Prediction of Movement during Propofol/Nitrous Oxide Anesthesia

Leslie, Kate; Sessler, Daniel I.; Smith, Warren D.; Larson, Merlín D.; Ozaki, Makoto; Blanchard, Don; Crankshaw, D. P.

doi:10.1097/00000542-199601000-00006

Cited by 138 publications

(42 citation statements)

References 30 publications

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“…Depth of sedation in Group 1 was monitored with classical signs. In Group 2, a bispectral index of 50, with a range of 40-60, was used as a target in accordance with previously published data [8,14].…”

Section: Discussionmentioning

confidence: 99%

“…It therefore becomes appealing to be able to control quantitatively the drug concentration in the effect compartment rather than in the central compartment [6,7]. This method can provide a better prediction of anaesthetic drug effect [8]. …”

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confidence: 99%

“…Recently, a new processed EEG technique, bispectral analysis, has proved to be a useful measure of anaesthetic drug effect in pharmacodynamic research and may be useful as a measure of depth of sedation [8]. Compared with the classical power spectral analyses which use the frequency and amplitude of the raw EEG signal to compute a processed univariate parameter [12], bispectral analysis uses not only complex Fourier transformation but also includes information about the influence of interrelations between different frequency components (phase coupling).…”

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confidence: 99%

“…Vernon et al [14] found a mean (SD) bispectral index of 55 (8) in a group of patients who did not move during surgical stimulation when using propofol and alfentanil infusions for anaesthesia. Others, such as Leslie et al [8], found a mean (range) bispectral index of 57 (54-60) for the 50% nonresponse level and 38 (31-43) for the 95% nonresponse level during propofol and nitrous oxide anaesthesia.…”

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Clinical usefulness of the bispectral index for titrating propofol target effect-site concentration

et al. 1998

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SummaryThe bispectral index, a new processed electroencephalographic parameter which may give information on depth of anaesthesia, was used in 58 patients undergoing outpatient gynaecological surgery in order to study if the addition of bispectral index monitoring to standard clinical monitoring could improve the titration of target propofol concentration when using effect-site target-controlled propofol infusion for sedation. In Group 1 (n ¼ 30), the bispectral index was recorded but the anaesthetist was unaware of the readings and therefore only classical signs of depth of anaesthesia were used to guide the anaesthetist in controlling the effect-site concentration. In Group 2 (n ¼ 28), bispectral index readings were available to the anaesthetist and effect-site concentration was adjusted to ensure that bispectral index was maintained between 40 and 60. Similar propofol induction and maintenance doses, blood and effect-site concentrations and mean bispectral index were found in the two groups. A greater percentage of bispectral index readings lying outside the target range (i.e. < 40 or > 60) and more movement at incision and during maintenance were found in Group 1. There was a trend towards more implicit awareness in patients in Group 1. Bispectral index was found to be useful for measuring depth of sedation when using propofol target-controlled infusion. Propofol dosage could not be decreased but a more consistent level of sedation could be maintained due to a more satisfactory titration of target effectsite concentration. For many years, anaesthetists have tried to correlate the pharmacokinetics and pharmacodynamics of propofol in order to achieve the most appropriate dosage schemes for continuous intravenous infusion [1]. Recently, a pharmacokinetically based technique for the administration of propofol (target-controlled infusion, TCI) has proved to have many advantages [2]. The concept underlying TCI techniques is to apply the three-compartmental pharmacokinetic model for propofol [3] and to predict by calculation its concentration in one of the compartments, e.g. the central (blood) compartment or the theoretical effect-site compartment [4]. Target-controlled infusion devices will rapidly achieve and maintain the desired predicted concentration in the chosen compartment [5]. Effect compartment modelling is motivated by the observed dissociation between the measured blood concentrations of the drug and the currently measured indices of drug effect, e.g. the processed electro-encephalogram (EEG). The hysteresis between pharmacokinetics and pharmacodynamics can be quantified by a rate constant, k e1 . The time course of a drug effect is found to parallel the time course of the effect compartment modelling. It therefore becomes appealing to be able to control quantitatively the drug concentration in the effect compartment rather than in the central compartment [6,7]. This method can provide a better prediction of anaesthetic drug effect [8].

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

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confidence: 99%

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confidence: 99%

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Clinical usefulness of the bispectral index for titrating propofol target effect-site concentration

et al. 1998

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“…Among them, spectral edge frequency (SEF) [2][3][4][5] and median frequency (MF) [5,6] have been studied as the single numerical parameter. Although temperaturedependent changes of SEF [7][8][9] and MF [9] have been studied, their results were inconsistent and there was no study under anaesthesia with propofol and alfentanil.…”

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Effects of cardiopulmonary bypass and hypothermia on electroencephalographic variables

et al. 1997

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SummaryWe studied the effects of hypothermia and cardiopulmonary bypass (CPB) on four depth of anaesthesia monitors; spectral edge frequency (SEF), median frequency (MF), bispectral index (BIS) and auditory evoked potential index (AEPIndex) in 12 patients during uneventful cardiac anaesthesia. Each variable was recorded simultaneously at 10 periods during anaesthesia. All four variables were not affected by the transition to CPB. During hypothermia, values of AEPIndex, MF and SEF were tightly distributed but values of BIS were very variable and overlapped with those before induction of anaesthesia. The variability decreased during rewarming. The values of AEPIndex throughout the anaesthesia never overlapped with those before induction of anaesthesia. The AEPIndex was the most stable and reliable as a depth of anaesthesia monitor among the four variables in cardiac bypass surgery.

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Neuromuscular Blocking Drugs Do Not Alter the Pupillary Light Reflex of Anesthetized Humans

Gray¹,

Krejci²,

Larson³

1997

Archives of Neurology

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Prediction of Movement during Propofol/Nitrous Oxide Anesthesia

Cited by 138 publications

References 30 publications

Clinical usefulness of the bispectral index for titrating propofol target effect-site concentration

Clinical usefulness of the bispectral index for titrating propofol target effect-site concentration

Effects of cardiopulmonary bypass and hypothermia on electroencephalographic variables

Neuromuscular Blocking Drugs Do Not Alter the Pupillary Light Reflex of Anesthetized Humans

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