24 June 2009 PROPOFOL LIPURO 1% (10 mg/ml) emulsion for injection or for infusion B/5 glass ampoules of 20 ml (CIP
More informationThe 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 informationDepartment of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, Beijing, PR China. Abstract
Biomedical Research 2017; 28 (10): 4380-4385 ISSN 0970-938X www.biomedres.info Minimum effective concentration for the inhibitory effect of remifentanil on circulatory response due to pneumoperitoneum
More informationMonitoring 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 informationSign up to receive ATOTW weekly Regarding the use of propofol in total intravenous anaesthesia:
TARGET CONTROLLED INFUSIONS IN ANAESTHETIC PRACTICE ANAESTHESIA TUTORIAL OF THE WEEK 75 26th NOVEMBER 2007 Dr Subash Sivasubramaniam University Hospitals of North Staffordshire subashken@yahoo.com SELF
More informationSTARSHIP WITHDRAWAL OF ANALGESIA AND SEDATION
STARSHIP WITHDRAWAL OF ANALGESIA AND SEDATION Patients receiving analgesia and/or sedation for longer than 5-7 days may suffer withdrawal if these drugs are suddenly stopped. To prevent this happening
More informationMr 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 informationPropofol or etomidate: Does it genuinely matter for induction in cardiac surgical procedures?
Original Research Article DOI: 10.18231/2394-4994.2016.0012 Propofol or etomidate: Does it genuinely matter for induction in cardiac surgical procedures? Manjunath Ratnakara Kamath 1,*, Suchitha Kamath
More informationJMSCR 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 informationStandard Operating Procedure (SOP) Management of intervention group patients SOP 001
` Standard Operating Procedure (SOP) Management of intervention group patients SOP 001 Authors: Mark Edwards & Rupert Pearse Authorisation: Rupert Pearse (Chief Investigator) Scope To provide guidance
More informationA SAFE AND EFFECTIVE WAY TO OPTIMIZE ANESTHESIA DURING SURGERY
Clinical Evidence Guide A SAFE AD EFFECTIVE WAY TO OPTIMIZE AESTHESIA DURIG SURGERY Bispectral Index (BIS) Complete Monitoring System This guide will help you review the clinical evidence that supports
More informationSEEING KETAMINE IN A NEW LIGHT
SEEING KETAMINE IN A NEW LIGHT BobbieJean Sweitzer, M.D., FACP Professor of Anesthesiology Director of Perioperative Medicine Northwestern University Bobbie.Sweitzer@northwestern.edu LEARNING OBJECTIVES
More informationIncreasing 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 informationINTRODUCTION. 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 informationEarly Goal Directed Sedation In Critically Ill Patients
Early Goal Directed Sedation In Critically Ill Patients Yahya Shehabi, FCICM, FANZCA, EMBA Professor, Intensive Care Medicine Clinical School of Medicine, University New South Wales School of Epidemiology
More informationChapter 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 informationPharmacology in the obese : does weight matter?
A A Pharmacology in the obese : does weight matter? Michel MRF Struys, MD, PhD Professor and Chair, Department of Anesthesia University Medical Center Groningen Groningen, The Netherlands Professor of
More informationREMIFENTANIL Alphapharm Remifentanil PRODUCT INFORMATION
REMIFENTANIL Alphapharm Remifentanil PRODUCT INFORMATION NAME OF THE MEDICINE Active ingredient : Remifentanil (as hydrochloride) Chemical name : 1-(2-Methoxycarbonyl-ethyl)-4-(phenylpropionyl-amino)-piperidine-4-carboxylic
More informationFaculty Development Talk
Faculty Development Talk Updates in Obstetric Anaesthesia Leong Wan Ling Consultant, Women s Anaesthesia, KK Women s & Children s Hospital 13 th September 2017 Topics Labour ward Neuraxial anaesthesia
More informationAge-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 informationTracheal Intubation in ICU: Life saving or life threatening?
Tracheal Intubation in ICU: Life saving or life threatening? Prof. Sheila Nainan Myatra Department of Anaesthesia, Critical Care & Pain Tata Memorial Hospital Mumbai, India sheila150@hotmail.com Three
More informationClosed-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 informationCan Goal Directed Sedation Improve Outcomes?
Can Goal Directed Sedation Improve Outcomes? Yahya SHEHABI, FANZCA, FCICM, EMBA Professor and Program Director Critical care Monash Health and Monash University - Melbourne School of Medicine, University
More informationTracheal 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 informationWhat Sedasys Is And What It s Not Randy Hickle, MD Anesthesiologist
What Sedasys Is And What It s Not Randy Hickle, MD Anesthesiologist 1 Background of CAPS 20 years ago, a moment of insight Assessment of pain outside the care of anesthesiologists 16 years ago Started
More informationOptimization 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 informationStavroula Ikonomakou-Nikolaidis, MD Reference List Book Chapter
Book Chapter 1. Nikolaidis, Stavroula I. Hypertrophic Cardiomyopathy Chapter 65, Fleisher & Roizen: Essence of Anesthesia Practice, 4th edition, Elsevier, Philadelphia, PA 2016, (submitted, in press) 2016
More informationUse of cerebral monitoring during anaesthesia: Effect on recovery profile
Best Practice & Research Clinical Anaesthesiology Vol. 20, No. 1, pp. 181 189, 2006 doi:10.1016/j.bpa.2005.08.001 available online at http://www.sciencedirect.com 15 Use of cerebral monitoring during anaesthesia:
More informationAwareness: Where do we stand?
1 Awareness: Where do we stand? Peter J. Davis, M.D. Professor of Anesthesiology and Pediatrics University of Pittsburgh School of Medicine Anesthesiologist-in-Chief Children s Hospital of Pittsburgh 2
More informationTranscontinental anaesthesia: a pilot study
British Journal of Anaesthesia 110 (5): 758 63 (2013) Advance Access publication 10 March 2013. doi:10.1093/bja/aes498 Transcontinental anaesthesia: a pilot study T. M. Hemmerling 1 *, E. Arbeid 1, M.
More informationOptimal sedation and management of anxiety in patients undergoing endobronchial ultrasound (EBUS)
Optimal sedation and management of anxiety in patients undergoing endobronchial ultrasound (EBUS) Georgios Dadoudis Anesthesiologist ICU DIRECTOR INTERBALKAN MEDICAL CENTER Optimal performance requires:
More informationNew Methods for Analgesia Delivery
New Methods for Analgesia Delivery Guy Ludbrook MBBS PhD FANZCA Royal Adelaide Hospital and University of Adelaide South Australia Anesthesiology is on the verge of a major evolution that will involve
More informationResearch 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 informationAnalgesia is a labeled indication for all of the approved drugs I will be discussing.
Comparative Opioid Pharmacology Disclosure Analgesia is a labeled indication for all of the approved drugs I will be discussing. I ve consulted with Glaxo (remifentanil), Abbott (remifentanil), Janssen
More informationSupplementary Appendix
Supplementary Appendix This appendix has been provided by the authors to give readers additional information about their work. Supplement to: Brown EN, Lydic R, Schiff ND, et al. General anesthesia, sleep,
More informationDisclosures. Set up audience participation. Test question. Outline. Neuromonitoring What and When? IP for monitoring technology licensed to Medtronic
Neuromonitoring What and When? Disclosures IP for monitoring technology licensed to Medtronic Ken Brady, MD Pediatrics, Anesthesia, Critical Care Texas Children s Hospital Baylor College of Medicine Set
More informationDepth 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 informationChildhood Obesity: Anesthetic Implications
Childhood Obesity: Anesthetic Implications The Changing Practice of Anesthesia 2015 UCSF Department of Anesthesia and Perioperative Care Marla Ferschl, MD Associate Professor of Anesthesia University of
More informationMeasure Summary: The opioid equivalency measure examines opioid administration for patients who undergo a surgical procedure.
Measure Abbreviation: Opioid Equivalency Data Collection Method: This informational measure (there is no threshold or target) is calculated based on data extracted from the electronic medical record combined
More informationComparison of propofol-remifentanil and propofol-ketamine combination for dilatation and currettage: a randomized double blind prospective trial
European Review for Medical and Pharmacological Sciences Comparison of propofol-remifentanil and propofol-ketamine combination for dilatation and currettage: a randomized double blind prospective trial
More informationHemodynamic 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 informationPOST-OP CARDIAC SURGERY PHYSICIAN S ORDER SHEET USE BALLPOINT PEN ONLY. CARDIAC INTENSIVE CARE UNIT
PHYSICIAN S SHEET Automatically Activate, if not in agreement, cross out and initial Activated by Checking Box ALLERGIES: None known YES Patient s Height: Patient s Weight: ALL MEDICATION and INTRAVENOUS
More informationCapnography: The Most Vital of Vital Signs. Tom Ahrens, PhD, RN, FAAN Research Scientist, Barnes-Jewish Hospital, St. Louis, MO May, 2017
Capnography: The Most Vital of Vital Signs Tom Ahrens, PhD, RN, FAAN Research Scientist, Barnes-Jewish Hospital, St. Louis, MO May, 2017 Assessing Ventilation and Blood Flow with Capnography Capnography
More informationCOMBINED REGIONAL-GENERAL ANESTHESIA: EVALUATION OF REMIFENTANIL BASED GENERAL ANESTHESIA AND POSTOPERATIVE EPIDURAL ANALGESIA
COMBINED REGIONAL-GENERAL ANESTHESIA: EVALUATION OF REMIFENTANIL BASED GENERAL ANESTHESIA AND POSTOPERATIVE EPIDURAL ANALGESIA W TOHME *, H KAFROUNI * AND S SFEIR ** Summary Objectives: To evaluate whether
More informationComparative 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 informationThe 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 informationCLINICAL USE OF THE BARM (with a current perspective on awareness monitoring in the operating theatre)
CLINICAL USE OF THE BARM (with a current perspective on awareness monitoring in the operating theatre) DR ADRIAN SULTANA MD FRCP (Glasg) FANZCA Cortical Dynamics Symposium Conflicts of Interest: Nil INDICATIONS
More informationEffects of maintaining intravenous infusion of remifentanil or propofol on anesthesia and palinesthesia during anesthesia and analepsia
Effects of maintaining intravenous infusion of remifentanil or propofol on anesthesia and palinesthesia during anesthesia and analepsia X. Zhao 1 *, Y.W. Jin 1 *, H.B. Li 2, Z.G. Wang 3, H. Feng 1 and
More informationMichel MRF Struys, MD, PhD, FRCA
Afdeling Anesthesiologie Neuromonitoring Michel MRF Struys, MD, PhD, FRCA Professor and Chair, Department of Anesthesia University Medical Center Groningen Groningen, The Netherlands Professor of Anesthesia,
More informationAnesthesia for Total Hip and Knee Arthroplasty
Anesthesia for Total Hip and Knee Arthroplasty Typical approach Describe anesthesia technique Rather Describe issues with THA and TKA How anesthesia can modify Issues Total Hip Total Knee Blood Loss ++
More informationAssessing Cardiac Risk in Noncardiac Surgery. Murali Sivarajan, M.D. Professor University of Washington Seattle, Washington
Assessing Cardiac Risk in Noncardiac Surgery Murali Sivarajan, M.D. Professor University of Washington Seattle, Washington Disclosure None. I have no conflicts of interest, financial or otherwise. CME
More informationRauf 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