Anaesthesia
-
Comparative Study
SNAP index and Bispectral index during different states of propofol/remifentanil anaesthesia.
The accuracy of the new SNAP index with the Bispectral index (BIS) to distinguish different states of propofol/remifentanil anaesthesia was compared in 19 female patients who were undergoing minor gynaecological surgery. Comparisons of the SNAP index, BIS, spectral edge frequency, mean arterial blood pressure and heart rate were performed. The ability of all parameters to distinguish between the steps of anaesthesia -awake vs. loss of response, awake vs. anaesthesia, anaesthesia vs. first reaction and anaesthesia vs. extubation - were analysed with the prediction probability. ⋯ Only the BIS showed no overlap between the investigated steps of anaesthesia. Both the SNAP index and BIS failed to differentiate the nuances of anaesthesia. The SNAP index and BIS were superior to mean arterial blood pressure and heart rate and spectral edge frequency in distinguishing between different steps of anaesthesia with propofol and remifentanil and provided useful additional information.
-
Effect-site concentration is a mathematical term related to the clinical effect of a drug. We have designed a patient-maintained sedation system for delivering propofol to the predicted effect-site concentration rather than plasma concentration. To assess its efficacy and safety, 20 healthy volunteers deliberately attempted to over-sedate themselves using the system. ⋯ Four out of 20 volunteers ended with minor arterial desaturation (lowest 88% at effect-site concentration 2.6-3.4 microg x ml(-1)). One volunteer ended after loss of verbal contact at effect-site concentration 3.4 microg x ml(-1). Further modification of the system's design is necessary before it can be recommended for routine practice.
-
Review Case Reports
Transient fixation on a non-native language associated with anaesthesia.
We report a patient with the unusual language disturbance of transient fixation on a non-native language after otherwise uneventful general anaesthesia. The patient was unable to speak his native language for a period of 5-10 min, despite a desire to do so. ⋯ The phenomenon raises a number of interesting questions about the nature of human language, anaesthesia and consciousness. We discuss our patient in the context of some of these questions and present a review of three similar patients reported in the anaesthetic literature.