Comparison of 1.5% lidocaine and 0.5% ropivacaine epidural anesthesia combined with propofol general anesthesia guided by bispectral index

Abstract

Abstract:Objective: To compare the effects of epidural anesthesia with 1.5% lidocaine and 0.5% ropivacaine on propofol requirements, the time to loss of consciousness (LOC), effect-site propofol concentrations, and the hemodynamic variables during induction of general anesthesia guided by bispectral index (BIS) were studied. Methods: Forty-five patients were divided into three groups to receive epidurally administered saline (Group S), 1.5% (w/w) lidocaine (Group L), or 0.5% (w/w) ropivacaine (Group R). Propofol infusion was started to produce blood concentration of 4 µg/ml. Once the BIS value reached 40~50, endotracheal intubation was facilitated by 0.1 mg/kg vecuronium. Measurements included the time to LOC, effect-site propofol concentrations, total propofol dose, mean arterial blood pressure (MABP), and heart rate (HR) at different study time points. Results: During induction of anesthesia, both Groups L and R were similar for the time to LOC, effect-site propofol concentrations, total propofol dose, MABP, HR, and BIS. The total doses of propofol administered until 1 min post-intubation were significantly less in patients of Groups R and L compared with Group S. MABP and HR were significantly lower following propofol induction compared with baseline values in the three groups, or MABP was significantly increased following intubation as compared with that prior to intubation in Group S but not in Groups R and L while HR was significantly increased following intubation in the three groups. Conclusion: Epidural anesthesia with 1.5% lidocaine and 0.5% ropivacaine has similar effects on the time to LOC, effect-site propofol concentrations, total propofol dose, and the hemodynamic variables during induction of general anesthesia.

Propofol protects human cardiac cells against chemical hypoxiainduced injury by regulating the JNK signaling pathways

“…However, side effects are inevitable and include irregular heart rate, low blood pressure, burning sensation at the site of injection and suppression of breathing (26). Combined application of epidural anesthesia, such as ropivacaine and lidocaine, may reduce the propofol doses required for the induction and maintenance of anesthesia, and further reduce its side effects in clinical practice (27,28). The present study investigated the effects of propofol and/or ropivacaine on cardiomyocytes in vitro under normoxic or CoCl 2 -induced hypoxic conditions.…”

Epidural ropivacaine with dexmedetomidine reduces propofol requirement based on bispectral index in patients undergoing lower extremity and abdominal surgeries

“…[ 4 ] Also, there are multiple studies that have shown that there is a significant reduction in the propofol dose required for induction of anesthesia. [ 1 5 ] BIS is used to measure the depth of anesthesia. We titrated the BIS value to 45–55 to avoid awareness.…”

“…Sample size calculation: A study carried out by Xiang and Li. [ 1 ] in 2007 has found that the time to loss of consciousness with propofol in ropivacaine group to be 111 s (standard deviation = 17). Based on the above finding the sample size for the present study was estimated with a relative precision of 6% and desired confidence level of 95%, it was estimated that 30 patients need to be included in ropivacaine group.…”

“…There is a reduced general anesthetics requirement during surgery when the two techniques are combined. [ 1 ] Alpha-2 adrenergic receptor agonists like dexmedetomidine have been the focus of interest for their sedative, analgesic, perioperative sympatholytic, and cardiovascular stabilizing effects with reduced anesthetic requirements. [ 2 ] Intraoperative uses of dexmedetomidine include its uses as adjunct to general anesthesia, epidural, intrathecal, brachial plexus block, caudal anesthesia, and monitored anesthesia care or as an adjuvant for total intravenous (IV) anesthesia.…”

Effect of electrokinetic stabilizers on the physicochemical properties of propofol emulsions

“…There have been many reports to reduce propofol injection pain, and combination therapy using various drugs, such as ketamine (Bano et al, 2007;Saadawy et al, 2007), metoprolol (Asik et al, 2003), metoclopramide (Fujii and Nakayama, 2005), bupivacaine (Senturk et al, 2002), dexamethasone (Kwak et al, 2008), remifentanil (Kwak et al, 2007a,b;Roehm et al, 2003), ropivacaine (Xiang and Li, 2007), alfentanil (Fang and Keyes, 2006), dexmedetomidine (Turan et al, 2005) and flurbiprofen (Fujii and Nakayama, 2004) have been suggested for the prevention of propofol pain. Consequently, our results can provide further insight into the physicochemical stability of propofol emulsions containing other drugs, and these data can also help clinical researchers gain a better understanding of propofol's administration in existing applications.…”