Quantitative analysis of the relationship between sedation and resting energy expenditure in postoperative patients

Terao, Yoshiaki; Miura, Keiji; Saito, Masataka; Sekino, Motohiro; Fukusaki, Makoto; Sumikawa, Koji

doi:10.1097/01.ccm.0000054868.93459.e1

Cited by 62 publications

(42 citation statements)

References 21 publications

(25 reference statements)

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“…[11][12][13][14] Pain and spasticity medications are well reported to reduce metabolism, energy expenditure, and may further cause overall weakness. 15,16 This may further increase stress to a level that is commonly associated with excess release of catabolic hormones (i.e. cortisol), which may further degrade the anabolic processes that evoke muscle hypertrophy and increase lean mass.…”

Section: 45mentioning

confidence: 99%

A report of anticipated benefits of functional electrical stimulation after spinal cord injury

Gorgey

Harnish

Daniels

et al. 2012

The Journal of Spinal Cord Medicine

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Background: Functional electrical stimulation (FES) has been regularly used to offset several negative body composition and metabolic adaptations following spinal cord injury (SCI). However, the outcomes of many FES trials appear to be controversial and incoherent. Objective: To document the potential consequences of several factors (e.g. pain, spasms, stress and lack of dietary control) that may have attenuated the effects on body composition and metabolic profile despite participation in 21 weeks of FES training. Participant: A 29-year-old man with T6 complete SCI participated in 21 weeks of FES, 4 days per week. Methods: Prior to and following training, the participant performed arm-crank-graded exercise testing to measure peak VO 2 . Tests conducted included anthropometrics and dual energy X-ray absorptiometry body composition assessments, resting energy expenditure, plasma lipid profiles and intravenous glucose tolerance tests. Results: The participant frequently reported increasing pain, stress and poor eating habits. VO 2 peak decreased by 2.4 ml/kg/minute, body mass increased by 8.5 kg, and body mass index increased from 25 to 28 kg/m 2 . Waist and abdominal circumferences increased by 2-4 cm, while %fat mass increased by 5.5%. Absolute increases in fat mass and fat-free mass of 8.4 and 1 kg, respectively, were reported. Fasting and peak plasma glucose increased by 12 and 14.5%, while lipid panel profiles were negatively impacted. Conclusion: Failure to control for the listed negative emerging factors may obscure the expected body composition and metabolic profile adaptations anticipated from FES training.

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Section: 45mentioning

confidence: 99%

A report of anticipated benefits of functional electrical stimulation after spinal cord injury

Gorgey

Harnish

Daniels

et al. 2012

The Journal of Spinal Cord Medicine

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“…However these agents are associated with many side effects or complications [19] and might even reduce cardiac output. On the other hand, prolonged NMB is also associated with various possible side effects.…”

Section: Discussionmentioning

confidence: 99%

The effect of neuromuscular blockade on oxygen consumption in sedated and mechanically ventilated pediatric patients after cardiac surgery

2008

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Objective: To measure the effect of intense neuromuscular blockade (NMB) on oxygen consumption (VO 2 ) in deeply sedated and mechanically ventilated children on the first day after complex congenital cardiac surgery. Design: Prospective clinical interventional study. Setting: Pediatric intensive care unit of an university medical centre. Measurements and results: Nine mechanically ventilated and sedated children (weight 2.8-8.7 kg) were included. All children were treated with vasoactive drugs. The level of sedation was quantified using the comfort score, Ramsay score and bispectral index (BIS). The intensity of NMB was quantified using acceleromyography and VO 2 was measured using indirect calorimetry. Analgosedation using various intravenous agents was targeted at a deep level (comfort score \ 18, BIS \ 60 and Ramsay score [ 4). NMB was achieved by intravenous administration of rocuronium. All measurements were conducted before, during and after recovery from a period of intense NMB. Baseline values were VO 2 6.1 ml/(kg min) (SD 1.3), comfort score 13 (SD 0.7), BIS 42.5 (SD 14.2), mean blood pressure 54.0 mmHg (SD 10.5), mean heart rate 129.9 bpm (SD 28.9) and mean core temperature 36.7°C (SD 0.5). There were no significant differences in VO 2 or other parameters between baseline, during NMB and the recovery phase. Conclusion: Neuromuscular blocking agents do not reduce oxygen consumption in deeply sedated and mechanically ventilated children after congenital cardiac surgery.

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“…Auditory evoked potential and oxygen consumption index (V ． O 2 I) are the procedures for the objective evaluation of the depth of sedation 3,5 The bispectral index (BIS), has been used to evaluate the anesthetic depth, and the usefulness in the operating room has been established [6][7][8][9][10] . The usefulness of BIS in ICU to evaluate sedation depth is controversial.…”

Section: Introductionmentioning

confidence: 99%

Age-dependent relationship between bispectral index and sedation level

Yamashita

Terao

Inadomi

et al. 2008

Journal of Clinical Anesthesia

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Interventions: The patients were allocated into 2 groups, group M (middle aged, <65 years) and group H (elderly, >65 years). Midazolam was administered at a bolus dose of 0.1 mg･kg -1 , followed by a continuous dose of 0.04 mg･kg -1 ･hr -1 , which was adjusted every 2 hrs to achieve a target level of sedation at 3-6 on Ramsay sedation scale (RSS), and buprenorphine was administered at a constant rate (0.625 μg･kg -1 ･hr -1 ).Measurements: BIS value, RSS, the dose of midazolam, body temperature, heart rate, the dose of dopamine, and mean arterial pressure were recorded every 2 hrs by an independent nurse. Data were analyzed using Spearman's rank correlation and Mann-Whitney U test.Main Results: The BIS values decreased depending on the depth of sedation, and there were significant correlation between RSS and BIS in both groups. The BIS values at levels of RSS 5 and 6 were significantly lower in group H than in group M.Conclusion: BIS correlated with sedation depth, and BIS in older patients were lower than that in middle-aged patients at a deep sedation depth.

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Quantitative analysis of the relationship between sedation and resting energy expenditure in postoperative patients

Abstract: An increase in the depth of sedation progressively decreases in oxygen consumption index and REEI in postoperative patients.

Cited by 62 publications

References 21 publications

A report of anticipated benefits of functional electrical stimulation after spinal cord injury

A report of anticipated benefits of functional electrical stimulation after spinal cord injury

The effect of neuromuscular blockade on oxygen consumption in sedated and mechanically ventilated pediatric patients after cardiac surgery

Age-dependent relationship between bispectral index and sedation level

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