BIS response to tamponade and dobutamine in swine varies with hypnotic/opiate ratio

Beydon, L.; Desfontis, Jean‐Claude; Ganster, F.; Petres, J.; Gautier, Freddy; Ferec, Séverine; Cailleux, A.; Dussaussoy, C.; Liu, N.; Chazot, Thierry; Fischler, Marc; Gogny, Marc

doi:10.1016/j.annfar.2009.05.014

Cited by 4 publications

(1 citation statement)

References 29 publications

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“…Beydon et al [ 74 ] who studied bispectral index stability in response to haemodynamic instability, suggested that a propofol-remifentanil TIVA with a lower dose propofol (8.4 mg/kg/h) and a higher dose of remifentanil (0.54 µg/kg/min) provides a more stable anaesthetic depth compared to propofol-remifentanil TIVA with a higher dose of propofol (26.7 mg/kg/h) and lower dose of remifentanil (0.34 µg/kg/min). Relative to the findings made by Beydon et al [ 74 ], Boezaart et al [ 68 ] used a very low dose of propofol for maintenance (3 mg/kg/h) and a low dose of remifentanil, while the remainder of articles reviewed here, used a low–mid range propofol dose and a low remifentanil dose (Table 3 ). Silva et al [ 71 ] defined a stable level of anaesthesia as total muscle relaxation, absence of palpebral reflex, and absence of hemodynamic response to interdigital space clamping.…”

Section: Reviewmentioning

confidence: 99%

Effect of propofol and remifentanil on cerebral perfusion and oxygenation in pigs: a systematic review

et al. 2015

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The objective of this review is to evaluate the existing literature with regard to the influence of propofol and remifentanil total intravenous anaesthesia (TIVA) on cerebral perfusion and oxygenation in healthy pigs. Anaesthesia has influence on cerebral haemodynamics and it is important not only in human but also in veterinary anaesthesia to preserve optimal regulation of cerebral haemodynamics. Propofol and remifentanil are widely used in neuroanaesthesia and are increasingly used in experimental animal studies. In translational models, the pig has advantages compared to small laboratory animals because of brain anatomy, metabolism, neurophysiological maturation, and cerebral haemodynamics. However, reported effects of propofol and remifentanil on cerebral perfusion and oxygenation in pigs have not been reviewed. An electronic search identified 99 articles in English. Title and abstract screening selected 29 articles for full-text evaluation of which 19 were excluded with reasons. Of the 10 peer-reviewed articles included for review, only three had propofol or remifentanil anaesthesia as the primary study objective and only two directly investigated the effect of anaesthesia on cerebral perfusion and oxygenation (CPO). The evidence evaluated in this systematic review is limited, not focused on propofol and remifentanil and possibly influenced by factors of potential importance for CPO assessment. In one study of healthy pigs, CPO measures were within normal ranges following propofol-remifentanil anaesthesia, and addition of a single remifentanil bolus did not affect regional cerebral oxygen saturation (rSO2). Even though the pool of evidence suggests that propofol and remifentanil alone or in combination have limited effects on CPO in healthy pigs, confirmative evidence is lacking.

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Section: Reviewmentioning

confidence: 99%

Effect of propofol and remifentanil on cerebral perfusion and oxygenation in pigs: a systematic review

et al. 2015

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Effects of cerebral hypoperfusion on bispectral index: A randomised, controlled animal experiment during haemorrhagic shock

et al. 2010

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The Influence of Hemorrhagic Shock on the Disposition and Effects of Intravenous Anesthetics: A Narrative Review

Egan

Johnson

2020

Anesthesia &Amp; Analgesia

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The need to reduce the dose of intravenous anesthetic in the setting of hemorrhagic shock is a well-established clinical dogma. Considered collectively,; the body of information concerning the behavior of intravenous anesthetics during hemorrhagic shock, drawn from animal and human data, confirms that clinical dogma and informs the rational selection and administration of intravenous anesthetics in the setting of hemorrhagic shock. The physiologic changes during hemorrhagic shock can alter pharmacokinetics and pharmacodynamics of intravenous anesthetics. Decreased size of the central compartment and central clearance caused by shock physiology lead to an altered dose-concentration relationship. For most agents and adjuncts, shock leads to substantially higher concentrations and increased effect. The notable exception is etomidate, which has relatively unchanged pharmacokinetics during shock. Increased concentrations lead to increased primary effect as well as increased side effects, notably cardiovascular effects. Pharmacokinetic changes are essentially reversed for all agents by fluid resuscitation. Propofol is unique among agents in that, in addition to the pharmacokinetic changes, it exhibits increased potency during shock. The pharmacodynamic changes of propofol persist despite fluid resuscitation. The persistence of these pharmacodynamic changes during shock is unlikely to be due to increased endogenous opiates, but is most likely due to increased fraction of unbound propofol. The stage of shock also appears to influence the pharmacologic changes. The changes are more rapid and pronounced as shock physiology progresses to the uncompensated stage. Although scant, human data corroborate the findings of animal studies. Both the animal and human data inform the rational selection and administration of intravenous anesthetics in the setting of hemorrhagic shock. The well-entrenched clinical dogma that etomidate is a preferred induction agent in patients experiencing hemorrhagic shock is firmly supported by the evidence. Propofol is a poor choice for induction or maintenance of anesthesia in severely bleeding patients, even with resuscitation; this can include emergent trauma cases or scheduled cases that routinely have mild or moderate blood loss.

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BIS response to tamponade and dobutamine in swine varies with hypnotic/opiate ratio

Cited by 4 publications

References 29 publications

Effect of propofol and remifentanil on cerebral perfusion and oxygenation in pigs: a systematic review

Effect of propofol and remifentanil on cerebral perfusion and oxygenation in pigs: a systematic review

Effects of cerebral hypoperfusion on bispectral index: A randomised, controlled animal experiment during haemorrhagic shock

The Influence of Hemorrhagic Shock on the Disposition and Effects of Intravenous Anesthetics: A Narrative Review

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