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Anaesthesiology Intensive Therapy 2015Total intravenous anaesthesia with propofol and remifentanil is widely used in neuroanaesthesiology and enables the quick recovery and early neurological assessment of... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Total intravenous anaesthesia with propofol and remifentanil is widely used in neuroanaesthesiology and enables the quick recovery and early neurological assessment of patients. The administration of muscle relaxants carries a risk of residual relaxation following surgery. The administration of a suitable dose of sugammadex reverses the neuromuscular block irrespective of its depth and has none of the side effects associated with acetylcholinesterase inhibitors. The aim of the present study was to evaluate the usefulness of sugammadex for the reversal of vecuronium-induced effects following intracranial surgery.
METHODS
The study involved 38 women who underwent supratentorial tumour removal. These women were randomly divided into two groups. Total intravenous anaesthesia with propofol and remifentanil using target-controlled infusion was administered according to the Schnider and Minto models, respectively. Endotracheal intubation was performed after the target concentrations of propofol and remifentanil reached 4 μg mL⁻¹ and 4 ng mL⁻¹, respectively. Vecuronium (100 μg kg⁻¹) was administered, and no response to TOF stimulation was observed. Relaxation was continued via the continuous infusion of vecuronium (0.8-1.2 μg kg⁻¹ min⁻¹) to provide a TOF of 2 throughout the surgery. In group I, neuromuscular conduction was restored with intravenous sugammadex (2 mg kg⁻¹), whereas in group II, no reversal agents were administered.
RESULTS
The times of the return of spontaneous breathing, extubation, eye opening (both spontaneous and in response to a verbal command) were found to be longer in group II than group I.
CONCLUSION
The use of sugammadex following craniotomy accelerates the achievement of optimal extubation conditions.
Topics: Adult; Aged; Anesthesia Recovery Period; Anesthesia, Intravenous; Body Temperature; Craniotomy; Female; Hemodynamics; Humans; Male; Middle Aged; Neural Conduction; Neuromuscular Blockade; Neuromuscular Nondepolarizing Agents; Pain, Postoperative; Sugammadex; Supratentorial Neoplasms; Vecuronium Bromide; gamma-Cyclodextrins
PubMed: 26401735
DOI: 10.5603/AIT.2015.0042 -
European Journal of Pediatrics Feb 2016The objective of this study was to assess the feasibility of monitoring stress responses in newborns during naso-tracheal intubation after two different premedication... (Randomized Controlled Trial)
Randomized Controlled Trial
UNLABELLED
The objective of this study was to assess the feasibility of monitoring stress responses in newborns during naso-tracheal intubation after two different premedication regimens, using skin conductance measurements (SCM). Twenty-two newborns were randomised and premedicated with morphine + vecuronium or propofol. SCM (peaks/s) were collected prior to, during and after the procedure. Threshold for interpreting responses as stressful was 0.21 peaks/s. Intubation conditions and physiological parameters were registered. Intubation conditions were good in all newborns. Administration of morphine (range 1.4-10.3 min) before administration of vecuronium did not affect SCM when a stressful stimulus was applied. Within 1.6 min (range 0.8-3 min) after administration of vecuronium, SCM disappeared in 10 of 11 newborns. Propofol reduced SCM in 10 of 11 newborns at the first attempt. Further attempts were associated with increasing SCM, mostly above a threshold of 0.21 peaks/s. There were no significant changes in physiological parameters during the procedure for either premedication regimen.
CONCLUSION
The variation in SCM between individual newborns limits the usefulness of SCM as stress monitor during intubation. The use of neuromuscular blockers for premedication precludes monitoring of SCM completely in newborns.
WHAT IS KNOWN
Skin conductance measurements have been used successfully to monitor pain in awake newborn infants.
WHAT IS NEW
Premedicated newborns display significant interindividual variation in skin conductance measurements during an intubation procedure. Neuromuscular blockade causes skin conductance measurements to disappear completely.
Topics: Anesthetics, Combined; Anesthetics, Intravenous; Deep Sedation; Feasibility Studies; Galvanic Skin Response; Humans; Infant; Infant, Newborn; Intubation, Intratracheal; Monitoring, Physiologic; Morphine; Pain; Premedication; Propofol; Stress, Physiological; Vecuronium Bromide
PubMed: 26328787
DOI: 10.1007/s00431-015-2621-6 -
ELife Apr 2015Using the visual system as a model, we recently showed that the efficient coding principle accounted for the allocation of computational resources in central sensory...
Using the visual system as a model, we recently showed that the efficient coding principle accounted for the allocation of computational resources in central sensory processing: when sampling an image is the main limitation, resources are devoted to compute the statistical features that are the most variable, and therefore the most informative (eLife 2014;3:e03722. DOI: 10.7554/eLife.03722 Hermundstad et al., 2014). Building on these results, we use single-unit recordings in the macaque monkey to determine where these computations--sensitivity to specific multipoint correlations--occur. We find that these computations take place in visual area V2, primarily in its supragranular layers. The demonstration that V2 neurons are sensitive to the multipoint correlations that are informative about natural images provides a common computational underpinning for diverse but well-recognized aspects of neural processing in V2, including its sensitivity to corners, junctions, illusory contours, figure/ground, and 'naturalness.'
Topics: Action Potentials; Anesthetics, Intravenous; Animals; Brain Mapping; Electrodes, Implanted; Image Processing, Computer-Assisted; Macaca mulatta; Neuromuscular Nondepolarizing Agents; Neurons; Pattern Recognition, Visual; Photic Stimulation; Propofol; Single-Cell Analysis; Vecuronium Bromide; Visual Cortex
PubMed: 25915622
DOI: 10.7554/eLife.06604 -
Anesthesia, Essays and Researches 2015Rocuronium (R) bromide and vecuronium (V) are monoquaternary aminosteroid compounds. The aim of this study was to evaluate the onset time, conditions of intubation and...
BACKGROUND
Rocuronium (R) bromide and vecuronium (V) are monoquaternary aminosteroid compounds. The aim of this study was to evaluate the onset time, conditions of intubation and duration of action of equipotent doses (3ED95) of R and V.
MATERIALS AND METHODS
The study was carried out in 60 adult American Society of Anesthesiologists physical status 1-2 patients of age 20-60 years. The patients were divided into two groups of 30 each and received either 0.9 mg/kg of R (Group R) or 0.168 mg/kg of V (Group V) to facilitate endotracheal intubation. Neuromuscular blockade was assessed at corrugator supercilii and adductor pollicis muscles to evaluate onset time and duration of neuromuscular block, respectively.
RESULTS
The mean onset time was significantly rapid in Group R as compared to Group V (P -0.011). Overall intubating conditions were excellent in 100% of patients in Group R as compared to 70% in Group V. The mean duration of action did not show a significant variation between the groups.
CONCLUSION
At equipotent doses, R provides clinically acceptable intubation conditions much earlier than V without significant variation in clinical duration of action.
PubMed: 25886427
DOI: 10.4103/0259-1162.150676 -
Anesthesia, Essays and Researches 2014ProSeal laryngeal mask airway (PLMA) efficacy in pediatric anesthesia.
Comparison of ProSeal laryngeal mask airway size 2 and 2½ in anesthetized and paralyzed pediatric patients with same weight group: A prospective randomized clinical study.
CONTEXT
ProSeal laryngeal mask airway (PLMA) efficacy in pediatric anesthesia.
AIMS
The aim of this study was to compare PLMA size 2 and 2½ in anesthetized paralyzed pediatric patients weighing 20-30 kg undergoing elective surgery.
SETTINGS AND DESIGN
A prospective randomized study was conducted in a tertiary care teaching hospital.
MATERIALS AND METHODS
A total of 60 American Society of Anesthesiologists I pediatric patients of either sex having body weight between 20 and 30 kg undergoing elective surgeries were randomly allocated to PLMA of either size 2 or 2½. Standardized anesthetic technique with propofol, sevoflurane, vecuronium bromide, nitrous oxide was used in all patients. Parameters such as number of attempts, time to achieve an effective airway, hemodynamic parameters, drain tube test, oropharyngeal leak pressure (OPL), gastric tube placement, and postoperative adverse events were noted. Statistical analysis by Kolmogorov-Smirnov analysis, Mann-Whitney U-test, Student's t-test, Wilk's lambda test and power analysis was done.
RESULTS
There were no significant differences in demographic variables, ease of insertion and ventilation, number of insertion attempts, hemodynamics, and postoperative complications. OPLs were slightly higher in PLMA size 2½ (27.38 ± 6.36 vs. 22.62 ± 2.85 cm H2O, respectively; P = 0.001) than size 2.
CONCLUSIONS
Both PLMA size 2 and 2½ provided adequate seal pressures that would allow positive pressure ventilation in healthy children. Thus PLMA of either size 2 or 2½ can be used as a reliable airway device in children weighing 20-30 kg.
PubMed: 25886330
DOI: 10.4103/0259-1162.143126 -
BMC Anesthesiology 2015It remains to be elucidated whether the Trendelenburg position increases intracranial pressure (ICP). ICP can be evaluated by measuring the sonographic optic nerve...
BACKGROUND
It remains to be elucidated whether the Trendelenburg position increases intracranial pressure (ICP). ICP can be evaluated by measuring the sonographic optic nerve sheath diameter (ONSD). We investigated the effect of the isolated Trendelenburg position on ONSD in patients undergoing robot-assisted laparoscopic radical prostatectomy. Additionally, we evaluated the effect of the Trendelenburg position combined with pneumoperitoneum on ONSD.
METHODS
Twenty-one patients scheduled for robot-assisted laparoscopic radical prostatectomy were enrolled. Sonographic ONSDs and hemodynamic parameters were measured at specific time points: in the supine position after induction of anesthesia, 3 min after the steep Trendelenburg position (35° incline), 3 min after the steep Trendelenburg position combined with pneumoperitoneum, and in the supine position after desufflation of the pneumoperitoneum.
RESULTS
The ONSD 3 min after the steep Trendelenburg position was significantly higher than that of the supine position after induction of anesthesia (5.1 ± 0.3 mm vs. 4.5 ± 0.4 mm). In addition, the ONSD 3 min after the steep Trendelenburg position combined with pneumoperitoneum was higher than that of the supine position after induction of anesthesia (4.9 ± 0.4 mm vs. 4.5 ± 0.4 mm). The ONSD in the supine position after desufflation of the pneumoperitoneum was similar to that in the supine position after induction of anesthesia.
CONCLUSIONS
Use of the isolated steep Trendelenburg position, for even a short duration, increased the sonographic ONSD, providing a better understanding of the effect of only a transient steep Trendelenburg position on ONSD as a surrogate measure for ICP.
Topics: Anesthetics; Anesthetics, Intravenous; Head-Down Tilt; Hemodynamics; Humans; Intracranial Pressure; Male; Middle Aged; Neuromuscular Nondepolarizing Agents; Observer Variation; Optic Nerve; Pneumoperitoneum, Artificial; Prostatectomy; Robotic Surgical Procedures; Supine Position; Thiopental; Ultrasonography; Vecuronium Bromide
PubMed: 25861241
DOI: 10.1186/s12871-015-0025-9 -
Indian Journal of Anaesthesia Mar 2015Obese patients are more vulnerable to residual neuromuscular block (NMB) and its associated complications in the post-operative period. This study was carried out to...
BACKGROUND AND AIMS
Obese patients are more vulnerable to residual neuromuscular block (NMB) and its associated complications in the post-operative period. This study was carried out to compare neostigmine induced reversal of vecuronium in normal weight, overweight and obese female patients, objectively using neuromuscular (NM) monitoring.
METHODS
Twenty female patients each belonging to normal weight, overweight and obese, based on body mass index, requiring general anaesthesia were recruited for this prospective cross sectional study. NMB was induced with vecuronium (0.1 mg/kg) dose based on patient's real body weight (RBW) and monitored using acceleromyographic train of four (TOF). All patients received neostigmine 40 μg/kg and glycopyrrolate 10 μg/kg at 25% of spontaneous recovery of first twitch height (T1) of TOF (DUR 25%) and were allowed to recover to TOF ratio of 0.9. Statistical analysis was done using analysis of variance test.
RESULTS
Recovery of TOF ratio to 0.5 was comparable in all three groups. Recovery of TOF ratio to 0.7 was delayed in obese (9.82 ± 3.21 min) compared with normal weight group (7.50 ± 2.52 min). Recovery of TOF to 0.9 was significantly delayed in both overweight (12.18 ± 4.29 min) and obese patients (13.78 ± 4.30 min). DUR 25% was significantly longer in overweight (mean, standard deviation [range]; 30.10 [19-40 min]) and obese (28.8 [12-45 min]) compared with normal weight patients (22.75 [16-30 min]).
CONCLUSION
In overweight and obese patients, when vecuronium induction dose is based on RBW, neostigmine induced recovery of NMB is delayed in late phases (TOF 0.7-0.9), which may result in vulnerability for associated complications of incomplete recovery. Ensuring safe recovery thus requires objective NM monitoring.
PubMed: 25838588
DOI: 10.4103/0019-5049.153038 -
American Journal of Veterinary Research Apr 2015To evaluate the potency of vecuronium and duration of vecuronium-induced neuromuscular blockade in dogs with centronuclear myopathy (CNM).
OBJECTIVE
To evaluate the potency of vecuronium and duration of vecuronium-induced neuromuscular blockade in dogs with centronuclear myopathy (CNM).
ANIMALS
6 Labrador Retrievers with autosomal-recessive CNM and 5 age- and weight-matched control dogs.
PROCEDURES
Dogs were anesthetized on 2 occasions (1-week interval) with propofol, dexmedetomidine, and isoflurane. Neuromuscular function was monitored with acceleromyography and train-of-four (TOF) stimulation. In an initial experiment, potency of vecuronium was evaluated by a cumulative-dose method, where 2 submaximal doses of vecuronium (10 μg/kg each) were administered IV sequentially. For the TOF's first twitch (T1), baseline twitch amplitude and maximal posttreatment depression of twitch amplitude were measured. In the second experiment, dogs received vecuronium (50 μg/kg, IV) and the time of spontaneous recovery to a TOF ratio (ie, amplitude of TOF's fourth twitch divided by amplitude of T1) ≥ 0.9 and recovery index (interval between return of T1 amplitude to 25% and 75% of baseline) were measured.
RESULTS
Depression of T1 after each submaximal dose of vecuronium was not different between groups. Median time to a TOF ratio ≥ 0.9 was 76.7 minutes (interquartile range [IQR; 25th to 75th percentile], 66.7 to 99.4 minutes) for dogs with CNM and 75.0 minutes (IQR, 47.8 to 96.5 minutes) for controls. Median recovery index was 18.0 minutes (IQR, 9.7 to 23.5 minutes) for dogs with CNM and 20.2 minutes (IQR, 8 to 25.1 minutes) for controls.
CONCLUSIONS AND CLINICAL RELEVANCE
For the study dogs, neither potency nor duration of vecuronium-induced neuromuscular blockade was altered by CNM. Vecuronium can be used to induce neuromuscular blockade in dogs with autosomal-recessive CNM.
Topics: Anesthesia Recovery Period; Anesthetics, Intravenous; Animals; Case-Control Studies; Dog Diseases; Dogs; Electromyography; Female; Male; Monitoring, Physiologic; Muscle Contraction; Muscular Diseases; Neuromuscular Nondepolarizing Agents; Vecuronium Bromide
PubMed: 25815571
DOI: 10.2460/ajvr.76.4.302 -
Anaesthesiology Intensive Therapy 2014Target-controlled infusion (TCI) is used to maintain the desired concentration of a hypnotic drug in the plasma and brain. However, pharmacodynamic variability can cause... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Target-controlled infusion (TCI) is used to maintain the desired concentration of a hypnotic drug in the plasma and brain. However, pharmacodynamic variability can cause problems with maintaining the adequate level of anaesthesia. The bispectral index (BIS) is one of only a few parameters that allow an assessment of the depth of anaesthesia. In the present study, we attempted to determine the optimal dosages of drugs used for total intravenous anaesthesia with TCI based on BIS-guided monitoring of depth of anaesthesia.
METHODS
The study was conducted in 60 ASA I patients undergoing elective surgery due to lumbar discopathy. The participants were divided into two groups of 30 individuals. The patients were premedicated with 15 mg oral midazolam. Group I was the control group; group II received BIS monitoring. Anaesthesia was induced with TCI propofol (4 mg mL⁻¹), fentanyl (2 mg kg⁻¹) and vecuronium (0.12 mg kg⁻¹) and maintained with TCI propofol, continuous infusion of vecuronium (0.03 mg kg⁻¹ h⁻¹) and fractionated doses of fentanyl. ECG, HR, MAP, SaO₂, ETCO₂, and the degree of neuromuscular blockade were monitored, specifically at the following time points: T₁ - before induction, T₂ - after induction, T₃ - after intubation, T₄ - after positioning of the patient, T₅-T₁₃ - every 5 min during surgery, T₁₄ - on completion of surgery, T₁₅ - before extubation, T₁₆ - after extubation.
RESULTS
The study groups were comparable in terms of age, body weight, duration of anaesthesia and recovery time. The haemodynamic parameters, such as HR and MAP, did not differ significantly between the groups. In both groups, changes in the mean MAP values were observed between T₁ and T₂, T₂ and T₃, T₃ and T₄ as well as T₁₄and T₁₅. The total dose of fentanyl and the doses of propofol were lower in the group that received BIS monitoring.
CONCLUSION
BIS monitoring reduces the doses of opioids and hypnotics used during total intravenous anaesthesia by TCI.
Topics: Adult; Analgesics, Opioid; Anesthesia Recovery Period; Anesthetics, Intravenous; Consciousness Monitors; Diskectomy; Dose-Response Relationship, Drug; Female; Fentanyl; Humans; Hypnotics and Sedatives; Lumbar Vertebrae; Male; Midazolam; Middle Aged; Propofol; Time Factors; Vecuronium Bromide
PubMed: 25293480
DOI: 10.5603/AIT.2014.0046 -
Indian Journal of Anaesthesia May 2014Priming principle refers to administration of a small dose of non-depolarising blocker, which when followed by a large intubating dose produces a relatively rapid and...
BACKGROUND AND AIMS
Priming principle refers to administration of a small dose of non-depolarising blocker, which when followed by a large intubating dose produces a relatively rapid and profound blockade to ensure suitable conditions for endotracheal intubation. We aimed to compare the effects of rocuronium, vecuronium, and atracurium as "pretreatment" drugs on intubating conditions with rocuronium facilitated endotracheal intubation.
METHODS
This double-blinded, randomised controlled prospective study was carried out at a tertiary health care hospital on patients undergoing surgical procedures under general anaesthesia. They were randomly allocated into three groups (n = 35) by computer generated randomisation chart to receive either rocuronium (0.06 mg/kg body weight) (Group A); vecuronium (0.01 mg/kg body weight) (Group B) or, atracurium (0.05 mg/kg body weight) (Group C), followed by intubating dose (0.6 mg/kg body weight) of rocuronium. The haemodynamic parameters and intubating conditions were studied and statistically analysed by ANOVA test and Student's t-test as applicable using statistical package for the social sciences 16.0 for windows (SPSS Inc., Chicago, IL, USA).
RESULTS
Excellent intubating conditions were noted in maximum number of patients in Group C (97.41%). No significant differences were observed in the systolic blood pressure in all the three groups at all-time intervals. The mean arterial pressure rose significantly from baseline value to maximum, at '0' min in all the groups; however, no significant difference was observed amongst the groups (P > 0.05).
CONCLUSION
Pretreatment with rocuronium bromide can facilitate endotracheal intubation in 60 s irrespective of non-depolarising muscle relaxants used for priming; however, it cannot attenuate haemodynamic changes associated with laryngoscopy and intubation.
PubMed: 25024474
DOI: 10.4103/0019-5049.135043