Lidocaine infusion adjunct to total intravenous anesthesia reduces the total dose of propofol during intraoperative neurophysiological monitoring

Buprenorphine is a partial mu receptor agonist and kappa/delta antagonist commonly used for the treatment of opioid dependence or as an analgesic. It has a long plasma halflife and a high binding affinity for opioid receptors. This affinity is so high, that the effects are not easily antagonized by competitive antagonists, such as naloxone. The high affinity also prevents binding of other opioids, at commonly used clinical doses, to receptor sites – preventing their analgesic and likely minimum alveolar concentration (MAC) reducing benefits. This case report contrasts the anesthetic requirements of a patient undergoing emergency cervical spine surgery while taking buprenorphine with anesthetic requirements of the same patient undergoing a similar procedure after weaning of buprenorphine. Use of intraoperative neurophysiological monitoring prevented use of paralytics and inhalational anesthetics during both cases, therefore total intravenous anesthesia (TIVA) was maintained with propofol and remifentanil infusions. During the initial surgery, intraoperative patient movement could not be controlled with very high doses of propofol and remifentanil. The patient stopped moving in response to surgical stimulation only after the addition of a ketamine. Buprenorphine-naloxone was discontinued postoperatively. Five days later the patient underwent a similar cervical spine surgery. She had drastically reduced anesthetic requirements during this case, suggesting buprenorphine’s profound effect on anesthetic dosing. This case report elegantly illustrates that discontinuation of buprenorphine is likely warranted for patients who present for major spine surgery, which necessitates the avoidance of volatile anesthetic and paralytic agents. The addition of ketamine may be necessary in patients maintained on buprenorphine in order to ensure a motionless surgical field. Key words: Buprenorphine, anesthesiology, intraoperative, total intravenous anesthesia, pharmacology

Download Full-text

Evaluation of the effect of preoperative anxiety on intraoperative hemodynamic stability and drug consumption in patients who underwent BIS-guided total intravenous anesthesia (TIVA) for neurophysiological monitoring in spine surgery

10.22514/sv.2022.006 ◽

2022 ◽

Keyword(s):

Heart Rate ◽

Spinal Surgery ◽

Preoperative Anxiety ◽

Drug Consumption ◽

Total Intravenous Anesthesia ◽

Neurophysiological Monitoring ◽

Anesthesia Induction ◽

Operating Table ◽

Hemodynamic Stability ◽

Intravenous Anesthesia

In our study, the aim was to evaluate the effects of preoperative anxiety measured by Spielberger’s State-Trait Anxiety Inventory-State (STAI-S) and State-Trait Inventory-Trait (STAI-T) scores on intraoperative hemodynamic stability, drug consumption and recovery in patients who underwent spinal surgery with neurophysiological monitoring and total intravenous anesthesia with bispectral index (BIS) monitoring, without the use of muscle relaxants. Eighty patients with planned spinal surgery and neurophysiological monitoring were included in this prospective observational study. Anxiety scores were recorded by applying Spielberger’s STAI-T and STAI-S scoring questionnaires to all patients included in the study 1 hour before the operation. Age, gender and American Society of Anesthesiologists (ASA) scores of the patients who were taken to the operating table without premedication were recorded. Before anesthesia induction, standard monitoring including electrocardiography (ECG), noninvasive blood pressure, peripheral oxygen saturation (SpO2), BIS was applied. The correlation between STAI-T and STAI-S scores with demographic characteristics of patients, preoperative, post-induction, 5th minute, 10th minute, 30th minute, 50th minute, 70th minute, 90th minute heart rate (HR), mean arterial pressure (MAP), SpO2, operation time, recovery time, and total amount of propofol and remifentanil used during the operation were evaluated statistically. A significant negative correlation was observed between STAI-S anxiety scoring and age (p < 0.05). A significant positive correlation was found between the total amount of remifentanil and propofol used with the STAI-S score (p < 0.05). Significant positive correlations were observed between the STAI-S score and the HR value preoperatively, and in the 5th, 30th, 50th, 70th, and 90th minutes (p < 0.05). Our study showed that preoperative anxiety increases intraoperative drug consumption and heart rate. It is of great importance to keep the amount of intraoperative medication at optimal levels, to measure preoperative anxiety, and to eliminate it with multimodal treatments, especially for the accurate detection of neurological damage in patients with neurophysiological monitoring.

Download Full-text

Impact of general anaesthesia on parameters of bulbocavernosus reflex

Medical alphabet ◽

10.33667/2078-5631-2021-36-37-40 ◽

2021 ◽

pp. 37-40

Author(s):

D. E. Malyshok ◽

A. Yu. Orlov ◽

M. V. Aleksandrov

Keyword(s):

Spinal Cord ◽

Current Strength ◽

Total Intravenous Anesthesia ◽

Neurophysiological Monitoring ◽

Spinal Cord Tumors ◽

Intravenous Anesthesia ◽

Intramedullary Tumors ◽

Inhalation Anesthesia ◽

Bulbocavernosus Reflex ◽

Intradural Extramedullary

Dysfunction of the pelvic organs in tumor lesions of the spinal cord is up to 20%. Registration of the bulbocavernosus reflex is performed to assess the integrity of the segmental apparatus of the spinal cord. Polymodal neurophysiological monitoring includes registration of the bulbocavernosus reflex during surgery of spinal cord tumors. The effect of the components of general anesthesia on the parameters of the bulbocavernosus reflex varies significantly according to various medical sources. The aim of the work was to compare the effect of inhalation anesthesia (sevoflurane) and total intravenous anesthesia (propofol) on the parameters of the bulbocavernosus reflex in the surgical treatment of spinal cord tumors. Thirty patients with intradural extramedullary and intramedullary tumors of the spinal cord at the level of Th11–S2 vertebrae were included in the study. The amplitude-frequency parameters of the bulbocavernosus reflex and the threshold intensity of stimulation were assessed in the study. The results of the study demonstrate that intraoperative registration of the bulbocavernosus reflex during resection of tumors of the distal spinal cord can be performed both with inhalation and total intravenous anesthesia. A sustained motor response of the bulbocavernosus reflex requires a higher intensity of stimulation with inhalation anesthesia with sevoflurane than with total intravenous anesthesia. If during the operation the depth of propofol's anesthesia increases by 1 mg/kg/h, then it is necessary to increase the current strength during stimulation by 10–11 mA.

Download Full-text

A Preliminary Study of Volatile Agents or Total Intravenous Anesthesia for Neurophysiological Monitoring During Posterior Spinal Fusion in Adolescents With Idiopathic Scoliosis

Spine ◽

10.1097/brs.0000000000000550 ◽

2014 ◽

Vol 39 (22) ◽

pp. E1318-E1324 ◽

Cited By ~ 24

Author(s):

David P. Martin ◽

Tarun Bhalla ◽

Arlyne Thung ◽

Julie Rice ◽

Allan Beebe ◽

...

Keyword(s):

Idiopathic Scoliosis ◽

Spinal Fusion ◽

Posterior Spinal Fusion ◽

Total Intravenous Anesthesia ◽

Neurophysiological Monitoring ◽

Intravenous Anesthesia ◽

Preliminary Study ◽

Volatile Agents

Download Full-text

The influence of moderate or deep neuromuscular block status on anesthetic depth monitoring system during total intravenous anesthesia using propofol and remifentanil: A randomized trial

Science Progress ◽

10.1177/00368504211010629 ◽

2021 ◽

Vol 104 (2) ◽

pp. 003685042110106

Author(s):

Hyo-Seok Na ◽

Dae-Jin Lim ◽

Bon-Wook Koo ◽

Ah-Young Oh ◽

Pyung-Bok Lee

Keyword(s):

Laparoscopic Cholecystectomy ◽

General Anesthesia ◽

Total Dose ◽

Neuromuscular Block ◽

Total Intravenous Anesthesia ◽

Intravenous Anesthesia ◽

Anesthetic Depth ◽

Time Points ◽

Group Assignment ◽

Deep Neuromuscular Block

The neuromuscular block state may affect the electroencephalogram-derived index representing the anesthetic depth. We applied an Anesthetic Depth Monitoring for Sedation (ADMS) to patients undergoing laparoscopic cholecystectomy under total intravenous anesthesia, and evaluated the requirement of propofol according to the different neuromuscular block state. Adult patients scheduled to undergo laparoscopic cholecystectomy were enrolled and randomly assigned to either the moderate (MB) or deep neuromuscular block (DB) group. The UniCon sensor of ADMS was applied to monitor anesthetic depth and the unicon value was maintained between 40 and 50 during the operation. According to the group assignment, intraoperative rocuronium was administered to maintain proper neuromuscular block state, moderate or deep block state. The unicon value, electromyography (EMG) index, and total dose of propofol and rocuronium were analyzed. At similar anesthetic depth, less propofol was used in the DB group compared to the MB group (6.19 ± 1.36 in the MB mg/kg/h group vs 4.93 ± 3.02 mg/kg/h in the DM group, p = 0.042). As expected, more rocuronium were used in the DB group than in the MB group (0.8 ± 0.2 mg/kg in the MB group vs 1.2 ± 0.2 mg/kg in the DB group, p = 0.023) and the EMG indices were lower in the DB group than in the MB group, at several time points as follows: at starting operation ( p < 0.001); at 15 ( p = 0.019), 45 ( p = 0.011), and 60 min ( p < 0.001) after the initiation of the operation; at the end of operation ( p = 0.003); and at 5 min after the administration of sugammadex ( p < 0.001). At similar anesthetic depth, patients under the deep neuromuscular block state required less propofol with lower intraoperative EMG indices compared to those under the moderate neuromuscular block state during general anesthesia.

Download Full-text