scholarly journals Dexmedetomidine versus fentanyl in intraoperative neuromuscular monitoring using propofol based total intravenous anesthesia regimen in kyphoscoliosis correction surgery

2021 ◽  
Vol 13 (1) ◽  
Author(s):  
Neha Amey Panse ◽  
Jyoti Vishnu Kale ◽  
Tejaswini Lalasaheb Phalke ◽  
Utkarsha Pradeep Bhojane
Keyword(s):  
Cost Effectiveness ◽  
Neurological Deficit ◽  
Deformity Correction ◽  
Neuromuscular Monitoring ◽  
Total Intravenous Anesthesia ◽  
Intravenous Anesthesia ◽  
Postoperative Neurological Deficit ◽  
Anesthetic Agents ◽  
Correction Surgery ◽  
Surgical Field

Abstract Background Intraoperative neuromuscular monitoring (IONM) is used to reduce the risk of postoperative neurological deficit in patients undergoing kyphoscoliosis correction surgery. Somatosensory evoked potentials (SSEPs) are among the several techniques developed by neurophysiologists to increase the sensitivity of intraoperative monitoring. We administered total intravenous anesthesia (TIVA) to 20 patients undergoing kyphoscoliosis deformity correction surgeries: group A: propofol and dexmedetomidine and group B: propofol and fentanyl. The primary objective of our study was to compare the effect of dexmedetomidine and fentanyl on intraoperative hemodynamic parameters and their interference with SSEP’s readings. The secondary objective was to assess the total intraoperative requirement of inhalational anesthetic agents, quality of surgical field, and the cost-effectiveness of either regimen. Results Intraoperative hemodynamic stability, analgesia, surgical field, and cost-effectiveness (due to reduced requirement of sevoflurane) were better with dexmedetomidine than fentanyl. SSEPs were successfully recorded with both the drugs while the requirement of inhalation anesthetic agents was significantly reduced in the dexmedetomidine group than in the fentanyl group. There were no injuries while recording SSEPs. The latency and amplitude of SSEPs were maintained throughout either group. No intraoperative awakening or awareness was noted (bispectral index was maintained in the range of 40 to 60). No postoperative neurological deficit was noted in any patient. Conclusions Both dexmedetomidine and fentanyl can be successfully used in propofol-based TIVA for SSEP monitoring in kyphoscoliosis correction surgeries, but the better analgesic profile, ease of maintaining stable hemodynamics with a significant reduction in inhalational agent requirement, and opioid-sparing effect by dexmedetomidine make it a more desirable agent to be used in propofol-based TIVA.

scholarly journals Total Intravenous Anesthesia in Neurosurgery

2018 ◽  
Vol 05 (03) ◽  
pp. 141-149 ◽  
Author(s):  
Narmadhalakshmi Kannabiran ◽  
Prasanna Udupi Bidkar
Keyword(s):  
Postoperative Nausea And Vomiting ◽  
Total Intravenous Anesthesia ◽  
Intravenous Anesthesia ◽  
Anesthetic Agents ◽  
Nociceptive Stimulus ◽  
Neurosurgical Patients ◽  
Effect Site Concentration ◽  
Safe Anesthesia ◽  
Infusion Technique ◽  
Rapid Emergence

AbstractIn recent years, neurosurgical anesthesia has been rapidly evolving in the fields of pharmacotherapy and techniques to administer safe anesthesia. Intravenous (IV) anesthetic agents reduce both cerebral blood flow and intracranial pressure besides maintaining flow–metabolism coupling in contrast to inhalational agents. In neuroanesthesia, the technique and choice of drugs directly influence the outcome of the patients. The purpose of this review is to provide the updated information of total intravenous anesthesia (TIVA) in neuroanesthesia. Administration of TIVA using target-controlled infusion technique is emerging as a standard method to administer safe anesthesia in neurosurgical patients. The propofol–remifentanil combination has become very popular due to their favorable pharmacokinetic and pharmacodynamic properties for neurosurgery cases. Plasma-effect site concentration monitoring from target TCI devices together with electroencephalogram or bispectral index monitors allows easy titration of anesthetic agents to ensure adequate depth of anesthesia depending upon the nociceptive stimulus. TIVA is associated with smooth induction and rapid emergence with less postoperative nausea and vomiting.

scholarly journals BIS-Guided Total Intravenous Anesthesia for Orchiopexy and Circumcision in a Child with Severe Autism: A Case Report

2012 ◽  
Vol 2012 ◽  
pp. 1-3
Author(s):  
Selçuk Okur ◽  
Müge Arıkan ◽  
Gülşen Temel ◽  
Volkan Temel
Keyword(s):  
Bispectral Index ◽  
Index System ◽  
Anesthetic Management ◽  
Hospital Setting ◽  
Total Intravenous Anesthesia ◽  
Intravenous Anesthesia ◽  
Anesthetic Agents ◽  
Postanesthetic Care Unit ◽  
Severe Autism

Autistic children are very difficult to manage in the hospital setting because they react badly to any change in routine. We describe a case of 10-year-old male patient with severe autism undergoing orchidopexy and circumcision. Following premedication, anesthesia was induced with remifentanil, propofol, atracurium, and maintained with total intravenous anesthesia (propofol and remifentanil). The Bispectral Index System was monitored for determination of the depth of anesthesia. After surgery, all infusions were discontinued. The patient was then transferred to the postanesthetic care unit. There were no adverse events observed during the anesthetic management. The patient was discharged from the hospital on the second postoperative day. Bispectral Index System-guided Total Intravenous Anesthesia can provide some advantages for patient with autism, such as hemodynamic stability, early and easy recovery, to facilitate faster discharge, to optimize the delivery of anesthetic agents, to minimize its adverse effects, and to maximize its safety.

The Effect of the Total Intravenous Anesthesia Compared with Inhalational Anesthesia on the Surgical Field during Endoscopic Sinus Surgery

2005 ◽  
Vol 19 (5) ◽  
pp. 514-520 ◽  
Author(s):  
Peter J. Wormald ◽  
Graham van Renen ◽  
Jonathon Perks ◽  
Janine A. Jones ◽  
Claire D. Langton-Hewer
Keyword(s):  
Computed Tomography ◽  
Endoscopic Sinus Surgery ◽  
Controlled Trial ◽  
Total Intravenous Anesthesia ◽  
Sinus Surgery ◽  
Fungal Sinusitis ◽  
Inhalational Anesthesia ◽  
Intravenous Anesthesia ◽  
Allergic Fungal Sinusitis ◽  
Surgical Field

Background Bleeding during endoscopic sinus surgery (ESS) may increase complications and negatively effect the surgery and its outcome. The aim of this study was to compare the surgical field in patients in whom total intravenous anesthesia (TIVA) is used as opposed to inhalation anesthesia. A prospective randomized controlled trial was performed. Methods Fifty-six patients undergoing ESS were randomly assigned to receive either inhaled sevoflurane with incremental doses offentanyl (n = 28) or TIVA via a propofol and remifentanil infusion (n = 28) for their general anesthesia. The surgical field was graded every 15 minutes using a validated scoring system. Results The two groups were matched for surgical procedure and computed tomography scores. Patients in the TIVA group were found to have a significantly lower surgical grade score than in the sevoflurane group (p < 0.001). Surgical grade score increased with time in both groups. Mean arterial pressure and pulse were found to influence the surgical field independently (p = 0.003 and p = 0.036 respectively). Mean surgical field grade scores were higher in the patients with allergic fungal sinusitis and nasal polyposis as opposed to chronic rhinosinusitis without polyps or fungus. Lund-Mackay computed tomography scores were found to correlate positively with surgical grade (Spearman rank correlation, p = 0.001). Conclusion In patients undergoing ESS, TIVA results in a better surgical field than inhalational anesthesia.

scholarly journals Analysis of Infusion Patterns of Propofol and Remifentanil During Rigid Bronchoscopy Under Total Intravenous Anesthesia

2020 ◽  
Vol 10 (4) ◽  
Author(s):  
Jong Cook Park ◽  
So Hui Yun ◽  
Changhwan Kim
Keyword(s):  
Operation Time ◽  
Rigid Bronchoscopy ◽  
Total Intravenous Anesthesia ◽  
Intravenous Anesthesia ◽  
Brain Concentration ◽  
Anesthetic Agents ◽  
Anesthetic Drugs ◽  
Total Operation Time ◽  
Pharmacokinetic Properties ◽  
Over Time

Objectives: We analyzed the dosage pattern of anesthetic drugs administered to maintain anesthesia during rigid bronchoscopy. Methods: We enrolled a total of 81 patients who underwent rigid bronchoscopy under total intravenous anesthesia between April 2015 and March 2019. Anesthesia was maintained using propofol (target brain concentration 2.0 - 6.0 µg/mL) and remifentanil (target brain concentration 2.0 - 6.0 ng/mL). We analyzed the dosage patterns of the anesthetic agents during the procedure, as well as the changes in the dose of the anesthetic agents and the number of procedures repeated in the same patient. Results: The dose of propofol administered per minute to maintain anesthesia was inversely correlated with the total operation time (r2 = 0.355, β = -0.067, P < 0.000) but was not significantly correlated with the number of times the procedure was repeated. The dose of remifentanil did not significantly differ during repeated procedures in the same patient. Conclusions: The dose of propofol infusion tended to decrease over time during the rigid bronchoscopy procedure. This pattern was specific to propofol but not to remifentanil using TIVA. Understanding the pharmacokinetic properties of anesthetic drugs will help in their appropriate administration.

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