Highlights
The incidence of seizure activity was 10%.
Seizure activity was detected within the first 30 min in three of the five patients.
Markers for patient selection for cEEG in neurosurgical patients are needed.
During general anesthesia, different modes of nerve stimulation are used for estimation of the degree of neuromuscular blockade. When switching between the different modes, it is important to know whether the preceding mode influences the responses to the succeeding mode, and if so, for how long. The object of our study was to determine the number of stimulations required for stabilization of the muscular response when switching between double-burst stimulation (DBS) applied every 20 sec, train-of-four (TOF) applied every 12 sec, and posttetanic count (PTC) at surgical degrees of neuromuscular blockade. A total of 33 women were anesthetized with fentanyl, thiopental, halothane, and nitrous oxide. A constant degree of neuromuscular blockade was maintained at a twitch height of 4 to 11% of the control twitch height using a continuous infusion of atracurium. The ulnar nerve was stimulated supramaximally at the wrist, and the contraction in the adductor pollicis was measured mechanomyographically. At surgical degrees of neuromuscular blockade, only the first twitch response to TOF stimulation (T1) and the first twitch response to DBS stimulation (D1) are consistently present. When switching from DBS to TOF, 4 to 7 stimulations (56 to 92 sec) were required for stabilization of the T1 response. When switching from TOF to DBS, 3 stimulations (36 to 52 sec) were required for stabilization of the D1 response, and, finally, when switching from PTC to DBS, 5 to 11 stimulations (81 to 201 sec) were required for stabilization of the D1 response. Stabilization of D1 was faster following TOF than following PTC (p < 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)
One hundred and twenty patients undergoing early legal termination of pregnancy by dilatation and suction curettage before 12 weeks of pregnancy were randomly allocated to receive total intravenous propofol anaesthesia either alone or supplemented with fentanyl 1.5 micrograms.kg-1 or alfentanil 15 micrograms.kg-1. Supplementation with fentanyl or alfentanil improved operating conditions (P < 0.01), reduced total propofol requirements (P < 0.01) and reduced postoperative pain intensity (P < 0.05). Immediate recovery, assessed by the time patients took to open the eyes, to give correct date of birth and by co-operation score, was more rapid in the alfentanil group compared to the control group (P < 0.05), whereas there was no significant difference between the alfentanil and fentanyl groups. The three anaesthetic techniques did not differ with regard to side effects. In conclusion, total intravenous propofol anaesthesia in patients undergoing early termination of pregnancy was improved by supplementation with either fentanyl 1.5 micrograms.kg-1 or alfentanil 15 micrograms.kg-1. The benefit was slightly greater with alfentanil than with fentanyl.
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