Intraoperative awareness during laparoscopic sleeve gastrectomy
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Objectives: The aim of this study is to determine the incidence of intraoperative awereness (IA) in our patients who underwent laparoscopic sleeve gastrectomy (LSG) and the factors affecting the formation of this complication. Methods: Four hundred ten patients who underwent LSG between March 2018 and September 2020 were included in the study. By April 2019, we started using the Bispectral index (BIS) monitoring, which measures the depth of anesthesia in all of our LSG cases (n = 167). Patients with and without BIS monitorization were divided into two groups and compared. Results: In our series, IA was seen in 3 patients (2 males) in two different hospitals (0.7%; n = 410). They were all in the non BIS group (n = 243). The median duration of anesthesia was 120 minutes (ranging 90-180) in the non-BIS, and 113 minutes (ranging, 90-140) in the BIS group (p < 0.001). Hypotension developed in 63 patients in non-BIS and 12 patients in BIS group at the beginning of the operation (< 90/60 mm Hg). The total remifentanil infusion dose administered during the anesthesia period in the BIS group was 1310 ± 351 mcg, and 1330 ± 270 mcg in the non BIS group (p = 0.002). The effect of BIS monitorization between groups on IA, did not show statistical significance (p = 0.27). Conclusions: Anesthesia techniques that work well for patients with normal weight may not be safe and appropriate for obese patients. Especially in patients with intraoperative hypotension, it is necessary to be more careful about dose adjustment of anesthetic drugs.Keywords:
Bispectral index
Sleeve gastrectomy
Background: In 2004, the cerebral state monitor, CSM, was launched as a low‐cost alternative to the bispectral index, BIS, for monitoring depth of sleep during anaesthesia. We tested whether the two monitors would reflect hypnosis equally during propofol/remifentanil anaesthesia. Methods: During laparoscopy or breast/surface surgery, 55 non‐paralyzed patients were monitored simultaneously with the BIS and the CSM. Trend curves for the indexes [BIS and cerebral state index (CSI)] were compared for congruence. The difference between the two indexes for the entire course was quantified, and the ability of the two monitors to separate awake from asleep during induction was described. Results: In the majority of the patients, 87%, there was a good fit between the indexes. There were major deviations in seven patients, in whom CSI indicated that the patients were awake during parts of the course despite clinical sleep, correctly identified with the BIS. Both indexes separated awake from asleep during induction in the individual patient, but the overlap in values between patients was more pronounced for CSI. Conclusion: CSM and BIS show some important differences in measuring hypnotic state during clinical propofol/remifentanil anaesthesia.
Bispectral index
Intraoperative Awareness
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Bispectral index
Intraoperative Awareness
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Patients with hypertension may be more prone to develop hypotension as a consequence of opioid administration under general anesthesia. The hemodynamic and bispectral index responses to a remifentanil bolus in neurosurgical hypertensive patients under target-controlled infusion with propofol and remifentanil are addressed.Ten healthy patients and 10 patients with diagnosed hypertension under pharmacological treatment were studied. A 2 microg/kg remifentanil bolus was administered to all patients before skin incision under target-controlled infusion with propofol and remifentanil. Mean arterial pressure, heart rate, and the area under the curve for the bispectral index of the electroencephalogram were analyzed within the groups and compared between them every 30 seconds for two minutes following the bolus.Two minutes after the remifentanil bolus, remifentanil predicted effect-site concentrations reached maximum values of 8.46+/-0.91 ng/ml and 9.74+/-1.29 ng/ml in the healthy and hypertensive patients, respectively. Both groups showed a significant decrease in mean arterial pressure, heart rate, and in the area under the curve for the bispectral index. Mean arterial pressure decreased by 17.3+/-10% and 24+/-9%, heart rate by 11.1+/-8% and 12+/-8%, and the bispectral index by 13+/-9.2% and 8.6+/-8.4% in the healthy and hypertensive patients, respectively, 120 seconds after the remifentanil bolus.In a clinical situation in which high remifentanil doses may be required, hypertensive patients are expected to have hemodynamic and bispectral index responses similar to those observed in healthy patients.
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Bolus (digestion)
Mean arterial pressure
Cardiac index
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Objective To evaluate the effect of target controlled infusion(TCI)remifentanil on bispectral index.Methods Sixty ASA class Ⅰ patients without premedication were randomly assigned to one of the four groups with 15 cases each,TCI of remifentanil was initiated 5 minutes after TCI of propofol given at the target plasma concentration of 3 μg/ml.After the loss of consciousness,vecuronium 0.1 mg/kg was administrated.Ventilation was adjusted to maintain end-tidal carbon dioxide partial pressure between 35-45 mmHg.Mean arterial pressure(MAP),heart rate(HR),bispectral index(BIS)were measured continuously from the baseline to 5 minutes after tracheal intubation.MAP,HR,BIS were obtained on the time points of before induction(T0),before remifentanil TCI(T1),before laryngoscopy(T2),and maximum values after intubation(T3).Results BIS values were not affected by remifentanil before laryngoscopy.In group R2(remifentanil 2 ng/ml),BIS,MAP,HR were significantly higher after intubation than those before,BIS changes were consistent with hemodynamic responses.Conclusion The addition of remifentanil to propofol did not affect BIS without a painful stimulus,BIS can guide the administration of propofol.4 ng/ml remifentanil TCI was the optimal dose for the intubation.
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Background:The present study was undertaken to determine the effect of remifentanil on the bispectral index (BIS) during intubation under TIVA (total intravenous anesthesia) using propofol.Methods: In this prospective, randomized, double-blind study, 80 healthy patients aged 1860 years undergoing elective surgery were investigated.Anesthesia was induced using propofol (target effect-site concentration 4μg/ml).After the loss of consciousness, rocuronium (0.9 mg/kg) and remifentanil was infused.The patients in the R group were infused with remifentanil using a target effect-site concentration of 4 ng/ml, and patients in the P group were infused with saline.The BIS value, mean arterial pressure (MAP) and heart rate (HR) were measured before induction, before remifentanil infusion and before and after tracheal intubation.Results: The BIS value remained constant after intubation in the two groups.The MAP and HR increased significantly after intubation in the two groups, but the degree of increase of MAP and HR was less in group R than in group P significantly.Conclusions: We suggest that the BIS value is not affected by the administration of remifentanil during intubation under TIVA using propofol.(
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Target controlled infusion
Intravenous bolus
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We describe the target‐controlled administration of propofol and remifentanil, combined with monitoring of the bispectral index, during an awake craniotomy for removal of a left temporo‐parietal tumour near the motor speech centre. Target concentrations of the two drugs were adjusted according to the patient's responses to painful stimuli and surgical events, and the need for speech testing. Allowing the effect‐site concentrations of propofol and remifentanil to decrease during surgery allowed the performance of cortical speech mapping and the testing of the patient's ability to speak. Although the bispectral index was not used as a guide for the administration of the drugs, its value correlated better with the patient's responsiveness than did the predicted effect‐site concentrations of propofol. Side‐effects, comprising hypotension, respiratory depression and airway obstruction, were related to rapid increases in drug infusion rates and were easily managed.
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Awake craniotomy
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