Bispectral Index Monitoring Allows Faster Emergence and Improved Recovery from Propofol, Alfentanil, and Nitrous Oxide Anesthesia 

1997 ◽  
Vol 87 (4) ◽  
pp. 808-815 ◽  
Author(s):  
Tong J. Gan ◽  
Peter S. Glass ◽  
Alastair Windsor ◽  
Fredrick Payne ◽  
Carl Rosow ◽  
...  
Keyword(s):  
Nitrous Oxide ◽  
Patient Outcomes ◽  
Bispectral Index ◽  
Clinical Signs ◽  
Postanesthesia Care Unit ◽  
Anesthetic Practice ◽  
Standard Clinical Practice ◽  
Significant Difference ◽  
Balanced Anesthesia ◽  
Oxide Anesthesia

Background The bispectral index (BIS), a parameter derived from the electroencephalograph (EEG), has been shown to correlate with increasing sedation and loss of consciousness. This study determined whether addition of BIS monitoring to standard anesthetic practice results in improvements in the conduct of anesthesia or in patient outcomes. Methods Three hundred two patients receiving a propofol-alfentanil-nitrous oxide anesthetic were studied at four institutions. Thirty-four patients were initially enrolled to determine preexisting anesthetic practice and patient outcomes at each institution. Subsequent patients were randomized to either standard clinical practice (SP group), or standard practice plus BIS monitoring (BIS group). In all patients, the anesthesiologist attempted to provide a stable anesthetic with the fastest possible recovery. BIS was recorded for all patients, but viewed only in the BIS group. In the BIS group, propofol infusions were adjusted to achieve a target BIS between 45-60, increasing to 60-75 during the final 15 min of the case. In the SP group, propofol dose adjustments were made based only on standard clinical signs. Drug use, intraoperative responses, and patient recovery parameters were recorded. Results Demographics were similar between groups. Compared with the SP group, patients in the BIS group required lower normalized propofol infusion rates (134 vs. 116 microg x kg[-1] x min[-1]; P < 0.001), were extubated sooner (11.22 vs. 7.25 min; P < 0.003), had a higher percentage of patients oriented on arrival to PACU (43% vs. 23%; P < 0.02), had better postanesthesia care unit (PACU) nursing assessments (P < 0.001), and became eligible for discharge sooner (37.77 vs. 31.70 min; P <0.04). There was no significant difference in the incidence of intraoperative responses between the groups. Conclusions Titrating propofol with BIS monitoring during balanced anesthesia decreased propofol use and significantly improved recovery. Intraoperative course was not changed. These findings indicate that the use of BIS may be valuable in guiding the administration of propofol intraoperatively.

Effects of Anticholinergics on Postoperative Vomiting, Recovery, and Hospital Stay in Children Undergoing Tonsillectomy with or without Adenoidectomy 

1999 ◽  
Vol 90 (3) ◽  
pp. 697-700 ◽  
Author(s):  
Ashwani K. Chhibber ◽  
Stewart J. Lustik ◽  
Rajbala Thakur ◽  
David R. Francisco ◽  
Kenneth B. Fickling
Keyword(s):  
Nitrous Oxide ◽  
Hospital Stay ◽  
Neuromuscular Blockade ◽  
Oxygen Mixture ◽  
Postanesthesia Care Unit ◽  
Postoperative Vomiting ◽  
Inhalation Induction ◽  
Number Of Patients ◽  
Significant Difference ◽  
Nitrous Oxide Oxygen

Background Nausea and vomiting are the most frequent problems after minor ambulatory surgical procedures. The agents used to induce and maintain anesthesia may modify the incidence of emesis. When neuromuscular blockade is antagonized with anticholinesterases, atropine or glycopyrrolate is used commonly to prevent bradycardia and excessive oral secretions. This study was designed to evaluate the effect of atropine and glycopyrrolate on postoperative vomiting in children. Methods Ninety-three patients undergoing tonsillectomy with or without adenoidectomy were studied. After inhalation induction of anesthesia with nitrous oxide, oxygen, and halothane, anesthesia was maintained with a nitrous oxide-oxygen mixture, halothane, morphine, and atracurium. Patients were randomized to receive, in a double-blinded manner, either 15 microg/kg atropine or 10 microg/kg glycopyrrolate with 60 microg/kg neostigmine to reverse neuromuscular blockade. Patient recovery, the incidence of postoperative emesis, antiemetic therapy, and the duration of postoperative hospital stay were assessed. Results There were no significant differences in age, gender, weight, or discharge time from the postanesthesia care unit or the hospital between the groups. Twenty-four hours after operation, the incidence of vomiting in the atropine group (56%) was significantly less than in the glycopyrrolate group (81%; P<0.05). There was no significant difference between the atropine and glycopyrrolate groups in the number of patients who required antiemetics or additional analgesics. Conclusions In children undergoing tonsillectomy with or without adenoidectomy, reversal of neuromuscular blockade with atropine and neostigmine is associated with a lesser incidence of postoperative emesis compared with glycopyrrolate and neostigmine.

scholarly journals Effects of nitrous oxide on middle ear pressure

2007 ◽  
Vol 60 (9-10) ◽  
pp. 473-478
Author(s):  
Branislava Majstorovic ◽  
Radomir Radulovic ◽  
Vojko Djukic ◽  
Dragana Kastratovic ◽  
Nada Popovic ◽  
...  
Keyword(s):  
Nitrous Oxide ◽  
Hearing Loss ◽  
General Anesthesia ◽  
Middle Ear ◽  
Wilcoxon Test ◽  
Middle Ear Surgery ◽  
Study Group ◽  
Ear Surgery ◽  
Significant Difference ◽  
Balanced Anesthesia

Introduction. Recent literature data suggest that permanent or reversible hearing loss may occur after general anesthesia. The etiology varies, while hearing loss following middle ear surgery is attributed to exposure to nitrous oxide (N2O). The objective of our study was to measure, using tympanometry, the middle air pressure change caused by nitrous oxide during general anesthesia and to establish its emetogenic effects during the postoperative period. Material and Methods. This academic (non-commercial) prospective study included two groups of patients (a total of 58), with ASA status I, II and III. The study group (n 30) consisted of patients undergoing unilateral ear surgery. In this group, the intratympanic pressure was measured in the unoperated (healthy) ear before and during the surgery. The control group (n 28) patients underwent nose, throat or neck surgical interventions. This group underwent measurement of bilateral intratympanic pressure in healthy ears, before and during the surgery. Both groups were operated under general balanced anesthesia. Pain, nausea and antiemetics were monitored during the first 24 postoperative hours. Statistical analysis was performed using the Mann-Whitney-Wilcoxon test. Results. This perioperative study confirmed the following: highly significant (p<0.001) increase in intratympanic pressure in non-operated ears in the study group and significant (p<0.05) in controls. However, there was no statistical significance (p>0.05) between groups. Pain was more frequent in controls, and nausea in the study group, but without significant difference (p>0.05). Conclusions. Postoperative audiometry findings showed no conductive or sensorineural hearing loss after interventions. Nitrous oxide can be used in general balanced anesthesia with discontinuation 15 to 45 minutes before insertion of the tympanic membrane and completion of middle ear surgery. .

Intracuff Pressure and Tracheal Morbidity

2001 ◽  
Vol 95 (5) ◽  
pp. 1120-1124 ◽  
Author(s):  
Xavier Combes ◽  
Franck Schauvliege ◽  
Olivier Peyrouset ◽  
Cyrus Motamed ◽  
Kracen Kirov ◽  
...  
Keyword(s):  
Nitrous Oxide ◽  
Endotracheal Tube ◽  
Sore Throat ◽  
Cuff Pressure ◽  
Postanesthesia Care Unit ◽  
Endotracheal Tube Cuff ◽  
Balanced Anesthesia ◽  
Group A ◽  
Endotracheal Tube Cuff Pressure ◽  
Nitrous Oxide Diffusion

Background Diffusion of nitrous oxide into the cuff of the endotracheal tube results in an increase in cuff pressure. Excessive endotracheal tube cuff pressure may impair tracheal mucosal perfusion and cause tracheal damage and sore throat. Filling the cuff of the endotracheal tube with saline instead of air prevents the increase in cuff pressure due to nitrous oxide diffusion. This method was used to test whether tracheal morbidity is related to excess in tracheal cuff pressure during balanced anesthesia. Methods Fifty patients with American Society of Anesthesiologists physical status I or II were randomly allocated to two groups with endotracheal tube cuffs initially inflated to 20-30 cm H(2)O with either air (group A) or saline (group S). Anesthesia was maintained with isoflurane and nitrous oxide. At the time of extubation, a fiberoptic examination of the trachea was performed by an independent observer, and abnormalities of tracheal mucosa at the level of the cuff contact area were scored. Patients assessed their symptoms (sore throat, dysphagia, and hoarseness) at the time of discharge from the postanesthesia care unit and 24 h after extubation on a 101-point numerical rating scale. Results Cuff pressure increased gradually during anesthesia in group A but remained stable in group S. The incidence of sore throat was greater in group A than in group S in the postanesthesia care unit (76 vs. 20%) and 24 h after extubation (42 vs. 12%; P &lt; 0.05). Tracheal lesions at time of extubation were seen in all patients of group A and in eight patients (32%) of group S (P &lt; 0.05). Conclusion Excess in endotracheal tube cuff pressure during balanced anesthesia due to nitrous oxide diffusion into this closed gas space causes sore throat that is related to tracheal mucosal erosion.

The Comparability of Bispectral Index and State Entropy Index During Maintenance of Sufentanil-Sevoflurane-Nitrous Oxide Anesthesia

2007 ◽  
Vol 105 (5) ◽  
pp. 1319-1325 ◽  
Author(s):  
Cécile Lefoll-Masson ◽  
Christophe Fermanian ◽  
Isabelle Aimé ◽  
Nicolas Verroust ◽  
Guillaume Taylor ◽  
...  
Keyword(s):  
Nitrous Oxide ◽  
Bispectral Index ◽  
Entropy Index ◽  
State Entropy ◽  
Oxide Anesthesia

Comparison of the Effects of Fenugreek Vaginal Cream and Ultra Low- Dose Estrogen on Atrophic Vaginitis

2020 ◽  
Vol 17 (9) ◽  
pp. 815-822
Author(s):  
Maryam Safary ◽  
Sevil Hakimi ◽  
Noushin Mobaraki-Asl ◽  
Paria Amiri ◽  
Habib Tvassoli ◽  
...  
Keyword(s):  
Postmenopausal Women ◽  
Low Dose ◽  
Intervention Group ◽  
Clinical Signs ◽  
Control Group ◽  
Conjugated Estrogens ◽  
Atrophic Vaginitis ◽  
Vaginal Cream ◽  
Intergroup Comparison ◽  
Significant Difference

Introduction: Atrophic vaginitis is a common problem in postmenopausal women and results from decreased levels of blood estrogen. It is associated with symptoms of itching, burning, dyspareunia, and postmenopausal bleeding. The present study evaluated the effects of fenugreek extract on atrophic vaginitis. Materials and Methods: This randomized controlled clinical trial was performed on 60 postmenopausal women in Ardabil, Iran, in 2018. The participants were selected using block randomization with the allocation ratio 1:1. Those in the intervention group received 0.5g (the applicator filled to the half-full mark) fenugreek vaginal cream 5% twice a week for 12 weeks. The control group received conjugated estrogens vaginal cream at the dose of 0.625 mg (the applicator filled to the half-full mark) containing 0.3 mg of conjugated estrogens. Atrophic vaginitis was evaluated before and after the treatment through clinical examination, clinical signs, and measurement of Vaginal Maturation Index (VMI). Findings: After the 12-week intervention and modification of the baseline score, the mean (standard error) score for atrophic vaginitis signs was 3.100 (1.43-4.75). This difference was statistically significant in intragroup comparison and in favor of the control group in intergroup comparison (p=0.001). VMI was less than 49% in 86.7% and 46.7% of the participants in the intervention and control groups, respectively. This was a significant difference in favor of the control group (p=0.001). Conclusion: The results of this study showed that total fenugreek extract could be effective in treating signs of atrophic vaginitis, but it was not as effective as ultra-low-dose estrogen.

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