EEG-Powerspektren und evozierte Potentiale unter Alfentanil/Midazolam-Analgosedierung bei Intensivpatienten

Freye, Enno; Neruda, B; Falke, K. J.

doi:10.1055/s-2007-1000605

Cited by 14 publications

(3 citation statements)

References 8 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…These reports suggest that BIS levels correlate well with depth of sedation [4,5]. Only a few investigators have studied the validity of BIS monitoring in ICU patients, but a correlation between BIS levels and sedation scales in ICU patients has been reported for various agents [6,7]. …”

Section: Introductionmentioning

confidence: 99%

Untitled

et al. 2003

View full text Add to dashboard Cite

Correspondence: Dilek Memis ², dilmemis@mynet.com R123 APACHE = Acute Physiology and Chronic Health Evaluation; BIS = bispectral index; ICU = intensive care unit. AbstractIntroduction In intensive care unit patients we assessed, using bispectral index (BIS) monitoring, whether the addition of magnesium sulphate infusion could decrease the sufentanil infusion required to maintain sedation. Patients and methods A total of 30 adult patients who were expected to require machanical ventilation for 6 hours in the intensive care unit were randomly assigned to receive either sufentanil infusion or sufentanil plus magnesium infusion. We monitored BIS levels continously. BIS levels in the range 61-88 are required to maintain a state of sedation, and in both groups BIS levels were kept within this range by increasing or decreasing the sufentanil infusion. Hourly consumption of sufentanil was monitored. Cardiovascular, respiratory and biochemical data were recorded. Results There was no significant difference between the groups with respect to cardiovascular, respiratory and biochemical parameters. Magnesium infusion, when added to sufentanil infusion, decreased the consumption of sufentanil at all times accept during the first hour (P < 0.001). There was no significant difference in BIS values between the groups (P > 0.05). Conclusion This is the first clinical study to demonstrate that magnesium sulphate infusion decreases sufentanil requirements. Because of the limited number of patients included and the short period of observation, our findings must be confirmed by larger clinical trials of magnesium infusion titrated to achieve prespecified levels of sedation. Furthermore, randomized clinical studies are needed to determine the effects of magnesium infusion on opioids.

show abstract

Section: Introductionmentioning

confidence: 99%

Untitled

et al. 2003

View full text Add to dashboard Cite

show abstract

“…To determine the sample size necessary for calculation of statistical significance, a priori power analysis seemed appropriate, because comparable data for SSEP and EEG measurements in ICU patients using combined opioid-benzodiazepine sedation exists [26]. From the standard deviation of these parameters it was possible to compute the sample size per group with an alpha of .05, a beta of 23, and by using compromised power analysis, a power of 80% was calculated when a sample size of at least 14 patients per group was used.…”

Section: Discussionmentioning

confidence: 99%

Withdrawal following sufentanil/propofol and sufentanil/midazolam

et al. 2005

View full text Add to dashboard Cite

The endorphinergic system is suppressed when a potent exogenous opioid like sufentanil is given over a long period of time. Following sedation, abstinence symptoms seem to be related to postinhibitory increased endorphin synthesis. This is mostly seen in the combination of sufentanil/midazolam. In addition, an increase in the amplitude of the sensory-evoked potential suggests a postinhibitory excitatory state within the nociceptive system.

show abstract

“…Im Elektroenzephalogramm war unter Alfentanil die für Opioide typische δund θ-Akzentuierung in allen Alfentanil zeigte dagegen eine für Opioide charakteristische dosisabhängige Amplitudensuppression im evozierten Potential, die sowohl beim Menschen [18] als auch beim Hund [40] und Kaninchen [22] nachgewiesen werden konnte. Als Wirkmechanimus kann eine durch die Rezeptorbesetzung an den Synapsen erfolgte Dämpfung der Freisetzung von Neurotransmitter diskutiert werden [13], die den Impulsstrom zum sensorischen Kortex dämpfen.…”

Section: Ergebnisseunclassified

Das Opioid Tramadol hat zentral-exzitatorische Effekte von nicht-opioidartigem Charakter

et al. 1998

Self Cite

View full text Add to dashboard Cite

Tramadol, an analgesic with mean potency one tenth that of morphine is used regularly for the treatment of chronic and postoperative pain. Previous reports have indicated that tramadol may induce seizure activity when given together with a selective serotonin reuptake inhibitor (SSRI). Therefore, its major mode of action may be questioned which purportedly is due to binding with the opioid receptor and partly due to the inhibition of monoamine reuptake. We therefore set out to study its potential in inducing seizure activity and to quantify its effect on EEG-power spectra and on the central modulation of sensory afferents in awake and trained dogs (n=7). In order to demonstrate if opioid receptors mediated these effects, incremental doses of tramadol were given which was followed by naloxone for possible reversal. After a wash-out period the same animals were exposed to graded doses of alfentanil, a pure mu-receptor agonist. Again this was followed by the opioid antagonist naloxone for reversal.The electroencephalogram (EEG) and the event-related evoked potentials (SEP) were used to demonstrate possible excitatory effects. In order to derive the SEP the front paw was stimulated electrically (Digi Stim II trade mark ) while the evoked potentials were picked up contralaterally from the somatosensory cortex using stick-on electrodes. 256 sweeps were averaged (Lifescan) and the peak-to-peak amplitude was measured to demonstrate CNS excitation compared to control (%). Additionally, the raw electroencephalogram was viewed for epileptogenic changes and its power computed into the various power bands alpha, beta, delta und theta using FFT over a time epoch of 60 s. Following control, graded doses of either tramadol (2-5-10 mg/kg i.v.) or alfentanil (10-30-60 microg/kg i.v.) were given every 15 min while the EEG and the SEP were recorded. Thereafter naloxone (20 microg/kg i.v.) was injected for reversal. Tramadol did not suppress the amplitude of the SEP at any dose. High doses (>5 mg/kg i.v.) resulted in an increase (+100%) of the amplitude of the evoked potential. This was accompanied by short-term muscle fibrillations, and a short-term spike-and-wave activity in the EEG followed by a long-lasting theta-dominance. These effects could not be reversed by naloxone. In contrast to tramadol, alfentanil induced a dose-related depression of amplitude in the SEP with a maximum of 82% suggesting a depressive effect of modulation of afferents in the sensory cortex. This effect was fully naloxone reversible and was followed by a rebound in amplitude of the SEP together with an increase in fast beta-waves in the EEG. Tramadol very little mediates its central action via the mu-opioid receptor as the present effects were not naloxone reversible. Consistent with the results is the very low affinity of tramadol to the opioid receptor which is several thousand times less than that of morphine. Most likely, inhibition of central norepinephrine and serotonin reuptake as well as the reduction in 5-HT-turnover may contribute to the effects ...

show abstract

EEG-Powerspektren und evozierte Potentiale unter Alfentanil/Midazolam-Analgosedierung bei Intensivpatienten

Cited by 14 publications

References 8 publications

Untitled

Untitled

Withdrawal following sufentanil/propofol and sufentanil/midazolam

Das Opioid Tramadol hat zentral-exzitatorische Effekte von nicht-opioidartigem Charakter

Contact Info

Product

Resources

About