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Total Intravenous Anesthesia (total + intravenous_anesthesia)
Selected AbstractsWorld SIVA: the pediatric initiativePEDIATRIC ANESTHESIA, Issue 3 2010KEIRA P. MASON MD Summary Total intravenous anesthesia and targeted controlled infusions are emerging and developing techniques that can have a broad range of important clinical applications in future pediatric care. [source] Overview of total intravenous anesthesia in childrenPEDIATRIC ANESTHESIA, Issue 3 2010VAITHIANADAN MANI MBChB FRCA Summary Total intravenous anesthesia (TIVA) can be defined as a technique, in which general anesthesia is induced and maintained using purely i.v. agents. TIVA has become more popular and possible in recent times because of the pharmacokinetic (PK) and pharmacodynamic properties of propofol and the availability of short-acting synthetic opioids. Also, new concepts in PK modeling and advances in computer technology have allowed the development of sophisticated delivery systems, which make control of anesthesia given by the i.v. route as straightforward and user friendly as conventional, inhalational techniques. Monitoring of depth of anesthesia is being validated for these techniques, and in the future, measurements of expired propofol may be possible to guide administration. TIVA is being used increasingly in children. [source] A combination of total intravenous anesthesia and thoracic epidural for thymectomy in juvenile myasthenia gravisPEDIATRIC ANESTHESIA, Issue 4 2007OLIVER BAGSHAW MBChB FRCAArticle first published online: 12 DEC 200 Summary Juvenile myasthenia gravis is the acquired form of the disease in children and presents with ocular signs, fatigability, weakness and bulbar problems. The majority of patients demonstrate thymic hyperplasia and have been shown to benefit from thymectomy. The main considerations for the anesthesiologist are the degree of muscle weakness, the muscle groups involved and sensitivity to neuromuscular blocking drugs and volatile agents. Total intravenous anesthesia (TIVA) with epidural analgesia is probably the anesthetic technique of choice, although the latter is often avoided, because of the risk of a very high block. Two cases of thymectomy are presented where anesthesia was provided using a combination of TIVA and thoracic epidural analgesia. Both patients tolerated the technique well and had an uncomplicated perioperative course. [source] The incidence of intra-operative awareness during general anesthesia in China: a multi-center observational studyACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 7 2009L. XU Background: The incidence of awareness in patients undergoing general anesthesia is 0.1,0.2% in Western countries. The medical literatures about awareness during general anesthesia are still rare in China, but some previous studies have reported a higher incidence (1.4,6%) of intra-operative awareness. To find out the reason why the incidence reported in China is much higher than that in Western countries, we performed a prospective, multicenter, non-randomized observational study to determine the true incidence of intra-operative awareness in China. Methods: This is a prospective, non-randomized descriptive cohort study that was conducted at 25 academic medical centers in China. Eleven thousand one hundred and eighty-five patients were interviewed by research staff for evaluation of awareness at the first and fourth day after general anesthesia with muscle relaxation. An independent blinded committee evaluated the responses and determined whether awareness occurred. Necessary data were collected for a binary logistic regression analysis. Results: Data from 11,101 patients were presented. Forty-six cases (0.41%) were reported as definite awareness and 47 additional cases (0.41%) as possible awareness. Three hundred and fifty-five patients (3.19%) had dreams during general anesthesia. Awareness was associated with increased American Society of Anesthesiologists (ASA) physical status, a previous anesthesia, and anesthesia methods of total intravenous anesthesia. Conclusion: The incidence of intra-operative awareness in China is approximately 0.41%, two to three times higher than that widely cited in Western countries. Inappropriately light anesthesia, and the population proportion of surgery and general anesthesia in China may account for the difference. (ClinicalTrials.gov Identifier, NCT00693875.) [source] Beneficial effects of high positive end-expiratory pressure in lung respiratory mechanics during laparoscopic surgeryACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 2 2009L. F. MARACAJÁ-NETO Background: The effect of neuromuscular blockade (NMB) and positive end-expiratory pressure (PEEP) on the elastic properties of the respiratory system during pneumoperitoneum (PnP) remains a controversial subject. The main objective of the present study was to evaluate the effects of NMB and PEEP on respiratory mechanics. Methods: We performed a dynamic analysis of respiratory mechanics in patients subjected to PnP. Twenty-one patients underwent cholecystectomy videolaparoscopy and total intravenous anesthesia. The respiratory system resistance (RRS), pulmonary elastance (EP), chest wall elastance (ECW), and respiratory system elastance (ERS) were computed via the least squares fit technique using an equation describing the motion of the respiratory system, which uses primary signs such as airway pressure, tidal volume, air flow, and esophageal pressures. Measurements were taken after tracheal intubation, PnP, NMB, establishment of PEEP (10 cmH2O), and PEEP withdrawal [zero end-expiratory pressure (ZEEP)]. Results: PnP significantly increased ERS by 27%; both EP and ECW increased 21.3 and 64.1%, respectively (P<0.001). NMB did not alter the respiratory mechanic properties. Setting PEEP reduced ERS by 8.6% (P<0.05), with a reduction of 10.9% in EP (P<0.01) and a significant decline of 15.7% in RRS (P<0.05). These transitory changes in elastance disappeared after ZEEP. Conclusions: We concluded that the 10 cmH2O of PEEP attenuates the effects of PnP in respiratory mechanics, lowering RRS, EP, and ERS. These effects may be useful in the ventilatory approach for patients experiencing a non-physiological increase in IAP owing to PnP in laparoscopic procedures. [source] Effects of remifentanil/propofol in comparison with isoflurane on dynamic cerebrovascular autoregulation in humansACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 8 2001K. Engelhard Background: This study investigates the effects of remifentanil and propofol in comparison to isoflurane on dynamic cerebrovascular autoregulation in humans. Methods: In 16 awake patients dynamic cerebrovascular autoregulation was measured using transcranial Doppler sonography (TCD). Thereafter patients were intubated, ventilated with O2/air (FiO2=0.33) and randomly assigned to one of the following anesthetic protocols: group 1 (n=8): 0.5 ,g · kg,1 · min,1 remifentanil combined with a propofol-target plasma concentration of 1.5 ,g · ml,1; group 2 (n=8): 1.8 % isoflurane (1.5 MAC). Following 20 min of equilibration the autoregulatory challenge was repeated. Arterial blood gases and body temperature were maintained constant over time. Statistics: Mann-Whitney U-test and Wilcoxon signed-rank test. Results: Dynamic autoregulation was intact in all patients prior to induction of anesthesia expressed by an autoregulatory index (ARI) of 5.4±1.21 (mean±SD, group 1) and 5.9±0.98 (mean±SD, group 2). With remifentanil/propofol anesthesia dynamic autoregulation was similar to the awake state (group 1: ARI=4.9±0.88). In contrast, autoregulatory response was delayed with 1.5 MAC isoflurane (group 2, ARI=2.1±0.92) (P<0.05). Conclusion: These data show that dynamic cerebrovascular autoregulation is maintained with remifentanil-based total intravenous anesthesia. This is consistent with the view that narcotics (and hypnotics) do not alter the physiologic cerebrovascular responses to changes in MAP. In contrast, 1.5 MAC isoflurane delays cerebrovascular autoregulation compared to the awake state. [source] Overview of total intravenous anesthesia in childrenPEDIATRIC ANESTHESIA, Issue 3 2010VAITHIANADAN MANI MBChB FRCA Summary Total intravenous anesthesia (TIVA) can be defined as a technique, in which general anesthesia is induced and maintained using purely i.v. agents. TIVA has become more popular and possible in recent times because of the pharmacokinetic (PK) and pharmacodynamic properties of propofol and the availability of short-acting synthetic opioids. Also, new concepts in PK modeling and advances in computer technology have allowed the development of sophisticated delivery systems, which make control of anesthesia given by the i.v. route as straightforward and user friendly as conventional, inhalational techniques. Monitoring of depth of anesthesia is being validated for these techniques, and in the future, measurements of expired propofol may be possible to guide administration. TIVA is being used increasingly in children. [source] Effects of dexmedetomidine on intraoperative motor and somatosensory evoked potential monitoring during spinal surgery in adolescentsPEDIATRIC ANESTHESIA, Issue 11 2008JOSEPH D. TOBIAS MD Summary Background:, Dexmedetomidine may be a useful agent as an adjunct to an opioid,propofol total intravenous anesthesia (TIVA) technique during posterior spinal fusion (PSF) surgery. There are limited data regarding its effects on somatosensory (SSEPs) and motor evoked potentials (MEPs). Methods:, The data presented represent a retrospective review of prospectively collected quality assurance data. When the decision was made to incorporate dexmedetomidine into the anesthetic regimen for intraoperative care of patients undergoing PSF, a prospective evaluation of its effects on SSEPs and MEPs was undertaken. SSEPs and MEPs were measured before and after the administration of dexmedetomidine in a cohort of pediatric patients undergoing PSF. Dexmedetomidine (1 ,g·kg,1 over 20 min followed by an infusion of 0.5 ,g·kg,1·h,1) was administered at the completion of the surgical procedure, but prior to wound closure as an adjunct to TIVA which included propofol and remifentanil, adjusted to maintain a constant depth of anesthesia as measured by a BIS of 45,60. Results:, The cohort for the study included nine patients, ranging in age from 12 to 17 years, anesthetized with remifentanil and propofol. In the first patient, dexmedetomidine was administered in conjunction with propofol at 110 ,g·kg,1·min,1 which resulted in a decrease in the bispectral index from 58 to 31. Although no significant effect was noted on the SSEPs (amplitude or latency) or the MEP duration, there was a decrease in the MEP amplitude. The protocol was modified so that the propofol infusion was incrementally decreased during the dexmedetomidine infusion to achieve the same depth of anesthesia. In the remaining eight patients, the bispectral index was 52 ± 6 at the start of the dexmedetomidine loading dose and 49 ± 4 at its completion (P = NS). There was no statistically significant difference in the MEPs and SSEPs obtained before and at completion of the dexmedetomidine loading dose. Conclusion:, Using the above-mentioned protocol, dexmedetomidine can be used as a component of TIVA during PSF without affecting neurophysiological monitoring. [source] A combination of total intravenous anesthesia and thoracic epidural for thymectomy in juvenile myasthenia gravisPEDIATRIC ANESTHESIA, Issue 4 2007OLIVER BAGSHAW MBChB FRCAArticle first published online: 12 DEC 200 Summary Juvenile myasthenia gravis is the acquired form of the disease in children and presents with ocular signs, fatigability, weakness and bulbar problems. The majority of patients demonstrate thymic hyperplasia and have been shown to benefit from thymectomy. The main considerations for the anesthesiologist are the degree of muscle weakness, the muscle groups involved and sensitivity to neuromuscular blocking drugs and volatile agents. Total intravenous anesthesia (TIVA) with epidural analgesia is probably the anesthetic technique of choice, although the latter is often avoided, because of the risk of a very high block. Two cases of thymectomy are presented where anesthesia was provided using a combination of TIVA and thoracic epidural analgesia. Both patients tolerated the technique well and had an uncomplicated perioperative course. [source] | ||||||||||