Influence of infiltration anaesthesia on perioperative outcomes following lumbar discectomy under surgical pleth index-guided general anaesthesia: A preliminary report from a randomised controlled prospective trial

Stasiowski, Michał; Missir, Anna; Pluta, Aleksandra; Szumera, Izabela; Stasiak, Małgorzata; Szopa, Wojciech; Błaszczyk, Bartłomiej; Możdżyński, Bartłomiej; Majchrzak, Krzysztof; Tymowski, Michał; Niewiadomska, Ewa; Ładziński, Piotr; Krawczyk, Lech; Kaspera, Wojciech

doi:10.1016/j.advms.2019.12.006

Cited by 10 publications

(12 citation statements)

References 38 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…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.…”

Section: Discussionmentioning

confidence: 99%

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

Pluta

Stasiowski

Lyssek-Boroń

et al. 2021

JCM

Self Cite

View full text Add to dashboard Cite

The intraprocedural immobilization of selected subsets of patients undergoing pars plana vitrectomy (PPV) requires the performance of general anesthesia (GA), which entails the intraoperative use of hypnotics and titration of opioids. The Adequacy of Anesthesia (AoA) concept of GA guidance optimizes the intraoperative dosage of hypnotics and opioids. Pre-emptive analgesia (PA) is added to GA to minimize intraoperative opioid (IO) usage. The current additional analysis evaluated the advantages of PA using either COX-3 inhibitors or regional techniques when added to AoA-guided GA on the rate of presence of postoperative nausea and vomiting (PONV), oculo-emetic (OER), and oculo-cardiac reflex (OCR) in patients undergoing PPV. A total of 176 patients undergoing PPV were randomly allocated into 5 groups: (1) Group GA, including patients who received general anesthesia alone; (2) Group T, including patients who received preventive topical analgesia by triple instillation of 2% proparacaine 15 min before induction of GA; (3) Group PBB, including patients who received PBB; (4) Group M, including patients who received PA using a single dose of 1 g of metamizole; (5) Group P, including patients who received PA using a single dose of 1 g of acetaminophen. The incidence rates of PONV, OCR, and OER were studied as a secondary outcome. Despite the group allocation, intraoperative AoA-guided GA resulted in an overall incidence of PONV in 9%, OCR in 12%, and OER in none of the patients. No statistically significant differences were found between groups regarding the incidence of OCR. PA using COX-3 inhibitors, as compared to that of the T group, resulted in less overall PONV (p < 0.05). Conclusions: PA using regional techniques in patients undergoing PPV proved to have no advantage when AoA-guided GA was utilised. We recommend using intraoperative AoA-guided GA to reduce the presence of OCR, and the addition of PA using COX-3 inhibitors to reduce the rate of PONV.

show abstract

Section: Discussionmentioning

confidence: 99%

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

Pluta

Stasiowski

Lyssek-Boroń

et al. 2021

JCM

Self Cite

View full text Add to dashboard Cite

show abstract

“…Finally, the current literature provides no consistent algorithm for the titration of rescue opioid analgesics based on the observance of SPI value fluctuations online [ 35 ]. Therefore, similar to our previous study, we adopted a methodology where the intraprocedural increase of SPI value by 15% constituted an indication to administer a single rescue dose of intravenous FNT [ 21 ].…”

Section: Discussionmentioning

confidence: 99%

“…The most widely used are the Bispectral Index (BIS) and a State and Response Entropy EEG (SE & RE EEG) [ 17 , 18 , 19 , 20 ]. In recent years, the Surgical Pleth Index (SPI), a new method of objective assessment of nociception/antinociception balance, has been added to RE and SE order to serve together as the Adequacy of Anesthesia (AoA) concept, a new tool (SPI; GE Healthcare, Helsinki, Finland) that, with different success rates, has been proven useful to guide adequate anesthetic dosages for hypnosis as well as opioids for analgesia [ 21 , 22 , 23 ], aiming to reduce the occurrence of unwelcome adverse events [ 24 , 25 , 26 ].…”

Section: Introductionmentioning

confidence: 99%

Adequacy of Anesthesia Guidance for Colonoscopy Procedures

et al. 2021

Self Cite

View full text Add to dashboard Cite

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.

show abstract

“…Our study has several limitations. 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].…”

Section: Discussionmentioning

confidence: 99%

Adequacy of Anesthesia and Pupillometry for Endoscopic Sinus Surgery

Stasiowski

Szumera

Wardas

et al. 2021

JCM

Self Cite

View full text Add to dashboard Cite

Inadequate intraoperative analgesia causes the deterioration of the condition of the surgical field (CSF) as a result of hemodynamic instability. Analgesia monitors are used to guide remifentanil) infusion to optimize intraoperative analgesia. The main aim of the current randomized controlled trial was to investigate the potential advantages of intraoperative analgesia monitoring using surgical Pleth index (SPI)- or pupillometry (PRD)-guided remifentanil administration for managing the volume of total intraoperative blood loss (TEIBL), CSF, and length of operation (LOP) in comparison with the standard practice in patients undergoing endoscopic sinus surgery (ESS). The 89 patients in our study were grouped as follows: 30 patients were assigned to the general analgesia (GA) group, 31 patients were assigned to the SPI group, and 28 patients were assigned to the PRD group. The speed of remifentanil infusion was accelerated by 50% when SPI, PRD, or BSS were increased by >15 points, >5%, or >2, respectively, in adjacent groups until their normalization. The SPI group showed significantly lower TEIBL in comparison to the GA group (165.2 ± 100.2 vs. 283.3 ± 193.5 mL; p < 0.05) and a higher mean arterial pressure (MAP; 73.9 ± 8 vs. 69.2 ± 6.8 mmHg; p < 0.05). In the PRD group, a shorter LOP compared with the GA group was observed (63.1 ± 26.7 min vs. 82.6 ± 33.1 min; p < 0.05). It was noted that the PRD group had a lower total remifentanil consumption than the SPI group (1.3 ± 1.4 vs. 1.8 ± 0.9 mg; p < 0.05). In ASA I-III patients undergoing ESS, intraoperative monitoring based on state entropy and SPI values can optimize the CSF and reduce TEIBL, whereas monitoring based on state entropy and PRD measurements can optimize the cost effectiveness of anesthetic drugs and the use of the operation room.

show abstract

Influence of infiltration anaesthesia on perioperative outcomes following lumbar discectomy under surgical pleth index-guided general anaesthesia: A preliminary report from a randomised controlled prospective trial

Cited by 10 publications

References 38 publications

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

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

Adequacy of Anesthesia Guidance for Colonoscopy Procedures

Adequacy of Anesthesia and Pupillometry for Endoscopic Sinus Surgery

Contact Info

Product

Resources

About