Należy cytować anglojęzyczną wersję artykułu z: Karwacki Z, Niewiadomski S, Rzaska M, Witkowska M: The effect of bispectral index monitoring on anaesthetic requirements in target--controlled infusion for lumbar microdiscectomy. Anaesthesiol Intensive Ther 2014; 46: 284-288 Wpływ monitorowania indeksu bispektralnego na dawkowanie środków anestetycznych w docelowej infuzji kontrolowanej do operacji dysków lędźwiowychThe effect of bispectral index monitoring on anaesthetic requirements in target-controlled infusion for lumbar microdiscectomy Zbigniew Karwacki, Seweryn Niewiadomski, Marta Rzaska, Małgorzata Witkowska Zakład Neuroanestezjologii Gdańskiego Uniwersytetu Medycznego AbstractBackground: 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, SaO 2 , ETCO 2, and the degree of neuromuscular blockade were monitored, specifically at the following time points: T 1 -before induction, T 2 -after induction, T 3 -after intubation, T 4 -after positioning of the patient, T 5 -T 13 -every 5 min during surgery, T 14 -on completion of surgery, T 15 -before extubation, T 16 -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 T 1 and T 2 , T 2 and T 3 , T 3 and T 4 as well as T 14 and T 15 . 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.
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 vecuroniuminduced effects following intracranial surgery. Method: 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.
Central nervous system (CNS) infections may involve the meninges, brain and/or spinal cord. The most common etiologic agents are Streptococcus pneumoniae, group B Streptococci, Neisseria meningitidis, Haemophilus influenzae, and Listeria monocytogenes. CNS is characterized by specific structure and function. Despite a unique system of brain barriers and autonomous immune system, CNS is very susceptible to microorganisms which may invade directly, via the blood, or less frequently by reverse axonal transport. The complex process of bacteria and activated polymorphonuclear leukocyte transfer to the subarachnoid space, which is devoid of natural immune defence mechanisms, initiates an inflammatory response that subsequently spreads to the brain tissue. Consequences of these changes include damage to the blood-brain barrier, development of vasogenic cerebral oedema, and intracranial pressurevolume disturbances leading to impaired CNS perfusion.
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