[Efficacy of bispectral index for anesthetic management of combined off-pump coronary artery bypass grafting and abdominal aortic aneurysm replacement].
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A 57-year-old female patient underwent combined off-pump coronary artery bypass grafting and abdominal aortic aneurysm replacement. Anesthesia was maintained with propofol, fentanyl, and thoracic epidural anesthesia. Propofol doses were adjusted to maintain bispectral index (BIS) between 40-60. Despite the remarkable hemodynamic changes, BIS remained stable at about 50 during the surgery. The average dose of propofol was 3.3 mg.kg-1.hr-1. The patient awoke an hour after the surgery and was extubated 1.5 hours thereafter. This case report suggests that BIS is a useful index to determine the depth of anesthesia during surgeries which induce marked hemodynamic changes.Keywords:
Bispectral index
Cardiac index
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A 57-year-old female patient underwent combined off-pump coronary artery bypass grafting and abdominal aortic aneurysm replacement. Anesthesia was maintained with propofol, fentanyl, and thoracic epidural anesthesia. Propofol doses were adjusted to maintain bispectral index (BIS) between 40-60. Despite the remarkable hemodynamic changes, BIS remained stable at about 50 during the surgery. The average dose of propofol was 3.3 mg.kg-1.hr-1. The patient awoke an hour after the surgery and was extubated 1.5 hours thereafter. This case report suggests that BIS is a useful index to determine the depth of anesthesia during surgeries which induce marked hemodynamic changes.
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Use of propofol in surgery on critical patients is limited because of the possibility of poorly corrected hypotonia. The effects of total anesthesia with propofol + fentanyl + nitric oxide under conditions of artificial ventilation of the lungs (tracrium) were evaluated during 63 operations on 42 patients with severe burns (ASA III-IV), divided into 2 groups depending on the protocol of anesthesia. The difference in the protocols consisted in the method of choice of anesthetic doses: in group A we proceeded from EEG data (bispectral index--BIS) and in group B relied only on general clinical and hemodynamic signs with a retrospective analysis of BIS. Prevention of hemodynamic disorders in both groups included infusion loading (7-8 ml/kg), dopamine (5-7 micrograms/kg/min) and decrease of the velocity of propofol infusion to 15 mg/kg/h during induction anesthesia. This method leveled the hypodynamic effects of propofol. Simultaneous monitoring of BIS showed that the propofol dose needed for adequate induction narcosis with subsequent intubation should be higher than the dose usually recommended for patients with ASA class III-IV. Use of BIS monitoring during the operation resulted in a decrease of the propofol and fentanyl doses. The authors do not recommend decreasing the velocity of propofol infusion below 3 mg/kg/h (at FiN2) = 0.6) because of the risk of awakening during narcosis.
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We report 3 patients who developed a sudden unpredicted increase in bispectral index (BIS) value during propofol and fentanyl anesthesia. The patients were induced with propofol 2-mg.kg-1 and fentanyl 2-micrograms.kg-1 and muscle relaxation was obtained by vecuronium 0.12-mg.kg-1. During induction of anesthesia, BIS value went down to below 50 in all three cases, and anesthesia was maintained by continuous infusion of propofol at a rate of 5 mg.kg-1.hr-1 and intermittent administration of fentanyl. Forty to sixty min after starting the operation, BIS value increased suddenly (up to 80) and the body movement of the patients was observed. The serum concentration of propofol was approximately 2.5 micrograms.ml-1. All patients were successfully treated with increasing the infusion rate of propofol and additional administration of fentanyl. No clear recall or explicit memory during operation was observed after anesthesia, but, anesthesiologists might have to pay more attention to unpredictable changes of anesthetic depth during propofol anesthesia using target controlled infusion.
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Objective To investigate the feasibility of Propofol target controlled infusion(TCI)for fast-track anesthesia on patients undergoing heart surgery.Methods Thirty patients scheduled for heart surgery from 6 to 45 years old,with physical state in grade Ⅱ～Ⅲ,were chosen for the investigation.Propofol TCI was administered for anesthesia induction.The bispectral index(BIS)value was ranged from 45 to 50.Fentanyl and Vecuronium Bromide were added according to the change of hemodynamics and BIS value during operation.The BIS value,change of hemodynamics,usage of vasoactive drug,extubation time and ICU stay time were observed and recorded.Results The concentration of Propofol was 1.8 μg/ml.It was maintained in 2～2.5 μg/ml during surgical procedure.Stability of hemodynamics was recorded.The extubation time(﹤3 hours)and ICU stay time(﹤18 hours)were observed simultaneously.Conclusions Propofol TCI is safe for fast-track anesthesia on patients undergoing heart operation.
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Fast track
Vasoactive
Cardiac index
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Objective To provide reasonable usage of medications by observing the effects of different doses of sufentanil on the circulatory system in elderly patients during induction of general aneasthesia under real-time monitoring of BIS.Methods 60 ASA Ⅰ and Ⅱ elderly patients undergoing elective abdominal surgeries were selected and randomly divided into three groups ( 20 for each group ):groups with sufentanil of 0.2 μg/kg ( group S1 ),0.3 μg/kg ( group S2 ),and 0.4 μg/kg ( group S3 ).The BIS values were ( 50 ± 5 ) during intubation and TCI of propofol was maintained.SBP,DBP,BIS values,HR,and dosage of propofol were recorded before aneasthesia ( T0 ) and intubation ( T1 ),and at the moment of completion of intubation ( T2 ),2 min ( T3 ),and 5 min after intubation ( T4 ).Results Before intubation,BIS values maintained at( 50 ± 5 )in all the three groups,with no significant differences.Blood pressure decreased at T1 as compared with TO in all the three groups,and did not differ significantly among the three groups.After intubation,the level of hemodynamic fluctuation was markedly higher in group S1 than in group S2 and group S3.The change in hemodynamics was least in group S3.Conclusions Intravenous sufentanil of 0.4 μg/kg can effectively inhibit cardiovascular stress responses in elderly patients and can keep the circulatory system stable.
Key words:
Sufentanil; Elderly; Tracheal intubation; Bispectral index; Cardiovascular responses
Sufentanil
Bispectral index
Cardiac index
Haemodynamic response
Elective surgery
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【Objective】 To evaluate the effect of Etomidate intravenous anesthesia on serum cortisol and postoperative cognitive dysfunction(POCD) in elderly patients.【Methods】 Sixty ASA Ⅰ～Ⅲ elderly patients including 35 males and 25 females were scheduled for general anesthesia undergoing elective abdominal surgery.All patients were randomly divided into Etomidate group(Group E) and Propofol group(Group P),30 cases in each group.Anesthesia was induced with midazolam 0.05 mg/kg,Etomidate intralipid 0.3 mg/kg(Group E) or Propofol 1.5 mg/kg(Group P),Fentanyl 30 μg/kg and atracurium 0.6 mg/kg.Anesthesia was maintained with target concentration infusion(TCI) atracurium 2.0～2.5 μg/mL,TCI Etomidate 1.0～1.3 μg/mL in Group E or TCI Propofol 3～4 μg/mL in Group P,intermittent bolus Fentanyl.To maintain the bispectral index(BIS) values between 40 and 60.The concentrations of serum cortisol were measured by radioimmunoassay before anesthesia 5 min,after intubation 5 min,the end of surgery,postoperative 24 h and 48 h after surgery,respectively.Mine-mental state examination(MMSE) method was tested to evaluate the cognitive function of patients before surgery 1-day,postoperative 1,3,5,7 day and the statistical scores were compared.【Results】 The cortisol concentrations in Group E and Group P at the end of surgery were all significantly lower than those of before anesthesia respectively(P 0.05).The cortisol concentration in Group E at the postoperative 24 h was significantly lower than that of before anesthesia(P 0.05).At the end of surgery,the cortisol concentration of Group E was significantly lower than that of Group P(P 0.05).The cortisol concentrations in Group E and Group P at the postoperative 48 h were all back to normal.MMSE scores were not statistically different between the two groups at each time point(P 0.05),but compared with the preoperative 1 day,there were significant difference of MMSE scores in two groups at the postoperative 1,3 day(P 0.05).【Conclusion】Etomidate has a transient and reversible inhibition on the function of the adrenal cortex in the elderly patients undergoing elective abdominal surgery.Etomidate can be used in total intravenous anesthesia in the elderly patients without increasing the incidence of POCD.
Etomidate
Midazolam
Postoperative cognitive dysfunction
Bispectral index
Bolus (digestion)
Elective surgery
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This study was undertaken to assess the effects of propofol (versus enflurane, fentanyl, and thiopental) on hemodynamic stability and recovery characteristics when used for maintenance of anesthesia during elective coronary artery bypass grafting (CABG) procedures.Ninety premedicated patients scheduled for elective coronary revascularization had anesthesia induced with fentanyl 25 micro gram/kg intravenously (IV). When the mean arterial blood pressure (MAP) increased 10% above preoperative baseline values, patients were randomized to receive one of four anesthetic treatments: enflurane, 0.25-2.0%; fentanyl, 10-20 micro gram/kg IV bolus doses; propofol, 50-250 micro gram centered dot kg-1 centered dot min-1 IV; or thiopental, 100-750 micro gram centered dot kg-1 centered dot min-1 IV. The maintenance anesthesia was titrated to achieve hemodynamic stability (i.e., maintain the MAP within 10% of the baseline values and heart rate [HR] within 20% of the baseline values). After bypass, anesthetic and cardiovascular drugs were titrated to maintain the MAP >65 mm Hg and the cardiac index (CI) >2.3 L centered dot min-1 centered dot m-2. Recovery was assessed by noting the times at which patients first opened their eyes, responded to verbal communication, correctly responded to specific commands, underwent tracheal extubation, and were discharged from the intensive care unit (ICU). Although less intraoperative hypertension was noted in the propofol-treated patients (19 +/- 11 min vs 38 +/- 26 min, 30 +/- 24 min, and 30 +/- 23 min in the enflurane, fentanyl, and thiopental groups, respectively) (P = 0.04), the incidence of hypotension did not differ significantly among the groups. Vasopressor drugs were required more often during the prebypass period in fentanyl and propofol patients (4/22 and 5/23, respectively) compared to the thiopental group (0/21) (P < 0.05). During CPB, fentanyltreated patients required vasoconstrictors more often than patients in the other three treatment groups (14/22 vs 6/24, 4/23, and 5/21 in the enflurane, propofol, and thiopental groups, respectively) (P < 0.01). Although fentanyl-treated patients had significantly greater requirements for inotropic support during weaning from CPB than propofol-treated patients (14/22 vs 7/23) (P < 0.038), there were no significant differences among the groups in the postbypass or ICU periods. Propofol-treated patients responded to verbal stimuli (2.1 +/- 1.3 h vs 4.0 +/- 3.5 h, 4.7 +/- 2.7 h, and 5.6 +/- 3.6 h in the enflurane, fentanyl, and thiopental groups, respectively) (P = 0.01) and followed commands earlier (propofol 7.3 +/- 5.2 h vs enflurane 12.5 +/- 5.7 h, fentanyl 13.1 +/- 6.6 h, and thiopental 12.8 +/- 6.7 h) (P = 0.01). In addition, propofoltreated patients were tracheally extubated sooner than patients in either the fentanyl or the thiopental group (14 +/- 5 h vs 29 +/- 19 h and 20 +/- 4 h, respectively) (P = 0.001). Although the cost of the study drug was highest in the propofol group (propofol $46 +/- 22 vs enflurane $7 +/- 3, fentanyl $10 +/- 4, and thiopental $6 +/- 3), the ability to "fast track" patients receiving propofol would be expected to offset its greater cost. We conclude that shorter-acting drugs (e.g., propofol and enflurane) can facilitate an early recovery after coronary artery revascularization without compromising intraoperative hemodynamic stability. (Anesth Analg 1995;81:900-10)
Enflurane
Cardiac index
Mean arterial pressure
Bispectral index
Bolus (digestion)
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Cardiac index
Trendelenburg position
Preload
Bispectral index
Afterload
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Elective surgery
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Total intravenous anesthesia is an anesthetic modality which is commonly used in cattle due to its practicality, as it eliminates the need for sophisticated equipment and can be used under field conditions, providing adequate anesthesia and analgesia for bovine patients. This study evaluated the bispectral index (BIS) and hemodynamic effects of a constant rate infusion of propofol combined with fentanyl in calves.
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