Speed of Recovery and Side-effect Profile of Sevoflurane Sedation Compared with Midazolam

Ibrahim, Andra E.; Ghoneim, Mohammed M.; Kharasch, Evan D.; Epstein, Richard H.; Groudine, Scott B.; Ebert, Thomas J.; Binstock, Wendy; Philip, Beverly K.

doi:10.1097/00000542-200101000-00018

Cited by 33 publications

(20 citation statements)

References 21 publications

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“…DSST and TMT are designed to objectively measure a patient's visual–motor co‐ordination and speed, and have been used in previous studies on modafinil use 20,21 . The DSST has also been used in studies comparing patient recovery following various forms of sedation, 22,23 while OAA/S and Aldrete scores are objective assessments of a patient's clinical recovery status. As mentioned previously, modafinil has been shown to counter the adverse effects of overnight sleep deprivation on working memory.…”

Section: Discussionmentioning

confidence: 99%

“…Another possible limitation of DSST is the time frame; the DSST runs for a 2‐min period, which may be a short time span when one considers the importance of tiredness in the context of this study. The DSST has also been used in studies comparing patient recovery following various forms of sedation, 22,23 while OAA/S and Aldrete scores are objective assessments of a patient's clinical recovery status.…”

Section: Discussionmentioning

confidence: 99%

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Modafinil reduces patient‐reported tiredness after sedation/analgesia but does not improve patient psychomotor skills

Galvin

Boesjes

Hol

et al. 2010

Acta Anaesthesiol Scand

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Modafinil reduces patient‐reported tiredness after sedation/analgesia but does not improve patient psychomotor skills

Galvin

Boesjes

Hol

et al. 2010

Acta Anaesthesiol Scand

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“…Sedation with sevoflurane is a relatively new technique and the first reports demonstrated faster recovery of cognitive function when compared with midazolam 28 . Cognitive impairment with delirium and confusion is a significant problem, especially in elderly patients, in the immediate postoperative period 29 . Postoperative cognitive dysfunction is characterized by a reduction in memory and concentration.…”

Section: Discussionmentioning

confidence: 99%

“…Sedação com sevoflurano é uma técnica relativamente nova e os primeiros relatos apontam para recuperação mais rá-pida da função cognitiva quando comparada com o midazolam 28 . O prejuízo cognitivo com delírio e confusão é um problema significativo, principalmente em pacientes idosos no período pós-operatório imediato 29 . A disfunção cognitiva no pós-operatório é uma condição caracterizada por prejuí-zo de memória e concentração.…”

Section: Métodounclassified

Avaliação dos efeitos cognitivos da indução inalatória com sevoflurano com ou sem associação com óxido nitroso: estudo comparativo em adultos voluntários

Fernandes

Gomes²,

Cordeiro

et al. 2007

Rev. Bras. Anestesiol.

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RESUMOFernandes CR, Gomes JMA, Cordeiro RAA, Pereira KS -Avaliação dos Efeitos Cognitivos da Indução Inalatória com Sevoflurano com ou sem Associação com Óxido Nitroso. Estudo Comparativo em Adultos Voluntários. JUSTIFICATIVA E OBJETIVOS:A indução com agentes inalatórios via máscara facial vem sendo alvo de crescente interesse desde a introdução do sevoflurano. Ao mesmo tempo a influência da adição de óxido nitroso merece atenção no que diz respeito ao padrão da indução e da recuperação, sobretudo, à completa recuperação da função cognitiva. O objetivo deste estudo foi avaliar os efeitos cognitivos da indução anestésica inalatória com sevoflurano de modo isolado ou associado ao óxido nitroso em adultos. MÉTODO:Foram estudados 20 voluntários adultos, estado físico ASA I, sem doença psiquiátrica ou utilização prévia de benzodiazepínicos. Após terem sido submetidos ao questionário Mini Exame do Estado Mental (MEEM), o Grupo I recebeu sevoflurano na concentração de 5% até que fosse atingido o índice bispectral (BIS) de 60. O Grupo II recebeu óxido nitroso em concentrações crescentes com incremento de 10 até 50% quando então foi administrado o sevoflurano até que fosse atingido o BIS de 60. Foram anotados valores de pressão arterial, freqüência cardíaca, oximetria de pulso, SEF 95% (Spectral Edge Frequency), tempo de indução e o tempo de recuperação anestésica. RESULTADOS:Não houve diferença entre o tempo de indução nos dois grupos. O Grupo II apresentou maior estabilidade hemodinâmica e menor valor do SEF 95% no momento BIS = 60. O tempo para recuperação da função cognitiva foi igual nos dois grupos, assim como a incidência de náuseas e vômitos. Não foi verificada ocorrência de apnéia. O Grupo II apresentou maior incidência de agitação psicomotora durante a indução. CONCLUSÕES:O sevoflurano isoladamente ou em associação com óxido nitroso constituiu opção adequada para indução inalatória ou sedação ambulatorial em adultos, com manutenção da ventilação espontânea, proporcionando rápida recuperação da função cognitiva.Unitermos: ANESTESIA, Geral: inalatória; ANESTÉSICOS, Gasoso, Volátil: óxido nitroso, sevoflurano; SEDAÇÃO: inalatória; SISTEMA NERVOSO CENTRAL: cognição. SUMMARY BACKGROUND AND OBJECTIVES:Anesthetic induction with inhalational agents using a facemask has gained attention since the introduction of sevoflurane. At the same time, the influence of adding nitrous oxide on the pattern of induction and recuperation deserves attention, especially regarding recovery of the cognitive function. The objective of this study was to evaluate the cognitive effects of inhalational anesthetic induction with sevoflurane alone or associated with nitrous oxide in adults. METHODS:Twenty adult volunteers, ASA physical state I, without a history of psychiatric disorders or prior use of benzodiazepines, were enrolled in the study. After answering the Mini-Mental State Examination (MMSE), Group I received 5% sevoflurane until a bispectral index (BIS) of 60 was achieved. Group II received nitrous oxide in increments of 10% until ...

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“…19,77 DSST is a measure of cognitive and psychomotor impairment that has been used to evaluate recovery from various sedation agents. 78,79 Blink counts have also been utilized to assess sedation, impairment, and recovery. 80-82 Both Blink and DSST measurements decrease during sedation and return to normal baselines after recovery.…”

Section: Discussionmentioning

confidence: 99%

Oral Clonidine Pretreatment Prior to Venous Cannulation

Hall

Rezvan

Tatakis

et al. 2006

Anesthesia Progress

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Clonidine is a preferential alpha-2 agonist drug that has been used for over 35 years to treat hypertension. Recently, it has also been used as a preoperative medication and as a sedative/anxiolytic drug. This randomized, double-blind, placebo-controlled crossover clinical trial characterized the effects of oral clonidine pretreatment on intravenous catheter placement in 13 patients. Parameters measured included the bispectral index (BIS), Observer's Assessment of Alertness/Sedation Scale (OAA/S), frontal temporal electromyogram (EMG), 30-Second Blink Count (Blink), Digit Symbol Substitution Test (DSST), State Anxiety Inventory (SAI), fingertip versus forearm skin temperatures, and multiple questionnaires. Oral clonidine significantly decreased SAI scores, OAA/S, EMG, and Blink, but did not cause statistically significant BIS or DSST reductions. Subjects preferred oral clonidine pretreatment prior to venipuncture compared to placebo. Questionnaires also indicated that clonidine provided minimal sedation, considerable anxiolysis, and some analgesia. Fingertip versus forearm skin temperature differentials were decreased. Reduced fingertip versus forearm temperature differentials suggest increased peripheral cutaneous blood flow prior to venous cannulation. Oral clonidine pretreatment not only helped control patient anxiety and pain but also provided cardiovascular stability.Key Words: Clonidine; Venous cannulation; BIS; SAI; DSST.I ntravenous (IV) catheters have become the accepted standard of care for general anesthesia and IV sedation. 1 Catheterization of peripheral veins can be made more comfortable using a variety of techniques, including local anesthesia infiltration, 2,3 nitrous oxide inhalation, 2,4,5 ethyl chloride topical, 4,6 eutectic mixture of local anesthetics (lidocaine-prilocaine) cream, 7,8 tetracaine patches, 9 and even midazolam nasal spray. 10 The goals of these methods are pain and anxiety reduction with minimal invasiveness and lack of significant complications. An additional benefit of some cannulation pretreatments is cutaneous vasodilation.Previous medical anesthesia/sedation studies have indicated that clonidine administration prior to surgery decreases pain 11,12 and anxiety 12 and also stabilizes blood pressure and heart rate by reduction of central sympathetic outflow. [13][14][15] Additional investigations have shown that clonidine pretreatment also increases skin temperature 16 and decreases the difference between fingertip and forearm temperatures. 17 These results suggest an increase in cutaneous blood flow. 18 The purpose of this randomized, double-blind, placebo-controlled crossover clinical trial was to characterize the sedative/anxiolytic effects and changes in skin temperatures of oral clonidine pretreatment prior to IV catheter placement. METHODSThe study protocol and informed consent form were approved by The Ohio State University Institutional Review Board. Inclusion criteria were (a) adults with American Society of Anesthesiologists ASA1 or ASA2 health status, (b) severe ...

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Speed of Recovery and Side-effect Profile of Sevoflurane Sedation Compared with Midazolam

Abstract: Sevoflurane for sedation produces faster recovery of cognitive function as measured by DSST and memory scores compared with midazolam. However, sevoflurane for sedation is complicated by a high incidence of intraoperative excitement.

Cited by 33 publications

References 21 publications

Modafinil reduces patient‐reported tiredness after sedation/analgesia but does not improve patient psychomotor skills

Modafinil reduces patient‐reported tiredness after sedation/analgesia but does not improve patient psychomotor skills

Avaliação dos efeitos cognitivos da indução inalatória com sevoflurano com ou sem associação com óxido nitroso: estudo comparativo em adultos voluntários

Oral Clonidine Pretreatment Prior to Venous Cannulation

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