Masui. The Japanese journal of anesthesiology
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Randomized Controlled Trial Clinical Trial
[Changes of arterial blood pressure and heart rate during induction of anesthesia with propofol--efficacy of propofol titration using bispectral index as an indicator].
Bispectral index (BIS) is a processed EEG parameter that measures the hypnotic effects of anesthetic and sedative agents on the brain. We studied whether propofol titration using BIS allows us to prevent hemodynamic changes during induction of anesthesia and endotracheal intubation. Thirty patients without hypertension and obesity were studied. ⋯ Diastolic blood pressure and heart rate increased significantly after endotracheal intubation in both groups. Systolic blood pressure significantly increased immediately after intubation in the bolus group, but was unchanged in the titration group. These results suggest that BIS is useful to prevent significant increases in systolic blood pressure associated with endotracheal intubation during induction of anesthesia with propofol.
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An 58-year-old woman with prolonged QT interval syndrome possibly associated with subarachnoid hemorrhage underwent clipping for cerebral artery aneurysm. Anesthesia was induced with diazepam, fentanyl and vecuronium, and maintained with nitrous oxide (66%)-oxygen and sevoflurane (1%) with fentanyl. However, three hours after the start of operation, torsades de pointes suddenly appeared and cardiac arrest was followed. ⋯ At that time, serum potassium was decreased to 2.7 mEq.l-1. Five days after the operation, she died despite cardiopulmonary resuscitation for frequent episodes of ventricular tachycardia including torsades de pointes. Ventricular tachycardia including torsades de pointes may have been caused by decreased serum potassium.
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To investigate the influence of ketamine on the bispectral index (BIS), the spectral edge frequency 90 (SEF 90) and relative power in four frequency bands (beta, alpha, theta, sigma), we studied 13 patients (ASA I-II) undergoing elective surgery. In the first study (n = 7), we administered ketamine (1.0 mg.kg-1, bolus, i.v.) during propofol anesthesia. Thirty minutes after the administration, BIS, SEF 90 and relative beta power increased significantly. ⋯ The infusion rate of ketamine was 0.5 mg.kg-1.h-1 for 30 minutes and then increased to 1.0 mg.kg-1.h-1. BIS, SEF 90 and relative beta power increased significantly after ketamine administration, but the parameters did not change in dose-related manner. We conclude that further investigation is necessary to use electroencephalographic parameters as an indicator of the anesthesia depth during propofol/ketamine anesthesia.
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A cuffed oropharyngeal airway (COPA) was used in 20 adult patients for airway management under epidural and brachial plexus block supplemented with light general anesthesia. Insertion of a COPA was successful at first attempt in 17 of 20 patients (85%). ⋯ Aspiration regurgitation, or laryngospasm was not observed. We conclude that a COPA can be an efficient airway device is spontaneously breathing patients under anesthesia.
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We studied the reasons why tracheal intubation using a lighted stylet (Trachlight) was sometimes difficult for unexperienced intubators. We also examined light-guided intubation skill acquisition in inexperienced anesthesiologists. Two anesthesiologists, with no prior experience in using a Trachlight, performed orotracheal intubation using a Trachlight in 60 anesthetized patients (30 patients each). ⋯ Both the intubation time and the incidence of difficult cases decreased significantly between the first and last epoch. The present study confirms that light-guided intubation is sometimes difficult when the tube tip is advanced to the vallecula or to the esophagus. An acceptable level of skill in light-guided intubation is achieved within 30 uses.