Intraoperative Awareness during High-Dose Fentanyl-Oxygen Anesthesia

Hilgenberg, John C.

doi:10.1097/00132586-198202000-00035

Cited by 11 publications

(12 citation statements)

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“…At a remifentanil dose of 0.8 mcg/kg/min, the patient remained awake, alert, and fully cooperative. At a postoperative visit the following day, he had a clear memory of the experience, which is in keeping with other reports of intraoperative awareness with high-dose opioid techniques [8,9].…”

Section: Discussionsupporting

confidence: 80%

Severe remifentanil-induced acute opioid tolerance following awake craniotomy in an adolescent

Stricker

Kraemer

Ganesh

2009

Journal of Clinical Anesthesia

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Section: Discussionsupporting

confidence: 80%

Severe remifentanil-induced acute opioid tolerance following awake craniotomy in an adolescent

Stricker

Kraemer

Ganesh

2009

Journal of Clinical Anesthesia

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“…That opioids act primarily in the nociceptive pathways rather than in the cortex to alter arousal and to partially alter cognition helps explain the high incidence of postoperative awareness in patients undergoing cardiac surgery, for which high-dose opioids have, until recently, been the primary anesthetic. 61,62 …”

Section: Mechanisms Of Unconsciousness Induced By Gener Al Anesthesiamentioning

confidence: 99%

General Anesthesia, Sleep, and Coma

2010

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In the united states, nearly 60,000 patients per day receive general anesthesia for surgery. 1 General anesthesia is a drug-induced, reversible condition that includes specific behavioral and physiological traits -unconsciousness, amnesia, analgesia, and akinesia -with concomitant stability of the autonomic, cardiovascular, respiratory, and thermoregulatory systems. 2 General anesthesia produces distinct patterns on the electroencephalogram (EEG), the most common of which is a progressive increase in low-frequency, high-amplitude activity as the level of general anesthesia deepens 3,4 (Fig. 1). How anesthetic drugs induce and maintain the behavioral states of general anesthesia is an important question in medicine and neuroscience. 6 Substantial insights can be gained by considering the relationship of general anesthesia to sleep and to coma.Humans spend approximately one third of their lives asleep. Sleep, a state of decreased arousal that is actively generated by nuclei in the hypothalamus, brain stem, and basal forebrain, is crucial for the maintenance of health. 7,8 Normal human sleep cycles between two states -rapid-eye-movement (REM) sleep and non-REM sleep -at approximately 90-minute intervals. REM sleep is characterized by rapid eye movements, dreaming, irregularities of respiration and heart rate, penile and clitoral erection, and airway and skeletal-muscle hypotonia. 7 In REM sleep, the EEG shows active high-frequency, lowamplitude rhythms (Fig. 1). Non-REM sleep has three distinct EEG stages, with higheramplitude, lower-frequency rhythms accompanied by waxing and waning muscle tone, decreased body temperature, and decreased heart rate.Coma is a state of profound unresponsiveness, usually the result of a severe brain injury. 9 Comatose patients typically lie with eyes closed and cannot be roused to respond appropriately to vigorous stimulation. A comatose patient may grimace, move limbs, and have stereotypical withdrawal responses to painful stimuli yet make no localizing responses or discrete defensive movements. As the coma deepens, the patient's responsiveness even to painful stimuli may diminish or disappear. Although the patterns of EEG activity observed in comatose patients depend on the extent of the brain injury, they frequently resemble the high-amplitude, low-frequency activity seen in patients under general anesthesia 10 (Fig. 1). General anesthesia is, in fact, a reversible drug-induced coma. Nevertheless, anesthesiologists refer to it as "sleep" to avoid disquieting patients. Unfortunately, anesthesiologists also use the word "sleep" in technical descriptions to refer to Copyright © 2010 CLINICAL SIGNS AND EEG PAT TERNS OF UNCONSCIOUSNESS INDUCED BY GENER AL ANESTHESIAThe clinical signs and EEG patterns of general anesthesia-induced unconsciousness can be described in relation to the three periods in which they appear: induction, maintenance, and emergence. INDUCTION PERIODBefore induction, the patient has a normal, active EEG, with prominent alpha activity (10 Hz) when the eyes are clo...

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“…When high-dose opioid anesthesia was used in the cardiac surgery, the incidences of intraoperative awareness [18] and delayed extubation [19] were higher, which may impede the approach of fast-track to cardiac patients. As expected, the time to extubation was significantly shorter in the isoflurane group in this study.…”

Section: Discussionmentioning

confidence: 99%

Isoflurane compared with fentanyl-midazolam-based anesthesia in patients undergoing heart transplantation

Hsu

Huang

et al. 2016

Medicine

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Inhalation anesthetics provide myocardial protection for cardiac surgery. This study was undertaken to compare the perioperative effects between isoflurane and fentanyl-midazolam-based anesthesia for heart transplantation. A retrospective cohort study was conducted by reviewing the medical records of heart transplantation in a single medical center from 1990 to 2013. Patients receiving isoflurane or fentanyl-midazolam-based anesthesia were included. Those with preoperative severe pulmonary, hepatic, or renal comorbidities were excluded. The perioperative variables and postoperative short-term outcomes were analyzed, including blood glucose levels, urine output, inotropic use, time to extubation, and length of stay in the intensive care units. After reviewing 112 heart transplantations, 18 recipients with fentanyl-midazolam-based anesthesia, and 29 receiving isoflurane anesthesia with minimal low-flow technique were analyzed. After cessation of cardiopulmonary bypass, recipients with isoflurane anesthesia had a significantly lower mean level and a less increase of blood glucose, as compared with those receiving fentanyl-based anesthesia. In addition, there was less use of dobutamine upon arriving the intensive care unit and a shorter time to extubation after isoflurane anesthesia. Compared with fentanyl-midazolam-based anesthesia, isoflurane minimal low-flow anesthesia maintained better perioperative homeostasis of blood glucose levels, less postoperative use of inotropics, and early extubation time among heart-transplant recipients without severe comorbidities.

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Intraoperative Awareness during High-Dose Fentanyl-Oxygen Anesthesia

Cited by 11 publications

References 0 publications

Severe remifentanil-induced acute opioid tolerance following awake craniotomy in an adolescent

Severe remifentanil-induced acute opioid tolerance following awake craniotomy in an adolescent

General Anesthesia, Sleep, and Coma

Isoflurane compared with fentanyl-midazolam-based anesthesia in patients undergoing heart transplantation

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