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Query: UMLS:C0344307 (analgesia)
 28,200 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

We investigated the EEG parameter changes of skin incision during different depth of sevoflurane/nitrous oxide analgesia. 65 ASA physical status I patients (aged 34 +/- 12 yr) scheduled for elective abdominal surgery were studied. The tracheal of each patient was intubated and the lungs were ventilated. Patients were randomly assigned to one of three groups. Anesthesia was maintained with 1% (group I n = 25), 1.5% (group II n = 20) or 2% (group III n = 20) end-tidal sevoflurane concentration in 66% nitrous oxide. Each of the concentration levels was maintained for at least 15 minutes before surgical incision. The EEG electrodes were placed on each patient in a front-oparietal montage (Fp1- A1, Fp2- A2) referred to Cz. EEG was recorded during 3-min period before incision. Hemodynamic variables were also monitored. Inadequate anesthetic depth was defined as patient movement in response to a 5-cm skin incision. The ventilation was controlled to maintain normocapnia (PETCO2 5 +/- 0.04 kPa). The data were analysed using ANOVA, liner correlation analysis and t-test. A significant difference between EEG parameters (SEF, BIS,) and skin incision responsive rate were found among the three concentration groups (P < 0.01). There were no difference of hemodynamics among the three groups. Patients who moved at incision also had significantly higher SEF, BIS leveles compared to non-movers (P < 0.01). Quantitative EEG determinants were correlated well with the end-tidal sevoflurane concentration and were a useful predictor of patient movement in response to skin incision during sevoflurane/nitrous oxide anesthesia.
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PMID:[Quantitative electroencephalogram monitoring the depth of anesthesia during skin incision]. 1067 83

The primary goal of sedation is to achieve security and comfort of mechanically ventilated ICU patients. Delivery of pharmacologic agents must avoid over sedation, which increases morbidity by prolongation of the duration of mechanical ventilation. Similarly, under sedation may favour life-threatening events such as accidental extubation. Many clinical scales have been generated to regularly measure the level of sedation (consciousness and tolerance to the ICU environment). No electrophysiological monitor (BIS) has proved reliability for measuring the depth of sedation or analgesia yet. The presence of brain damage in ICU patients makes the level of sedation impossible to interpret. Glasgow coma scale, which is exclusively devoted to the consciousness domain, is the only recommendation that can be made in neurocritical care at the present time.
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PMID:[Evaluation of the depth of sedation in neurocritical care: clinical scales, electrophysiological methods and BIS]. 1515 49

The growing interest in combining local and general anesthesia has led to studies investigating possible interactions between general anesthesia and local anesthetics administered via spinal, epidural, IV, or IM routes. However, no study has evaluated the effect of local anesthetics on all three components of balanced anesthesia, i.e., hypnosis, analgesia, and muscle relaxation. In this prospective, randomized, double-blind study, we investigated the effect of epidural bupivacaine on the dose requirement of propofol (as evaluated by using the bispectral index [BIS]), fentanyl, and vecuronium for general anesthesia. This study consisted of 30 adults, ASA physical status I and II, undergoing Whipple's pancreaticoduodenectomy for periampullary carcinoma lasting >4 h. An epidural catheter was placed between T9-10. Depending on the group allocation, 10 mL of the study drug was administered as a bolus followed by an infusion at 6 mL/h via the epidural catheter. Patients were divided into 2 groups of 15 each. Patients in the control group received epidural normal saline whereas those in the bupivacaine group received epidural bupivacaine 0.1%. Induction of anesthesia was performed with IV fentanyl 2 mug/kg and propofol titrated to achieve BIS between 40-50. Endotracheal intubation was facilitated by the IV administration of vecuronium 0.1 mg/kg and patient's lungs were ventilated with 66% nitrous oxide in oxygen. After intubation, infusion of propofol 1% was titrated to maintain BIS between 40-50. Inadequate analgesia was defined as an increase in systolic blood pressure and/or heart rate by >20% of baseline values in response to surgical stimulus and was treated with bolus fentanyl 0.5 mug/kg. Neuromuscular monitoring was used to assess the need for additional doses of vecuronium. Data were analyzed by using the Student's t-test and P </= 0.05 was considered significant. The requirement of propofol for induction and maintenance of anesthesia in the bupivacaine group was 1.3 +/- 0.3 mg/kg and 2.4 +/- 0.9 mg . kg(-1) . h(-1), respectively, compared with 2.4 +/- 0.6 mg/kg and 4.4 +/- 1.6 mg . kg(-1) . h(-1) observed in the control group (P < 0.05). Significant reduction was also observed in the requirement of vecuronium and fentanyl during maintenance in the bupivacaine group (P < 0.05). We conclude that epidural bupivacaine given before induction of anesthesia reduces the requirement of propofol, fentanyl, and vecuronium during general anesthesia.
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PMID:The effect of epidural bupivacaine on induction and maintenance doses of propofol (evaluated by bispectral index) and maintenance doses of fentanyl and vecuronium. 1611 22

In order to study the depth of anaesthesia during endotracheal intubation, 30 patients received either thiopentone or propofol for anaesthesia induction. The BIS value as a parameter for the depth of anaesthesia and the rate pressure product (RPP) were acquired online. Patients who received thiopentone for anaesthesia induction showed significantly higher BIS values at the moment of intubation and reached BIS values >60 significantly more frequently than patients receiving propofol. The RPP in the propofol group lay significantly below that of the thiopentone patients. For all patients there was an mean increase in BIS values of 8 index points and an increase in the RPP. Therefore, BIS values around 50 should be achieved before intubation in order to avoid the critical BIS value for awareness of >60 despite the increase caused by the intubation procedure. Within 24 h of intubation all patients were interviewed for possible signs of awareness. None of the patients was able to remember the intubation or reported other experiences that indicated an unconscious awareness. Nevertheless, the progress of BIS values in a standardized intubation as performed in the normal clinical routine, shows that the use of thiopentone for initiating anaesthesia results in a very flat level of anaesthesia during intubation. The risk for patients to experience awareness should therefore, not be underestimated. Therefore, when using thiopentone it is recommended to also use a rapid acting muscle relaxant or to select a high ED95 to compensate for the flat level of anaesthesia. Alternatively, repetetive boluses of the hypnotic shortly before intubation should be considered or to revert to propofol. The dosage and pharmacokinetics of the analgesic should also be taken into consideration because an insufficient analgesia leads to a faster flattening of the depth of anaesthesia.
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PMID:[Depth of anaesthesia during intubation: comparison between propofol and thiopentone]. 1764 95

Sedation/analgesia is a mode of anaesthesia which facilitates an uncomfortable or painful procedure, such as gastrointestinal endoscopy, in a rousable and cooperative patient. The objective of the study was to assess the practice trends for administering sedation analgesia in non operative locations in Aga Khan Hospital, Karachi by anaesthetists. It was a descriptive study which retrospective reviewed anaesthesia records. A total of 41 ASA I-IV cases were reviewed. Non invasive cardiorespiratory monitoring and clinical sedation monitoring were applied. Intravenous Propofol infusion and midazolam boluses were used, singly or in combination with fentanyl boluses. All our patients recovered uneventfully within 5 minutes of the end of procedure. The practice trends for drug regimens are similar to those reported in recent literature. However we need to provide BIS monitoring, target controlled and patient maintained sedation to enhance patient and operator comfort.
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PMID:Sedation-analgesia in non operative locations: practice trends of anaesthetists. 1833 28

A 74-year-old man with gastric cancer was complicated with abdominal aortic aneurysm. A two-stage operation was scheduled (repair of abdominal aortic aneurysm and subsequent gastrectomy). He also had severe chronic obstructive pulmonary disease (COPD). We planned to maintain spontaneous breathing during operations under epidural anesthesia and light general anesthesia. For the first surgery, two epidural catheters were placed at T1-2 and T7-8 on the day before surgery. After establishing epidural anesthesia, general anesthesia was induced and maintained with midazolam, fentanyl and sevoflurane, but without muscle relaxants under BIS monitoring. Ropivacaine solution 0.375% was infused through an epidural catheter to provide analgesia, and spontaneous breathing was kept throughout the procedure. Surgery lasted 4 hours and 50 minutes, and patient recovered without complications. Forty days after the first surgery, the second operation was scheduled. Anesthetic management was almost the same as in the first one, except for the use of dexmedetomizine rather than sevoflurane. In both operations, sufficient analgesia was provided with epidural anesthesia, and the surgeons rated muscle relaxation as satisfactory. No respiratory complications developed postoperatively. Maintaining spontaneous breathing during abdominal surgery using epidural anesthesia and light general anesthesia is a good option for COPD patients.
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PMID:[Anesthetic management of a patient with severe combined pulmonary disease under epidural anesthesia with spontaneous respiration]. 1851 92

The aim of the present study was to compare the perioperative hemodynamics, propofol consumption and recovery profiles of remifentanil and dexmedetomidine when used with air-oxygen and propofol, in order to evaluate a postoperative analgesia strategy and explore undesirable side-effects (nausea, vomiting, shivering). In a prospective randomized double-blind study 50 ASAI-III patients scheduled for supratentorial craniotomy, were allocated into two equal Groups. Group D patients (n = 25), received i.v. dexmedetomidine 1 microg kg(-1) as preinduction over a 15-min period and 0.2-1 microg kg(-1) hr(-1) by continuous i.v. infusion during the operation period. Group R patients (n = 25), received remifentanil 1 microg kg(-1) as induction i.v. over a 15-min period and 0.05-1 microg kg(-1) min(-1) as maintenance. The propofol infusion was started at a rate of 10 mg kg(-1) h(-1) and titrated to maintain BIS in the range 40-50. Propofol doses for induction and maintenance of anesthesia was lower with dexmedetomidine (respectively p < 0.05, p < 0.01). The time for BIS to reach 50 was significantly shorter in Group D (p < 0.01). Comparison of the parameters of recovery revealed; extubation time (p < 0.01); response to verbal commands (p < 0.05) and time for orientation (p < 0.05) were longer with Group D. With respect to Post Anesthesia Care Unit (PACU) discharge time, dexmedetomidine patients required longer time when compared to remifentanil patients to achieve their first normal neurological score (33 min vs 31 min). The earliest opioid administration was at 38 min. in the dexmedetomidine group and 33 min. in the remifentanil group. Propofol-remifentanil and propofol-dexmedetomidine are both suitable for elective supratentorial craniotomy and provide similar intraoperative hemodynamic responses and postoperative adverse events. Propofol-remifentanil allows earlier cognitive recovery; however, it leads to earlier demand for postoperative analgesics. Undesirable side-effects were similar in two Groups.
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PMID:Remifentanil-propofol vs dexmedetomidine-propofol--anesthesia for supratentorial craniotomy. 1926 28

Adequate monitoring of analgesia and sedation should be one of the main goals in the Intensive Care Units. Once the analgesia is assured, the correct dosage of the sedatives will depend on the correct monitoring of the sedation level. For years, clinical scales have been used to evaluate the sedation level. These scales are appropriate for the evaluation of mild sedation but they cannot correctly evaluate deeply sedated patients or those patients who require continuous intravenous administration of neuromuscular blockade agents. In this chapter, we review the most used monitor to control the adequate level of sedation in the Intensive Care Units as well as the BIS(R) Monitor, which is the one recommended by the Analgesia and Sedation Work Group of the Spanish Society of Critical Care Medicine (SEMICYUC).
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PMID:[Monitoring of deep sedation. The BIS(R) monitor]. 2003 84

The paper concerns the anesthetic aspects of safe conscious sedation and dental treatment of patients with metabolic syndrome. BIS monitoring in combination with routine pulse oximetry and blood pressure measurement is getting dental sedation safer. Independently of the bolus or continuous intravenous midazolam infusion the investigators approved high efficacy of bispectral index in benzodiazepine dose titration. Successful dental treatment under conscious sedation and no evident associated with analgesia complications show the importance of BIS-monitoring in the improvement of safe sedation and dental treatment in patients with metabolic syndrome.
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PMID:[The improvement of safe sedation and dental treatment in patients with metabolic syndrome]. 2243 38

Almost all children in the pediatric intensive care (PICU) need analgesia and/or sedation. Analgesics drugs are used to control pain from surgical incisions, drainages, vascular access or endotracheal suctioning. Sedatives are used to facilitate the delivery of nursing care, to facilitate mechanical ventilation, prevent self-extubation and to minimize patient discomfort. A therapeutic plan for analgesia and sedation should be established for each patient and regularly reviewed. The most often used sedation agents in PICU patients are Morphine or Fentanyl alone or in combination with Midazolam. Several other drugs should be helpful to manage PICU patients therefore techniques like regional anesthesia and patient controlled analgesia to decrease the use of intravenous analgesia and sedation and to reduce the incidence of withdrawal syndrome. The therapeutic plan for analgesia and sedation should be established for each patient and regularly reviewed. Doses of sedative agents should be titrated to produce the desired level of sedation. The level of sedation should be regularly assessed and documented using few validated sedation assessment tool. However, behavioral evaluation tools based on patient responsiveness, cannot be used during the administration of neuromuscular blocking agents. Under this conditions it could be difficult to interpret the degree of sedation. EEG derived Monitoring devices may represents an useful tools of assessing the level of sedation, but there is insufficient evidence to support the routine use of the BIS monitor in PICU.
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PMID:Sedation and analgesia in pediatric intensive care. 2251 93


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