scholarly journals Bispectral Index Monitoring (BIS) as a Guide for Intubation Without Neuromuscular Blockade in Office-Based Pediatric General Anesthesia: A Retrospective Evaluation

2011 ◽  
Vol 58 (1) ◽  
pp. 3-7 ◽  
Author(s):  
Zakaria S Messieha ◽  
Samuel Guirguis ◽  
Sherine Hanna
Keyword(s):  
General Anesthesia ◽  
Neuromuscular Blockade ◽  
Bispectral Index ◽  
Index System ◽  
Muscle Relaxation ◽  
Pediatric Anesthesia ◽  
Vital Signs ◽  
Mean Value ◽  
American Society ◽  
End Tidal

The Bispectral Index System is a useful guide for timing of adequate intubation conditions in office-based pediatric general anesthesia without neuromuscular blockade. As the number of cases in the office-based setting increase, many clinicians opt to intubate patients without neuromuscular blockade to avoid airway complications associated with skeletal muscle relaxation. Conventionally, this technique is conducted using the traditional monitoring criteria of vital signs, end-tidal inhalation agents, as well as anesthesiologist timing and knowledge of the pharmacodynamics of the anesthetic agent to help determine the proper depth of anesthesia for adequate intubating conditions. This study retrospectively assesses the use of the Bispectral Index System (BIS) as a guide for timing of nonparalytic tracheal intubation in pediatric office-based general anesthesia. Anesthetic records for 168 children, American Society of Anesthesiology physical status I and II, and ranging in age from 18 months to 17 years were retrospectively analyzed. Intubation outcomes were based on 6 preset criteria to reflect the adequacy of the technique. The mean BIS value during the time of intubation was 34.7. There were no complications encountered. A BIS mean value of 34.7 provided adequate intubation conditions without muscle relaxation in office-based pediatric anesthesia without complications.

scholarly journals The Use of Bispectral Index Monitoring Does Not Change Intraoperative Exposure to Volatile Anesthetics in Children

2020 ◽  
Vol 9 (8) ◽  
pp. 2437
Author(s):  
Cornelius A. Sullivan ◽  
Chinyere Egbuta ◽  
Raymond S. Park ◽  
Karina Lukovits ◽  
David Cavanaugh ◽  
...  
Keyword(s):  
General Anesthesia ◽  
Bispectral Index ◽  
Volatile Anesthetics ◽  
Day Surgery ◽  
Primary Objective ◽  
Recovery Profile ◽  
The Face ◽  
End Tidal ◽  
Discharge Criteria

The exposure of infants and children to volatile anesthetics, such as sevoflurane, has been a topic of concern with respect to the potential risk for long term neurocognitive effects. The primary objective of this study was to determine whether the perioperative utilization of Bispectral Index (BIS) monitoring alters the sevoflurane delivery and exposure to children. This is a prospective randomized trial of two groups of healthy ambulatory day surgery patients (2 to 12 years). The patients in both groups had the BIS applied soon after the induction of general anesthesia, but only the anesthesiologists in the group randomized to BIS visible were able to see the BIS values. All of the patients received general anesthesia with sevoflurane. This study found no difference in the overall exposure to sevoflurane between both groups (mean end-tidal sevoflurane level of 1.8 in both groups, P = 084). The duration of time in the recovery room, the time to meet discharge criteria, the Pediatric Agitation Emergence Delirium (PAED) scores and the Face, Legs, Activity, Cry, Consolability (FLACC) scores were not statistically different between the groups. The application and utilization of intraoperative BIS monitoring does not alter the sevoflurane administration nor the discharge readiness nor the recovery profile in healthy ambulatory children.

scholarly journals Oxycodone for prevention of etomidate-induced myoclonus: a randomized double-blind controlled trial

2018 ◽  
Vol 46 (5) ◽  
pp. 1839-1845
Author(s):  
Wei Wang ◽  
Jie Lv ◽  
Qi Wang ◽  
Lei Yang ◽  
Wanyou Yu
Keyword(s):  
General Anesthesia ◽  
Intravenous Injection ◽  
Adverse Reactions ◽  
Controlled Trial ◽  
Vital Signs ◽  
Physical Status ◽  
Double Blind ◽  
American Society ◽  
American Society Of Anesthesiologists

Objective This study was performed compare the effectiveness of oxycodone and fentanyl in reducing the incidence and severity of etomidate-induced myoclonus. Methods In total, 162 patients with an American Society of Anesthesiologists physical status of I or II were assigned at random to three groups. Patients assigned to Group O received 0.1 mg/kg of oxycodone (n = 54), those assigned to Group F were given 1 µg/kg of fentanyl (n = 54), and those assigned to Group S were given an equal volume of saline intravenously 2 minutes prior to administration of 0.3 mg/kg of etomidate (n = 54). The incidence and severity of myoclonus was evaluated 2 minutes after etomidate administration. The patients’ vital signs, coughing, nausea, dizziness, and other related adverse reactions were also recorded. Results The incidence of myoclonus was significantly lower in Group O (0.0%) than in Group F (31.5%) and Group S (72.2%); the intensity was also lowest in Group O. All patients in each group had stable cardiovascular profiles. Conclusions Intravenous injection of 0.1 mg/kg of oxycodone 2 minutes prior to etomidate is more effective in preventing etomidate-induced myoclonus during general anesthesia than is 1 µg/kg of fentanyl.

The Dynamic Relationship between End-tidal Sevoflurane and Isoflurane Concentrations and Bispectral Index and Spectral Edge Frequency of the Electroencephalogram 

1999 ◽  
Vol 90 (5) ◽  
pp. 1345-1353 ◽  
Author(s):  
Erik Olofsen ◽  
Albert Dahan
Keyword(s):  
Bispectral Index ◽  
Effect Compartment ◽  
Spectral Edge Frequency ◽  
Spectral Edge ◽  
Emax Model ◽  
Dynamic Relationship ◽  
Ic50 Values ◽  
American Society ◽  
End Tidal ◽  
Speed Of Onset

Background Inhalational anesthetics produce dose-dependent effects on electroencephalogram-derived parameters, such as 95% spectral edge frequency (SEF) and bispectral index (BIS). The authors analyzed the relationship between end-tidal sevoflurane and isoflurane concentrations (FET) and BIS and SEF and determined the speed of onset and offset of effect (t1/2k(e0)). Methods Twenty-four patients with American Society of Anesthesiologists physical status I or II were randomly assigned to receive anesthesia with sevoflurane or isoflurane. Several transitions between 0.5 and 1.5 minimum alveolar concentration were performed. BIS and SEF data were analyzed with a combination of an effect compartment and an inhibitory sigmoid Emax model, characterized by t1/2k(e0), the concentration at which 50% depression of the electroencephalogram parameters occurred (IC50), and shape parameters. Parameter values estimated are mean +/- SD. Results The model adequately described the FET-BIS relationship. Values for t1/2k(e0), derived from the BIS data, were 3.5 +/- 2.0 and 3.2 +/- 0.7 min for sevoflurane and isoflurane, respectively (NS). Equivalent values derived from SEF were 3.1 +/- 2.4 min (sevoflurane) and 2.3 +/- 1.2 min (isoflurane; NS). Values of t1/2k(e0) derived from the SEF were smaller than those from BIS (P < 0.05). IC50 values derived from the BIS were 1.14 +/- 0.31% (sevoflurane) and 0.60 +/- 0.11% (isoflurane; P < 0.05). Conclusions The speed of onset and offset of anesthetic effect did not differ between isoflurane and sevoflurane; isoflurane was approximately twice as potent as sevoflurane. The greater values of t1/2k(e0) derived from the BIS data compared with those derived from the SEF data may be related to computational and physiologic delays.

Letters to the Editor

PEDIATRICS ◽  
1995 ◽  
Vol 95 (3) ◽  
pp. 454-454
Author(s):  
Robert K. Williams
Keyword(s):  
Laryngeal Mask Airway ◽  
General Anesthesia ◽  
Pediatric Anesthesia ◽  
Letters To The Editor ◽  
The Past ◽  
Adults And Children ◽  
American Society ◽  
American Society Of Anesthesiologists ◽  
Spontaneously Breathing ◽  
Potential Use

Use of the laryngeal mask airway (LMA) has grown considerably over the past few years in both adults and children.1,2 The LMA may have special benefits in the management of severe airway problems and the American Society of Anesthesiologists have incorporated its potential use into its algorithm on management of the difficult airway.3 Recently, its use in resuscitation of neonates has been advocated.4,5 I have used the LMA in my practice of pediatric anesthesia and have generally been pleased with its performance in spontaneously breathing patients under general anesthesia.

Abstract 19572: Elevated PETCO2 During Cardiac Resuscitation Without Return of Spontaneous Circulation

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Cameron Hypes ◽  
Dan Spaite ◽  
Tyler Vadeboncoeur ◽  
Ryan A Murphy ◽  
Chengcheng Hu ◽  
...  
Keyword(s):  
Cardiac Rhythm ◽  
Vital Signs ◽  
Mean Value ◽  
Spontaneous Circulation ◽  
Accelerometer Data ◽  
Improvement Program ◽  
Study Population ◽  
Cpr Quality ◽  
The Mean ◽  
End Tidal

Background: Quantitative End-Tidal CO2 (PETCO2) measurement during cardiac arrest is recommended for monitoring the CPR quality to detect ROSC. While low ETC02 can reflect suboptimal CPR quality and increases in ETC02 are often associated with ROSC the significance of high values of PETCO2 without ROSC remain unclear. Objectives: To describe the population of OHCA victims with high PETCO2 (>50 mm Hg) during ongoing resuscitation including demographics, rhythm characteristics, occurrence of ROSC, the later occurrence of field termination of resuscitation and the presumed etiology. Methods: An observational analysis of adult OHCAs with available PETCO2 data occurring between Oct 2010 and Nov 2014 at two sites involved in the Save Hearts in Arizona Registry and Education (SHARE) quality improvement program. CPR and PETCO2 data were recorded using ZOLL E and X Series EMS monitors. PETCO2 is reported as the mean value for each minute. The cardiac rhythm and the presence of ROSC were determined for each minute using EMS provider reports, vital signs, ECG, and accelerometer data. The first recorded minute of PETCO2 and minutes with ROSC were excluded. Results: Study population included 654 OHCAs with PETCO2 data, 96 cases (58% male, age median 65 (IQR 54-75)) with at least 1 min of high PETCO2 in the absence of ROSC were identified. Of these, 31 (32%) had ROSC at least once during their resuscitation. Cases were of presumed cardiac etiology in 81 (84%), while 12% and 4% had presumed respiratory and other etiologies, respectively. A total of 322 minutes of PETCO2 >50 mm Hg in the absence of ROSC were identified. The mean PETC02 value was 67 (IQR 54-75). Of these 296 minutes (92%) occurred during PEA. Despite high PETCO2, resuscitation was terminated in the field in 21 (22%) patients. Only one subject survived to hospital discharge. Conclusions: In this observational study, high PETCO2 was frequently found during resuscitation without ROSC and PEA was the most common cardiac rhythm. Further study is warranted to determine the significance and possible reasons for this finding.

scholarly journals Use of Local Anesthesia During Dental Rehabilitation With General Anesthesia: A Survey of Dentist Anesthesiologists

2014 ◽  
Vol 61 (1) ◽  
pp. 11-17 ◽  
Author(s):  
Janice A. Townsend ◽  
Joseph L. Hagan ◽  
Megann Smiley
Keyword(s):  
General Anesthesia ◽  
Local Anesthesia ◽  
Local Anesthetic ◽  
Vital Signs ◽  
Rare Exception ◽  
Dental Rehabilitation ◽  
American Society ◽  
E Mail ◽  
Current Practices

AbstractThe purpose of this study was to document current practices of dentist anesthesiologists who are members of the American Society of Dentist Anesthesiologists regarding the supplemental use of local anesthesia for children undergoing dental rehabilitation under general anesthesia. A survey was administered via e-mail to the membership of the American Society of Dentist Anesthesiologists to document the use of local anesthetic during dental rehabilitations under general anesthesia and the rationale for its use. Seventy-seven (42.1%) of the 183 members responded to this survey. The majority of dentist anesthesiologists prefer use of local anesthetic during general anesthesia for dental rehabilitation almost always or sometimes (90%, 63/70) and 40% (28/70) prefer its use with rare exception. For dentist anesthesiologists who prefer the administration of local anesthesia almost always, they listed the following factors as very important: “stabilization of vital signs/decreased depth of general anesthesia” (92.9%, 26/28) and “improved patient recovery” (82.1%, 23/28). There was a significant association between the type of practice and who determines whether or not local anesthesia is administered during cases. The majority of respondents favor the use of local anesthesia during dental rehabilitation under general anesthesia.

Bispectral Index Monitoring:Validity and Utility in Pediatric Dentistry

2014 ◽  
Vol 38 (4) ◽  
pp. 366-369
Author(s):  
A Goyal ◽  
N Mittal ◽  
P Mittal ◽  
K Gauba
Keyword(s):  
General Anesthesia ◽  
Present Article ◽  
Bispectral Index ◽  
Index System ◽  
Vital Sign ◽  
Age Groups ◽  
Pediatric Dentistry ◽  
Sedation Level ◽  
Sedative Drugs ◽  
Do So

Reliable and safe provision of sedation and general anesthesia is dependent on continuous vigilance of patient’s sedation depth. Failure to do so may result in unintended oversedation or undersedation. It is a common practice to observe sedation depth by applying subjective sedation scales and in case of general anesthesia, practitioner is dependent on vital sign assessment. The Bispectral Index System (BIS) is a recently introduced objective, quantitative, easy to use, and free from observer bias, and clinically useful tool to assess sedation depth and it precludes the need to stimulate the patient to assess his sedation level. The present article is an attempt to orient the readers towards utility and validity of BIS for sedation and general anesthesia in pediatric dentistry. In this article, we attempt to make the readers understand the principle of BIS, its variation across sedation continuum, its validity across different age groups and for a variety of sedative drugs.

scholarly journals Evaluation of Differences between PaCO2 and ETCO2 by Age as Measured during General Anesthesia with Patients in a Supine Position

2015 ◽  
Vol 2015 ◽  
pp. 1-5
Author(s):  
Kenichi Satoh ◽  
Ayako Ohashi ◽  
Miho Kumagai ◽  
Masahito Sato ◽  
Akiyoshi Kuji ◽  
...  
Keyword(s):  
Carbon Dioxide ◽  
Pressure Gradient ◽  
Partial Pressure ◽  
General Anesthesia ◽  
Supine Position ◽  
Physical Status ◽  
American Society ◽  
End Tidal ◽  
American Society Of Anesthesiologists

Objective. The aim of this study was to evaluate the arterial to end-tidal partial pressure gradient of carbon dioxide according to age in the supine position during general anesthesia. Methods. From January 2001 to December 2013, we evaluated 596 patients aged ≥16 years who underwent general anesthesia in the supine position. The anesthetic charts of these 596 patients, all classified as American Society of Anesthesiologists physical status I or II, were retrospectively reviewed to investigate the accuracy of PaCO2 and ETCO2. Results. The a-ETCO2 was 3.0 ± 2.1 mmHg for patients aged 16 to <65 years and 4.1±3.1 mmHg for patients ≥65 years. The a-ETCO2 was 2.4±3.1 mmHg for patients aged 16 to 25 years, 3.1±2.2 mmHg for patients aged 26 to 35 years, 3.0±2.2 mmHg for patients aged 36 to 45 years, 3.4±2.0 mmHg for patients aged 46 to 55 years, 3.2±2.0 mmHg for patients aged 56 to 64 years, 4.3±3.2 mmHg for patients aged 65 to 74 years, and 3.7±2.8 mmHg for patients aged 75 to 84 years. Conclusion. The arterial to end-tidal partial pressure gradient of carbon dioxide tended to increase with increasing age.

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