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1.
Medicine (Baltimore) ; 100(4): e23930, 2021 Jan 29.
Artigo em Inglês | MEDLINE | ID: mdl-33530193

RESUMO

BACKGROUND: To investigate whether closed-loop systems under bispectral index anesthesia depth monitoring can reduce the intraoperative propofol dosage. METHODS: All randomized controlled trials (RCTs) on reducing propofol dosage under closed-loop systems were collected, and the literature was screened out, the abstracts and full texts were carefully read, and the references were tracked, data extraction and quality evaluation were conducted on the included research, and the RevMan5.3 software was used for meta-analysis. The main results were propofol and the incidence of adverse reactions such as hypertensive hypotension and postoperative cognitive dysfunction. A total of 879 cases were included in 8 articles, including 450 occurrences in the closed-loop system group and 429 cases in the open-loop system group. RESULTS: Compared with manual control, closed-loop systems under bispectral index anesthesia depth monitoring reduced the dose of propofol (MD: -0.62, 95% CI: -1.08--0.16, P = .008), with heterogeneity (I2 = 80%). Closed-loop systems significantly reduced the incidence of abnormal blood pressure (MD: -0.02, 95%CI: -0.05-0.01, P = .15, I2 = 74%) and postoperative cognitive dysfunction (MD: -0.08, 95% CI: -0.14 -0.01, P = .02, I2 = 94%). CONCLUSION: Bispectral index monitoring of propofol closed-loop target-controlled infusion system can reduce the amount of propofol, reduce the incidence of adverse reactions such as hypertensive or hypotension and postoperative cognitive dysfunction.


Assuntos
Anestésicos Intravenosos/uso terapêutico , Monitores de Consciência , Propofol/uso terapêutico , Anestesia Intravenosa/métodos , Anestésicos Intravenosos/administração & dosagem , Anestésicos Intravenosos/efeitos adversos , Relação Dose-Resposta a Droga , Humanos , Complicações Cognitivas Pós-Operatórias/induzido quimicamente , Propofol/administração & dosagem , Propofol/efeitos adversos , Ensaios Clínicos Controlados Aleatórios como Assunto
2.
Medicine (Baltimore) ; 100(6): e24690, 2021 Feb 12.
Artigo em Inglês | MEDLINE | ID: mdl-33578603

RESUMO

ABSTRACT: Pediatric procedural sedation (PPS) is often performed outside of the operating room, and by various sub-specialty providers. There is no consistency in how pediatric emergency medicine (PEM) fellows are trained in PPS. The objective of this study was to survey PEM program directors (PDs) and PEM fellows about their current sedation teaching practices via a direct survey. While many fellowship programs train PEM fellows in PPS, we hypothesize that there is no consistent method of developing and measuring this skill.A 12-question survey was sent to PEM PDs directly via email. A separate 17-question survey was sent to current PEM fellows via their program coordinators by email. Each survey had multiple choice, yes-no and select-all program questions. Responses were collected in an online (REDCap) database and summarized as frequencies and percentages.Based on identifiable email, 67 programs were contacted, with a PD response rate of 46 (59%). Sixty-two program coordinators were contacted based on identifiable email with 78 fellow responses. We noted that 11/46 PD respondents offer a formal PPS rotation. Thirty programs report using propofol in the emergency department and 93% of PD respondents (28/30) actively train fellows in the use of propofol. Approximately 62% of PEM fellow respondents (48/78) report sedating without any attending oversight. Twenty-eight percent of PEM fellow respondents report using simulation as a component of their sedation training.PPS is a critical skill. However, there is a lack of consistency in both education and evaluation of competency in this area. An organized PPS rotation would improve PPS case exposure and PPS skills.


Assuntos
Anestesiologia/educação , Educação de Pós-Graduação em Medicina/estatística & dados numéricos , Bolsas de Estudo/estatística & dados numéricos , Medicina de Emergência Pediátrica/educação , Anestésicos Intravenosos/administração & dosagem , Anestésicos Intravenosos/uso terapêutico , Competência Clínica/estatística & dados numéricos , Gerenciamento de Dados , Educação de Pós-Graduação em Medicina/métodos , Escolaridade , Serviço Hospitalar de Emergência/estatística & dados numéricos , Humanos , Internato e Residência/normas , Avaliação de Programas e Projetos de Saúde/estatística & dados numéricos , Propofol/administração & dosagem , Propofol/uso terapêutico , Treinamento por Simulação/estatística & dados numéricos , Inquéritos e Questionários
3.
Br J Anaesth ; 126(2): 386-394, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33317804

RESUMO

BACKGROUND: Target-controlled infusion (TCI) systems incorporating pharmacokinetic (PK) or PK-pharmacodynamic (PK-PD) models can be used to facilitate drug administration. Existing models were developed using data from select populations, the use of which is, strictly speaking, limited to these populations. Recently a propofol PK-PD model was developed for a broad population range. The aim of the study was to prospectively validate this model in children, adults, older subjects, and obese adults undergoing general anaesthesia. METHODS: The 25 subjects included in each of four groups were stratified by age and weight. Subjects received propofol through TCI with the Eleveld model, titrated to a bispectral index (BIS) of 40-60. Arterial blood samples were collected at 5, 10, 20, 30, 40, and 60 min after the start of propofol infusion, and every 30 min thereafter, to a maximum of 10 samples. BIS was recorded continuously. Predictive performance was assessed using the Varvel criteria. RESULTS: For PK, the Eleveld model showed a bias < ±20% in children, adults, and obese adults, but a greater bias (-27%) in older subjects. Precision was <30% in all groups. For PD, the bias and wobble were <5 BIS units and the precision was close to 10 BIS units in all groups. Anaesthetists were able to achieve intraoperative BIS values of 40-60 using effect-site target concentrations about 85-140% of the age-adjusted Ce50. CONCLUSIONS: The Eleveld propofol PK-PD model showed predictive precision <30% for arterial plasma concentrations and BIS predictions with a low (population) bias when used in TCI in clinical anaesthesia practice.


Assuntos
Anestesia Geral , Anestésicos Intravenosos/farmacocinética , Estado de Consciência/efeitos dos fármacos , Modelos Biológicos , Propofol/farmacocinética , Adolescente , Adulto , Fatores Etários , Idoso , Anestésicos Intravenosos/administração & dosagem , Anestésicos Intravenosos/sangue , Peso Corporal , Criança , Pré-Escolar , Feminino , Humanos , Infusões Intravenosas , Masculino , Pessoa de Meia-Idade , Obesidade , Propofol/administração & dosagem , Propofol/sangue , Estudos Prospectivos , Reprodutibilidade dos Testes , Adulto Jovem
4.
Medicine (Baltimore) ; 99(52): e23844, 2020 Dec 24.
Artigo em Inglês | MEDLINE | ID: mdl-33350773

RESUMO

BACKGROUND: Pain on injection is a well-recognized adverse event of propofol administration for the stimulation of general anesthesia. Pre-treatment with lidocaine or flurbiprofen axetil has proven to be effectual in the reduction propofol-induced pain in adults. Nonetheless, only few studies have evaluated the clinical therapeutic effects of lidocaine combination with flurbiprofen axetil to prevent pain on injection of propofol. The current study aims to evaluate the clinical therapeutic effects of lidocaine combination with flurbiprofen axetil to reduce pain on injection of propofol among adult patients. METHODS: The literature search will be conducted from their inception to November 2020 from MEDLINE, EMBASE, Web of Science, and Cochrane Library databases without date or geographical restrictions. However, language will be restricted to publications in English and Chinese. Two authors will independently screen abstracts and titles of all papers to determine whether to include or exclude them. The authors will also study characteristic and outcomes of data extraction and carry out risk of bias assessment. We plan to use either a fixed-effects or random-effects model to estimate the risk ratios (RR) or mean difference (MD) or standardized mean difference (SMD) together with 95% confidence interval (CI). RESULTS: This study will provide high-quality evidence for the clinical therapeutic effects of lidocaine combination with flurbiprofen axetil for reducing pain on injection of propofol in adult patients. CONCLUSION: This study will summarize current evidence for the management of pain on injection of propofol in adult patients and provide guidance for both intervention and future research. ETHICS AND DISSEMINATION: Since no data collection will be involved, there is no need for an ethics approval. REGISTRATION NUMBER: November 17, 2020.osf.io/72tpj/. (https://osf.io/72tpj/).


Assuntos
Flurbiprofeno/análogos & derivados , Lidocaína/farmacologia , Dor Processual , Propofol/efeitos adversos , Adulto , Anestésicos Intravenosos/administração & dosagem , Anestésicos Intravenosos/efeitos adversos , Anestésicos Locais/farmacologia , Quimioterapia Combinada/métodos , Flurbiprofeno/farmacologia , Humanos , Metanálise como Assunto , Dor Processual/etiologia , Dor Processual/prevenção & controle , Propofol/administração & dosagem , Projetos de Pesquisa , Revisões Sistemáticas como Assunto , Resultado do Tratamento
5.
PLoS One ; 15(12): e0244145, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33351856

RESUMO

PURPOSE: Aging affects pharmacodynamics/pharmacokinetics of anesthetics, but age effects on Entropy-guided total intravenous anesthesia with target-controlled infusions (TIVA-TCI) are not fully characterized. We compared aging effects on effective estimated brain concentration of Propofol (CeP) during TIVA-TCI Entropy-guided anesthesia, without neuromuscular blockade (NMB). METHODS: We performed an observational, prospective, single-center study enrolling 75 adult women undergoing Entropy-guided Propofol-Remifentanil TIVA-TCI for breast surgery. Primary endpoint was the relationship between age and CeP at maintenance of anesthesia (MA) during Entropy-guided anesthesia. Secondary endpoints were relationships between age and CeP at arousal reaction (AR), return of consciousness (ROC) and explicit recall evenience. We calculated a linear model to evaluate the age's impact on observational variable and performed pairwise tests to compare old (≥65 years, n = 50) and young (<65 years, n = 25) patients or patients with and without an AR. RESULTS: We did not observe age-related differences in CeP during MA, but CeP significantly (p = 0,01) decreased with age at ROC. Entropy values during MA increased with age and were significantly higher in the elderly (RE: median 56[IQR49.3-61] vs 47.5[42-52.5],p = 0.001; SE: 51.6[45-55.5] vs 44[IQR40-50],p = 0.005). 18 patients had an AR, having higher maximum RE (92.5[78-96.3] vs 65[56.5-80.5],p<0.001), SE (79[64.8-84] vs 61[52.5-69],p = 0.03, RE-SE (12.5[9.5-16.5] vs 6 [3-9],p<0.001. CONCLUSION: Older age was associated with lower CeP at ROC, but not during MA in unparalysed patients undergoing breast surgery. Although RE and SE during MA, at comparable CeP, were higher in the elderly, Entropy, and in particular an increasing RE-SE, is a reliable index to detect an AR.


Assuntos
Envelhecimento , Anestesia Intravenosa , Anestésicos Intravenosos/administração & dosagem , Encéfalo/fisiopatologia , Estado de Consciência , Eletroencefalografia , Propofol/administração & dosagem , Idoso , Entropia , Feminino , Humanos , Pessoa de Meia-Idade , Estudos Prospectivos
6.
BMJ Open ; 10(12): e039881, 2020 12 15.
Artigo em Inglês | MEDLINE | ID: mdl-33323432

RESUMO

OBJECTIVES: We compared early recovery outcomes between living kidney donors who received total intravenous (IV) propofol versus inhalational desflurane during hand-assisted laparoscopic nephrectomy. DESIGN: A single-centre, prospective randomised controlled trial. SETTING: University hospital. PARTICIPANTS: Study participants were enrolled between October 2019 and February 2020. A total of 80 living donors were randomly assigned to an intravenous propofol group (n=40) or a desflurane group (n=40). INTERVENTION: Propofol group received intravenous propofol and desflurane group received desflurane, as a maintenance anaesthetic. PRIMARY AND SECONDARY OUTCOME MEASURES: The quality of postoperative functional recovery was primarily assessed using the Korean version of the Quality of Recovery-40 (QoR-40K) questionnaire on postoperative day 1. Secondarily, ambulation, pain score, rescue analgesics, complications and total hospital stay were assessed postoperatively. RESULTS: Our study population included 35 males and 45 females. The mean age was 46±13 years. The global QoR-40K score (161 (154-173) vs 152 (136-161) points, respectively, p=0.001) and all five subdimension scores (physical comfort, 49 (45-53) vs 45 (42-48) points, respectively, p=0.003; emotional state, 39 (37-41) vs 37 (33-41) points, respectively, p=0.005; psychological support, 30 (26-34) vs 28 (26-32) points, respectively, p=0.04; physical independence, 16 (11-18) vs 12 (8-14) points, respectively, p=0.004; and pain, 31 (28-33) vs 29 (25-31) points, respectively, p=0.021) were significantly higher in the intravenous propofol group than the desflurane group. The early ambulation success rate and numbers of early and total steps were higher, but the incidence of nausea/vomiting was lower, in the intravenous propofol group than the desflurane group. The total hospital stay after surgery was shorter in the intravenous propofol group than the desflurane group. CONCLUSIONS: Intravenous propofol may enhance the quality of postoperative recovery in comparison to desflurane in living kidney donors. TRIAL REGISTRATION NUMBER: KCT0004365.


Assuntos
Anestésicos Inalatórios , Desflurano , Laparoscopia Assistida com a Mão , Rim , Propofol , Doadores de Tecidos , Anestesia Intravenosa , Anestésicos Inalatórios/administração & dosagem , Anestésicos Intravenosos/administração & dosagem , Desflurano/administração & dosagem , Feminino , Humanos , Rim/cirurgia , Masculino , Pessoa de Meia-Idade , Nefrectomia/efeitos adversos , Nefrectomia/métodos , Propofol/administração & dosagem , Estudos Prospectivos
7.
Medicine (Baltimore) ; 99(45): e23061, 2020 Nov 06.
Artigo em Inglês | MEDLINE | ID: mdl-33157963

RESUMO

OBJECTIVE: This study is aims to compare the anesthetic safety of propofol combined with etomidate for painless gastroscopy. METHODS: Three hundred patients undergoing painless gastroscopy were randomly assigned to P, PE1, and PE2 groups. Patients were anesthetized with propofol (P group) or propofol combined with etomidate (volume ratio 1: 1, PE1 group; volume ratio 2: 1, PE2 group). The hemodynamics and adverse reactions were observed. The sleep quality satisfaction and nature of dreams were recorded. RESULTS: Compared with pre-anesthesia, the mean arterial pressure and heart rate of the 3 groups were significantly slower during the examination and at the end of the examination. PE1 group had a higher incidence of muscle spasm, body moving, choking, and deglutition. The incidence of hypoxemia and injection pain was higher in P group. P and PE2 group had higher sleep quality satisfaction and dream incidence after awaking. However, there was no difference in the nature of dreams among 3 groups. CONCLUSION: Our data indicate that the combination of 10 ml 1.0% propofol and 5 ml 0.2% etomidate for painless gastroscopy reduces adverse reactions while not affecting the patients respiratory function. Moreover, it is safe and effective, which is worthy of clinical application and promotion.


Assuntos
Anestésicos Intravenosos/efeitos adversos , Etomidato/efeitos adversos , Gastroscopia/métodos , Propofol/efeitos adversos , Adulto , Obstrução das Vias Respiratórias/induzido quimicamente , Anestésicos Intravenosos/administração & dosagem , Pressão Arterial/efeitos dos fármacos , Estudos de Casos e Controles , Quimioterapia Combinada , Etomidato/administração & dosagem , Feminino , Gastroscopia/tendências , Frequência Cardíaca/efeitos dos fármacos , Hemodinâmica/efeitos dos fármacos , Humanos , Hipóxia/induzido quimicamente , Incidência , Reação no Local da Injeção , Masculino , Pessoa de Meia-Idade , Mioclonia/induzido quimicamente , Propofol/administração & dosagem , Segurança , Espasmo/induzido quimicamente , Espasmo/epidemiologia , Resultado do Tratamento
9.
Anesth Analg ; 131(5): 1529-1539, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-33079876

RESUMO

BACKGROUND: A number of recent studies have reported an association between intraoperative burst suppression and postoperative delirium. These studies suggest that anesthesia-induced burst suppression may be an indicator of underlying brain vulnerability. A prominent feature of electroencephalogram (EEG) under propofol and sevoflurane anesthesia is the frontal alpha oscillation. This frontal alpha oscillation is known to decline significantly during aging and is generated by prefrontal brain regions that are particularly prone to age-related neurodegeneration. Given that burst suppression and frontal alpha oscillations are both associated with brain vulnerability, we hypothesized that anesthesia-induced frontal alpha power could also be associated with burst suppression. METHODS: We analyzed EEG data from a previously reported cohort in which 155 patients received propofol (n = 60) or sevoflurane (n = 95) as the primary anesthetic. We computed the EEG spectrum during stable anesthetic maintenance and identified whether or not burst suppression occurred during the anesthetic. We characterized the relationship between burst suppression and alpha power using logistic regression. We proposed 5 different models consisting of different combinations of potential contributing factors associated with burst suppression: (1) a Base Model consisting of alpha power; (2) an Extended Mechanistic Model consisting of alpha power, age, and drug dosing information; (3) a Clinical Confounding Factors Model consisting of alpha power, hypotension, and other confounds; (4) a Simplified Model consisting only of alpha power and propofol bolus administration; and (5) a Full Model consisting of all of these variables to control for as much confounding as possible. RESULTS: All models show a consistent significant association between alpha power and burst suppression while adjusting for different sets of covariates, all with consistent effect size estimates. Using the Simplified Model, we found that for each decibel decrease in alpha power, the odds of experiencing burst suppression increased by 1.33-fold. CONCLUSIONS: In this study, we show how a decrease in anesthesia-induced frontal alpha power is associated with an increased propensity for burst suppression, in a manner that captures individualized information above and beyond a patient's chronological age. Lower frontal alpha band power is strongly associated with higher propensity for burst suppression and, therefore, potentially higher risk of postoperative neurocognitive disorders. We hypothesize that low frontal alpha power and increased propensity for burst suppression together characterize a "vulnerable brain" phenotype under anesthesia that could be mechanistically linked to brain metabolism, cognition, and brain aging.


Assuntos
Ritmo alfa/efeitos dos fármacos , Anestesia/efeitos adversos , Encéfalo/efeitos dos fármacos , Eletroencefalografia/métodos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Envelhecimento/fisiologia , Anestésicos Intravenosos/administração & dosagem , Anestésicos Intravenosos/farmacologia , Química Encefálica/efeitos dos fármacos , Cognição , Estudos de Coortes , Relação Dose-Resposta a Droga , Delírio do Despertar/diagnóstico , Delírio do Despertar/fisiopatologia , Feminino , Humanos , Monitorização Neurofisiológica Intraoperatória , Masculino , Pessoa de Meia-Idade , Modelos Estatísticos , Propofol/administração & dosagem , Propofol/farmacologia , Adulto Jovem
10.
Medicine (Baltimore) ; 99(43): e22712, 2020 Oct 23.
Artigo em Inglês | MEDLINE | ID: mdl-33120766

RESUMO

BACKGROUND: Although dexmedetomidine has been used as either the anesthetic agent for light sedation or as an adjunct to other sedatives, no study has investigated the usefulness of dexmedetomidine as the main sedative agent for invasive and painful procedures. The purpose of this study was to compare the safety of dexmedetomidine-remifentanil and propofol-remifentanil during monitored anesthesia care (MAC) for hysteroscopy. METHODS: Female patients undergoing hysteroscopy were randomly assigned to either the dexmedetomidine (group D) or the propofol group (group P). The study drug (0.6 ml/kg; dexmedetomidine 2 µg/ml or propofol 4 mg/ml) was loaded for 10 minutes followed by 0.1 to 0.5 ml/kg/hour to maintain a bispectral index of 60 to 80 during the procedure. In both groups, remifentanil was infused using a target-controlled-infusion system with a target concentration of 2 ng/ml and titrated during the procedure. The incidence rates of intraoperative respiratory depression in both groups were compared. Postoperative pain and patients satisfaction were also compared. RESULTS: A total of 69 female patients were included in this study. Dexmedetomidine significantly decrease the incidence of respiratory depression compared with propofol (15/34 [44.1%] vs 5/35 [14.3%], P = .006, group P and D, respectively). Postoperative pain and patients satisfaction score did not differ between the groups. CONCLUSION: The combination of dexmedetomidine-remifentanil can reduce the incidence of respiratory depression without increasing hemodynamic complications compared with propofol-remifentanil for MAC during hysteroscopy.


Assuntos
Analgésicos Opioides/administração & dosagem , Anestésicos Intravenosos/administração & dosagem , Dexmedetomidina/administração & dosagem , Hipnóticos e Sedativos/administração & dosagem , Histeroscopia , Monitorização Intraoperatória , Propofol/administração & dosagem , Remifentanil/administração & dosagem , Adulto , Combinação de Medicamentos , Feminino , Humanos , Pessoa de Meia-Idade , Método Simples-Cego
11.
Anesthesiology ; 133(4): 774-786, 2020 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-32930729

RESUMO

BACKGROUND: It is a commonly held view that information flow between widely separated regions of the cerebral cortex is a necessary component in the generation of wakefulness (also termed "connected" consciousness). This study therefore hypothesized that loss of wakefulness caused by propofol anesthesia should be associated with loss of information flow, as estimated by the effective connectivity in the scalp electroencephalogram (EEG) signal. METHODS: Effective connectivity during anesthesia was quantified by applying bivariate Granger to multichannel EEG data recorded from 16 adult subjects undergoing a slow induction of, and emergence from, anesthesia with intravenous propofol. During wakefulness they were conducting various auditory and motor tasks. Functional connectivity using EEG coherence was also estimated. RESULTS: There was an abrupt, substantial, and global decrease in effective connectivity around the point of loss of responsiveness. Recovery of behavioral responsiveness was associated with a comparable recovery in information flow pattern (expressed as normalized values). The median (interquartile range) change was greatest in the delta frequency band: decreasing from 0.15 (0.21) 2 min before loss of behavioral response, to 0.06 (0.04) 2 min after loss of behavioral response (P < 0.001). Regional decreases in information flow were maximal in a posteromedial direction from lateral frontal and prefrontal regions (0.82 [0.24] 2 min before loss of responsiveness, decreasing to 0.17 [0.05] 2 min after), and least for information flow from posterior channels. The widespread decrease in bivariate Granger causality reflects loss of cortical coordination. The relationship between functional connectivity (coherence) and effective connectivity (Granger causality) was inconsistent. CONCLUSIONS: Propofol-induced unresponsiveness is marked by a global decrease in information flow, greatest from the lateral frontal and prefrontal brain regions in a posterior and medial direction. Loss of information flow may be a useful measure of connected consciousness.


Assuntos
Anestésicos Intravenosos/administração & dosagem , Córtex Cerebral/efeitos dos fármacos , Eletroencefalografia/efeitos dos fármacos , Rede Nervosa/efeitos dos fármacos , Propofol/administração & dosagem , Inconsciência/induzido quimicamente , Adulto , Córtex Cerebral/fisiologia , Eletroencefalografia/métodos , Feminino , Humanos , Hipnóticos e Sedativos/administração & dosagem , Masculino , Rede Nervosa/fisiologia , Desempenho Psicomotor/efeitos dos fármacos , Desempenho Psicomotor/fisiologia , Inconsciência/psicologia
12.
Medicine (Baltimore) ; 99(30): e21303, 2020 Jul 24.
Artigo em Inglês | MEDLINE | ID: mdl-32791716

RESUMO

The PLEM100 (Inbody Co., Ltd., Seoul, Korea) is a device for measuring phase lag entropy (PLE), a recently developed index for the quantification of consciousness during sedation and general anesthesia. In the present study, we assessed changes in PLE along with the level of consciousness during the induction of general anesthesia using propofol. PLE was compared with the bispectral index (BIS), which is currently the most commonly used index of consciousness.After obtaining Institutional Review Board approval and written informed consent, we enrolled 15 patients (8 men, 7 women; mean age: 37 ±â€Š9 years; mean height: 168 ±â€Š8 cm; mean weight; 68 ±â€Š11 kg) undergoing nasal bone reduction. PLE and BIS sensors were attached simultaneously, and general anesthesia was induced via target-controlled infusion (TCI) of propofol. PLE and BIS scores were recorded when the calculated effect site concentration shown on the TCI pump was equal to the target concentrations of 1.5, 2.0, 2.5, 2.8, 3.0, 3.2, 3.4, and 3.5 µg/mL (and at each 0.1 µg/mL increase, thereafter). Observer's Assessment of Alertness/Sedation (OAA/S) scores were also recorded until unconsciousness was achieved. Throughout the anesthesia period, all pairs of PLE and BIS data were collected using data acquisition software.The partial correlation coefficients between OAA/S scores and PLE, and between OAA/S scores and BIS were 0.778 (P < .001) and 0.846 (P < .001), respectively. Throughout the period of anesthesia, PLE and BIS exhibited a significant positive correlation. The partial correlation coefficient prior to the loss of consciousness was 0.838 (P < .001), and 0.669 (P < .001) following the loss of consciousness. Intra-class correlation between the 2 indices was 0.889 (P < .001) and 0.791 (P < .001) prior and following the loss of consciousness, respectively.PLE exhibited a strong and predictable correlation with both BIS and OAA/S scores. These results suggest that PLE is reliable for assessing the level of consciousness during sedation and general anesthesia.


Assuntos
Anestesia Geral/métodos , Anestésicos Intravenosos/administração & dosagem , Entropia , Propofol/administração & dosagem , Adulto , Estado de Consciência/efeitos dos fármacos , Estado de Consciência/fisiologia , Monitores de Consciência , Eletroencefalografia/instrumentação , Feminino , Humanos , Infusões Intravenosas/métodos , Masculino , Pessoa de Meia-Idade , Osso Nasal/cirurgia , Estudos Prospectivos
13.
Br J Anaesth ; 125(3): 330-335, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32653082

RESUMO

BACKGROUND: Anaesthetic drugs may cause neuroapoptosis in children and are routinely used off-label in specific age groups. Techniques that reduce anaesthetic drug dose requirements in children may thus enhance the safety of paediatric sedation or anaesthesia. Brainwave entrainment, notably in the form of auditory binaural beats, has been shown to have sedative effects in adults. We evaluated the influence of brainwave entrainment on propofol dose requirements for sedation in children. METHODS: We randomised 49 boys scheduled for sub-umbilical surgery under caudal blockade to an entrainment or a control group. Small differences in pitch were applied to each ear to create binaural beats, supplemented by synchronous visual stimuli, within the electroencephalographic frequency bands seen during relaxation and (rapid eye movement/non-rapid eye movement) sleep. After establishment of caudal block, propofol infusion was started at 5 mg kg-1 h-1. Intraoperatively, the infusion rate was adjusted every 5 min depending on the sedation state judged by the bispectral index (BIS). The infusion rate was decreased by 1 mg kg-1 h-1 if BIS was <70, and was increased if BIS was >70, heart rate increased by 20%, or if there were other signs of inadequate sedation. RESULTS: Mean propofol infusion rates were 3.0 (95% confidence interval [CI]: 2.4-3.6) mg kg-1 h-1vs 4.2 (95% CI: 3.6-4.8) mg kg-1 h-1 in the entrainment and control groups, respectively (P<0.01). BIS values were similar in the two groups. CONCLUSIONS: Brainwave entrainment effectively reduced the propofol infusion rates required for sedation in children undergoing surgery with regional anaesthesia. Further studies are needed to investigate the possibility of phasing out propofol infusions completely during longer surgical procedures and optimising the settings of brainwave stimulation. CLINICAL TRIAL REGISTRATION: DRKS00005064.


Assuntos
Estimulação Acústica/métodos , Anestésicos Intravenosos/administração & dosagem , Ondas Encefálicas/fisiologia , Estimulação Luminosa/métodos , Propofol/administração & dosagem , Procedimentos Cirúrgicos Operatórios , Criança , Pré-Escolar , Relação Dose-Resposta a Droga , Eletroencefalografia , Humanos , Lactente , Masculino
15.
Medicine (Baltimore) ; 99(25): e20714, 2020 Jun 19.
Artigo em Inglês | MEDLINE | ID: mdl-32569207

RESUMO

Surgical management of cancer may induce stress and increase the likelihood of cancer metastasis and recurrence. Appropriate surgical and anesthetic techniques may affect the patient's outcome. Although numerous studies have been performed, conflicting results have been obtained regarding the effect of anesthetic techniques on the outcome of patients with cancer. We conducted this study to evaluate the association of anesthetic techniques with overall and recurrence-free survival in patients who had undergone gastric cancer surgery.This retrospective study reviewed the electronic medical records of patients, who had visited our hospital and had been diagnosed with gastric cancer between July 1st, 2006 to June 30th, 2016. Univariate analysis of the potential prognostic factors was performed using the log-rank test for categorical factors, and parameters with a P-value < .05 at the univariate step were included in the multivariate regression analysis. Propensity Score Matching was performed to account for differences in baseline characteristics: propofol or desflurane, in a 1:1 ratio.A total of 408 patients anesthetized with desflurane (218) and propofol (190) were eligible for analysis. After propensity matching, 167 patients remained in each group. The overall mortality rate was significantly higher in the desflurane group (56%) than in the propofol group (34%) during follow-up (P < .001). In addition, a greater percentage of patients in the desflurane group (41%) exhibited postoperative metastasis than those in the propofol group (19%, P < .001).The authors found some association between types of anesthesia used and the long-term prognosis of gastric cancer. Propofol-based total intravenous anesthesia improved survival and reduced the risk of recurrence and metastasis during the 5-year follow-up period after gastric cancer surgery.


Assuntos
Anestesia Intravenosa/métodos , Anestésicos Inalatórios/administração & dosagem , Anestésicos Intravenosos/administração & dosagem , Desflurano/administração & dosagem , Propofol/administração & dosagem , Neoplasias Gástricas/cirurgia , Idoso , Feminino , Humanos , Masculino , Pontuação de Propensão , Estudos Retrospectivos , Neoplasias Gástricas/mortalidade , Taxa de Sobrevida
16.
Medicine (Baltimore) ; 99(22): e20298, 2020 May 29.
Artigo em Inglês | MEDLINE | ID: mdl-32481399

RESUMO

Continuous epidural analgesia (CEA) using local anesthetics is frequently used to control herpes zoster pain and prevent postherpetic neuralgia (PHN). However, few studies have been conducted to determine the efficacy of epidural drugs administered as CEA to manage PHN. This retrospective study was designed to evaluate the effectiveness of CEA with ropivacaine alone or with ropivacaine and fentanyl for controlling pain caused by PHN.We reviewed the medical records of 71 patients. We studied 2 groups: epidural ropivacaine (ER; CEA with ropivacaine alone; n = 44) and epidural ropivacaine and fentanyl (Epidural ropivacaine and fentanyl (ERF); CEA with ropivacaine and fentanyl; n = 27). To evaluate pain, a numeric rating scale (NRS) was evaluated at 6 time points: immediately before the procedure (baseline NRS score); 1 hour after the procedure; 14 days after the procedure; and 1, 3, and 6 months after the procedure. Complication rates were recorded during CEA. We also investigated whether additional invasive procedures were needed due to insufficient pain control during the 6-month follow-up period.After adjusting for confounding variables, there were no significant differences in the NRS scores between the 2 groups at any time point. The adjusted odds ratio for additional invasive procedures within 6 months after CEA was 1.03-times higher in the ERF group than in the ER group, but this difference was not statistically significant (95% confidence interval: 0.33-3.23, P = .96). Rates of complication (dysuria, vomiting, nausea, itching sensation, and hypotension) during CEA were higher in the ERF group than in the ER group. However, the differences were not statistically significant.There was no difference in the management of pain in patients with PHN between the groups. Epidural administration of fentanyl with ropivacaine did not improve pain management when compared to ropivacaine alone. Although not statistically significant, the incidence of complications during CEA was higher in the opioid combination group.


Assuntos
Analgesia Epidural/métodos , Anestésicos Intravenosos/uso terapêutico , Anestésicos Locais/uso terapêutico , Fentanila/uso terapêutico , Neuralgia Pós-Herpética/tratamento farmacológico , Ropivacaina/uso terapêutico , Idoso , Anestésicos Intravenosos/administração & dosagem , Anestésicos Intravenosos/efeitos adversos , Anestésicos Locais/administração & dosagem , Anestésicos Locais/efeitos adversos , Quimioterapia Combinada , Feminino , Fentanila/administração & dosagem , Fentanila/efeitos adversos , Humanos , Masculino , Pessoa de Meia-Idade , Medição da Dor , Estudos Retrospectivos , Ropivacaina/administração & dosagem , Ropivacaina/efeitos adversos
17.
A A Pract ; 14(6): e01180, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32224688

RESUMO

A 69-year-old man underwent total laryngopharyngectomy with radial forearm free flap reconstruction. He had lost 15 kg over a period of 6 months and did not receive any preoperative nutritional workup or management. The patient had a general total intravenous anesthetic with ketamine, lidocaine, and propofol, which was uneventful for an 8-hour surgery. The patient remained deeply sedated for 4 hours after discontinuation of all sedative medications. Diagnostic workup only revealed hypoalbuminemia and hypoproteinemia. We hypothesized relative overdosage of sedative anesthetic drugs due to preoperative malnutrition accentuated by intraoperative fluid administration.


Assuntos
Anestesia Geral/efeitos adversos , Anestésicos Intravenosos/administração & dosagem , Hipoalbuminemia/induzido quimicamente , Hipoproteinemia/induzido quimicamente , Desnutrição/complicações , Idoso , Anestésicos Intravenosos/efeitos adversos , Retalhos de Tecido Biológico , Humanos , Hipoalbuminemia/diagnóstico , Hipoproteinemia/diagnóstico , Ketamina/administração & dosagem , Ketamina/efeitos adversos , Laringectomia/efeitos adversos , Lidocaína/administração & dosagem , Lidocaína/efeitos adversos , Masculino , Faringectomia/efeitos adversos , Propofol/administração & dosagem , Propofol/efeitos adversos
18.
Anesth Analg ; 130(5): 1320-1330, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32149755

RESUMO

The need to reduce the dose of intravenous anesthetic in the setting of hemorrhagic shock is a well-established clinical dogma. Considered collectively,; the body of information concerning the behavior of intravenous anesthetics during hemorrhagic shock, drawn from animal and human data, confirms that clinical dogma and informs the rational selection and administration of intravenous anesthetics in the setting of hemorrhagic shock. The physiologic changes during hemorrhagic shock can alter pharmacokinetics and pharmacodynamics of intravenous anesthetics. Decreased size of the central compartment and central clearance caused by shock physiology lead to an altered dose-concentration relationship. For most agents and adjuncts, shock leads to substantially higher concentrations and increased effect. The notable exception is etomidate, which has relatively unchanged pharmacokinetics during shock. Increased concentrations lead to increased primary effect as well as increased side effects, notably cardiovascular effects. Pharmacokinetic changes are essentially reversed for all agents by fluid resuscitation. Propofol is unique among agents in that, in addition to the pharmacokinetic changes, it exhibits increased potency during shock. The pharmacodynamic changes of propofol persist despite fluid resuscitation. The persistence of these pharmacodynamic changes during shock is unlikely to be due to increased endogenous opiates, but is most likely due to increased fraction of unbound propofol. The stage of shock also appears to influence the pharmacologic changes. The changes are more rapid and pronounced as shock physiology progresses to the uncompensated stage. Although scant, human data corroborate the findings of animal studies. Both the animal and human data inform the rational selection and administration of intravenous anesthetics in the setting of hemorrhagic shock. The well-entrenched clinical dogma that etomidate is a preferred induction agent in patients experiencing hemorrhagic shock is firmly supported by the evidence. Propofol is a poor choice for induction or maintenance of anesthesia in severely bleeding patients, even with resuscitation; this can include emergent trauma cases or scheduled cases that routinely have mild or moderate blood loss.


Assuntos
Anestésicos Intravenosos/administração & dosagem , Anestésicos Intravenosos/efeitos adversos , Choque Hemorrágico/diagnóstico , Choque Hemorrágico/fisiopatologia , Idoso , Alfentanil/administração & dosagem , Alfentanil/efeitos adversos , Animais , Pressão Sanguínea/efeitos dos fármacos , Pressão Sanguínea/fisiologia , Etomidato/administração & dosagem , Etomidato/efeitos adversos , Feminino , Humanos , Infusões Intravenosas , Propofol/administração & dosagem , Propofol/efeitos adversos , Choque Hemorrágico/induzido quimicamente
19.
J Zoo Wildl Med ; 51(1): 59-66, 2020 Mar 17.
Artigo em Inglês | MEDLINE | ID: mdl-32212547

RESUMO

In this study, adult intact male and female (n = 10) naked mole-rats (Heterocephalus glaber) were anesthetized using a combination of dexmedetomidine (0.06 mg/kg intramuscularly [IM]), ketamine (20 mg/kg IM), and midazolam (1.0 mg/kg IM). Atipamezole (1.0 mg/kg IM) and flumazenil (0.1 mg/kg IM) were administered 40 min after induction. Induction and recovery times were monitored and recorded. Vital parameters, including heart rate, respiratory rate, and SpO2, and reflexes were monitored every 5 min during the anesthetic period. Anesthetic induction was smooth and rapid. All monitored reflexes were lost within a median time of 60 sec (interquartile range, 15 sec). Heart rate and respiratory rate were significantly decreased from baseline, whereas there was no difference in SpO2 over the anesthetic period. The mean time to recovery was 15 ± 7 min (mean ± SD). One animal was found dead 40 min after apparent recovery, which is suspected to be an anesthetic-related death. Based on these findings, dexmedetomidine-ketamine-midazolam anesthesia is an effective anesthetic protocol in naked mole rats that provides a consistent anesthetic plane but should be used with caution in animals with underlying conditions.


Assuntos
Anestesia Intravenosa/veterinária , Anestésicos Intravenosos/administração & dosagem , Dexmedetomidina/administração & dosagem , Ketamina/administração & dosagem , Midazolam/administração & dosagem , Ratos-Toupeira , Animais , Combinação de Medicamentos , Feminino , Masculino
20.
PLoS One ; 15(3): e0230290, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32182262

RESUMO

BACKGROUND: Previous researches have shown that anesthetic techniques may influence the patients' outcomes after cancer surgery. Here, we studied the relationship between the type of anesthetic techniques and patients' outcomes following elective robot-assisted radical prostatectomy. METHODS: This was a retrospective cohort study of patients who received elective, robot-assisted radical prostatectomy between January 2008 and December 2018. Patients were grouped according to the anesthesia they received, namely desflurane or propofol. A Kaplan-Meier analysis was conducted, and survival curves were presented from the date of surgery to death. Univariable and multivariable Cox regression models were used to compare hazard ratios for death after propensity matching. Subgroup analyses were performed for tumor-node-metastasis stage and disease progression. The primary outcome was overall survival, and the secondary outcome was postoperative biochemical recurrence. RESULTS: A total of 365 patients (24 deaths, 7.0%) under desflurane anesthesia, and 266 patients (2 deaths, 1.0%) under propofol anesthesia were included. The all-cause mortality rate was significantly lower in the propofol anesthesia than in the desflurane anesthesia during follow-up (P = 0.001). Two hundred sixty-four patients remained in each group after propensity matching. The propofol anesthesia was associated with improved overall survival (hazard ratio, 0.11; 95% confidence interval, 0.03-0.48; P = 0.003) in the matched analysis. Subgroup analyses showed that patients under propofol anesthesia had less postoperative biochemical recurrence than those under desflurane (hazard ratio, 0.20; 95% confidence interval, 0.05-0.91; P = 0.038) in the matched analysis. CONCLUSIONS: Propofol anesthesia was associated with improved overall survival in robot-assisted radical prostatectomy compared with desflurane anesthesia. In addition, patients under propofol anesthesia had less postoperative biochemical recurrence.


Assuntos
Anestésicos Inalatórios/efeitos adversos , Anestésicos Intravenosos/efeitos adversos , Desflurano/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Propofol/efeitos adversos , Prostatectomia/métodos , Anestésicos Inalatórios/administração & dosagem , Anestésicos Intravenosos/administração & dosagem , Desflurano/administração & dosagem , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Propofol/administração & dosagem , Prostatectomia/efeitos adversos , Robótica/métodos , Taxa de Sobrevida
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