Remifentanil Requirements during Sevoflurane Administration to Block Somatic and Cardiovascular Responses to Skin Incision in Children and Adults

2002 ◽  
Vol 97 (5) ◽  
pp. 1142-1145 ◽  
Author(s):  
Hernán R. Muñoz ◽  
Luis I. Cortínez ◽  
Fernando R. Altermatt ◽  
Jorge A. Dagnino
Keyword(s):  
Infusion Rate ◽  
Cardiovascular Responses ◽  
Skin Incision ◽  
Autonomic Response ◽  
P Value ◽  
Anesthesia Induction ◽  
Remifentanil Infusion ◽  
Autonomic Responses ◽  
Unpaired Student ◽  
Somatic Response

Background The authors found no studies comparing intraoperative requirements of opioids between children and adults, so they determined the infusion rate of remifentanil to block somatic (IR50) and autonomic response (IRBAR50) to skin incision in children and adults. Methods Forty-one adults (aged 20-60 yr) and 24 children (aged 2-10 yr) undergoing lower abdominal surgery were studied. In adults, anesthesia induction was with sevoflurane during remifentanil infusion, whereas in children remifentanil administration was started after induction with sevoflurane. After intubation, sevoflurane was administered in 100% O2 and was adjusted to an ET% of 1 MAC-awake corrected for age at least 15 min before surgery. Patients were randomized to receive remifentanil at a rate ranging from 0.05 to 0.35 microg x kg(-1) x min(-1) for at least 20 min before surgery. At the beginning of surgery, only the skin incision was performed, and the somatic and autonomic responses were observed. The somatic response was defined as positive with any gross movement of extremity, and the autonomic response was deemed positive with any increase in heart rate mean arterial pressure equal to or more than 10% of preincision values. Using logistic regression, the IR50 and IRBAR50 were determined in both groups of patients and compared with unpaired Student t test. A P value less than 0.05 was considered significant. Results The IR50 +/- SD was 0.10 +/- 0.02 microg x kg(-1) x min(-1) in adults and 0.22 +/- 0.03 microg x kg(-1) x min(-1) in children (P < 0.001). The IRBAR50 +/- SD was 0.11 +/- 0.02 microg x kg(-1) x min(-1) in adults and 0.27 +/- 0.06 microg x kg(-1) x min(-1) in children (P < 0.001). Conclusions To block somatic and autonomic responses to surgery, children require a remifentanil infusion rate at least twofold higher than adults.

scholarly journals Effect of Index of Conciousness (Ioc2) Monitoring on Remifentanil Dosage During Desflurane Anesthsia: A Randomized Trial

2019 ◽  
Vol 2 (1) ◽  
pp. 10-17
Author(s):  
Nirajan Mahaseth ◽  
Rabin Khapung ◽  
Budal BS
Keyword(s):  
Blood Pressure ◽  
Clinical Experience ◽  
Infusion Rate ◽  
Skin Incision ◽  
Control Group ◽  
P Value ◽  
Extubation Time ◽  
Eye Opening ◽  
American Society ◽  
American Society Of Anesthesiologists

Background: Our study investigated the effects of IOC2 index monitoring on remifentanil dosage during desflurane anesthesia. The objective of this study was to compare the intra-operative events and recovery characteristics between remifentanil adjusted by IOC2 monitoring guidelines versus remifentanil adjusted by clinical experience according to fluctuation in blood pressure and heart rate during desflurane anesthesia. Methods: Total of 50 consecutive patients of American Society of Anesthesiologists (ASA)  status I and II, aged 18-65 years, BMI 18-30 kg/m2 undergoing elective laparoscopic cholecystectomy under desflurane anesthesia were enrolled. The patients were randomized and allocated into 2 groups, group T (Trial group=25) and group C (control group=25) using sealed envelope method. The infusion rate of remifentanil was adjusted according to IOC2 monitoring guideline between 30 to 50 in Group T whereas the infusion rate of remifentanil is adjusted by clinical experience according to fluctuation in blood pressure in group C. Remifentanil dose, adjustment frequency, infusion duration, intraoperative events, and quality of anesthetic recovery were compared between the two groups.  Results: Mean dose as well as the adjustment frequency of remifentanil was significantly higher in group T in compared with group C (0.1376±0.0268 vs 0.0956±0.0223 mcg/kg/min and 5.19±1.97vs1.7±0.57 times/surgery, P<0.05). IOC2 value at the time of skin incision, at the time of gall bladder resection and at the time of skin suture was significantly different between two groups (all P value <0.05). Although apparent differences in frequencies of hypotension, bradycardia, hypertension, the total number of patents with intraoperative events were not statistically different between two groups (all P > 0.05). Both groups had similar  voluntary eye opening time, extubation time, emergence agitation ,residual sedation  1 and 10 minutes after extubation, post-operative vomiting and NRS score (in PACU and 24 hours after extubation (all P > 0.05). Conclusion: IOC2 data was significantly high when opioid adjusted by clinical experience. The dose of opioid used according to IOC2 (30-50) monitoring guideline utilized higher dose in compared with dose used by clinical experience however, the intraoperative hemodynamic  and recovery characteristics was unchanged. Hence, application of IOC2 monitoring might be beneficial to adjust the analgesic depth.

Abdominal Wound Problem after Hysterectomy using Scalpel Versus Electrocautery for Skin and Subcutaneous Dissection

2021 ◽  
Vol 15 (9) ◽  
pp. 2870-2872
Author(s):  
Erum Memon ◽  
Kiran Batool ◽  
Mubashra Samina ◽  
Sana Ashfaq ◽  
Kaniz Zehra Naqvi
Keyword(s):  
Subcutaneous Tissue ◽  
Abdominal Hysterectomy ◽  
Skin Incision ◽  
Wound Complications ◽  
P Value ◽  
Abdominal Wound ◽  
Wound Infections ◽  
Tissue Dissection ◽  
Wound Problem ◽  
Operative Wound

Objective: To evaluate the postoperative abdominal wound problem after hysterectomy with scalpel versus electrocautery for skin and subcutaneous dissection. Material and Methods: A total of 516 post-menopausal women having age 40 to 65 years who were planned for elective hysterectomy were included in this study. Patients having only benign disorders were included. In group E (N=258); Skin incision and tissue dissection was done using electrocautery by setting the electrocautery machine at cutting mode at 30 to 50 watts’ power. In group S (N=258); conventional scalpel was used for skin incision. Scalpel number 23 was used for skin and subcutaneous tissue dissection. Post-operative wound complications such as seroma, hematoma, wound dehiscence and wound infections were primary study endpoints. Results: Mean age was 48.6±6.9 years in electrocautery and 49.2±6.3 years in scalpel group (p-value 0.30). Seroma formation was diagnosed in 98 (37.98%) patients in electrocautery group and in 52 (20.1%) patients in scalpel group (p-value <0.0001). Wound infections were diagnosed in 50 (19.3%) patients in electrocautery group versus in 87 (33.7%) patients in scalpel group (p-value 0.0002). Hematoma was diagnosed in 10 (3.87%) patients in electrocautery group and in 19 (7.4%) in scalpel group (p-value 0.08). Conclusion: The use of electrocautery is associated with lower rate of post-operative wound infections and hematoma formation. The present study advocates the use of electrocautery for skin and subcutaneous tissue dissection in patients undergoing abdominal hysterectomy. Keywords: Abdominal hysterectomy, electrocautery, scalpel, wound complications.

Neurons controlling cardiovascular responses to emotion are located in lateral hypothalamus-perifornical region

1990 ◽  
Vol 259 (5) ◽  
pp. R943-R954 ◽  
Author(s):  
O. A. Smith ◽  
J. L. DeVito ◽  
C. A. Astley
Keyword(s):  
Electrical Stimulation ◽  
Lateral Hypothalamus ◽  
Axonal Degeneration ◽  
Neuronal Cell ◽  
Cardiovascular Responses ◽  
Ibotenic Acid ◽  
Defense Reaction ◽  
Autonomic Responses ◽  
Neuronal Cell Bodies ◽  
Thoracic Cord

We did four experiments to determine whether the lateral hypothalamus-perifornical (LH/PF) region is the source of neuronal cell bodies responsible for producing the cardiovascular (CV) responses associated with emotion or the defense reaction. Of particular concern was whether the paraventricular nucleus (PVN) plays a role in the generation of these CV responses. Mapping the hypothalamus with electrical stimulation showed that the CV pattern of responses was never produced by stimulating the PVN and was invariably produced by stimulating the LH/PF region. Complete electrolytic destruction of the PVN and subsequent axonal degeneration did not change the CV pattern of responses elicited by LH/PF stimulation, whereas any encroachment of the lesion on the LH/PF region decreased the magnitude of the CV responses. Injection of the neuroexcitotoxin ibotenic acid (Ibo) into the PVN did not affect responses to LH/PF stimulation, whereas Ibo injection into the LH/PF region eliminated or severely attenuated the CV responses. Retrograde labeling of cells from the thoracic cord and the ventrolateral reticular formation revealed a scattered group of cells in the LH/PF region that may be the cells controlling the CV responses. These results point directly to the LH/PF region as the source of the cell bodies responsible for the autonomic responses associated with emotion or defense reactions.

scholarly journals Comparison between scalpel incision and electrocautery incision in midline abdominal surgery: a comparative study

2021 ◽  
Vol 8 (5) ◽  
pp. 1507
Author(s):  
Amit Yadav ◽  
Lakshman Agarwal ◽  
Sumit A. Jain ◽  
Sanjay Kumawat ◽  
Sandeep Sharma
Keyword(s):  
Postoperative Pain ◽  
Blood Loss ◽  
Abdominal Surgery ◽  
Wound Infection ◽  
Skin Incision ◽  
P Value ◽  
Wound Area ◽  
Significant Difference ◽  
Group A ◽  
Group B

Background: Fear of poor wound healing have curtailed the use of diathermy for making skin incision. Scalpel produces little damage to surrounding tissue but causing more blood loss. Our aim of study was to compare electrocautery incision with scalpel incision in terms of incision time, blood loss, postoperative pain and wound infection.Methods: Total of 104 patients were included in the study undergoing midline abdominal surgery. Patients were randomized into electrocautery (group A) and scalpel (group B). The incision dimension, incision time and blood loss were noted intraoperatively. Postoperative pain was noted on postoperative day 2 using visual analog scale. Wound complications were recorded on every postoperative day till the patient was discharged.Results: 52 patients in each of the two groups were analyzed. There was significant difference found between group A and group B in terms of mean incision time per unit wound area, 8.16±1.59 s\cm2 and 11.02±1.72 s\cm2 respectively (p value=0.0001). The mean blood loss per unit wound area was found to be significantly lower in group A (0.31±0.04 ml\cm2) as compared to group B (1.21±0.21), p value=0.0001. There was no significant difference noted in terms of postoperative pain and wound infection between both groups.Conclusions: Electrocautery can be considered safe in making skin incision in midline laparotomy compared to scalpel incision with comparable postoperative pain and wound infection with less intraoperative blood loss and less time consuming.

scholarly journals Comparative Evaluation of Effectiveness of Intravenous Paracetamol and Intravenous Diclofenac as Post-operative Analgesia in Laparoscopic Cholecystectomy

2018 ◽  
Vol 6 (2) ◽  
pp. 6
Author(s):  
Kalpana Kharbuja ◽  
Mahesh Sharma ◽  
Nil Raj Sharma
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Visual Analogue Scale ◽  
Analogue Scale ◽  
P Value ◽  
Anesthesia Induction ◽  
Chi Square ◽  
Rescue Analgesia ◽  
Post Operative Period ◽  
Post Operative Pain ◽  
Intravenous Paracetamol

Introduction: Though the development of minimally invasive surgery  has revolutionized the field of surgery,  post-operative pain is still a significant issue. Unlike in the past, concerns about adverse effects have limited the role of opioids in post-operative pain management. This study aims to compare the effectiveness of intravenous paracetamol and  diclofenac as postoperative analgesia in laparoscopic cholecystectomy. Methods:One hundred and twenty eight patients of American Society of Anesthesiologists (ASA) categories I and II  included in this study  were divided into two groups. Anesthesia induction and maintenance were standardized. The first group received 15mg/kg (maximum 1gm) intravenous paracetamol and the second group received 2mg/kg (maximum 75mg) intravenous diclofenac 30 minutes prior to ending of surgery. A questionnaire was responded by patients and chart was maintained by visual analogue scale. Mann Whitney U test was used to analyze quantitative data and Chi-square test for categorical data. P value <0.05 was considered statistically significant. Results:  Profiles of hemodynamic changes were almost similar in both groups with respect to heart rate and blood pressure. However, paracetamol infusion provided hemodynamic stability in post-operative period. We observed statistically significant differences  in visual analogue scale between the two groups. Most of the patients in paracetamol group had low mean pain scores in post-operative period and provided an extended analgesia compared to diclofenac. No serious postoperative complication was observed in  paracetamol group.   Conclusion: Administration of intravenous paracetamol has better and prolonged analgesic effect  with low mean pain score and less requirement for rescue analgesia compared to diclofenac.

Reduction of the Minimum Alveolar Concentration of Isoflurane by Dexmedetomidine 

1997 ◽  
Vol 86 (5) ◽  
pp. 1055-1060 ◽  
Author(s):  
Riku Aantaa ◽  
Marja-Leena Jaakola ◽  
Antero Kallio ◽  
Jussi Kanto
Keyword(s):  
Minimum Alveolar Concentration ◽  
Study Drug ◽  
Abdominal Hysterectomy ◽  
Skin Incision ◽  
Control Group ◽  
High Dose ◽  
Anesthesia Induction ◽  
Drug Infusion ◽  
Target Plasma Concentration ◽  
End Tidal

Background alpha 2-Adrenergic agonists have been shown to reduce anesthetic requirements of other anesthetics, and they may even act as complete anesthetics by themselves at high doses in animal models. The present study was designed to define the interaction of intravenous infusion of dexmedetomidine, an alpha 2-adrenergic agonist, and isoflurane in patients having surgery by using the minimum alveolar concentration (MAC) of isoflurane as the measure of anesthetic potency. Methods Forty-nine women scheduled for abdominal hysterectomy were randomly allocated to receive either a placebo infusion (n = 16) or a two-stage infusion of dexmedetomidine with target plasma concentration of 0.3 ng/ml (n = 17) or 0.6 ng/ml (n = 16). The study drug infusion was commenced 15 min before induction of anesthesia with thiopental and alfentanil and was continued until skin incision. The end-tidal concentration of isoflurane for each patient was predetermined according to the "up-down" method of Dixon, and it was maintained for at least 15 min before the patient's response to skin incision was assessed. Results The MAC of isoflurane was 0.85% end-tidal in the control group, 0.55% end-tidal with the low dose of dexmedetomidine, and 0.45% end-tidal with the high dose of dexmedetomidine. Conclusions The MAC of isoflurane in the control group was lower than that reported previously in similar patients having surgery, probably due to anesthesia induction with thiopental and alfentanil. Nevertheless, with the high dose of dexmedetomidine, the MAC of isoflurane was still 47% less than that without dexmedetomidine.

scholarly journals Baroreflex-mediated cardiovascular responses to hyperbaric oxygen

2013 ◽  
Vol 115 (6) ◽  
pp. 819-828 ◽  
Author(s):  
Ivan T. Demchenko ◽  
Sergei Y. Zhilyaev ◽  
Alexander N. Moskvin ◽  
Alexander I. Krivchenko ◽  
Claude A. Piantadosi ◽  
...  
Keyword(s):  
Cardiac Output ◽  
Cardiovascular Responses ◽  
Common Mechanism ◽  
Sympathetic Outflow ◽  
Arterial Baroreflex ◽  
Autonomic Responses ◽  
Conscious Rats ◽  
Carotid Baroreceptor ◽  
Hyperbaric Hyperoxia ◽  
Baroreceptor Activation

The cardiovascular system responds to hyperbaric hyperoxia (HBO2) with vasoconstriction, hypertension, bradycardia, and reduced cardiac output (CO). We tested the hypothesis that these responses are linked by a common mechanism—activation of the arterial baroreflex. Baroreflex function in HBO2 was assessed in anesthetized and conscious rats after deafferentation of aortic or carotid baroreceptors or both. Cardiovascular and autonomic responses to HBO2 in these animals were compared with those in intact animals at 2.5 ATA for conscious rats and at 3 ATA for anesthetized rats. During O2 compression, hypertension was greater after aortic or carotid baroreceptor deafferentation and was significantly more severe if these procedures were combined. Similarly, the hyperoxic bradycardia observed in intact animals was diminished after aortic or carotid baroreceptor deafferentation and replaced by a slight tachycardia after complete baroreceptor deafferentation. We found that hypertension, bradycardia, and reduced CO—the initial cardiovascular responses to moderate levels of HBO2—are coordinated through a baroreflex-mediated mechanism initiated by HBO2-induced vasoconstriction. Furthermore, we have shown that baroreceptor activation in HBO2 inhibits sympathetic outflow and can partially reverse an O2-dependent increase in arterial pressure.

scholarly journals Effects of Volatile versus Total Intravenous Anesthesia on Occurrence of Myocardial Injury after Non-Cardiac Surgery

2019 ◽  
Vol 8 (11) ◽  
pp. 1999 ◽  
Author(s):  
Kwon ◽  
Park ◽  
Lee ◽  
Oh ◽  
Lee ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Myocardial Injury ◽  
Kidney Injury ◽  
High Sensitivity ◽  
Total Intravenous Anesthesia ◽  
P Value ◽  
Type I ◽  
Intravenous Anesthesia ◽  
Remifentanil Infusion ◽  
New Onset

The cardioprotective effects of volatile anesthetics versus total intravenous anesthesia (TIVA) are controversial, especially in patients undergoing non-cardiac surgery. Using current generation high-sensitivity cardiac troponin (hs-cTn), we aimed to evaluate the effect of anesthetics on the occurrence of myocardial injury after non-cardiac surgery (MINS). From February 2010 to December 2016, 3555 patients without preoperative hs-cTn elevation underwent non-cardiac surgery under general anesthesia. Patients were grouped according to anesthetic agent; 659 patients were classified into a propofol-remifentanil total intravenous anesthesia (TIVA) group, and 2896 patients were classified into a volatile group. To balance the use of remifentanil between groups, a balanced group (n = 1622) was generated with patients who received remifentanil infusion in the volatile group, and two separate comparisons were performed (TIVA vs. volatile and TIVA vs. balanced). The primary outcome was occurrence of MINS, defined as rise of hs-cTn I ≥ 0.04 ng/mL within postoperative 48 hours. The secondary outcomes were 30-day mortality, postoperative acute kidney injury (AKI), and adverse events during hospital stay (mortality, type I myocardial infarction (MI), and new-onset arrhythmia). In propensity-matched analyses, the occurrence of MINS was lower in the TIVA group compared to the volatile group (OR 0.642; 95% CI 0.450–0.914; p = 0.014). However, after balancing the use of remifentanil, there was no difference between groups in the risk of MINS (OR 0.832; 95% CI 0.554–1.251; p-value = 0.377). There were no significant associations between the two groups in type 1 MI, new-onset atrial fibrillation, in-hospital and 30-day mortality before and after balancing the use of remifentanil. However, the incidence of postoperative AKI was lower in the TIVA group (OR 0.362; 95% CI 0.194–0.675; p-value = 0.001). After balancing the use of remifentanil, volatile anesthesia and TIVA showed comparable effects on MINS in patients undergoing non-cardiac surgery without preoperative myocardial injury. Further studies are needed on the benefit of remifentanil infusion.

IS THERE AN OPTIMAL REMIFENTANIL INFUSION RATE FOR INTRACRANIAL SURGERY?

1998 ◽  
Vol 89 (Supplement) ◽  
pp. 374A
Author(s):  
Paul F. White ◽  
Zsuzsanna Gesztesi ◽  
Lee Mootz
Keyword(s):  
Infusion Rate ◽  
Remifentanil Infusion ◽  
Intracranial Surgery
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