Effects of epidural anesthesia with 0.2% and 1% ropivacaine on predicted propofol concentrations and bispectral index values at three clinical end points

Kanata, Kazue; Sakura, Shinichi; Kushizaki, Hiroyuki; Nakatani, Toshihiko; Saito, Yoji

doi:10.1016/j.jclinane.2006.01.004

Cited by 14 publications

(7 citation statements)

References 22 publications

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“…Our clinical experience is that there are reduced general anesthetics requirements during surgery when the two techniques are combined. Previous studies have sought to explore the effects of epidural anesthesia on general anesthesia and have demonstrated that epidural lidocaine (Lu et al, 2005) or bupivacaine (Agarwal et al, 2004) or ropivacaine (Kanata et al, 2006) reduced the requirements of volatile (Lu et al, 2005) or i.v. (Agarwal et al, 2004;Kanata et al, 2006) anesthetics in upper or lower abdominal surgery.…”

Section: Introductionmentioning

confidence: 99%

“…Previous studies have sought to explore the effects of epidural anesthesia on general anesthesia and have demonstrated that epidural lidocaine (Lu et al, 2005) or bupivacaine (Agarwal et al, 2004) or ropivacaine (Kanata et al, 2006) reduced the requirements of volatile (Lu et al, 2005) or i.v. (Agarwal et al, 2004;Kanata et al, 2006) anesthetics in upper or lower abdominal surgery. Ishiyama et al(2005) recently reported that epidural ropivacaine anesthesia decreased the bispectral index (BIS) during the awake phase and during general anesthesia.…”

Section: Introductionmentioning

confidence: 99%

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Comparison of 1.5% lidocaine and 0.5% ropivacaine epidural anesthesia combined with propofol general anesthesia guided by bispectral index

Xiang

2007

J. Zhejiang Univ. - Sci. B

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Abstract:Objective: To compare the effects of epidural anesthesia with 1.5% lidocaine and 0.5% ropivacaine on propofol requirements, the time to loss of consciousness (LOC), effect-site propofol concentrations, and the hemodynamic variables during induction of general anesthesia guided by bispectral index (BIS) were studied. Methods: Forty-five patients were divided into three groups to receive epidurally administered saline (Group S), 1.5% (w/w) lidocaine (Group L), or 0.5% (w/w) ropivacaine (Group R). Propofol infusion was started to produce blood concentration of 4 µg/ml. Once the BIS value reached 40~50, endotracheal intubation was facilitated by 0.1 mg/kg vecuronium. Measurements included the time to LOC, effect-site propofol concentrations, total propofol dose, mean arterial blood pressure (MABP), and heart rate (HR) at different study time points. Results: During induction of anesthesia, both Groups L and R were similar for the time to LOC, effect-site propofol concentrations, total propofol dose, MABP, HR, and BIS. The total doses of propofol administered until 1 min post-intubation were significantly less in patients of Groups R and L compared with Group S. MABP and HR were significantly lower following propofol induction compared with baseline values in the three groups, or MABP was significantly increased following intubation as compared with that prior to intubation in Group S but not in Groups R and L while HR was significantly increased following intubation in the three groups. Conclusion: Epidural anesthesia with 1.5% lidocaine and 0.5% ropivacaine has similar effects on the time to LOC, effect-site propofol concentrations, total propofol dose, and the hemodynamic variables during induction of general anesthesia.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Comparison of 1.5% lidocaine and 0.5% ropivacaine epidural anesthesia combined with propofol general anesthesia guided by bispectral index

Xiang

2007

J. Zhejiang Univ. - Sci. B

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“…Another study compared different doses of epidural ropivacaine (0.2% and 1%) on the propofol need during general anesthesia. It also revealed that higher doses of the medication were more effective in lowering the need for the anesthetic agent (8). Another study also reported that compared to high doses of bupivacaine, lower doses of the drug (0.625%) plus fentanyl (2µg/cc) have similar effects in reducing anesthetic need during general anesthesia (2).…”

Section: Discussionmentioning

confidence: 99%

“…In different centers, various concentrations of different LAs are used, while general anesthesia is administered empirically or based on cardiovascular responses during the surgery without knowing the depth of anesthesia. Several studies have shown that some drugs can be used instead of opioids and anesthetics (3-6), and have also evaluated the effects of different LA agents on anesthetic requirements during CGEA using bispectral index (BIS) monitoring; the optimal combination and dose, however, have not been yet reported (4, 5, 7, 8). …”

Section: Introductionmentioning

confidence: 99%

The Effect of Epidural Bupivacaine on BIS Levels in the Awake Phase and on the Maintenance Doses of Propofol and Fentanyl During General Anesthesia

et al. 2013

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BackgroundSimultaneous administration of epidural local anesthetic agents (LA) and general anesthetics (intravenous or inhaled) is a common procedure in patients undergoing major operations. The effects of epidural anesthesia during combined general-epidural anesthesia on the alertness level (CGEA) in the awake phase and the doses of anesthetics have been reported.ObjectivesThe present study was designed to determine the effects of epidural bupivacaine on the alertness level measured by bispectral index (BIS) in the awake phase and the maintenance doses of propofol and fentanyl during general anesthesia for vascular operation on the lower limb.Patients and MethodsA double-blinded randomized clinical trial was conducted on patients awaiting vascular surgery on lower extremities in a teaching hospital from October 2007 to October 2008. During the epidural anesthesia, the control group received 0.9% NS while 0.125% bupivacaine was injected in the case group via the epidural route. No sedative drug was utilized for epidural catheter placement. The BIS measurement was performed in both groups during the awake phase, before performing epidural anesthesia, and 10 minutes after epidural injection at 1-min intervals for 15 min. After induction of general anesthesia in both groups, anesthesia maintenance was established using the infusion of propofol with the aim of keeping the BIS level between 40 and 50 throughout the anesthesia. At the end of the study period, maintenance dose requirements of propofol and fentanyl were measured.ResultsThirty-two patients were enrolled in the study. There was no difference in BIS levels of the two groups in the awake phase. There was a significant difference between the propofol and fentanyl requirements of the two groups.ConclusionsPerforming CGEA using bupivacaine was reported to reduce propofol and fentanyl doses required to maintain BIS levels between 40 and 50 considerably.

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“…(16) We did not measure the blood concentration of propofol, however, propofol was administered via an infusion, and it can be assumed that the predicted propofol concentrations would not differ relevantly, since we used an objective monitor of sedation (BIS) in patients who are homogeneous with regard to age, gender, weight and height.…”

Section: Discussionmentioning

confidence: 99%

Comparison of the Effects of Bupivacaine and Levobupivacaine Used in Spinal Anesthesia on Propofol Requirement in BIS Guided Sedation

Şahin¹,

Kesimci²,

İzdeş³

et al. 2012

J Turk Anaesth Int Care

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SUMMARYObjective: This study was designed to compare the effects of equivalent doses of bupivacaine and levobupivacaine on propofol requirement in BIS guided sedation under spinal anesthesia.Material and Methods: Spinal anesthesia was performed on seventy patients scheduled for elective lower limb surgery with 3 mL's of either isobaric bupivacaine (Group B) or plain levobupivacaine (Group L). Five minutes after induction of spinal anesthesia, propofol infusion was started at 100 µg/kg/min and titrated to maintain bispectral index (BIS) score in the range of 65-75. Onset (to reach BIS ≤ 75) and recovery (the time from cessation of propofol infusion until BIS=90) time for sedation, and total propofol consumption during this time interval were recorded as well as time to recovery from sensory and motor block, length of stay (LOS) and sedation scores (OAA/S) in the postanesthesia care unit (PACU). Data were analyzed with One way ANOVA, Mann Whitney-U, Student's t and x 2 tests. Results: BIS was significantly decreased in Group B compared to Group L at 10 and 15 min after spinal anesthesia (p<0.01). The maximum sensory block level was higher, while time to reach maximum motor block level was shorter in Group B (p<0.05, p<0.001 respectively). Offset time of sensory and motor block, recovery time and LOS in PACU were significantly increased in Group L (p<0.05).Conclusion: Plain bupivacaine provides higher sensory block with faster onset of motor block, independent of propofol requirement as assessed by BIS monitorization. 'dan başlatılıp BİS 65-75 olacak şekilde titre edildi. Başlangıç zamanı (BİS 75'e düşünceye kadar geçen süre), derlenme süresi (propofol kesildikten BİS 90 olana kadar geçen süre), bu sırada tüketilen toplam propofol miktarı ile derlenme ünitesinde kalma süresi, sedasyon düzeyi (OAA/S), duyusal ve motor blok dönme zamanları kaydedildi. İstatistiksel analizde One way ANOVA, Mann Whitney-U, Student's t and x 2 testleri kullanıldı. Bulgular: Spinal anestezi sonrası 10. ve 15. dk.'larda BİS değerlerinin Grup B'de, Grup L'ye göre anlamlı düşük olduğu saptandı (p<0.01). Maksimum duyusal blok seviyesi Grup B'de Grup L'ye göre anlamlı yüksek, maksimum motor blok düzeyine ulaşma süresinin ise Grup L'de Grup B'ye göre anlamlı uzun olduğu belirlendi (p<0.05, p<0.001). Duyusal ve motor bloğun tam dönme süresi, derlenme süresi ve derlenmede kalış süresi Grup L'de Grup B'ye göre anlamlı olarak uzundu (p<0.05).Sonuç: Bupivakain BIS monitorizasyonu ile takip edilen sedasyonda propofol tüketiminden bağımsız olarak, yüksek duyusal blok seviyesi, erken motor blok başlangıcı sağlamaktadır.Anahtar kelimeler: spinal anestezi, lokal anestezikler, bupivakain, levobupivakain, sedatifler, propofol, sedasyon

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Effects of epidural anesthesia with 0.2% and 1% ropivacaine on predicted propofol concentrations and bispectral index values at three clinical end points

Cited by 14 publications

References 22 publications

Comparison of 1.5% lidocaine and 0.5% ropivacaine epidural anesthesia combined with propofol general anesthesia guided by bispectral index

Comparison of 1.5% lidocaine and 0.5% ropivacaine epidural anesthesia combined with propofol general anesthesia guided by bispectral index

The Effect of Epidural Bupivacaine on BIS Levels in the Awake Phase and on the Maintenance Doses of Propofol and Fentanyl During General Anesthesia

Comparison of the Effects of Bupivacaine and Levobupivacaine Used in Spinal Anesthesia on Propofol Requirement in BIS Guided Sedation

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