Comparison of Depth of Anesthesia Indices (SNAPTM vs. Bispectral) during Balanced General Anesthesia in Patients Undergoing Outpatient Gynecologic Surgery

Background Dreaming during anesthesia is not a well-understood phenomenon. Anticholinergic drugs are used in anesthesia as premedication, but their use to decrease the incidence of dreams and psychological adverse reactions after anesthesia is not well established. The authors therefore studied the efficacy of intramuscular atropine and scopolamine for the prevention of dreams during general anesthesia with propofol and nitrous oxide. Methods Healthy women undergoing minor gynecologic surgery were randomly assigned to receive 2.5 microg/kg scopolamine or 10 microg/kg atropine intramuscularly (n = 50/group). In both groups, anesthesia was induced and maintained with propofol as a 2.5-mg/kg bolus, followed by 12 mg x kg(-1) x h(-1) as a continuous infusion and 70% nitrous oxide in oxygen. Two interviews regarding dreaming activity and characteristics were conducted at 20 min and 6 h after surgery. Results None of the patients in the scopolamine group and 47% of the patients in the atropine group reported the occurrence of dreams 20 min after recovery. The results were similar at 6 h: 6% of the scopolamine group and 43% of the atropine group reported dream activity. No differences in sedation or anesthetic requirements were found. Conclusions Previous studies in animals and humans suggest that dreams are affected by drugs acting on the central cholinergic system. The current results suggest that intramuscular scopolamine prevents dreams or dream recall in healthy young women undergoing short elective surgery with propofol-nitrous oxide anesthesia.

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Effects of Female Reproductive Hormone Levels on Inadvertent Intraoperative Hypothermia during Laparoscopic Gynecologic Surgery: A Retrospective Study

Medicina ◽

10.3390/medicina57111255 ◽

2021 ◽

Vol 57 (11) ◽

pp. 1255

Author(s):

Cheol Lee ◽

SeongNam Park ◽

ByoungRyun Kim ◽

Hyeonbin Yim ◽

Myeongjong Lee ◽

...

Keyword(s):

Retrospective Study ◽

General Anesthesia ◽

Odds Ratio ◽

Reproductive Hormones ◽

Gynecologic Surgery ◽

Reproductive Hormone ◽

Hormone Levels ◽

Intraoperative Hypothermia ◽

Hypothermia Group ◽

Laparoscopic Gynecologic Surgery

Background and Objectives: Female reproductive hormones may affect core body temperature. This study aimed to investigate the effects of female reproductive hormones on inadvertent intraoperative hypothermia in patients who underwent laparoscopic gynecologic surgery under general anesthesia. Materials and Methods: This retrospective study included 660 menstruating and menopausal female patients aged 19–65 years. The patients were divided into two groups according to the occurrence of inadvertent intraoperative hypothermia: non-hypothermia group (N = 472) and hypothermia group (N = 188). After propensity score matching, 312 patients (N = 156 in each group) were analyzed to investigate the association between intraoperative hypothermia and female reproductive hormones. As potential predictors of inadvertent hypothermia, the levels of female reproductive hormones were analyzed using binary logistic regression. Results: The association of estradiol (r = −0.218, p = 0.000) and progesterone (r = −0.235, p = 0.000) levels with inadvertent intraoperative hypothermia was significant but weakly negative before matching; however, it was significant and moderately negative after matching (r = −0.326, p = 0.000 and r = −0.485, p = 0.000, respectively). In a binary logistic analysis, the odds ratio for estradiol was 0.995 (p = 0.014, 0.993 < 95% confidence interval [CI] < 0.998) before matching and 0.993 (p = 0.000, 0.862 < 95% CI < 0.930) after matching, and that for progesterone was 0.895 (p = 0.000, 0.862 < 95% CI < 0.930) before matching and 0.833 (p = 0.014, 0.990 < 95% CI < 0.996) after matching. Conclusions: Estradiol and progesterone levels were associated with inadvertent intraoperative hypothermia. However, the odds ratio for female reproductive hormone levels was close to 1. Therefore, female reproductive hormones may not be a risk factor for hypothermia during gynecologic surgery under general anesthesia. However, a small sample size in this study limits the generalizability of the results.

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Assessment of changes in the electrical activity of the brain during general anesthesia using portable electroencephalography

Colombian Journal of Anesthesiology ◽

10.5554/22562087.e956 ◽

2020 ◽

Vol 49 (2) ◽

Author(s):

Verónica Gaviria García ◽

Daniel Loaiza López ◽

Carolina Serna Rojas ◽

Sara Ríos Arismendy ◽

Eduardo Montoya Guevara ◽

...

Keyword(s):

Electrical Activity ◽

General Anesthesia ◽

Brain Activity ◽

Low Cost ◽

Conscious State ◽

Depth Of Anesthesia ◽

Cross Sectional ◽

Eyes Closed ◽

Eeg Recordings ◽

The Brain

Introduction: The analysis of the electrical activity of the brain using scalp electrodes with electroencephalography (EEG) could reveal the depth of anesthesia of a patient during surgery. However, conventional EEG equipment, due to its price and size, are not a practical option for the operating room and the commercial units used in surgery do not provide access to the electrical activity. The availability of low-cost portable technologies could provide for further research on the brain activity under general anesthesia and facilitate our quest for new markers of depth of anesthesia. Objective: To assess the capabilities of a portable EEG technology to capture brain rhythms associated with the state of consciousness and the general anesthesia status of surgical patients anesthetized with propofol. Methods: Observational, cross-sectional trial that reviewed 10 EEG recordings captured using OpenBCI portable low-cost technology, in female patients undergoing general anesthesia with propofol. The signal from the frontal electrodes was analyzed with spectral analysis and the results were compared against the reports in the literature. Results: The signal captured with frontal electrodes, particularly α rhythm, enabled the distinction between resting with eyes closed and with eyes opened in a conscious state, and sustained anesthesia during surgery. Conclusions: It is possible to differentiate a resting state from sustained anesthesia, replicating previous findings with conventional technologies. These results pave the way to the use of portable technologies such as the OpenBCI tool, to explore the brain dynamics during anesthesia.

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Effects of circadian rhythm on Narcotrend index and target-controlled infusion concentration of propofol anesthesia

BMC Anesthesiology ◽

10.1186/s12871-021-01445-z ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Jiang-hua Shen ◽

Min Ye ◽

Qian Chen ◽

Yan Chen ◽

Hai-lin Zhao ◽

...

Keyword(s):

Circadian Rhythms ◽

General Anesthesia ◽

Closed Loop ◽

Depth Of Anesthesia ◽

Drug Infusion ◽

Anesthetic Depth ◽

Time Points ◽

Target Controlled Infusion ◽

Medical University ◽

Narcotrend Index

Abstract Background The effects of circadian rhythms on drug metabolism and efficacy are being increasingly recognized. However, the extent to which they affect general anesthesia remains unclear. This study aims to investigate the effects of circadian rhythms on anesthetic depth and the concentrations of propofol target-controlled infusion (TCI). Methods Sixty patients undergoing laparoscopic surgeries were sequentially assigned to four groups. Group ND (n = 15): Propofol TCI with Narcotrend monitor during the day (8:00–18:00), Group NN (n = 15): Propofol TCI with Narcotrend monitor during the night (22:00–5:00), Group CLTD (n = 15): Propofol closed-loop TCI guided by bispectral index (BIS) during the day (8:00–18:00), Group CLTN (n = 15): Propofol closed-loop TCI guided by BIS during the night (22:00–5:00). The Narcotrend index, mean arterial pressure (MAP) and heart rate (HR) were compared between group ND and NN at 7 time points, from 5 min before induction to the end of operation. The propofol TCI concentrations, MAP and HR were compared between group CLTD and CLTN at 7 time points, from 5 min after induction to the end of operation. Results The Narcotrend index, MAP, and HR in group NN were lower than those in group ND from the beginning of mechanical ventilation to the end of operation (p < 0.05). The propofol TCI concentrations in group CLTN were lower than those in group CLTD from the beginning of operation to the end of operation (p < 0.05). Conclusion Circadian rhythms have a significant effect on the depth of anesthesia and drug infusion concentrations during propofol TCI. When using general anesthesia during night surgery, the propofol infusion concentration should be appropriately reduced compared to surgery during the day. Trial registration The present study was registered on the ClinicalTrials.gov website (NCT02440269) and approved by the Medical Ethics Committee of Southwest Hospital of Third Military Medical University (ethics lot number: 2016 Research No. 93). All patients provided informed written consent to participate in the study.

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Effects of Adjuvant Ketamine on Induction of Anesthesia for the Cesarean Section

Current Clinical Pharmacology ◽

10.2174/1574884715666200310103317 ◽

2020 ◽

Vol 15 ◽

Cited By ~ 6

Author(s):

Mahmoudreza Moradkhani ◽

Siavash Beiranvand ◽

Sedigheh Nadri ◽

Paridokht Hejri

Keyword(s):

Cesarean Section ◽

General Anesthesia ◽

Low Doses ◽

Depth Of Anesthesia ◽

Intraoperative Awareness ◽

The Past ◽

Group A ◽

Group B ◽

Larger Sample ◽

Intravenous Ketamine

Background: The cesarean section has shown an increase in the trends within the past few years. The use of appropriate and effective anesthesia for the procedure is important, not only to reduce the incidence of maternal and fetal morbidities but also to reduce the incidence of intraoperative awareness. objective: The aim of this study is to evaluate the intraoperative and postoperative effects of adjuvant ketamine, when used in combination with general anesthesia. Objective: The aim of this study is to evaluate the intraoperative and postoperative effects of adjuvant ketamine, when used in combination with general anesthesia. Methods: The study was conducted on the patients referred to Asali hospital for the cesarean section. 100 patients were assigned to two groups. Patients in Group A received thiopental (4 mg / kg) as an anesthetic agent for the surgery whereas; those in group B received thiopental along with 0.5 mg / kg of intravenous ketamine. The effects of ketamine such as, depth of anesthesia, intraoperative and postoperative awareness, vomiting and hallucination were recorded in the questionnaire and data were statistically analyzed using SPSS v25. Results: Of 100 patients in group A, 10 of them were not deeply unconscious. 40 patients in group A and 25 in group B had intraoperative awareness. 1 patient in group A and 3 in group B had vomiting and 1 patient in group B was presented with the hallucinations. Conclusion: Overall use of ketamine is associated with better sedation and no significant side effects with low doses of ketamine, were seen in our study. Comparative studies using other analgesics, with larger sample size are therefore recommended.

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Utilization of Pleth Index in Hysteroscopic Surgery: A Randomized Controlled Trial

10.21203/rs.3.rs-80596/v1 ◽

2020 ◽

Author(s):

Lifeng Yao ◽

Changshun Huang ◽

Jungang Zheng ◽

Yong Li

Keyword(s):

General Anesthesia ◽

Controlled Trial ◽

Depth Of Anesthesia ◽

Hysteroscopic Surgery ◽

Bodily Movement ◽

Anesthetic Drugs ◽

Recovery Times ◽

Monitoring Group ◽

Group B ◽

Intraoperative Movement

Abstract Background: When performing hysteroscopic surgery under general anesthesia in non-intubated patients, anesthesiologists and gynecologists face challenges including patient movement and respiratory depression due to variability in the depth of patient anesthesia. Intraoperative modulation of the depth of anesthesia is dictated by clinical practice. In recent years, the noninvasive surgical pleth index (SPI) has been purported to objectively reflect the depth of anesthesia. In the present study, we investigated the performance of SPI monitoring in hysteroscopic surgery.Methods: Eighty patients scheduled for hysteroscopic surgery under general anesthesia with a laryngeal mask airway (i.e., spontaneous ventilation without a muscle relaxant) were randomly divided into two groups (both n = 40): (1) bispectral index (BIS)- and SPI-monitoring group (BS Group); and (2) BIS-monitoring group (B group). Intraoperative analgesia was provided via target-controlled infusion (TCI) of remifentanil, which was modulated according to the SPI value (target interval, 20–50) in the BS Group or via the anesthesiologist's assessment in the B Group. In both groups, anesthesia was administered to maintain the BIS values between 40–60. Additionally, the incidences and degree of movement, consumption of anesthetic drugs, recovery times, complications, and satisfactory levels were compared between the two groups.Results: The incidence and degree of bodily movement in the BS Group were significantly lower than those in the B Group (P < 0.05). Furthermore, the remifentanil induction dose and recovery time in the BS group were significantly lower than those in the B group (P < 0.05). However, there were no significant differences between the two groups with regard to adverse events including nausea, vomiting, and dizziness. Finally, gynecologists had higher satisfactory levels in the BS Group (P < 0.05).Conclusion: SPI- and BIS-guided general anesthesia is clinically feasible in hysteroscopic surgery and leads to both inhibition of intraoperative movement and faster recovery.

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Comparison Between Isoflurane and Sevoflurane on Pulse Rate in Patients Under Going General Surgery

Journal of Techniques ◽

10.51173/jt.v3i1.262 ◽

2021 ◽

Vol 3 (1) ◽

pp. 20-23

Author(s):

Ismael Waadullah Ismael ◽

Husam K. Mghames ◽

Mortatha A. Khulaif ◽

Zahraa T. Jaafer

Keyword(s):

Prospective Study ◽

General Anesthesia ◽

Pulse Rate ◽

General Surgery ◽

Muscle Relaxant ◽

Depth Of Anesthesia ◽

Anesthetic Agents ◽

Medical City ◽

Anesthetic Gases ◽

Time Of Operation

The inhalational agents are very important to maintain the depth of anesthesia, provide analgesia and muscle relaxant. Many factors have effect of anesthetic gases, including type in an anesthetic agents and its MAC and other properties and postoperative stays. This study were designed to comparison between isoflurane and sevoflurane as inhalational agents on the pulse rate during general anesthesia. This prospective study were carried out at Baghdad Teaching Hospital, Medical City Complex, Baghdad/Iraq from 2nd January 2020 – 20th February 2020. Thirty (30) patients between 7 - 68 years old were enrolled in this study. Male was 13 and female was 17, in all selected patients, pulse rate was recorded at baseline, at intubation at 5 min, 10 min, 15 min, 20 min, 25 min, 30min, 40 min of the time of operation, extubation, and recovery. Results showed that the pulse rate at baseline there is not significant different in pulse rate of each gas, at intubation there is significant change in pulse rate, at 5 min ,10 min, 15 min, 20 min, 25 min, 30 min, 40 min, extubation, recovery there is not significant different in pulse rate.

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