Impact factor 0.175

Signa Vitae

Journal of Intensive Care and Emergency Medicine

Haemodynamic stability during anaesthesia induction with propofol – impact of phenylephrine. A double-blind, randomised clinical trial.

Abstract

Background. We studied the effects of a parallel phenylephrine infusion during bispectral index guided anaesthesia induction with propofol on haemodynamic parameters. We hypothesised that mean arterial pressure and cardiac index would be better maintained in the group of patients receiving the phenylephrine infusion during induction.

Methods. We studied ASA I-III patients scheduled for oncological abdominal surgery. Forty patients randomly received either a 0.9% NaCl or a phenylephrine (0.5 μg/kg/min) infusion during the induction of anaesthesia with propofol to a bispectral index value of 60. Mean arterial pressure, stroke volume index and systemic vascular resistance index were recorded, starting at one minute before induction for 20 minutes, at one-minute intervals.

Results. After induction of anaesthesia before intubation mean arterial pressure and stroke volume index decreased significantly compared to baseline in both groups, while the systemic vascular resistance index increased slightly. At the end of measurements, mean arterial pressure (66 11 vs. 94 14 mmHg; 0.9% NaCl vs. phenylephrine group p<0.01) and stroke volume index (34.2 9.1 vs. 44.0 9.7 ml/m2; 0.9% NaCl vs. phenylephrine group p<0.01) were lower in both groups in comparison to baseline values, but were better maintained in the phenylephrine group, whereas systemic vascular resistance index was higher than at baseline (2308 656 vs. 3198 825 dynes s/cm5/m2; 0.9% NaCl vs. phenylephrine group p<0.01) with significant differences between groups.

Conclusion. Our study shows that a continuous phenylephrine infusion can attenuate the drop in mean arterial pressure and stroke volume index during anaesthesia induction with propofol.

Key words: anaesthetics, propofol, monitoring, depth of anaesthesia, consciousness monitors, bispectral index, sympathetic nervous system, phenylephrine, measurement techniques, cardiac output

Read More

Dexmedetomidine in abdominal and thoracic anesthesia

Background

The Bispectral Index (BIS) is a processed electroencephalographic parameter that correlates with the sedative-hypnotic actions of anaesthetic drugs. Dexmedetomidine and lidocaine have both opioid sparing effects. Their influence in laparoscopic surgery has not been studied yet. We investigated their effect on perioperative opioid consumption, cognitive function and incidence of neuropathic pain.

Keywords: bispectral index, dexmedetomidine, lidocaine

Read More

Dexmedetomidine and Non-Intubated VATS – Our Experiences in University Medical Centre Ljubljana

Background

Non-intubated thoracic surgery has evolved since the early beginning of 21.century. In University Medical Centre Ljubljana we started with simple non-intubated procedures in October 2015. Many contributung factors are imperative for early start with good results. Surgical technique in VATS procedures has to be fully established. Anesthesiologist, involved in such procedures, has to be confident in thoracic anesthesia with emphasis on airway management. Good technical equipment is fundamental. On the other hand, patient have to be preciselly selected with writen informed conset.

Key words: non-intubated VATS, intercostal blockade, dexmedetomidine, bispectral index, videolaryngoscope

Read More

Bispectral analysis in medical-surgical ICU

Abstract

The effectiveness of sedation in the ICU is routinely assessed by subjective monitoring of the patient’s clinical condition or by using the monitors. The aim of our study was to review the monitoring of sedation using bispectral analysis (BIS) in medical-surgical ICU. A retrospective analysis of patients who were treated in the ICU from 2008 to 2014 was made. The data of 104 patients were analyzed. The average values of age are 54.38 (SD ±18,93; median 58). 39 (37,5%) of the patients died. The patients were referred to the ICU from medical (37), surgical departments (23) and traumatology (44). The patients were treated in the ICU for 13.84 days (SD ±17.29; median 8). The burst suppression pattern was noticed in 31 (29.8%) patients. Delirium occurred in 3 patients after the separation from the ventilator. In heterogeneous groups of patients, in which BIS was applied, it is not possible to make certain conclusions. The cost of the method unfortunately limits its wider usage. It is necessary to wait for the results of future studies which will set clear indications for the use of BIS in certain groups of patients.

Key words: bispectral index, critical care, monitoring, sedation

Read More

© 2019. Signa Vitae. Except where otherwise noted, content on this site is licensed under a Creative Commons Attribution 4.0 International license.