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

2001 ◽  
Vol 94 (5) ◽  
pp. 799-803 ◽  
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.

Does Epidural Anesthesia Have General Anesthetic Effects? 

1999 ◽  
Vol 91 (6) ◽  
pp. 1687-1687 ◽  
Author(s):  
Peter S. Hodgson ◽  
Spencer S. Liu ◽  
Troy W. Gras
Keyword(s):  
General Anesthesia ◽  
Epidural Anesthesia ◽  
Controlled Trial ◽  
Saline Control ◽  
Control Group ◽  
Double Blind ◽  
Lidocaine Group ◽  
Group I ◽  
End Tidal ◽  
Volatile Agents

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.

scholarly journals The Use of Bispectral Index Monitoring Does Not Change Intraoperative Exposure to Volatile Anesthetics in Children

2020 ◽  
Vol 9 (8) ◽  
pp. 2437
Author(s):  
Cornelius A. Sullivan ◽  
Chinyere Egbuta ◽  
Raymond S. Park ◽  
Karina Lukovits ◽  
David Cavanaugh ◽  
...  
Keyword(s):  
General Anesthesia ◽  
Bispectral Index ◽  
Volatile Anesthetics ◽  
Day Surgery ◽  
Primary Objective ◽  
Recovery Profile ◽  
The Face ◽  
End Tidal ◽  
Discharge Criteria

The exposure of infants and children to volatile anesthetics, such as sevoflurane, has been a topic of concern with respect to the potential risk for long term neurocognitive effects. The primary objective of this study was to determine whether the perioperative utilization of Bispectral Index (BIS) monitoring alters the sevoflurane delivery and exposure to children. This is a prospective randomized trial of two groups of healthy ambulatory day surgery patients (2 to 12 years). The patients in both groups had the BIS applied soon after the induction of general anesthesia, but only the anesthesiologists in the group randomized to BIS visible were able to see the BIS values. All of the patients received general anesthesia with sevoflurane. This study found no difference in the overall exposure to sevoflurane between both groups (mean end-tidal sevoflurane level of 1.8 in both groups, P = 084). The duration of time in the recovery room, the time to meet discharge criteria, the Pediatric Agitation Emergence Delirium (PAED) scores and the Face, Legs, Activity, Cry, Consolability (FLACC) scores were not statistically different between the groups. The application and utilization of intraoperative BIS monitoring does not alter the sevoflurane administration nor the discharge readiness nor the recovery profile in healthy ambulatory children.

scholarly journals Lidocaine versus magnesium sulfate infusion during isoflurane anesthesia for brain tumor resection, effect on minimum alveolar concentration reduction guided by bispectral index: a prospective randomized controlled trial

2021 ◽  
Keyword(s):  
Brain Tumor ◽  
Magnesium Sulfate ◽  
Bispectral Index ◽  
Muscle Relaxant ◽  
Minimum Alveolar Concentration ◽  
Tumor Resection ◽  
Loading Dose ◽  
Depth Of Anesthesia ◽  
Lidocaine Group ◽  
Significant Difference

Objective: Goals of neuro-anesthesia include smooth induction, stable perioperative hemodynamics, early and quiet recovery with adequate analgesia. Intraoperative use of co-sedatives allows reduction of anesthetic agents consumption while maintaining a desirable depth of anesthesia. Many drugs like opioids and dexmedetomidine had been studied in different surgeries. Using such drugs enhances rapid recovery for early postoperative assessment and detection of complications. Methods: This study enrolled 50 adult patients undergoing supratentorial brain tumor surgery. Patients of the lidocaine group (group L) received 1.5 mg.kg−1 of lidocaine as a loading dose over 10 min before induction of anesthesia and followed by infusion at a rate of 1.5 mg.kg−1.h−1. Patients of the magnesium group (group M) received 30 mg.kg−1 of magnesium sulfate as a loading dose over 10 min before induction of anesthesia and followed by infusion at a rate of 10 mg.kg−1.h−1. Depth of anesthesia was guided by bispectral index in a range of 50 ± 2, with the primary outcome objective, minimum alveolar concentration reduction of inhaled isoflurane. Results: No significant difference was found regarding patient demographics, basal hemodynamic data, and anesthesia duration. The used isoflurane concentration at the matching time points (every 15 min intraoperatively) and the total dose of muscle relaxant (160 ± 15 mg, 175 ± 18 mg respectively, p 0.003) were statistically lower in group M than in group L. The time required for recovery was statistically shorter in group M than in group L (5.1 ± 0.99 min vs 9.8 ± 1.9 min, respectively, p 0.00). Conclusion: Compared to lidocaine infusion, magnesium sulfate (MgSO4) infusion during anesthesia for brain surgery resulted in lower anesthetic consumption, muscle relaxant requirement, a shorter recovery time, and a better postoperative pain profile. MgSO4 can be used effectively as a co-sedative adjuvant with superior clinical properties than lidocaine infusion.

The use of Preoperative Lidocaine to Prevent Stridor and Laryngospasm after Tonsillectomy and Adenoidectomy

1998 ◽  
Vol 118 (6) ◽  
pp. 880-882 ◽  
Author(s):  
CAN KOÇ ◽  
FALIH KOCAMAN ◽  
ERDINÇ AYGENÇ ◽  
CAFER ÖZDEM ◽  
ALI ÇEKIÇ
Keyword(s):  
Early Postoperative Period ◽  
Control Group ◽  
Double Blind Study ◽  
Intravenous Lidocaine ◽  
Double Blind ◽  
Lidocaine Group ◽  
Group 4 ◽  
Topical Lidocaine ◽  
Plasma Lidocaine ◽  
Sedation Scores

The most important complications from tonsillectomy and adenoidectomy are bleeding, stridor, and laryngospasm. This controlled, double-blind study was designed to investigate the effects of topical and intravenous lidocaine on stridor and laryngospasm. A total of 134 patients scheduled for elective tonsillectomy and/or adenoidectomy were randomly separated into four groups. In the topical lidocaine group 4 mg/kg of 2% lidocaine was applied to subglottic, glottic, and supraglottic areas before endotracheal intubation. Normal saline solution was used topically for the first control group. In the intravenous lidocaine group, patients were given 1 mg/kg of 2% lidocaine before extubation, and the same amount of 0.9% NaCl was given to the second control group. Postoperative stridor, laryngospasm, cyanosis, bleeding, sedation degree, and respiratory depression were observed, and plasma lidocaine levels were measured. Both topical and intravenous lidocaine groups revealed less stridor and laryngospasm than the control groups, and no difference was found between the topical and intravenous lidocaine groups except the higher sedation scores in the early postoperative period for the intravenous lidocaine group. (Otolaryngol Head Neck Surg 1998;118:880–2.)

Is Intravenous Lidocaine Clinically Effective in Acute Migraine?

Cephalalgia ◽  
1991 ◽  
Vol 11 (6) ◽  
pp. 245-248 ◽  
Author(s):  
David C Reutens ◽  
Daniel M Fatovich ◽  
Edward G Stewart-Wynne ◽  
David A Prentice
Keyword(s):  
Controlled Trial ◽  
Pain Intensity Score ◽  
Acute Migraine ◽  
Intravenous Lidocaine ◽  
Double Blind ◽  
Lidocaine Group ◽  
The Difference ◽  
To Receive ◽  
Analogue Scales ◽  
Initial Intensity

We performed a prospective, randomized, double-blind, placebo-controlled trial of intravenous lidocaine (1 mg/kg) in the treatment of acute migraine. Thirteen subjects were randomly allocated to receive intravenous lidocaine and 12 received intravenous normal saline. Subjects scored the intensity of headache and nausea on separate visual analogue scales before the injection and at 10 and 20 min after injection. At 20 min, the mean pain intensity score was 80% of initial intensity in the lidocaine group and 82% in the placebo group. The difference was not statistically significant; at 20 min, the 95% confidence interval for the difference between the two groups in mean percentage of initial pain score was 2 ± 29%. At the dose studied, intravenous lidocaine has, at best, only a modest effect in acute migraine.

scholarly journals Comparison between Bispectral Index and Patient State Index as Measures of the Electroencephalographic Effects of Sevoflurane

2008 ◽  
Vol 109 (5) ◽  
pp. 799-805 ◽  
Author(s):  
Martin Soehle ◽  
Richard K. Ellerkmann ◽  
Matthias Grube ◽  
Matthias Kuech ◽  
Stefan Wirz ◽  
...  
Keyword(s):  
Bispectral Index ◽  
Pharmacodynamic Modeling ◽  
Depth Of Anesthesia ◽  
Sevoflurane Anesthesia ◽  
Effect Site ◽  
Effect Site Concentration ◽  
Patient State ◽  
State Index ◽  
Patient State Index ◽  
End Tidal

Background The Bispectral Index (BIS) and the Patient State Index (PSI) quantify depth of anesthesia by analyzing the electroencephalogram. The authors examined the response of BIS and PSI to sevoflurane anesthesia. Methods In 22 patients, sevoflurane anesthesia was induced by inhalation with a tight-fitting facemask and was maintained via a laryngeal mask. Sevoflurane concentrations were increased until burst suppression occurred and subsequently decreased until BIS recovered to values above 60. This procedure was repeated twice until patients underwent intubation for subsequent surgery. End-tidal sevoflurane concentrations, BIS, and PSI were recorded simultaneously. The performance of PSI and BIS to predict the estimated sevoflurane effect site concentration, as derived from simultaneous pharmacokinetic and pharmacodynamic modeling, was compared by determination coefficients (rho(2)) and prediction probabilities (P(K)). Results A significant (P < 0.001) correlation between BIS and PSI was found (r(2) = 0.75), and a close sigmoid relation between sevoflurane effect site concentration and both BIS (rho(2) = 0.84 +/- 0.09) and PSI (rho(2) = 0.85 +/- 0.15) was observed. The maximum sevoflurane electroencephalographic effect resulted in PSI values (1.3 +/- 4.3) that were significantly (P = 0.019) lower than BIS values (7.9 +/- 12.1), and the effect site efflux constant k(e0) was significantly smaller (P = 0.001) for PSI (0.13 +/- 0.08 min(-1)) than for BIS (0.24 +/- 0.15 min(-1)). The probability of BIS (P(K) = 0.80 +/- 0.11) to predict sevoflurane effect site concentration did not differ (P = 0.76) from that of PSI (P(K) = 0.79 +/- 0.09). Conclusions The BIS reacted faster to changes in sevoflurane concentrations, whereas the PSI made better use of the predefined index range. However, despite major differences in their algorithms and minor differences in their dose-response relations, both PSI and BIS predicted depth of sevoflurane anesthesia equally well.

scholarly journals Bispectral Index Monitoring (BIS) as a Guide for Intubation Without Neuromuscular Blockade in Office-Based Pediatric General Anesthesia: A Retrospective Evaluation

2011 ◽  
Vol 58 (1) ◽  
pp. 3-7 ◽  
Author(s):  
Zakaria S Messieha ◽  
Samuel Guirguis ◽  
Sherine Hanna
Keyword(s):  
General Anesthesia ◽  
Neuromuscular Blockade ◽  
Bispectral Index ◽  
Index System ◽  
Muscle Relaxation ◽  
Pediatric Anesthesia ◽  
Vital Signs ◽  
Mean Value ◽  
American Society ◽  
End Tidal

The Bispectral Index System is a useful guide for timing of adequate intubation conditions in office-based pediatric general anesthesia without neuromuscular blockade. As the number of cases in the office-based setting increase, many clinicians opt to intubate patients without neuromuscular blockade to avoid airway complications associated with skeletal muscle relaxation. Conventionally, this technique is conducted using the traditional monitoring criteria of vital signs, end-tidal inhalation agents, as well as anesthesiologist timing and knowledge of the pharmacodynamics of the anesthetic agent to help determine the proper depth of anesthesia for adequate intubating conditions. This study retrospectively assesses the use of the Bispectral Index System (BIS) as a guide for timing of nonparalytic tracheal intubation in pediatric office-based general anesthesia. Anesthetic records for 168 children, American Society of Anesthesiology physical status I and II, and ranging in age from 18 months to 17 years were retrospectively analyzed. Intubation outcomes were based on 6 preset criteria to reflect the adequacy of the technique. The mean BIS value during the time of intubation was 34.7. There were no complications encountered. A BIS mean value of 34.7 provided adequate intubation conditions without muscle relaxation in office-based pediatric anesthesia without complications.

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