Effects of Clonidine on Propofol-Based Anesthesia

2002 ◽  
Vol 19 (2) ◽  
pp. 87-89 ◽  
Author(s):  
Edward B. Lack ◽  
John D. Rachel ◽  
Oana Patrascu
Keyword(s):  
Elective Surgery ◽  
Control Group ◽  
Intravenous Sedation ◽  
Hemodynamic Stability ◽  
Beneficial Effects ◽  
Dosage Rate ◽  
Grade Ii ◽  
American Society ◽  
American Society Of Anesthesiologists ◽  
Higher Doses

Introduction: Propofol-based anesthesia is a safe and effective method to provide intravenous sedation in office-based elective surgery. Clonidine is a drug that can provide anxiolytic sedation and hemodynamic stability, thus reducing the propofol consumption rate. This study reports the effect of 0.1 mg of clonidine administered orally and preoperatively on the dosage rate of propofol. The authors also describe the hemodynamic effects on patients undergoing elective liposculpture surgery. Materials and Methods: In a retrospective review, 20 American Society of Anesthesiologists grade I and grade II patients undergoing elective liposculpture surgery under monitored anesthesia care were studied. Ten patients received premedication (0.1 mg clonidine) 30–45 minutes before the induction of anesthesia. A control group receiving no premedication underwent the same procedures conducted by the same surgeon. Propofol dosage rate, heart rate, and blood pressure of both groups were monitored preoperatively, intraoperatively, and in the recovery room. Results: The average propofol dosage rate was 3.21 mg/ kg/h for the treatment group and 2.78 mg/kg/h for the control group. Hemodynamic stability was obtained for both groups during and after the treatment periods. Neither group had episodes of hypotension or changes in expectable recovery time. Discussion: Clonidine premedication of 0.1 mg orally did not reduce the requirements for propofol dosage rates. In contrast to previous studies using higher doses, this clonidine dose did not provide the beneficial effects of lowering the anesthetic requirement for propofol. However, hemodynamic stability was achieved, and no adverse effects were observed.

scholarly journals Comparison of Train of Four Measurements with Kinemyography NMT DATEX and Accelerography TOFscan

2021 ◽  
Vol 9 (2) ◽  
pp. 21
Author(s):  
Cyrus Motamed ◽  
Migena Demiri ◽  
Nora Colegrave
Keyword(s):  
Neuromuscular Blockade ◽  
Lower Limit ◽  
Elective Surgery ◽  
Orotracheal Intubation ◽  
Neuromuscular Blocking ◽  
Physical Status Classification ◽  
Train Of Four ◽  
Surgery First ◽  
American Society ◽  
American Society Of Anesthesiologists

Introduction: This study was designed to compare the Datex neuromuscular transmission (NMT) kinemyography (NMTK) device with the TOFscan (TS) accelerometer during the onset and recovery of neuromuscular blockade. Patients and methods: This prospective study included adult patients who were scheduled to undergo elective surgery with general anesthesia and orotracheal intubation. The TS accelerometer was randomly placed at the adductor pollicis on one hand, and the NMTK was placed on the opposite arm. Anesthesia was initiated with remifentanil target-controlled infusion (TCI) and 2.0–3.0 mg/kg of propofol. Thereafter, 0.5 mg/kg of atracurium or 0.6 mg/kg of rocuronium was injected. If needed, additional neuromuscular blocking agents were administered to facilitate surgery. First, we recorded the train of four (TOF) response at the onset of neuromuscular blockade to reach a TOF count of 0. Second, we recorded the TOF response at the recovery of neuromuscular blockade to obtain a T4/T1 90% by both TS and NMTK. Results: There were 32 patients, aged 38–83 years, with the American Society of Anesthesiologists (ASA) Physical Status Classification I–III included and analyzed. Surgery was abdominal, gynecologic, or head and neck. The Bland and Altman analysis for obtaining zero responses during the onset showed a bias (mean) of 2.7 s (delay) of TS in comparison to NMTK, with an upper/lower limit of agreement of [104; −109 s] and a bias of 36 s of TS in comparison to NMTK, with an upper/lower limit of agreement of [−21.8, −23.1 min] during recovery (T4/T1 > 90%). Conclusions: Under the conditions of the present study, the two devices are not interchangeable. Clinical decisions for deep neuromuscular blockade should be made cautiously, as both devices appear less accurate with significant variability.

scholarly journals Obtenção de Consentimento Informado para Anestesia em Cirurgia Eletiva num Hospital Terciário: Práticas e Contexto Ético-Legal

2019 ◽  
Vol 32 (1) ◽  
pp. 53
Author(s):  
Luís Guilherme Casimiro ◽  
Sara Marisa Pereira ◽  
Sofia Cardoso Pires ◽  
Joana Mourão
Keyword(s):  
Informed Consent ◽  
Elective Surgery ◽  
University Hospital ◽  
Anesthetic Technique ◽  
Patient Relationship ◽  
Active Process ◽  
Legal Principles ◽  
American Society ◽  
American Society Of Anesthesiologists ◽  
Written Informed Consent

Introduction: Informed consent is an active process of the doctor-patient relationship, based on ethical and legal principles. The anesthetic act has inherent risks, which should be subject of specific consent. The aim of this study was to evaluate the degree of implementation of written specific informed consent for anesthesia in the context of elective surgery.Material and Methods: An observational prospective study, at a tertiary university hospital, in 230 patients aged 60 years or older, undergoing elective surgery between May and July 2017. Eligible patients who consented to participate were interviewed clinically on the day before surgery. In the postoperative period, the anesthetic technique and the existence of the written informed consent for the anesthetic and surgical procedures were assessed. Patients who were unable to give informed consent or those admitted in the Intensive Care Unit after surgery were excluded. Results: Written informed consent for the surgical procedure was obtained for 225 (97.8%), while it was obtained in just 96 (41.7%) patients for the anesthetic act. There was a higher prevalence of stroke, anemia, and higher Charlson and physical American Society of Anesthesiologists scores in patients without written informed consent for the anesthetic act.Discussion: We identified a low implementation of written informed consent for anesthesia. This situation may have important implications in the context of disciplinary, civil or criminal liability.Conclusion: Despite its importance, the practice of written informed consent for anesthesia in this institution is not yet implemented on a regular basis.

The Combitube in Elective Surgery

2001 ◽  
Vol 94 (1) ◽  
pp. 79-82 ◽  
Author(s):  
Luis A. Gaitini ◽  
Sonia J. Vaida ◽  
Somri Mostafa ◽  
Boris Yanovski ◽  
Milian Croitoru ◽  
...  
Keyword(s):  
Elective Surgery ◽  
Airway Device ◽  
Spontaneous Ventilation ◽  
Mechanically Ventilated ◽  
Entire Duration ◽  
Duration Of Surgery ◽  
American Society ◽  
End Tidal ◽  
American Society Of Anesthesiologists ◽  
Spontaneously Breathing

Background The Combitube has proved to be a valuable device for securing the airway in cases of difficult intubation. This study investigated the effectiveness of the Combitube in elective surgery during both mechanical and spontaneous ventilation. Methods Two hundred patients classified as American Society of Anesthesiologists physical status I and II, with normal airways, scheduled for elective surgery were randomly allocated into two groups: nonparalyzed, spontaneously breathing (n = 100); or paralyzed, mechanically ventilated (n = 100). After induction of general anesthesia and insertion of the Combitube, oxygen saturation, end-tidal carbon dioxide and isoflurane concentration, systolic and diastolic blood pressure and heart rate, as well as breath-by-breath spirometry data were obtained every 5 min. Results In 97% of patients, it was possible to maintain oxygenation, ventilation, and respiratory mechanics, as well as hemodynamic stability during either mechanical or spontaneous ventilation for the entire duration of surgery. The duration of surgery was between 15 and 155 min. Conclusions The results of this study suggest that the Combitube is an effective and safe airway device for continued management of the airway in 97% of elective surgery cases.

scholarly journals A Comparison of Ondansetron and Lidocaine in Reducing Injection Pain of Propofol: A Randomized Controlled Study

2021 ◽  
Author(s):  
Wirat Wasinwong ◽  
Sarocha Termthong ◽  
Prae Plansangkate ◽  
Jutarat Tanasansuttiporn ◽  
Riam Kosem ◽  
...  
Keyword(s):  
Primary Outcome ◽  
Elective Surgery ◽  
Controlled Study ◽  
Injection Pain ◽  
Syringe Pump ◽  
Intravenous Catheter ◽  
Randomized Controlled ◽  
American Society ◽  
American Society Of Anesthesiologists ◽  
Median Pain

Abstract Background Propofol injection pain is common. Previous studies found that ondansetron can also block sodium channels. Objective The primary outcome was the efficacy of ondansetron compared to lidocaine and placebo for the reduction of propofol injection pain. Method This trial was conducted in 240 patients, American Society of Anesthesiologists classification I-III and aged between 18-65 years old, undergoing elective surgery, and having a 20-gauge intravenous catheter at the hand dorsum. Each group of 80 patients received 8 mg of ondansetron in the O Group, 40 mg of lidocaine in the L Group and normal saline in the C Group. The study medications were blindly given then 1 minute later, the propofol was administered via the syringe pump at the rate of 600 ml/hr. for 30 seconds. Thereafter, the syringe pump of propofol was temporarily paused, and the patients were asked to rate his/her pain. Result The incidence of pain was lowest in the L group (66.2%) compared with the O (82.5%) and the C groups (85.0%) (P<0.01). The median pain score in the L, O, and C groups were 2 (0-4), 4 (2-5), and 4.5 (2-6), respectively (P<0.01). The incidences of no pain, mild, moderate, and severe pain were also significantly different in the L group (33.8%, 37.5%, 21.2%, and 7.5%, respectively) compared with those in the O group (17.5%, 31.2%, 31.2%, and 20.0%, respectively) and the C groups (15.0%, 22.5%, 40.0%, and 22.5%, respectively) (P<0.01).. Conclusion Pretreatment with intravenous lidocaine, rather than ondansetron, can reduce the incidence and intensity of propofol-induced pain.

scholarly journals Analysis of factors affecting reversal of Hartmann’s procedure and post-reversal complications

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Jae Hyun Kang ◽  
Byung Mo Kang ◽  
Sang Nam Yoon ◽  
Jeong Yeon Kim ◽  
Jun Ho Park ◽  
...  
Keyword(s):  
Medical Records ◽  
Elective Surgery ◽  
Multivariable Analysis ◽  
Colorectal Disease ◽  
Hartmann’S Procedure ◽  
Class Iii ◽  
Factors Affecting ◽  
Hartmann's Procedure ◽  
American Society ◽  
American Society Of Anesthesiologists

Abstract Although Hartmann’s procedure (HP) is commonly used as emergency treatment for colorectal disease, the reversal of HP (HR) is infrequently performed. The aims were to evaluate the rate of HR and determine the factors predictive of achieving HR. We retrospectively reviewed the medical records of patients who underwent HP between January 2007 and June 2019 at six Hallym University-affiliated hospitals. Multivariable analysis was performed to identify which factors were independently associated with HR. In the study period, 437 patients underwent HP, and 127 (29.0%) subsequently underwent HR. Of these, 46 (35.9%) patients experienced post-HR complications. In multivariable analysis, an interval between HP and HR of > 6 months was associated with the only lower rate of post-HR complications. Multivariate analysis showed that HR was less likely in patients aged > 70 years, those with American Society of Anesthesiologists (ASA) class III or IV, elective surgery, those experiencing more than two HP-related complications, and those with a malignancy (an indication for HP). One-third of the patients underwent HR. Age > 70 years, ASA class III or IV, elective surgery, more than two HP-related complications, and malignancy were associated with a non-HR rate.

scholarly journals Gastric pH in patients premedicated with Esomeprazole or Famotidine undergoing routine surgery under general anaesthesia

2013 ◽  
Vol 1 (2) ◽  
pp. 71-76
Author(s):  
BR Shrestha ◽  
S Shrestha ◽  
S Moktan ◽  
OS Shrestha
Keyword(s):  
General Anaesthesia ◽  
Ph Value ◽  
Elective Surgery ◽  
Gastric Ph ◽  
Control Group ◽  
Ph Indicator ◽  
Double Blind ◽  
Group Iii ◽  
Group I ◽  
American Society

Background: Stress and anxiety in patients planned for surgery under anaesthesia may change pH of gastric secretion. Premedication of surgical patients with pH altering drugs may modify the pH favourably. With the advent of newer agents, premedication has been carried out with different agents. Most of the time choice of drug is made by the perioperative physician on his/her own. Objective: To study gastric pH in patients premedicated either with Esomeprazole or Famotidine. Methods: This is a randomized controlled double blind prospective study conducted in 150 patients of American Society of Anesthesiologists grade I and II posted for elective surgery under general anaesthesia. The patients enrolled in the study were randomly assigned to three groups having 50 patients in each. Group I (control group) did not receive any pH altering drug, Group II (Famotidine Group) received 40 mg of Famotidine and Group III (Esomeprazole Group) received 40 mg of Esomeprazole the night before surgery. The observer was totally blind about the groups or drugs given to the patients. On the day of surgery, after induction of anaesthesia gastric juice was obtained via nasogastric tube and was checked for pH using pH indicator paper. Results: The pH raised by Esomeprazole was statistically significant (p<0.001) when compared to that of control group or Famotidine group. The mean pH value in control group was less than 2.5 whereas the pH value was higher than 2.5 in patients premedicated with either Famotidine or Esomeprazole. Conclusions: Gastric pH is raised by Famotidine or Esomeprazole premedication prior to routine surgery, Esomeprazole being superior to Famotidine, p<0.001. Patients (84%) not premedicated with either of the drugs had pH less than 2.5. DOI: http://dx.doi.org/10.3126/jkmc.v1i2.8141 Journal of Kathmandu Medical College, Vol. 1, No. 2, Oct.-Dec., 2012: 71-76

scholarly journals Prospective Comparison of Ultrasound-Guided Versus Palpation Techniques for Arterial Line Placement by Residents in a Teaching Institution

2019 ◽  
Vol 11 (2) ◽  
pp. 177-181 ◽  
Author(s):  
Yar Luan Yeap ◽  
John W. Wolfe ◽  
Jennifer Stewart ◽  
Kevin M. Backfish
Keyword(s):  
Elective Surgery ◽  
Baseline Heart Rate ◽  
Arterial Line ◽  
Teaching Institution ◽  
Line Placement ◽  
Prospective Comparison ◽  
Baseline Systolic Blood Pressure ◽  
American Society ◽  
American Society Of Anesthesiologists ◽  
Emergent Surgery

ABSTRACT Background  Arterial line insertion is traditionally done by blind palpation. Residents may need multiple attempts for successful insertion, leading to longer procedure times and many failed attempts. Objective  We hypothesized that ultrasound guidance (USG) would be faster and more successful than traditional blind palpation (TBP) for radial artery line placement by residents. Methods  Patients undergoing elective surgery requiring a radial arterial line were randomized to either the USG or TBP groups. Exclusion criteria included a need for arterial line placement in an awake patient, emergent surgery, or American Society of Anesthesiologists (ASA) physical status class VI. After the induction of anesthesia, a postgraduate year 3 (PGY-3) or PGY-4 anesthesia resident placed an arterial line by either USG or TBP. Results  A total of 412 patients and 85 of 106 residents (80%) in the training program were included. The 2 groups were similar with respect to sex, weight, height, ASA class, baseline systolic blood pressure, and baseline heart rate. USG was faster than TBP (mean times 171.1 ± 16.7 seconds versus 243.6 ± 23.5 seconds, P = .012), required fewer attempts (mean 1.78 ± 0.11 versus 2.48 ± 0.15, P = .035), and had an improved success rate (96% versus 90%, P = .012). Conclusions  We found that residents using USG in an academic institution resulted in significantly faster placement of the arterial lines, fewer attempts, and fewer catheters used.

scholarly journals EFFECT OF DEXMEDETOMIDINE ON DOSE REQUIREMENT OF PROPOFOL AND THIOPENTONE INDUCTION IN PATIENTS UNDER GENERAL ENDOTRACHEAL ANESTHESIA

2018 ◽  
Vol 11 (6) ◽  
pp. 262
Author(s):  
Laxman K Senapati ◽  
Priyadarsini Samanta
Keyword(s):  
Saline Infusion ◽  
Controlled Study ◽  
Control Group ◽  
Dose Requirement ◽  
Preanesthetic Medication ◽  
American Society ◽  
Double Blinded ◽  
American Society Of Anesthesiologists ◽  
Dexmedetomidine Infusion ◽  
Endotracheal Anesthesia

Objectives: The present study was undertaken to assess the effect of dexmedetomidine as a premedicant on dose requirement of induction agents, thiopentone and propofol in patients undergoing various surgeries under general endotracheal anesthesia under the bispectral index (BIS) guidance.Methods: A double-blinded randomized controlled study was conducted during the year 2014–2015 among 120 patients aged 18–55 years with American Society of Anesthesiologists’ physical status Score I or II and Mallampati Grades I and II. After obtaining informed consent, all the eligible patients were randomly assigned to one of the four groups each containing 30 patients: Group SP (control group) - saline infusion before induction with propofol, group DP - dexmedetomidine infusion before induction with propofol, group ST (control group) - saline infusion before induction with thiopentone, and group DT - dexmedetomidine infusion before induction with thiopentone.Results: The mean dose of propofol required was 95.0±6.15 mg and 55.0±7.0 mg in group SP and DP, respectively, whereas the requirement of thiopentone was 6.6±0.93 mg/kg in group ST as opposed to 4.8±0.58 mg/kg in group DT. The decrease in the dose requirement in dexmedetomidine groups than the control groups was statistically significant and also dose reduction in dexmedetomidine was more in DP group compared to that in DT group (p<0.001).Conclusion: Dexmedetomidine as a preanesthetic medication significantly decreases intraoperative anesthetic requirement of thiopentone and propofol, and dose requirement is significantly less in case of propofol as compared to thiopentone.

scholarly journals On-line Monitoring of End-tidal Propofol Concentration in Anesthetized Patients

2007 ◽  
Vol 106 (4) ◽  
pp. 659-664 ◽  
Author(s):  
Akira Takita ◽  
Kenichi Masui ◽  
Tomiei Kazama
Keyword(s):  
Mass Spectrometry ◽  
Proton Transfer ◽  
Elective Surgery ◽  
Plasma Concentrations ◽  
Paired Data ◽  
Data Points ◽  
On Line ◽  
American Society ◽  
End Tidal ◽  
American Society Of Anesthesiologists

Background Propofol (2,6-diisopropylphenol) has some volatility, so it can be detected in expired breath of individuals receiving intravenous propofol. This study measured volatile propofol exhaled by patients and investigated the relation between exhaled and plasma propofol concentrations. Methods Nineteen patients with American Society of Anesthesiologists physical status I or II who were undergoing elective surgery participated in this two-part study. In study 1 (n = 11), anesthesia was induced with 2 mg/kg propofol, 0.1 mg/kg vecuronium, and 2 microg/kg fentanyl. After intubation, propofol was administered continuously for 60 min at each of three rates: 3, 6, and 9 mg x kg(-1) x h(-1). Blood samples were obtained just before each change in the infusion rate, and the plasma concentrations of propofol were measured. The exhaled propofol concentration was measured continuously by means of proton transfer mass spectrometry. End-tidal propofol concentrations during blood sampling were averaged and compared with plasma propofol concentrations. In study 2 (n = 8), after induction of anesthesia, patients received a bolus injection of 2 mg/kg propofol, and the exhaled propofol concentration was measured. Results Volatile propofol was detected in expired gas from all study patients. From study 1, the authors obtained 24 paired data points, i.e., concentrations of end-tidal and plasma propofol. With Bland-Altman analysis, bias +/- precision was 5.2 +/- 10.4 with 95% limits of agreement of -15.1 and 25.6. In study 2, the exhaled propofol concentration curve showed an obvious peak in all patients. Conclusions Agreement between plasma and exhaled propofol concentrations suggests that proton transfer mass spectrometry can be used for real-time propofol monitoring.

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.

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