Does Epidural Anesthesia Have General Anesthetic Effects?

Background Clinically, patients require surprisingly low end-tidal concentrations of volatile agents during combined epidural-general anesthesia. Neuraxial anesthesia exhibits sedative properties that may reduce requirements for general anesthesia. The authors tested whether epidural lidocaine reduces volatile anesthetic requirements as measured by the minimum alveolar concentration (MAC) of sevoflurane for noxious testing cephalad to the sensory block. Methods In a prospective, randomized, double-blind, placebo-controlled trial, 44 patients received 300 mg epidural lidocaine (group E), epidural saline control (group C), or epidural saline-intravenous lidocaine infusion (group I) after premedication with 0.02 mg/kg midazolam and 1 microg/kg fentanyl. Tracheal intubation followed standard induction with 4 mg/kg thiopental and succinylcholine 1 mg/kg. After 10 min or more of stable end-tidal sevoflurane, 10 s of 50 Hz, 60 mA tetanic electrical stimulation were applied to the fifth cervical dermatome. Predetermined end-tidal sevoflurane concentrations and the MAC for each group were determined by the up-and-down method and probit analysis based on patient movement. Results MAC of sevoflurane for group E, 0.52+/-0.18% (+/- 95% confidence interval [CI]), differed significantly from group C, 1.18+/-0.18% (P < 0.0005), and from group I, 1.04+/-0.18% (P < 0.001). The plasma lidocaine levels in groups E and I were comparable (2.3+/-1.0 vs. 3.0+/-1.2 microg/ml +/- SD). Conclusions Lidocaine epidural anesthesia reduced the MAC of sevoflurane by approximately 50%. This MAC sparing is most likely caused by indirect central effects of spinal deafferentation and not to systemic effects of lidocaine or direct neural blockade. Thus, lower concentrations of volatile agents than those based on standard MAC values may be adequate during combined epidural-general anesthesia.

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Succinylcholine Dosage and Apnea-induced Hemoglobin Desaturation in Patients

Anesthesiology ◽

10.1097/00000542-200501000-00009 ◽

2005 ◽

Vol 102 (1) ◽

pp. 35-40 ◽

Cited By ~ 34

Author(s):

Mohamed Naguib ◽

Abdulhamid H. Samarkandi ◽

Khaled Abdullah ◽

Waleed Riad ◽

Saleh W. Alharby

Keyword(s):

Oxygen Saturation ◽

Upper Airway ◽

Study Drug ◽

Face Mask ◽

Saline Control ◽

Control Group ◽

Double Blind Study ◽

Double Blind ◽

The Face ◽

End Tidal

Background The authors examined the notion that a reduction in succinylcholine dose from 1 mg/kg to approximately 0.6 mg/kg would allow a faster recovery of spontaneous ventilation and reduction in the incidence of hemoglobin desaturation during the period of apnea in simulated complete upper airway obstruction situations. Methods This prospective, randomized, double-blind study involved 60 patients. After preoxygenation to an end-tidal oxygen concentration >90%, patients were anesthetized with 2 microg/kg fentanyl and 2 mg/kg propofol. After loss of consciousness, patients were randomly allocated to receive 0.56 or 1.0 mg/kg succinylcholine or saline (control group). Oxygen saturation was monitored continuously at the index finger. When the patient became apneic, the face mask was removed and the patient's airway was left unsupported. If the oxygen saturation decreased to 90%, the face mask was reapplied, and ventilation was assisted until the patient was awake. Time from injection of the study drug to the first visible spontaneous diaphragmatic movements was noted. Results Oxygen saturation decreased <90% in 45%, 65%, and 85% of patients in the control, 0.56 mg/kg, and 1.0 mg/kg succinylcholine groups, respectively (P = 0.03). Corresponding times (mean +/- SD) to spontaneous of diaphragmatic movements were 2.7 +/- 1.2, 4.8 +/- 2.5, and 4.7 +/- 1.3 min, respectively. These times were longer (P < 0.001) after either dose of succinylcholine compared with controls. Conclusions Reduction in succinylcholine dose from 1.0 mg/kg to 0.56 mg/kg decreased the incidence of hemoglobin saturation <90% from 85% to 65% but did not shorten the time to spontaneous diaphragmatic movements. A significant fraction of patients would be at risk if there were failure to intubate and ventilate whether succinylcholine is administered or not and regardless of the dose of succinylcholine administered.

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A small dose of remifentanil pretreatment suppresses sufentanil-induced cough during general anesthesia induction: a randomized, double-blind, placebo-controlled trial

10.21203/rs.2.12883/v2 ◽

2019 ◽

Author(s):

Wendong Lin ◽

Jiehao Sun ◽

Shuying Fu

Keyword(s):

General Anesthesia ◽

Small Dose ◽

Elective Surgery ◽

Controlled Trial ◽

Inhibitory Effect ◽

Control Group ◽

Anesthesia Induction ◽

Double Blind ◽

Prospective Randomized Controlled Trial ◽

Size Groups

Abstract Background: Intravenous use of sufentanil can elicit cough. This study aimed to evaluate the inhibitory effect of pre-injection of a mall dose of remifentanil on sufentanil-induced cough during the induction of general anesthesia. Methods: This prospective, randomized, controlled trial was conducted from January 10, 2019 to March 01, 2019. A total of 100 patients undergoing elective surgery under general anesthesia were enrolled, and at last 84 patients were included and randomly allocated into two equal size groups (n=42): Patients in the Remifentanil group (R group) received an intravenous infusion of remifentanil 0.3 µg/kg (diluted to 2 ml) 1 minute before sufentanil injection; patients in the Control group (C group) received 2 ml of normal saline (NS) at the same time point. Injections of patients in both groups were completed within 5 seconds. Then, sufentanil 0.5 µg/kg was injected within 5 seconds and the number of coughs that occurred within 1 minute after sufentanil injection were recorded. One minute after sufentanil injection, etomidate 0.3 mg/kg and cisatracurium 0.15 mg/kg were given for general anesthesia induction irrespective of the presence or absence of cough. The mean arterial pressure (MAP) and heart rate (HR) at time points just before remifentanil pretreatment administration (T0), 3 minutes after administration (T1), 1 minute after intubation (T2), and 3 minutes after intubation (T3) were recorded. Results: The incidence of cough in patients in the R group and C group was 4.8% and 31%, respectively. Compared with group C, the incidence and severity of cough in group R was significantly lower (P <0.01). No significant differences were observed in MAP and HR at the time of general anesthesia induction between the two groups (P> 0.05). Conclusion: Pretreatment with a small dose of remifentanil effectively and safely reduced the incidence and severity of cough induced by sufentanil during anesthesia induction and can be used as an alternative treatment to inhibit coughing caused by sufentanil.

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Effects of Intravenous Lidocaine on Alfentanil Consumption During Procedural Sedation for Colonoscopy in Patients With Inflammatory Bowel Disease: a Randomized Controlled Trial

10.21203/rs.3.rs-50910/v1 ◽

2020 ◽

Author(s):

Twan Aalbers ◽

Sandra A.S. van den Heuvel ◽

Ewald M. Bronkhorst ◽

Aura A.J. van Esch ◽

Gert Jan Scheffer ◽

...

Keyword(s):

Controlled Trial ◽

Intervention Group ◽

Primary Objective ◽

Procedural Sedation ◽

Controlled Study ◽

Control Group ◽

Double Blind ◽

Lidocaine Group ◽

Sedation And Analgesia ◽

Inflammatory Bowel

Abstract Background: Procedural sedation and analgesia (PSA) is used during colonoscopy to facilitate the procedure and relieve patient’s discomfort. The foremost risk of PSA is respiratory depression. Lidocaine could be a promising additional analgesic in IBD patients to minimise side effects of PSA.Our primary objective was to investigate whether i.v. lidocaine reduces the amount of alfentanil used during PSA in IBD patients. Additionally, we investigated whether lidocaine reduces cardiorespiratory incidents and the amount of propofol required during the procedure.Methods: A randomised, double-blind, placebo controlled study was performed at the endoscopy unit of the Radboud University Medical Centre from November 2016 to December 2018. Seventy-six patients with IBD, ASA 1 or 2, between 18 and 65 years, scheduled for colonoscopy with PSA were included. Patients received lidocaine 1.5 mg kg-1 followed by a continuous infusion of 2 mg kg-1 h-1 (intervention group, n=38) or 0.9% saline in equivalent volumes (control group, n=38) during colonoscopy.Results: There was a reduction in the use of alfentanil (327µg (95%CI=-31-505, p=0.082)), and propofol (39 mg (95%CI=-5-83, p=0.083)) in the lidocaine group compared with the control group. Ten patients (26%) in the control group and 8 patients in the lidocaine group (21%) experienced a period of hypoxia (p=0.788). In both groups, no periods of hypotension were noted.Conclusion: Our investigation has shown a reduction in the use of propofol and alfentanil in patients undergoing colonoscopy with PSA. The differences were not statistically significant. Lidocaine did not reduces the incidence of cardiorespiratory events.Trial registration:EudraCT, 2016-002210-46, registered 19 may 2016,https://www.clinicaltrialsregister.eu/ctr-search/trial/2016-002210-46/resultsISRCTN, ISRCTN47787339, retrospectively registered 6 February 2019, http://www.isrctn.com/ISRCTN47787339

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Intrauterine levobupivacaine for pain control during intrauterine device insertion

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20170596 ◽

2017 ◽

Vol 6 (3) ◽

pp. 1117

Author(s):

Nilufer Akgun ◽

Esra Keskin ◽

Muberra Namlı Kalem ◽

Batuhan Bakirarar

Keyword(s):

Pain Control ◽

Controlled Trial ◽

Intrauterine Device ◽

Saline Control ◽

Control Group ◽

Double Blind ◽

Pain Scores ◽

Significant Difference ◽

Vas Scores

Background: Safe, effective, long term and a reversible contraception method is offered by intrauterine devices (IUDs). The objective was to determine the potency of intrauterine administration of 5 cc levobupivacain for pain relief with IUD insertion, when compared with saline placebo.Methods: This was a prospective randomized, double blind placebo-controlled trial undergoing İUD insertion. The trial medication was intrauterine anesthesia, either 5 mL 0.9% saline (control group), or 5 mL 0.5% levobupivacaine. Our primary outcome was self-reported pain scores on a 10 cm visual analogue scale (VAS) immediately following IUD insertion.Results: 95 women were enrolled, and data for 88 women were analyzed. In IUD insertion procedure, no difference was observed between groups during teneculum placement and solution administration, in the course of VAS scores (p=0.349, p=0.396). There was a significant difference in the VAS scores measuring pain suffering during and after IUD procedure (p=0.001).Conclusions: Intrauterine instillation of 5 cc of levobupivacaine along with saline solution reduces pain with IUD insertion when compared to intrauterine saline placebo. Broad deviation in pain scores and persistent pain after IUD insertion recommends that patient would benefit from more functioning method of pain control than before at IUD insertion and during the post interval.

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A small dose of remifentanil pretreatment suppresses sufentanil-induced cough during general anesthesia induction: a randomized, double-blind, placebo-controlled trial

10.21203/rs.2.12883/v3 ◽

2019 ◽

Author(s):

Wendong Lin ◽

Jiehao Sun ◽

Shuying Fu

Keyword(s):

General Anesthesia ◽

Small Dose ◽

Elective Surgery ◽

Controlled Trial ◽

Inhibitory Effect ◽

Control Group ◽

Anesthesia Induction ◽

Double Blind ◽

Prospective Randomized Controlled Trial ◽

Size Groups

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Intravenous Esmolol Infusion Improves Surgical Fields during Sevoflurane-Anesthetized Endoscopic Sinus Surgery: A Double-Blind, Randomized, Placebo-Controlled Trial

American Journal of Rhinology and Allergy ◽

10.2500/ajra.2011.25.3701 ◽

2011 ◽

Vol 25 (6) ◽

pp. e208-e211 ◽

Cited By ~ 16

Author(s):

Ping-Hung Shen ◽

Erik Kent Weitzel ◽

Jen-Tsung Lai ◽

Peter-John Wormald ◽

Chee-Sang Ho

Keyword(s):

Blood Pressure ◽

Blood Loss ◽

Endoscopic Sinus Surgery ◽

Controlled Trial ◽

Sinus Surgery ◽

Constant Infusion ◽

Saline Control ◽

Control Group ◽

Double Blind ◽

The Impact

Background There is increasing evidence to support the use of anesthetics to affect operative fields during endoscopic sinus surgery and thus the speed, thoroughness, and safety of the surgery itself. Previous research has suggested preoperative beta-blockers improve surgical fields (SFs); our study is novel in showing the impact of a beta-blocker infusion on SFs during sinus surgery. Methods A prospective, randomized, double-blind, placebo-controlled trial was conducted in 40 patients. Patients undergoing endoscopic sinus surgery for chronic rhinosinusitis received a constant infusion of i.v. esmolol or saline in addition to a standard inhaled anesthetic protocol. At regular 15-minutes intervals, the quality of SF, heart rate (HR), systolic blood pressure (SBP), and diastolic blood pressure (DBP) were assessed. Total blood loss was also recorded. Results Average vital sign parameters (HR/SBP/DBP) were significantly lower in the esmolol group (69.1/90.2/55.1 versus 77.2/99.5/63.5; p < 0.01). The esmolol infusion improved SFs relative to control (2.3 versus 2.6; p = 0.045). Esmolol infusion resulted in good SFs (grades 1 and 2) more often than poor fields (grades 3 and 4); on the contrary, the control group showed more poor than good SFs (chi-square; p = 0.04). A correlation between increasing HR and worsening SFs was identified (r = 0.259; p = 0.002). The control group had significantly higher average blood loss (1.3 versus 0.8 mL/min; p = 0.037). Conclusion Esmolol-induced relative hypotension and bradycardia during endoscopic sinus surgery achieves significantly improved SFs relative to saline control.

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Effect of propofol combined with opioids on cough reflex suppression in gastroscopy: study protocol for a double-blind randomized controlled trial

BMJ Open ◽

10.1136/bmjopen-2016-014881 ◽

2017 ◽

Vol 7 (9) ◽

pp. e014881 ◽

Cited By ~ 4

Author(s):

Ning Yin ◽

Jiangyan Xia ◽

Yi-Zhi Cao ◽

Xinjian Lu ◽

Jing Yuan ◽

...

Keyword(s):

Controlled Trial ◽

Assisted Ventilation ◽

Saline Control ◽

Control Group ◽

Manuscript Submission ◽

Time Duration ◽

Double Blind ◽

Cough Reflex ◽

Institutional Ethics ◽

Group 2

IntroductionThe best methods for inducing analgesia and sedation for gastroscopy are still debated but finding an adequate regimen of sedation/analgesia is important. Stimulation of the larynx under sedation can cause reflex responses. Propofol with opioids has been recommended for gastroscopy sedation but the effects on cough reflex suppression remain unclear. This trial will evaluate the effects of propofol combined with small doses of dezocine, oxycodone, sufentanil or fentanyl for gastroscopy. We hypothesise that better performance may be obtained with a combination of propofol and oxycodone. We will observe the incidence and degree of reflex coughing and gagging under sedation when using propofol combined with one of the above drugs or propofol alone.Methods and analysisThis will be a prospective, randomised, double-blind, controlled trial. ASA I–II level patients aged 18–65 years and scheduled for gastroscopy will be included. It is planned that 500 subjects will be randomised to intravenously receive 2–2.2 mg/kg propofol plus 0.5–0.8 μg/kg fentanyl (fentanyl group), 2–2.2 mg/kg propofol plus 0.05–0.08 μg/kg sufentanil (sufentanil group), 2–2.2 mg/kg propofol plus 0.04–0.05 mg/kg dezocine (dezocine group), 2–2.2 mg/kg propofol plus 0.04–0.05 mg/kg oxycodone (oxycodone group), or 2.4–3 mg/kg propofol plus 2–2.5 mL saline (control group) for sedation. The primary endpoint is the incidence and degree of reflex coughing and gagging. The secondary endpoints include the occurrence of discomfort or side effects, the use of jaw thrust, assisted ventilation or additional propofol, recovery time, duration of procedure and Steward score.Ethics and disseminationThis study has been approved by the Institutional Ethics Committee for Clinical Research of Zhongda Hospital, Affiliated to Southeast University (No. 2015ZDSYLL033.0). The results of the trial will be published in an international peer-reviewed journal.Trial registrationThis study has been registered with the Chinese Clinical Trial Register (No. ChiCTR-ICR-15006952).Trial statusAt the time of manuscript submission, the study was in the recruitment phase.

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Epidural Lidocaine Decreases Sevoflurane Requirement for Adequate Depth of Anesthesia as Measured by the Bispectral Index ® Monitor

Anesthesiology ◽

10.1097/00000542-200105000-00018 ◽

2001 ◽

Vol 94 (5) ◽

pp. 799-803 ◽

Cited By ~ 109

Author(s):

Peter S. Hodgson ◽

Spencer S. Liu

Keyword(s):

General Anesthesia ◽

Epidural Anesthesia ◽

Bispectral Index ◽

Depth Of Anesthesia ◽

Intravenous Lidocaine ◽

Lidocaine Group ◽

Plasma Lidocaine ◽

Intravenous Saline ◽

End Tidal ◽

To Receive

Background Epidural anesthesia potentiates sedative drug effects and decreases minimum alveolar concentration (MAC). The authors hypothesized that epidural anesthesia also decreases the general anesthetic requirements for adequate depth of anesthesia as measured by Bispectral Index (BIS). Methods After premedication with 0.02 mg/kg midazolam and 1 microg/kg fentanyl, 30 patients aged 20-65 yr were randomized in a double-blinded fashion to receive general anesthesia with either intravenous saline placebo or intravenous lidocaine control (1-mg/kg bolus dose; 25 microg x kg(-1) x min(-1)). A matched group was prospectively assigned to receive epidural lidocaine (15 ml; 2%) with intravenous saline placebo. All patients received 4 mg/kg thiopental and 1 mg/kg rocuronium for tracheal intubation. After 10 min of a predetermined end-tidal sevoflurane concentration, BIS was measured. The ED50 of sevoflurane for each group was determined by up-down methodology based on BIS less than 50 (MAC(BIS50)). Plasma lidocaine concentrations were measured. Results The MAC(BIS50) of sevoflurane (0.59% end tidal) was significantly decreased with lidocaine epidural anesthesia compared with general anesthesia alone (0.92%) or with intravenous lidocaine (1%; P < 0.0001). Plasma lidocaine concentrations in the intravenous lidocaine group (1.9 microg/ml) were similar to those in the epidural lidocaine group (2.0 microg/ml). Conclusions Epidural anesthesia reduced by 34% the sevoflurane required for adequate depth of anesthesia. This effect was not a result of systemic lidocaine absorbtion, but may have been caused by deafferentation by epidural anesthesia or direct rostral spread of local anesthetic within the cerebrospinal fluid. Lower-than-expected concentrations of volatile agents may be sufficient during combined epidural-general anesthesia.

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Dexmedetomidine vs. lidocaine for postoperative analgesia in pediatric patients undergoing craniotomy: a protocol for a prospective, randomized, double-blinded, placebo-controlled trial

Trials ◽

10.1186/s13063-021-05774-9 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Yuan Zhang ◽

Di Bao ◽

Dongmei Chi ◽

Lu Li ◽

Bin Liu ◽

...

Keyword(s):

Postoperative Pain ◽

Postoperative Analgesia ◽

Pediatric Patients ◽

Pediatric Population ◽

Controlled Trial ◽

Intervention Group ◽

Saline Control ◽

Control Group ◽

Double Blind ◽

Double Blinded

Abstract Background Postoperative pain is a common problem that occurs in pediatric patients following neurosurgery which may lead to severe complications. Dexmedetomidine is a commonly used adjuvant medicine in craniotomy owing to its sedative, amnestic, analgesic, and neuroprotective properties. Besides, studies suggest that lidocaine has similar effects on sedation, analgesia, and neuroprotection. Both two adjuvants can reduce postoperative pain after neurosurgery in adults. However, it is still unknown whether dexmedetomidine or lidocaine can reduce postoperative pain in children undergoing craniotomy, and if yes, which is a better medicine choice. Therefore, we aimed to compare the effect of dexmedetomidine vs. lidocaine on postoperative pain in pediatric patients after craniotomy. Methods/design We will perform a randomized (1:1:1), double-blind, placebo-controlled, single-center trial. Children aged 1–12 years scheduled for craniotomy will be eligible for inclusion. The 255 recruited participants will be stratified by age in two strata (1–6 years and 7–12 years), and then each stratum will be equally randomized to three groups: group D (infusion of dexmedetomidine [intervention group]), group L (infusion of lidocaine [intervention group]), and group C (infusion of normal saline [control group]). Patients will be followed up at 1 h, 2 h, 4 h, 24 h, and 48 h after surgery. The primary outcome will be total sufentanil consumption within 24 h after surgery. Discussion In this clinical trial, we expect to clarify and compare the postoperative analgesic effect of dexmedetomidine vs. lidocaine infusion on pediatric patients undergoing craniotomy. We believe that the results of this trial will provide more choices for postoperative analgesia for the pediatric population. Trial registration Chinese ClinicalTrials.gov ChiCTR1800019411. Registered on 10 November 2018

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Evaluation of Prophylactic Effect of Intramuscular Diclofenac Sodium for Prevention of Succinylcholine-Induced Myalgia

KYAMC Journal ◽

10.3329/kyamcj.v10i1.41481 ◽

2019 ◽

Vol 10 (1) ◽

pp. 35-38

Author(s):

Muhammad Sazzad Hossain ◽

Md Afzalur Rahman ◽

Syed Ariful Islam ◽

Md Waliullah

Keyword(s):

Intramuscular Injection ◽

Elective Surgery ◽

Demographic Data ◽

Diclofenac Sodium ◽

Saline Control ◽

Control Group ◽

Double Blind Study ◽

Double Blind ◽

Duration Of Action ◽

Group I

Background: Succinylcholine a depolarizing muscle relaxant with rapid onset, predictable course and short duration of action is associated with myalgia. Objectives: To assess the efficacy of intramuscular injection of diclofenac sodium in preventing succinylcholine-induced myalgia. Materials and Methods: Eighty healthy adults scheduled for elective surgery under general anesthesia were enrolledin a double-blind study and randomly allocated into two groups of forty patients. Patients in Group I (diclofenacgroup) were pretreated with inj. diclofenac 75 mg deep intramuscularly into gluteal region one hour prior to induction of anesthesia, while patients in Group II (saline group) received an equivalent volume of saline inj. in same site. Anesthesia was induced in both groups with fentanyl 1.5 mcg/kg, propofol 2.0 mg/kg and succinylcholine1.5 mg/kg. Postoperative myalgia was assessed 24 hours after induction and graded as nil, mild, moderate, or severe. Results:The demographic data for both groups were comparable (p > 0.05). Postoperative myalgia was recorded at 24 hours after induction in diclofenac group with twelve (30%) patients and 24 (60%) patients in normal saline (control) group respectively (p < 0.05). Conclusion: Prophylactic use of intramuscular injection of diclofenac is effective in the prevention of postoperative myalgia KYAMC Journal Vol. 10, No.-1, April 2019, Page 35-38

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