Rocuronium dose-dependently suppresses the spectral entropy response to tracheal intubation during propofol anaesthesia

Kawaguchi, Masahiko; Takamatsu, Isao; Kazama, Tomiei

doi:10.1093/bja/aep040

Cited by 33 publications

(26 citation statements)

References 15 publications

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“…These computations are useful clinically in patients under anaesthesia 16,17 ; or unable to communicate distress as in sleep apnea 18 or dyspnea [19][20][21] and the potential risk associated with diabetes mellitus 14 and obesity 15 has been studied previously using these methods. This study aimed to assess the risk of dynamical disease by novel chaotic globals to HRV in subjects with malnutrition.…”

Section: Introductionmentioning

confidence: 99%

Risk Appraisal by Novel Chaotic Globals to HRV in Subjects With Malnutrition

Barreto

Vanderlei

et al. 2014

J. Hum. Growth Dev.

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The aim of this study is to assess the risk of dynamical diseases in malnourished children. This is achieved by the application of novel chaotic global techniques to the RR-intervals of the electrocardiogram (ECG) in the cohort. Heart Rate Variability (HRV) is an inexpensive and non-invasive tool to measure the autonomic impulses. Here there has been a decrease in chaotic response of HRV. Seventy children were divided into equal groups and the HRV monitored for 20-25 minutes. The Chaos Forward Parameter (CFP) which applies all three chaotic global parameters is suggested to be the most robust algorithm. These three parameters are high spectral entropy (hsEntropy), high spectral detrended fluctuation analysis (hsDFA) and spectral multi-taper method (sMTM). hsEntropy is a function of the irregularity of amplitude and frequency of the power spectrums peaks. It is derived by applying Shannon entropy to the multi-taper method power spectrum. To derive hsDFA we calculate the spectral adaptation in exactly the same way as for hsEntropy using an adaptive multi-taper method power spectrum with the same settings; but DFA rather than Shannon entropy is the algorithm applied. sMTM is the area between the multi-taper method power spectrum and the baseline. After Anderson-Darling and Lilliefors tests of normality; Kruskal-Wallis was used for the statistical analysis, with the level of significance set at (p < 0.01). Principal Component Analysis (PCA) identified two components representing 100% of total variance. Autonomic imbalance measured as HRV and an increased cardiovascular risk are described for overweight children as well as for malnourished and those with anorexia nervosa. The relationship between malnourishment and complexity measures is useful in the risk assessment of dynamical diseases associated with the condition. This is supportive in treatments, assisting the determination of the level of dietary or pharmacological intervention especially in related dynamical diseases.

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Section: Introductionmentioning

confidence: 99%

Risk Appraisal by Novel Chaotic Globals to HRV in Subjects With Malnutrition

Barreto

Vanderlei

et al. 2014

J. Hum. Growth Dev.

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“…Roküronyumun 1,2 mg kg -1 olan hızlı entübasyon dozu, kalp cerrahisinde opioid indüksiyonu sonrasında, kalp atım hızını hafif arttırması, göğüs duvarı sertliği ile kötüleşebilen havayolunu hızla kontrol altına alması ve kalıntı bloğunun azlığı nedeni ile tercih edilmektedir (7). Roküronyumun 1,2 mg kg -1 dozu, 0,3 mg kg -1 dan başlayan diğer düşük dozlarına göre, entübasyona elektromiyografik yanıtı en iyi baskılayan dozdur (10). Benzer olarak, çalışmamızda da roküronyumun Friedman testi.…”

Section: Discussionunclassified

“…Roküronyu-mun 1,2 mg kg -1 İV hızlı entübasyon dozu, kalp atım hızını hafif artırması, kalp cerrahisinde yüksek doz opioid indüksi-yonu sonrasında göğüs kafesi sertliği nedeni ile zorlaşabilen hava yolunu hızla kontrol altına alabilmesi ve etki süresine bağlı olarak kalıntı bloğunun azlığı nedeni ile tercih edilmektedir (7,9). Roküronyumun 1,2 mg kg -1 dozunun, 0,3 mg kg -1 dan başlayan diğer düşük dozlarına göre, entübasyona elektromiyografik yanıtı en iyi baskılayan doz olduğu saptanmıştır (10). Kötü sol ventrikül fonksiyonu olan koroner arter bypass greft cerrahisi uygulanacak olgularda, roküronyumun, entübasyona hemodinamik yanıtı diğer nöromüsküler bloker ajanlardan daha iyi baskıladığı bildirilmiştir (11).…”

Section: Sonuçunclassified

“…Laringoskopi ve entübasyon, adrenerjik sinir uçlarından ve adrenal medulladan katekolamin salınımına neden olarak kalp atım hızını ve sistemik arter basıncını artırmakta ve aritmilere neden olmaktadır (10). Çalışmamızda gözlenen ST depresyonu, ventrikül erken atımları ve inatçı olmayan ventrikül taşikardileri, iskemik kalp hastalıklı bireylerde ciddi hemodinamik bozukluklara yol açma olasılığı mevcut aritmilerdi.…”

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Effects of High-Dose Rocuronium on the QTc Interval During Anaesthesia Induction in Patients Undergoing Coronary Artery Bypass Graft Surgery

Agdanli¹,

Öztürk²,

Ütük³

et al. 2014

Turk J Anesth Reanim

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Objective: Existing myocardial damage in coronary artery disease patients causes prolonged QT syndrome. The primary objective of this trial is to explore the effects of different doses of the muscle relaxant agent rocuronium (0.6 mg kg -1 and 1.2 mg kg -1) on QTc following anaesthetic induction. The second objective is to determine the incidence and kinds of arrhythmias. Methods:In this prospective and randomized trial, patients undergoing elective coronary artery revascularization surgery were included in one of two groups. Both groups took the same anaesthetic induction agents: midazolam and fentanyl. Rocuronium was administered in Group 1 (n=20) with dose of 0.6 mg kg -1 and in Group 2 (n=20) with a dose of 1.2 mg kg -1 for muscle relaxation. Heart rate, average arterial pressure and QTc were recorded before induction (T0), after induction (T1), after muscle relaxant (T2), and 2 minutes (T3) and 5 minutes after intubation (T4).Results: QTc was significantly longer 2 minutes after intubation (in Group 1 and Group 2, respectively, 447.9±28.3 and 466.1±37.8 ms) than at the beginning (respectively, 426.9±25.7, 432.0±35.5 ms) (p<0.01). In the intergroup comparison, average QTc values were similar in all trial periods (p>0.05). The prevalence of arrhythmias in between Group 1 (35%, n=7) and Group 2 (15%, n=3) was similar (p=0.06). Arrhythmias were recorded 2 minutes after intubation in both groups (n=10, 25%). Conclusion:In patients undergoing coronary artery revascularization surgery, rocuronium doses of 0.6 mg kg -1 and 1.2 mg kg -1 prolong the QTc interval after intubation. Cardiac arrhythmias related to long QTc arising after intubation should be taken into consideration.Key Words: Rocuronium, QTc, coronary artery disease Amaç: Koroner arter hastalarında, mevcut miyokard hasarının kendisi uzun QT sendromu oluşumuna neden olmaktadır. Ça-lışmanın esas amacı anestezi indüksiyonu sonrasında, roküronyu-mun 2 farklı dozunun (0,6 mg kg -1 ve 1,2 mg kg -1 ) QTc intervali üzerine etkilerini araştırmaktır. ikincil amacı ise aritmi sıklığı ve niteliğini saptamaktır.Yöntemler: Çalışmaya elektif koroner arter revaskülarizasyon cerrahisi geçirecek 40 olgu alındı. Olgular iki gruptan birine dahil edildiler. Gruplarda kullanılan midazolam ve fentanil' in indük-siyon dozları aynı idi. Group 1; 0,6 mg kg -1 , Group 2; 1,2 mg kg -1 doz roküronyum ile entübe edildiler. Kalp atım hızı, ortalama arter basıncı ve QTc, indüksiyon öncesi (T0), indüksiyon sonrası (T1), roküronyum sonrası (T2), entübasyon sonrası 2. dakika (T3) 5. dakikalarda (T4) kaydedildi. Bulgular:Grup içi karşılaştırmada, yalnızca entübasyon sonrası 2. dakikadaki ortalama QTc değerleri (Grup 1 ve Grup 2'de sı-rası ile, 447,9±28,3, 466,1±37,8 ms), başlangıca göre (sırası ile, 426,9±25,7, 432,0±35,5 ms) istatistiksel olarak anlamlı uzun bulundu (p<0,01). Gruplar arası karşılaştırmada, ortalama QTc tüm çalışma dönemlerinde benzerdi (p>0,05). Grup 1 (%35, n=7), ile Grup 2'de (%15, n=3) aritmi görülme sıklığı benzerdi (p=0,06). Her iki grupta da aritmiler (n=10, %25), en...

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“…94 The same restrictions as those described for CVI also apply to RE-SE, and particularly the effect of muscle relaxation. 49,[95][96][97] …”

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confidence: 99%

How Electroencephalography Serves the Anesthesiologist

et al. 2014

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Major clinical endpoints of general anesthesia, such as the alteration of consciousness, are achieved through effects of anesthetic agents on the central nervous system, and, more precisely, on the brain. Historically, clinicians and researchers have always been interested in quantifying and characterizing those effects through recordings of surface brain electrical activity, namely electroencephalography (EEG). Over decades of research, the complex signal has been dissected to extract its core substance, with significant advances in the interpretation of the information it may contain. Methodological, engineering, statistical, mathematical, and computer progress now furnishes advanced tools that not only allow quantification of the effects of anesthesia, but also shed light on some aspects of anesthetic mechanisms. In this article, we will review how advanced EEG serves the anesthesiologist in that respect, but will not review other intraoperative utilities that have no direct relationship with consciousness, such as monitoring of brain and spinal cord integrity. We will start with a reminder of anesthestic effects on raw EEG and its time and frequency domain components, as well as a summary of the EEG analysis techniques of use for the anesthesiologist. This will introduce the description of the use of EEG to assess the depth of the hypnotic and anti-nociceptive components of anesthesia, and its clinical utility. The last part will describe the use of EEG for the understanding of mechanisms of anesthesia-induced alteration of consciousness. We will see how, eventually in association with transcranial magnetic stimulation, it allows exploring functional cerebral networks during anesthesia. We will also see how EEG recordings during anesthesia, and their sophisticated analysis, may help corroborate current theories of mental content generation.

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Rocuronium dose-dependently suppresses the spectral entropy response to tracheal intubation during propofol anaesthesia

Abstract: The RE-SE response to tracheal intubation was suppressed by increasing the rocuronium dose. Estimates of nociception using RE-SE should be interpreted carefully in different states of muscle paralysis during general anaesthesia.

Cited by 33 publications

References 15 publications

Risk Appraisal by Novel Chaotic Globals to HRV in Subjects With Malnutrition

Risk Appraisal by Novel Chaotic Globals to HRV in Subjects With Malnutrition

Effects of High-Dose Rocuronium on the QTc Interval During Anaesthesia Induction in Patients Undergoing Coronary Artery Bypass Graft Surgery

How Electroencephalography Serves the Anesthesiologist

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