scholarly journals Evaluation of the effect of preoperative anxiety on intraoperative hemodynamic stability and drug consumption in patients who underwent BIS-guided total intravenous anesthesia (TIVA) for neurophysiological monitoring in spine surgery

2022 ◽  
Keyword(s):  
Heart Rate ◽  
Spinal Surgery ◽  
Preoperative Anxiety ◽  
Drug Consumption ◽  
Total Intravenous Anesthesia ◽  
Neurophysiological Monitoring ◽  
Anesthesia Induction ◽  
Operating Table ◽  
Hemodynamic Stability ◽  
Intravenous Anesthesia

In our study, the aim was to evaluate the effects of preoperative anxiety measured by Spielberger’s State-Trait Anxiety Inventory-State (STAI-S) and State-Trait Inventory-Trait (STAI-T) scores on intraoperative hemodynamic stability, drug consumption and recovery in patients who underwent spinal surgery with neurophysiological monitoring and total intravenous anesthesia with bispectral index (BIS) monitoring, without the use of muscle relaxants. Eighty patients with planned spinal surgery and neurophysiological monitoring were included in this prospective observational study. Anxiety scores were recorded by applying Spielberger’s STAI-T and STAI-S scoring questionnaires to all patients included in the study 1 hour before the operation. Age, gender and American Society of Anesthesiologists (ASA) scores of the patients who were taken to the operating table without premedication were recorded. Before anesthesia induction, standard monitoring including electrocardiography (ECG), noninvasive blood pressure, peripheral oxygen saturation (SpO2), BIS was applied. The correlation between STAI-T and STAI-S scores with demographic characteristics of patients, preoperative, post-induction, 5th minute, 10th minute, 30th minute, 50th minute, 70th minute, 90th minute heart rate (HR), mean arterial pressure (MAP), SpO2, operation time, recovery time, and total amount of propofol and remifentanil used during the operation were evaluated statistically. A significant negative correlation was observed between STAI-S anxiety scoring and age (p < 0.05). A significant positive correlation was found between the total amount of remifentanil and propofol used with the STAI-S score (p < 0.05). Significant positive correlations were observed between the STAI-S score and the HR value preoperatively, and in the 5th, 30th, 50th, 70th, and 90th minutes (p < 0.05). Our study showed that preoperative anxiety increases intraoperative drug consumption and heart rate. It is of great importance to keep the amount of intraoperative medication at optimal levels, to measure preoperative anxiety, and to eliminate it with multimodal treatments, especially for the accurate detection of neurological damage in patients with neurophysiological monitoring.

scholarly journals Hemodynamic stability in total intravenous propofol anesthesia with midazolam coinduction versus general balanced anaesthesia in laparoscopic cholecystectomy

2012 ◽  
Vol 69 (11) ◽  
pp. 967-972 ◽  
Author(s):  
Maja Surbatovic ◽  
Zoran Vesic ◽  
Dragan Djordjevic ◽  
Sonja Radakovic ◽  
Snjezana Zeba ◽  
...  
Keyword(s):  
Heart Rate ◽  
Laparoscopic Cholecystectomy ◽  
Cardiovascular Diseases ◽  
Total Intravenous Anesthesia ◽  
Measured Parameter ◽  
Time Intervals ◽  
Hemodynamic Stability ◽  
Intravenous Anesthesia ◽  
Balanced Anesthesia ◽  
Balanced Anaesthesia

Background/Aim. Laparoscopic cholecystectomy can be a greater challenge for anesthesiologist than for surgeon if the patient is ASA III with concomitant cardiovascular diseases. The aim of our study was to compare the effect of total intravenous anesthesia (TIVA - propofol with midazolam) and general balanced anesthesia (GBA - midazolam, thiopenton, nitrous oxide and O2) on hemodynamic stability in the ASA III patients who underwent laparoscopic cholecystectomy. Methods. In our study, 60 patients were randomized into two groups depending on whether they received TIVA or GBA. Heart rate, systolic, diastolic and mean arterial pressure were monitored continuously and recorded in five time intervals. Results. Statistical analysis showed that TIVA with propofol provides better hemodynamic stability (less than 10% deviation from basal values for each measured parameter) then GBA group (p < 0.01). Conclusion. Total intravenous anesthesia with propofol provides better hemodynamic stability for ASA III patients with concomitant cardiovascular diseases then GBA.

Additive Interactions between Propofol and Ketamine When Used for Anesthesia Induction in Female Patients 

1995 ◽  
Vol 82 (3) ◽  
pp. 641-648 ◽  
Author(s):  
T. W. Hui ◽  
T. G. Short ◽  
W. Hong ◽  
T. Suen ◽  
T. Gin ◽  
...  
Keyword(s):  
Heart Rate ◽  
Arterial Pressure ◽  
Additional Term ◽  
Anesthesia Induction ◽  
Response Curves ◽  
Intravenous Anesthesia ◽  
Verbal Command ◽  
Female Patients ◽  
Loss Of Response ◽  
Significant Difference

Background Propofol and ketamine may be paired for anesthesia induction and for total intravenous anesthesia. The nature of any sedative interactions occurring between propofol and ketamine are unknown. The combination when used for anesthesia induction in female patients was studied. Methods Quantal dose-response curves were determined in 180 female patients to whom the drugs were administered individually and in combination. Two minutes after administering the drugs, two endpoints were assessed. First, loss of response to verbal command (hypnosis) and then, in those who failed to respond to this endpoint, loss of response to a 5-s transcutaneous tetanus (anesthesia). Interactions were analyzed by fitting the data to a mathematical model in which response was analyzed in terms of the doses of the two drugs and an additional term included to describe nonadditive interactions. The incidences of apnea, arterial pressure, and heart rate changes during the first 5 min were recorded. Results At the hypnotic endpoint, the ED50s were 1.10 mg/kg propofol (95% CIs 0.93-1.27), 0.39 mg/kg ketamine (95% CIs 0.27-0.46), and the combination of 0.63 mg/kg propofol and 0.21 mg/kg ketamine (95% CIs 0.53/0.18-0.73/0.24). At the anesthetic endpoint, the ED50s were 1.85 mg/kg propofol (95% CIs 1.58-2.36) 0.66 mg/kg ketamine (95% CIs 0.58-0.77), and the combination of 1.05 mg/kg propofol and 0.35 mg/kg ketamine (95% CIs 0.88/0.29-1.27/0.42). The effects were additive at both endpoints; there was no evidence of an interaction. The ED50s for apnea were 1.61 mg/kg propofol (95% CIs 1.39-1.94), greater than 0.85 mg/kg ketamine and for the combination 1.50 mg/kg propofol and 0.50 mg/kg ketamine (95% CIs 1.15/0.38-3.09/1.03). The addition of ketamine did not significantly alter the ED50 for apnea of propofol. There was a significant difference in the arterial pressures among the three groups (P &lt; 0.001). Using the combination, the cardiostimulant effects of ketamine balanced the cardiodepressant effects of propofol. There was no change in arterial pressure or heart rate after the noxious stimulus. Conclusions When using the combination, doses were additive at hypnotic and anesthetic endpoints. Ketamine had no influence on the incidence of apnea after propofol, and the net hemodynamic effects were minimal.

Heart rate variability during total intravenous anesthesia: Effects of nociception and analgesia

2009 ◽  
Vol 147 (1-2) ◽  
pp. 91-96 ◽  
Author(s):  
Mathieu Jeanne ◽  
Régis Logier ◽  
Julien De Jonckheere ◽  
Benoît Tavernier
Keyword(s):  
Heart Rate ◽  
Heart Rate Variability ◽  
Total Intravenous Anesthesia ◽  
Intravenous Anesthesia

scholarly journals Effect of Buprenorphine on Total Intravenous Anesthetic Requirements During Spine Surgery

2015 ◽  
Vol 2;18 (2;3) ◽  
pp. E261-E264
Author(s):  
Yury Khelemsky
Keyword(s):  
Case Report ◽  
Cervical Spine ◽  
Spine Surgery ◽  
Volatile Anesthetic ◽  
Total Intravenous Anesthesia ◽  
Neurophysiological Monitoring ◽  
Intravenous Anesthesia ◽  
Cervical Spine Surgery ◽  
Initial Surgery ◽  
Receptor Sites

Buprenorphine is a partial mu receptor agonist and kappa/delta antagonist commonly used for the treatment of opioid dependence or as an analgesic. It has a long plasma halflife and a high binding affinity for opioid receptors. This affinity is so high, that the effects are not easily antagonized by competitive antagonists, such as naloxone. The high affinity also prevents binding of other opioids, at commonly used clinical doses, to receptor sites – preventing their analgesic and likely minimum alveolar concentration (MAC) reducing benefits. This case report contrasts the anesthetic requirements of a patient undergoing emergency cervical spine surgery while taking buprenorphine with anesthetic requirements of the same patient undergoing a similar procedure after weaning of buprenorphine. Use of intraoperative neurophysiological monitoring prevented use of paralytics and inhalational anesthetics during both cases, therefore total intravenous anesthesia (TIVA) was maintained with propofol and remifentanil infusions. During the initial surgery, intraoperative patient movement could not be controlled with very high doses of propofol and remifentanil. The patient stopped moving in response to surgical stimulation only after the addition of a ketamine. Buprenorphine-naloxone was discontinued postoperatively. Five days later the patient underwent a similar cervical spine surgery. She had drastically reduced anesthetic requirements during this case, suggesting buprenorphine’s profound effect on anesthetic dosing. This case report elegantly illustrates that discontinuation of buprenorphine is likely warranted for patients who present for major spine surgery, which necessitates the avoidance of volatile anesthetic and paralytic agents. The addition of ketamine may be necessary in patients maintained on buprenorphine in order to ensure a motionless surgical field. Key words: Buprenorphine, anesthesiology, intraoperative, total intravenous anesthesia, pharmacology

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