Esmolol Reduces Anesthetic Requirement for Skin Incision during Propofol/Nitrous Oxide/Morphine Anesthesia

Background Although beta blockers have been used primarily to decrease unwanted perioperative hemodynamic responses, the sedative properties of these compounds might decrease anesthetic requirements. This study was designed to determine whether esmolol, a short-acting beta 1-receptor antagonist, could reduce the propofol concentration required to prevent movement at skin incision. Methods Sixty consenting patients were premedicated with morphine, and then propofol was delivered by computer-assisted continuous infusion along with 60% nitrous oxide. Patients were randomly divided into three groups, propofol alone, propofol plus low-dose esmolol (bolus of 0.5 mg/kg, then 50 micrograms.kg-1.min-1), and propofol plus high-dose esmolol (bolus of 1 mg/kg, then 250 micrograms.kg-1.min-1). Two venous blood samples were drawn at equilibrium. The serum propofol concentration that prevented movement to incision in 50% of patients (Cp50) was calculated by logistic regression. Results The propofol Cp50 with nitrous oxide was 3.85 micrograms/ ml. High-dose esmolol infusion was associated with a significant reduction in the Cp50 to 2.80 micrograms/ml (P < 0.04). Propofol computer-assisted continuous infusion produced stable serum concentrations with a slight positive blas. Esmolol did not alter the serum propofol concentration. No intergroup differences in heart rate or blood pressure response to intubation or incision were found. Conclusions Esmolol significantly decreased the anesthetic requirement for skin incision. The components and mechanism of this interaction remain unclear. A simple pharmacokinetic interaction between esmolol and propofol does not explain the Cp50 reduction. These results demonstrate an anesthetic-sparing effect of a beta-adrenergic antagonist in humans under clinically relevant conditions.

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Plasma Concentration of Fentanyl with Xenon to Block Somatic and Hemodynamic Responses to Surgical Incision

Anesthesiology ◽

10.1097/00000542-200004000-00022 ◽

2000 ◽

Vol 92 (4) ◽

pp. 1043-1048 ◽

Cited By ~ 38

Author(s):

Yoshinori Nakata ◽

Takahisa Goto ◽

Hayato Saito ◽

Yoshiki Ishiguro ◽

Katsuo Terui ◽

...

Keyword(s):

Nitrous Oxide ◽

Plasma Concentrations ◽

Hemodynamic Response ◽

Skin Incision ◽

Computer Assisted ◽

Hemodynamic Responses ◽

Surgical Incision ◽

Model Driven ◽

Bodily Movement ◽

Somatic Response

Background Although anesthesia with xenon has been supplemented with fentanyl, its requirement has not been established. This study was conducted to determine the plasma concentrations of fentanyl necessary to suppress somatic and hemodynamic responses to surgical incision in 50% patients in the presence of 0.7 minimum alveolar concentration (MAC) xenon. Methods Twenty-five patients were allocated randomly to predetermined fentanyl concentration between 0.5 and 4.0 ng/ml during 0.7 MAC xenon anesthesia. Fentanyl was administered using a pharmacokinetic model-driven computer-assisted continuous infusion device. At surgical incision each patient was monitored for somatic and hemodynamic responses. A somatic response was defined as any purposeful bodily movement. A positive hemodynamic response was defined as a more than 15% increase in heart rate or mean arterial pressure more than the preincision value. The concentrations of fentanyl to prevent somatic and hemodynamic responses in 50% of patients were calculated using logistic regression. Results The concentration of fentanyl to prevent a somatic response to skin incision in 50% of patients in the presence of 0.7 MAC xenon was 0.72 +/- 0.07 ng/ml and to prevent a hemodynamic response was 0.94 +/- 0.06 ng/ml. Conclusions Comparing these results with previously published results in the presence of 70% nitrous oxide, the fentanyl requirement in xenon anesthesia is smaller than that in the equianesthetic nitrous oxide anesthesia.

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Abstract 641: Renal Denervation does not Lower Blood Pressure in Spontaneously Hypertensive Rats Treated with a Beta-1 Adrenergic Receptor Antagonist.

Hypertension ◽

10.1161/hyp.64.suppl_1.641 ◽

2014 ◽

Vol 64 (suppl_1) ◽

Author(s):

Jeremiah Phelps ◽

Gregory Fink

Keyword(s):

Blood Pressure ◽

Adrenergic Receptor ◽

Renal Denervation ◽

Blood Pressure Response ◽

Beta Blockers ◽

Antihypertensive Drug Therapy ◽

Spontaneously Hypertensive ◽

Adrenergic Antagonist ◽

Before And After ◽

Pre Treatment

We have used the SHR as an animal model to understand how renal denervation (RDN) lowers blood pressure. In order to determine how concomitant antihypertensive drug therapy could affect the blood pressure response to RDN, we performed RDN both before and after chronic (several days) treatment via the drinking water with the selective alpha-1 adrenergic antagonist prazosin and the selective beta-1 adrenergic antagonist atenolol. In the presence of prazosin treatment, RDN (n=7) significantly (p<0.05) lowered mean arterial pressure (MAP) compared to sham operated (SO; n=6) SHR (Δ=–4.0±1.7mmHg in RDN-SHR vs +1.5±1.3 in SO-SHR). Subsequent addition of atenolol during prazosin treatment reduced MAP significantly in both groups, but MAP in SO-SHR fell to the same level as in RDN-SHR, i.e. the antihypertensive effect of RDN was lost. After discontinuation of all drug treatment, the change in MAP from pre-treatment baseline was –7.7±3.5mmHg in RDN-SHR and +3.0±4.0mmHg in SO-SHR, p=0.06). To test whether the BP response to RDN would be lost during blockade of beta-1 adrenergic receptors alone, we performed RDN in SHR (n=5) pre-treated with atenolol. Atenolol alone significantly reduced MAP (Δ=-20.7±2.5mmHg). Steady-state MAP was not further reduced by RDN (Δ=+2.1±0.9mmHg). When atenolol was withdrawn MAP rose but remained reduced from baseline (Δ= -9.5±0.9mmHg). This magnitude of BP reduction is comparable to what we have previously observed after RDN in untreated SHR. In summary, in SHR RDN does not lower BP in the presence of an effective antihypertensive dose of a beta-1 antagonist. This indicates that RDN is reducing BP in SHR by interrupting a mechanism also affected by beta-1 adrenergic receptor signaling. Although further investigation is necessary, the data suggest that possibility that patients on clinically effective antihypertensive doses of beta-blockers may not exhibit a good response to RDN.

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Possible Role of High-Dose Barbiturates and Early Administration of Parenteral Ketogenic Diet for Reducing Development of Chronic Epilepsy in Febrile Infection-Related Epilepsy Syndrome: A Case Report

Neuropediatrics ◽

10.1055/s-0040-1716903 ◽

2020 ◽

Author(s):

Shimpei Baba ◽

Tohru Okanishi ◽

Koichi Ohsugi ◽

Rika Suzumura ◽

Keiko Niimi ◽

...

Keyword(s):

Continuous Infusion ◽

Ketogenic Diet ◽

Epilepsy Syndrome ◽

High Dose ◽

Early Administration ◽

Chronic Epilepsy ◽

Time Period ◽

Irreversible Brain Damage ◽

Electroencephalogram Eeg

AbstractWe describe the efficacy of high-dose barbiturates and early administration of a parenteral ketogenic diet (KD) as initial treatments for acute status epilepticus (SE) in an 8-year-old girl with febrile infection-related epilepsy syndrome (FIRES). The patient was admitted to our hospital with refractory focal SE. Abundant epileptic discharges over the left frontal region were observed on electroencephalogram (EEG). Treatment with continuous infusion of thiamylal for 4 hours, increased incrementally to 40 mg/kg/h, successfully ended the clinical SE, and induced a burst-suppression coma. The infusion rate was then gradually decreased to 4 mg/kg/h over the next 12 hours. Parenteral KD was administered from days 6 to 21 of illness. Continuous infusion of thiamylal was switched to midazolam on day 10 without causing seizures or EEG exacerbations. The patient has remained seizure free in the 15 months since hospital discharge. The effectiveness of KD for the treatment of FIRES has attracted attention amongst clinicians, but KD treatment may need to last for 2 to 4 days before it can stop SE, a time period that could cause irreversible brain damage. Considering the severity of SE in our patient and the dose of barbiturates needed to treat it, we consider this case to have had a good clinical outcome. The results suggest that rapid termination of seizure using high-dose barbiturates in conjunction with early administration of parenteral KD could reduce the development of chronic epilepsy in patients with FIRES.

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Ambulatory 4-day continuous-infusion schedule of high-dose ifosfamide with mesna uroprotection and granulocyte colony-stimulating factor in advanced solid tumours: A phase I study

Annals of Oncology ◽

10.1093/oxfordjournals.annonc.a059118 ◽

1995 ◽

Vol 6 (2) ◽

pp. 193-196 ◽

Cited By ~ 16

Author(s):

S. Toma ◽

R. Palumbo ◽

A. Comandone ◽

C. Oliva ◽

M. Vincenti ◽

...

Keyword(s):

Phase I ◽

Continuous Infusion ◽

Phase I Study ◽

Solid Tumours ◽

High Dose ◽

Granulocyte Colony Stimulating Factor ◽

Colony Stimulating Factor ◽

Infusion Schedule ◽

Stimulating Factor

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Oxaliplatin with high-dose leucovorin and 5-fluorouracil 48-hour continuous infusion in pretreated metastatic colorectal cancer

European Journal of Cancer ◽

10.1016/s0959-8049(96)00370-x ◽

1997 ◽

Vol 33 (2) ◽

pp. 214-219 ◽

Cited By ~ 265

Author(s):

A. de Gramont ◽

J. Vignoud ◽

C. Tournigand ◽

C. Louvet ◽

T. André ◽

...

Keyword(s):

Colorectal Cancer ◽

Metastatic Colorectal Cancer ◽

Continuous Infusion ◽

High Dose

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Bispectral Analysis of the Electroencephalogram Correlates with Patient Movement to Skin Incision during Propofol/Nitrous Oxide Anesthesia

Anesthesiology ◽

10.1097/00000542-199412000-00010 ◽

1994 ◽

Vol 81 (6) ◽

pp. 1365-1370 ◽

Cited By ~ 118

Author(s):

Lee A. Kearse ◽

Paul Manberg ◽

Nassib Chamoun ◽

Fred deBros ◽

Alan Zaslavsky

Keyword(s):

Nitrous Oxide ◽

Skin Incision ◽

Bispectral Analysis ◽

Patient Movement ◽

Oxide Anesthesia

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Interaction of Isoflurane and Nitrous Oxide Combinations Similar for Median Electroencephalographic Frequency and Clinical Anesthesia

Anesthesiology ◽

10.1097/00000542-199604000-00004 ◽

1996 ◽

Vol 84 (4) ◽

pp. 782-788. ◽

Cited By ~ 18

Author(s):

Heiko Ropcke ◽

Helmut Schwilden

Keyword(s):

Nitrous Oxide ◽

Minimum Alveolar Concentration ◽

Dose Range ◽

Volatile Anesthetic ◽

Oxide Concentration ◽

Anesthetic Requirement ◽

Clinical Anesthesia ◽

Sparing Effect ◽

The Relationship ◽

Nitrous Oxide Concentration

Background The volatile anesthetic sparing effect of nitrous oxide in clinical studies is less than might be expected from the additivity of minimum alveolar concentration values. Other studies identify nonadditive interactions between isoflurane and nitrous oxide. The aim of this study was to quantify the interaction of isoflurane and nitrous oxide at a constant median electroencephalographic frequency. Methods Twenty-five patients were studied during laparotomies. Nitrous oxide was randomly administered in concentrations of 0, 20, 40, 60, and 75 vol%, to ten patients for each nitrous oxide concentration. Isoflurane vaporizer settings were chosen so that the median electroencephalographic frequency was held between 2 and 3 Hz. The relationship between nitrous oxide concentrations and required isoflurane concentrations was examined with the method of isoboles. Results Nitrous oxide linearly decreased the isoflurane requirement. Addition of every 10 vol% of nitrous oxide decreases the isoflurane requirement by approximately 0.04 vol%. The total anesthetic requirement of isoflurane and nitrous oxide, expressed in terms of previously reported minimum alveolar concentration values, increased significantly with increasing nitrous oxide concentrations. Conclusions The interaction of isoflurane and nitrous oxide in the dose range 0-75 vol% on median electroencephalographic frequency is compatible with additivity. The potency of nitrous oxide as a substitute for isoflurane is less than on a minimum alveolar concentration basis. Maintaining median electroencephalographic frequency more appropriately reflects the clinical usage of isoflurane and nitrous oxide than does maintaining minimum alveolar concentration.

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