Document Detail


The effect of neuromuscular block and noxious stimulation on hypnosis monitoring during sevoflurane anesthesia.
MedLine Citation:
PMID:  17717224     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: There are conflicting results on the influence of neuromuscular block (NMB) on the bispectral index (BIS). We investigated the influence of two degrees of NMB on BIS, Alaris auditory-evoked potential index (AAI), and the electromyogram (EMG) obtained with needle electrodes from the frontal and temporal muscles, immediately adjacent to the BIS-sensor. METHODS: Twenty patients were anesthetized with sevoflurane, titrated for 30 min to an end-tidal concentration of 1.2% (baseline). Rocuronium was infused to 50% (partial) and 95% (profound) depression of the first twitch in a train-of-four response, the order being randomly chosen. Noxious tetanic electrical stimulation was applied at four occasions: 1) at baseline (control measurement), 2 and 3) at each degree of NMB, and 4) after neostigmine reversal. BIS, AAI, and EMG were obtained 2 min before and 2 min after each noxious stimulation. RESULTS: Median BIS and AAI at baseline were 44 (39-50) and 15 (14-16), respectively. The two degrees of NMB did not affect BIS, AAI, and EMG before noxious stimulation. In contrast, profound NMB altered the BIS and AAI responses to noxious stimulation when compared with partial NMB, (BIS P = 0.01, AAI P < 0.01), after neostigmine reversal (BIS P < 0.01, AAI P = 0.01) and compared with baseline (BIS P = 0.08, AAI P = 0.02). No significant increase in EMG was found. CONCLUSION: BIS and AAI responses to noxious tetanic electrical stimulation are affected by the degree of NMB during sevoflurane anesthesia whereas NMB does not affect BIS or AAI in the absence of noxious stimulation.
Authors:
Andreas Ekman; Erik Stålberg; Eva Sundman; Lars I Eriksson; Lars Brudin; Rolf Sandin
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Publication Detail:
Type:  Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Anesthesia and analgesia     Volume:  105     ISSN:  1526-7598     ISO Abbreviation:  Anesth. Analg.     Publication Date:  2007 Sep 
Date Detail:
Created Date:  2007-08-24     Completed Date:  2007-09-18     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  1310650     Medline TA:  Anesth Analg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  688-95     Citation Subset:  AIM; IM    
Affiliation:
Department of Physiology and Pharmacology, Section for Anesthesiology and Intensive Care Medicine, Karolinska Institute, Stockholm, Sweden. andrease@ltkalmar.se
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MeSH Terms
Descriptor/Qualifier:
Adult
Androstanols / administration & dosage,  pharmacology*
Anesthetics, Inhalation*
Brain / drug effects*
Cholinesterase Inhibitors / pharmacology
Consciousness / drug effects*
Electric Stimulation / methods
Electroencephalography
Electromyography
Evoked Potentials, Auditory / drug effects*
Female
Humans
Infusions, Intravenous
Male
Mental Recall / drug effects
Methyl Ethers*
Middle Aged
Monitoring, Intraoperative / methods
Neostigmine / pharmacology
Neuromuscular Nondepolarizing Agents / administration & dosage,  pharmacology*
Pain Threshold / drug effects*
Prospective Studies
Research Design
Time Factors
Ulnar Nerve
Chemical
Reg. No./Substance:
0/Androstanols; 0/Anesthetics, Inhalation; 0/Cholinesterase Inhibitors; 0/Methyl Ethers; 0/Neuromuscular Nondepolarizing Agents; 143558-00-3/rocuronium; 28523-86-6/sevoflurane; 59-99-4/Neostigmine

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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