Pharmacodynamic Interaction between Propofol and Remifentanil Regarding Hypnosis, Tolerance of Laryngoscopy, Bispectral Index, and Electroencephalographic Approximate Entropy

Bouillon, Thomas; Bruhn, Jørgen; Radulescu, Lucian; Andresen, Corina; Shafer, Thomas J.; Cohane, Carol; Shafer, Steven L.

doi:10.1097/00000542-200406000-00006

Cited by 331 publications

(254 citation statements)

References 37 publications

Supporting

Mentioning

235

Contrasting

Unclassified

Order By: Relevance

“…It was observed that considerable periods in dynamic conditions were obtained (approximately 50 % for each observed signal). The technique may be employed in search of combined periods of input and output SS, allowing the construction of surface models translating the relation between hypnotic and analgesic drugs and their impact on the output signals, under SS conditions, and under the influence of different stimuli intensities [33].…”

Section: Discussionmentioning

confidence: 99%

A novel multivariate STeady-state index during general ANesthesia (STAN)

Castro

Almeida

Amorim

et al. 2016

J Clin Monit Comput

View full text Add to dashboard Cite

The assessment of the adequacy of general anesthesia for surgery, namely the nociception/anti-nociception balance, has received wide attention from the scientific community. Monitoring systems based on the frontal EEG/EMG, or autonomic state reactions (e.g. heart rate and blood pressure) have been developed aiming to objectively assess this balance. In this study a new multivariate indicator of patients' steady-state during anesthesia (STAN) is proposed, based on wavelet analysis of signals linked to noxious activation. A clinical protocol was designed to analyze precise noxious stimuli (laryngoscopy/ intubation, tetanic, and incision), under three different analgesic doses; patients were randomized to receive either remifentanil 2.0, 3.0 or 4.0 ng/ml. ECG, PPG, BP, BIS, EMG and CO 2 were continuously recorded. ECG, PPG and BP were processed to extract beat-to-beat information, and CO 2 curve used to estimate the respiration rate. A combined steady-state index based on wavelet analysis of these variables, was applied and compared between the three study groups and stimuli (Wilcoxon signed ranks, KruskalWallis and Mann-Whitney tests). Following institutional approval and signing the informed consent thirty four patients were enrolled in this study (3 excluded due to signal loss during data collection). The BIS index of the EEG, frontal EMG, heart rate, BP, and PPG wave amplitude changed in response to different noxious stimuli. Laryngoscopy/intubation was the stimulus with the more pronounced response ðP\0:05Þ. These variables were used in the construction of the combined index STAN; STAN responded adequately to noxious stimuli, with a more pronounced response to laryngoscopy/intubation (18.5-43.1 %, P\0:05), and the attenuation provided by the analgesic, detecting steady-state periods in the different physiological signals analyzed (approximately 50 % of the total study time). A new multivariate approach for the assessment of the patient steady-state during general anesthesia was developed. The proposed wavelet based multivariate index responds adequately to different noxious stimuli, and attenuation provided by the analgesic in a dose-dependent manner for each stimulus analyzed in this study.

show abstract

Section: Discussionmentioning

confidence: 99%

A novel multivariate STeady-state index during general ANesthesia (STAN)

Castro

Almeida

Amorim

et al. 2016

J Clin Monit Comput

View full text Add to dashboard Cite

show abstract

“…Other combinations which can be used are ketamine [28], propofol [27], propofol with fentanyl ,propofol with remifentanyl [29],etc. Each has its own positive and negative points.…”

Section: Anaesthesia Section Discussionmentioning

confidence: 99%

Anaesthesia for TMJ Ankylosis with the Use of TIVA, Followed by Endotracheal Intubation

Rupa¹,

G²

2012

JCDR

View full text Add to dashboard Cite

TMJ ankylosis, though it is not common, is an anaesthetic challenge, as it is a difficult airway situation with a moderate to a severely limited mouth opening. Fiber-optic intubation is the gold standard for such cases, but it may not be readily available at all centres. Blind nasal intubation, retro-grade intubation and tracheostomy are the other alternatives, but they require patient co-operation and are associated with considerable morbidity. We are presenting a case of unilateral TMJ ankylosis in a 12 years old boy who was posted for condylectomy and interpositional arthroplasty. He was maintained on TIVA for condylectomy and was then intubated for the remaining procedure. The procedure and the recovery were uneventful.

show abstract

“…Secondly, he thinks it unlikely that this was a case of inadvertent intravascular injection and was more likely to be one of local anaesthetic overdose. It is well recognised that inadvertent intravascular injection of local anaesthetic can occur despite all the precautions designed to prevent such an occurrence [3] and that toxicity can occur with a wide range of doses [4,5]. I would suggest that it is difficult to be absolutely certain that inadvertent intravascular injection did not occur in this case.…”

Section: A Replymentioning

confidence: 96%

“…Previous investigators have studied propofol in isolation however we know that propofol and remifentanil are subject to a complex interaction [3]. Finally, the authors might use their current data to calculate more appropriate values of ke0 for each of the parameters that they have reported and consider how these lie within the population of previous estimates.…”

Section: A Replymentioning

confidence: 99%

A reply

Whiteside¹

2008

Anaesthesia

View full text Add to dashboard Cite

Pharmacodynamic Interaction between Propofol and Remifentanil Regarding Hypnosis, Tolerance of Laryngoscopy, Bispectral Index, and Electroencephalographic Approximate Entropy

Cited by 331 publications

References 37 publications

A novel multivariate STeady-state index during general ANesthesia (STAN)

A novel multivariate STeady-state index during general ANesthesia (STAN)

Anaesthesia for TMJ Ankylosis with the Use of TIVA, Followed by Endotracheal Intubation

A reply

Contact Info

Product

Resources

About