Adequacy of Anesthesia Guidance for Colonoscopy Procedures

Abstract

In patients undergoing colonoscopy procedures (CPs), inadequate dosing of hypnotic drugs (HD) and opioid analgesics (OA) during intravenous sedoanalgesia (ISA) may lead to intraprocedural awareness with recall (IAwR), intraprocedural (IPP) and postprocedural pain (PPP), as well as postoperative nausea and vomiting (PONV). The aim of this study was to evaluate whether the titration of HD and OA based on the observance of changing values of state entropy (SE) and surgical pleth index (SPI) (adequacy of anesthesia—AoA), state entropy alone, or standard practice may reduce the number of adverse events. One hundred and fifty-eight patients were included in the final analysis. The rate of IAwR and IPP was statistically more frequent in patients from the C group in comparison with the AoA and SE groups (p < 0.01 and p < 0.05, respectively). In turn, the rate of PPP, PONV, and patients’ and operators’ satisfaction with ISA between groups was not statistically significant (p > 0.05). Changes in hemodynamic parameters, demand for HD, and OA were statistically significant, but of no clinical value. In patients undergoing CPs under ISA using propofol and FNT, as compared to standard practice, intraprocedural SE monitoring reduced the rate of IAwR and IPP, with no influence on the rate of PPP, PONV, or patients’ and endoscopists’ satisfaction. AoA guidance on propofol and FNT titration, as compared to SE monitoring only, did not reduce the occurrence of the aforementioned studied parameters, imposing an unnecessary extra cost.

Adverse Events during Vitrectomy under Adequacy of Anesthesia—An Additional Report

“…Therefore, similarly to our previous studies, we adopted a methodology in which the intraprocedural increase in SPI value by 15, from the baseline calculated during the calibration of an SPI sensor, between LMA installation and start of the VRS (stage 2), constituted an indication to administer a single rescue dose of intravenous FNT [ 51 , 52 ]. Finally, an in-depth analysis of the risk factors for the occurrence of PONV and OCR in patients with certain comorbidities undergoing PPV under AoA-guided GA will be published separately due to the word count limit, vast volume of collected data, and complexity of analysis.…”

“…The study was conducted according to the guidelines of the Declaration of Helsinki, and approved by the Institutional Review Board of the Bioethical Committee of Medical University of Silesia (protocol code KNW/0022/KB1/101/15 and date of approval 29th of September 2015). The project was registered in the Clinical Trial Registry (SilesianMUKOAiIT2, NCT02973581) and received the same approval as that from previous studies [ 24 , 50 , 51 ].…”

Adequacy of Anesthesia and Pupillometry for Endoscopic Sinus Surgery

“…Although the anesthetic regimen of SPI-guided remifentanil infusion is usually based on the assumption that any SPI value > 50 or intraoperative delta SPI > 10 constitutes an indication of the acceleration of remifentanil infusion [38], we adopted a more liberal protocol (delta SPI >15 as compared with mean SPI value before the start of FESS, stage 2) to avoid potential miscalculations and hazardous uncontrolled hypotension and bradycardia [18,[39][40][41][42][43]. We have applied the same methodology in several recently published studies [44][45][46][47]. Furthermore, a stricter protocol could possibly have led to even more impressive intraoperative outcomes at the cost of excluding ASA III patients, limiting the application of these novel techniques, or imposing unnecessary risks of perioperative complications [47].…”

Adverse Events during Vitreoretinal Surgery under Adequacy of Anesthesia Guidance—Risk Factor Analysis

“…Its administration could have proportionally affected the final rate of incidence of PONV. Third, as shown in the current literature, there is no consistent algorithm for the titration of IRNA available, which could be due to the on-line observation of fluctuations in the SPI value [59]; therefore, we adopted a methodology of IRNA titration from our previous studies [60][61][62][63][64].…”

“…The study was conducted according to the guidelines of the Declaration of Helsinki and approved by the Institutional Review Board of the Bioethical Committee of the Medical University of Silesia (protocol code KNW/0022/KB1/101/15 and date of approval 29 September 2015). The project was registered in the Clinical Trial Registry (SilesianMUKOAiIT2, NCT02973581) and received the same approval as previous studies [11,12,60,61]. Informed consent was obtained from all patients recruited.…”