Hyperbaric bupivacaine affects the doses of midazolam required for sedation after spinal anaesthesia

Toprak, Hüseyin; Özpolat, Zekine; Öztürk, Erkut; Ülger, M. Hacer; Sağır, Özlem; Ersoy, M. Özcan

doi:10.1017/s0265021505001535

Cited by 9 publications

(10 citation statements)

References 8 publications

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“…found that patients with a higher spinal block experienced increased sedation , whereas Toprak et al . reported that spinal anaesthesia caused a reduction in the requirement for midazolam, but this dose reduction was not correlated with the level of the sensory block . Our results support the findings of Gentili et al .…”

Section: Discussionsupporting

confidence: 88%

Modelling of the Sedative Effects of Propofol in Patients undergoing Spinal Anaesthesia: A Pharmacodynamic Analysis

Roh

Youngsoon

et al. 2016

Basic Clin Pharma Tox

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Sedation can increase patient comfort during spinal anaesthesia. Understanding the relationship between the propofol effect-site concentration (Ce) and patient sedation level could help clinicians achieve the desired sedation level with minimal side effects. We aimed to model the relationship between the propofol Ce and adequate and deep sedation and also incorporate covariates. Thirty patients scheduled for orthopaedic surgery received spinal anaesthesia with 0.5% bupivacaine. Propofol was administered via an effect-site target-controlled infusion device using the Schnider pharmacokinetic model. The pharmacodynamic models for both adequate sedation [Observer's Assessment of Alertness/Sedation (OAA/S) scores of 3-4] and deep sedation (OAA/S scores of 1-2) were developed using nonlinear mixed-effects modelling. Increments in the propofol Ce were associated with increased depths of sedation. In the basic model, the estimated population Ce 50 values for adequate and deep sedation were 0.94 and 1.52 lg/ml, respectively. The inclusion of the patient's age and sensory block level for adequate sedation and of age for deep sedation as covariates significantly improved the basic model by decreasing the objective function's minimum value from 10696.72 to 10677.92 (p = 0.0003). The simulated Ce 50 values for adequate sedation in 20-year-old patients with a T 12 sensory level and in 80-year-old patients with a T 4 level were 1.63 and 0.53 lg/ml, respectively. Both age and sensory block level should be considered for adequate sedation, and the propofol concentration should be reduced for elderly patients with a high spinal block to avoid unnecessarily deep levels of sedation.Propofol is one of the most commonly used drugs for sedation during spinal anaesthesia because of its rapid onset, easy titration and rapid offset. However, propofol frequently induces unnecessary deep sedation or side effects such as respiratory and cardiovascular depression because it has a narrow therapeutic range [1][2][3]. The use of a target-controlled infusion (TCI) system for propofol administration allows rapid induction and safe maintenance of the desired level of sedation, thereby making it ideal for technically demanding procedures [4][5][6]. Understanding the concentration-response relationship of sedation is fundamental for the safe use of propofol with incorporating factors influencing the sedative effect. However, few studies have evaluated the quantitative relationship between the effect-site concentration (Ce) of propofol and its sedative effect under spinal anaesthesia, although propofol is considered to induce sedation in a dose-dependent manner [7]. Therefore, we attempted to model the relationship between propofol Ce and sedation and also to characterize the covariates in the pharmacodynamic relationship between propofol Ce and adequate and deep sedation in patients undergoing spinal anaesthesia. Materials and MethodsStudy population. This study was approved by the ethics committee of the Yonsei University Health System (4...

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Section: Discussionsupporting

confidence: 88%

Modelling of the Sedative Effects of Propofol in Patients undergoing Spinal Anaesthesia: A Pharmacodynamic Analysis

Roh

Youngsoon

et al. 2016

Basic Clin Pharma Tox

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“…(5) Furthermore, neural blocks performed by local anesthetics cause somnolence even in the absence of systemic sedatives. (9) Eappen et al demonstrated that in rats subarachnoid bupivacaine reduced anesthetic requirements for thiopental.…”

Section: Discussionmentioning

confidence: 99%

“…(3)(4)(5) The literature includes studies assessing the effect of the change in the local anesthetic and consequent varying levels of sensation under propofol sedation during spinal anesthesia. Yang et al reported that varicose vein surgery patients having spinal anesthesia with hyperbaric tetracaine demonstrated lower propofol requirements than the ones for whom equal doses of isobaric tetracaine were used.…”

Section: Introductionmentioning

confidence: 99%

Comparison of the Effects of Bupivacaine and Levobupivacaine Used in Spinal Anesthesia on Propofol Requirement in BIS Guided Sedation

Şahin¹,

Kesimci²,

İzdeş³

et al. 2012

J Turk Anaesth Int Care

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SUMMARYObjective: This study was designed to compare the effects of equivalent doses of bupivacaine and levobupivacaine on propofol requirement in BIS guided sedation under spinal anesthesia.Material and Methods: Spinal anesthesia was performed on seventy patients scheduled for elective lower limb surgery with 3 mL's of either isobaric bupivacaine (Group B) or plain levobupivacaine (Group L). Five minutes after induction of spinal anesthesia, propofol infusion was started at 100 µg/kg/min and titrated to maintain bispectral index (BIS) score in the range of 65-75. Onset (to reach BIS ≤ 75) and recovery (the time from cessation of propofol infusion until BIS=90) time for sedation, and total propofol consumption during this time interval were recorded as well as time to recovery from sensory and motor block, length of stay (LOS) and sedation scores (OAA/S) in the postanesthesia care unit (PACU). Data were analyzed with One way ANOVA, Mann Whitney-U, Student's t and x 2 tests. Results: BIS was significantly decreased in Group B compared to Group L at 10 and 15 min after spinal anesthesia (p<0.01). The maximum sensory block level was higher, while time to reach maximum motor block level was shorter in Group B (p<0.05, p<0.001 respectively). Offset time of sensory and motor block, recovery time and LOS in PACU were significantly increased in Group L (p<0.05).Conclusion: Plain bupivacaine provides higher sensory block with faster onset of motor block, independent of propofol requirement as assessed by BIS monitorization. 'dan başlatılıp BİS 65-75 olacak şekilde titre edildi. Başlangıç zamanı (BİS 75'e düşünceye kadar geçen süre), derlenme süresi (propofol kesildikten BİS 90 olana kadar geçen süre), bu sırada tüketilen toplam propofol miktarı ile derlenme ünitesinde kalma süresi, sedasyon düzeyi (OAA/S), duyusal ve motor blok dönme zamanları kaydedildi. İstatistiksel analizde One way ANOVA, Mann Whitney-U, Student's t and x 2 testleri kullanıldı. Bulgular: Spinal anestezi sonrası 10. ve 15. dk.'larda BİS değerlerinin Grup B'de, Grup L'ye göre anlamlı düşük olduğu saptandı (p<0.01). Maksimum duyusal blok seviyesi Grup B'de Grup L'ye göre anlamlı yüksek, maksimum motor blok düzeyine ulaşma süresinin ise Grup L'de Grup B'ye göre anlamlı uzun olduğu belirlendi (p<0.05, p<0.001). Duyusal ve motor bloğun tam dönme süresi, derlenme süresi ve derlenmede kalış süresi Grup L'de Grup B'ye göre anlamlı olarak uzundu (p<0.05).Sonuç: Bupivakain BIS monitorizasyonu ile takip edilen sedasyonda propofol tüketiminden bağımsız olarak, yüksek duyusal blok seviyesi, erken motor blok başlangıcı sağlamaktadır.Anahtar kelimeler: spinal anestezi, lokal anestezikler, bupivakain, levobupivakain, sedatifler, propofol, sedasyon

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“…Depth of sedation correlates with BIS scores; however, inconsistencies have been reported [2][3][4]. Intrapatient variability of approximately ±20 BIS units (two standard deviations) has been shown; thus, a BIS score of 55 could represent an actual BIS value of anywhere between 35 to 75 [2].…”

Section: General Anesthesia Is Not Defined By a Bis Levelmentioning

confidence: 99%

“…Propofol-based sedation combined with spinal anesthesia may easily turn into general anesthesia. We would like to add that spinal anesthesia by itself induces sedation related to the sensory level block [3,4] and enhances the pharmacokinetic effects of propofol in the animal model; spinally administered local anesthetic blockade decreases anesthetic requirements due to decreased afferent input [5]. Sedation during neuraxial block is associated with detectable bispectral index score modifications and blockdependent alterations in the brainstem auditory evoked responses; central nervous system (CNS) alertness is depressed through mechanisms related to decreased brainstem neural activity [6].…”

mentioning

confidence: 99%

Spinal anesthesia-induced sedation may obviously facilitate general anesthesia

Gentili

Enel

Bonnet³

2011

Journal of Clinical Anesthesia

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Hyperbaric bupivacaine affects the doses of midazolam required for sedation after spinal anaesthesia

Cited by 9 publications

References 8 publications

Modelling of the Sedative Effects of Propofol in Patients undergoing Spinal Anaesthesia: A Pharmacodynamic Analysis

Modelling of the Sedative Effects of Propofol in Patients undergoing Spinal Anaesthesia: A Pharmacodynamic Analysis

Comparison of the Effects of Bupivacaine and Levobupivacaine Used in Spinal Anesthesia on Propofol Requirement in BIS Guided Sedation

Spinal anesthesia-induced sedation may obviously facilitate general anesthesia

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