Sedation with target-controlled propofol infusion during shoulder surgery under interscalene brachial plexus block in the sitting position

Vincent, Simi; Laurent, David Burckett-St; Francis, Byron F.

doi:10.1017/s0265021505001444

Cited by 16 publications

(9 citation statements)

References 19 publications

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“…No hypotensive episodes needed treatment in either group, probably because our study population was 18–65 years old and otherwise healthy except for being ASA I or II. Despite the many surgical advantages of this position, sedation and continous observation of the airway and hemodynamics which are of anaesthetic relevance may be difficult in awake patients [ 28 ]. It is known that inadequate sedation in these patients might result in complaints of noise or discomfort from prolonged immobility and can increase the risk of side effects unless there is further improvement in the analgesia quality [ 20 ].…”

Section: Discussionmentioning

confidence: 99%

Bispectral index-guided general anaesthesia in combination with interscalene block reduces desflurane consumption in arthroscopic shoulder surgery: a clinical comparison of bupivacaine versus levobupivacaine

et al. 2015

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BackgroundThe goal of this study was to compare the influence of an interscalene brachial plexus block (ISB) performed with either bupivacaine or levobupivacaine in conjunction with general anaesthesia (GA) on desflurane consumption, which was titrated to maintain the recovery profiles and postoperative analgesia while also keeping the bispectral index score (BIS) between 40 and 60 in patients undergoing arthroscopic shoulder surgery.MethodsSixty patients undergoing arthroscopic shoulder surgery were prospectively randomized to receive GA with desflurane alone (group C) or in combination with a preoperative ISB by either bupivacaine 0.25 % (group B) 40 ml or levobupivacaine 0.25 % (group L) 40 ml. BIS scores or respiratory and hemodynamic parameters during the operation, recovery characteristics, consumed doses of desflurane and pain intensities were evaluated.ResultsThe eye opening time was 4.0 ± 2.5 minutes for group B, 4.6 ± 2.4 minutes for group L, and 6.2 ± 2.1 minutes for group C (p < 0.05). Group B and group L saved 36 % and 25 % desflurane per unit time respectively when compared with group C (p < 0.001and p < 0.05) while the mean pain scores and analgesic requirements the first day after surgery were higher in group C (p < 0.05).ConclusionsBecause of lower desflurane consumption, a superior recovery profile, and a high degree of patient acceptance, general anaesthesia in combination with interscalene block may be preferred in arthroscopic shoulder surgery.Trial registrationThe trial registration number is ACTRN12613000381785

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Section: Discussionmentioning

confidence: 99%

Bispectral index-guided general anaesthesia in combination with interscalene block reduces desflurane consumption in arthroscopic shoulder surgery: a clinical comparison of bupivacaine versus levobupivacaine

et al. 2015

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“…[78] Vincent and colleagues used TCI propofol for sedation in patients undergoing shoulder arthroscopic surgery under regional anaesthesia at target plasma concentrations of 0.8-0.9 μg/ml. [4] When TCI propofol is used alone, a plasma concentration of 4-6 μg/ml is necessary to maintain the necessary depth of anaesthesia in ASA 1 patients. The concomitant use of N 2 O reduces this requirement to as low as 2.5 μg/ml.…”

Section: Discussionmentioning

confidence: 99%

“…[3] There is little information on the use of intravenous propofol for shoulder arthroscopy as the primary anaesthetic agent. Souron and colleagues,[4] reported the use of target control infusion (TCI) of propofol as a sedative during shoulder surgery under inter-scalene brachial plexus block. TCI propofol and single agent anaesthesia with sevoflurane have been compared by different authors,[5] for spine surgeries, but in patients who received no regional anaesthesia.…”

Section: Introductionmentioning

confidence: 99%

Target-controlled infusion (Propofol) versus inhaled anaesthetic (Sevoflurane) in patients undergoing shoulder arthroscopic surgery

et al. 2013

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Background:One of the challenges of anaesthesia for shoulder arthroscopic procedures is the need for controlled hypotension to lessen intra-articular haemorrhage and thereby provide adequate visualisation to the surgeon. Achievement of optimal conditions necessitates several interventions and manipulations by the anaesthesiologist and the surgeon, most of which directly or indirectly involve maintaining intra-operative blood pressure (BP) control.Aim:This study aimed to compare the efficacy and convenience of target controlled infusion (TCI) of propofol and inhalational agent sevoflurane in patients undergoing shoulder arthroscopic surgery after preliminary inter-scalene blockade.Methods:Of thirty four patients studied, seventeen received TCI propofol (target plasma concentration of 3 μg/ml) and an equal number, sevoflurane (1.2-1.5 Minimum Alveolar Concentration). N2O was used in both groups. Systolic, diastolic, mean blood pressures and heart rate were recorded regularly throughout the procedure. All interventions to control BP by the anaesthesiologist and pump manipulation requested by the surgeon were recorded. The volume of saline irrigant used and the haemoglobin (Hb) content of the return fluid were measured.Results:TCI propofol could achieve lower systolic, mean BP levels and the number of interventions required was also lower as compared to the sevoflurane group. The number of patients with measurable Hb was lower in the TCI propofol group and this translated into better visualisation of the joint space. A higher volume of saline irrigant was required in the sevoflurane group. No immediate peri-operative anaesthetic complications were noted in either category.Conclusion:TCI propofol appears to be superior to and more convenient than sevoflurane anaesthesia in inter-scalene blocked patients undergoing shoulder arthroscopy.

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“…Previous studies have suggested that intraoperative sedation is not a major triggering factor for HBEs [8,9]. Souron et al [51] demonstrated that in a single observation group, with 140 patients, target-controlled propofol infusion (0.8-0.9 µg/ml) following hydroxyzine premedication is a safe and effective technique for sedation when combined with ISBPB during shoulder surgery in the sitting position. The incidence of HBEs in their study was 5.7% (8 patients).…”

Section: New Contributing Factors For Hbesmentioning

confidence: 99%

Hypotensive bradycardic events during shoulder arthroscopic surgery under interscalene brachial plexus blocks

Song

Roh

2012

Korean J Anesthesiol

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Sudden, profound hypotensive and bradycardic events (HBEs) have been reported in more than 20% of patients undergoing shoulder arthroscopy in the sitting position. Although HBEs may be associated with the adverse effects of interscalene brachial plexus block (ISBPB) in the sitting position, the underlying mechanisms responsible for HBEs during the course of shoulder surgery are not well understood. The basic mechanisms of HBEs may be associated with the underlying mechanisms responsible for vasovagal syncope, carotid sinus hypersensitivity or orthostatic syncope. In this review, we discussed the possible mechanisms of HBEs during shoulder arthroscopic surgery, in the sitting position, under ISBPB. In particular, we focused on the relationship between HBEs and various types of syncopal reactions, the relationship between HBEs and the Bezold-Jarisch reflex, and the new contributing factors for the occurrence of HBEs, such as stellate ganglion block or the intraoperative administration of intravenous fentanyl.

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Sedation with target-controlled propofol infusion during shoulder surgery under interscalene brachial plexus block in the sitting position

Abstract: Target-controlled propofol infusion (0.8-0.9 microg mL(-1)) following hydroxyzine premedication is a safe and effective technique for sedation when combined with interscalene brachial plexus block during shoulder surgery in the sitting position.

Cited by 16 publications

References 19 publications

Bispectral index-guided general anaesthesia in combination with interscalene block reduces desflurane consumption in arthroscopic shoulder surgery: a clinical comparison of bupivacaine versus levobupivacaine

Bispectral index-guided general anaesthesia in combination with interscalene block reduces desflurane consumption in arthroscopic shoulder surgery: a clinical comparison of bupivacaine versus levobupivacaine

Target-controlled infusion (Propofol) versus inhaled anaesthetic (Sevoflurane) in patients undergoing shoulder arthroscopic surgery

Hypotensive bradycardic events during shoulder arthroscopic surgery under interscalene brachial plexus blocks

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