The effect of multimodal analgesia on minimum alveolar concentration of isoflurane for skin incision at constant bispectral index

Savitha, Keelara Shivalingaiah; Dhanpal, Radhika; Shilpa, J

doi:10.4103/0259-1162.177520

Cited by 6 publications

(9 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…These dichotomies provide strong evidence that the pRB is effective in controlling intraoperative and postoperative nociception. Considering the effects of intraoperative nociception on postoperative pain, 2,6,[25][26][27][28][29][30] pRB bupivacaine should be regarded as the standard of care for all canine enucleation cases for which pRB is not contraindicated.…”

Section: Discussionmentioning

confidence: 99%

“…Enucleation is painful and previous studies have investigated how to ameliorate this pain. Both the human and veterinary medical literature recommend multimodal analgesia to decrease medication doses and their potential side effects, and to optimize patient comfort . A multimodal approach that has recently received considerable attention is the use of a locoregional anesthestic block during enucleation.…”

Section: Introductionmentioning

confidence: 99%

“…Theoretically, wind up pain should be prevented by performing a nerve block prior to surgical stimulation . Presurgical nerve blocks have been shown to reduce peri‐ and postoperative pain as represented by intraoperative isoflurane requirement, intraoperative hemodynamics, pain scores, patient‐driven postoperative analgesic rescue, and patient‐controlled postoperative opioid consumption …”

Section: Introductionmentioning

confidence: 99%

“…23,25 Theoretically, wind up pain should be prevented by performing a nerve block prior to surgical stimulation. 25 Presurgical nerve blocks have been shown to reduce peri-and postoperative pain as represented by intraoperative isoflurane requirement, 6 intraoperative hemodynamics, 26 pain scores, 2,27-29 patient-driven postoperative analgesic rescue, 29,30 and patient-controlled postoperative opioid consumption. 2,27 Previous studies 14,16 comparing pain scores between a bupivacaine retrobulbar block and a bupivacaine orbital splash block for canine enucleation have not detected a difference in postoperative pain.…”

mentioning

confidence: 99%

See 3 more Smart Citations

A preoperative bupivacaine retrobulbar block offers superior antinociception compared with an intraoperative splash block in dogs undergoing enucleation

Zibura

Posner

Ru³

et al. 2019

Veterinary Ophthalmology

View full text Add to dashboard Cite

Purpose Investigate nociception differences in dogs undergoing enucleation administered bupivacaine either via preoperative retrobulbar block (pRB) or intraoperative splash block (iSB). Methods Prospective, randomized, double‐masked, clinical comparison study. Dogs undergoing unilateral enucleation were randomized to two groups: one received bupivacaine pRB and saline iSB of the same volume, and the other received saline pRB and bupivacaine iSB. The following intraoperative parameters were recorded: heart rate (HR), respiratory rate (RR), end‐tidal CO2 (EtCO2); systolic, mean, and diastolic arterial blood pressure (SAP, MAP, and DAP respectively); inspired end‐tidal isoflurane concentration (EtISOIns), and expired end‐tidal isoflurane concentration (EtISOExp). Pain scores were recorded pre‐ and postoperatively. Analgesic rescue was documented. Surgical hemorrhage and postoperative bruising and swelling were graded subjectively by the surgeon (HDW) and study coordinator (AEZ). Results A significant (P = .0399) increase from baseline in overall mean heart rate was recorded in iSB bupivacaine patients (n = 11) compared with pRB bupivacaine patients (n = 11), with no significant differences in other intraoperative physiologic parameters, or pain scores. More analgesic rescue events occurred in iSB bupivacaine patients compared to pRB bupivacaine patients. A near‐significant increase in intraoperative bleeding (P = .0519), and a significant increase in bruising (P = .0382) and swelling (P = .0223) was noted in the iSB bupivacaine group. Conclusions Preoperative retrobulbar block bupivacaine is more effective than an iSB bupivacaine at controlling both intraoperative and postoperative nociception in dogs undergoing enucleation. Additionally, iSB causes more postoperative bruising and swelling and may be associated with increased intraoperative hemorrhage.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

mentioning

confidence: 99%

See 2 more Smart Citations

A preoperative bupivacaine retrobulbar block offers superior antinociception compared with an intraoperative splash block in dogs undergoing enucleation

Zibura

Posner

Ru³

et al. 2019

Veterinary Ophthalmology

View full text Add to dashboard Cite

show abstract

“…Increasing the alveolar concentration of a volatile anesthetic predisposes to dose-dependent side effects. "MAC sparing" strategies reduce the proportion of volatile anesthetic required to maintain surgical anesthesia and therefore dose-dependent side effects (3,4,8,(17)(18)(19). During general anesthesia monitoring, end-tidal volatile anesthetic concentration is a MAC proxy and a way to more accurately determine the amount of volatile anesthetic delivered.…”

Section: Discussionmentioning

confidence: 99%

Clinical Assessment of an Ipsilateral Cervical Spinal Nerve Block for Prosthetic Laryngoplasty in Anesthetized Horses

Morris

Lumsden²,

Dunlop³

et al. 2020

Front. Vet. Sci.

View full text Add to dashboard Cite

The nociceptive blockade of locoregional anesthesia prior to surgical stimulation can decrease anesthetic agent requirement and thereby potential dose-dependent side effects. The use of an ipsilateral second and third cervical spinal nerve locoregional anesthetic block for prosthetic laryngoplasty in the anesthetized horses has yet to be described. Anesthetic records of 20 horses receiving locoregional anesthesia prior to laryngoplasty were reviewed and compared to 20 horses of a similar patient cohort not receiving locoregional anesthesia. Non-blocked horses were 11 times more likely to require adjunct anesthetic treatment during surgical stimulation (P = 0.03) and were 7.4 times more likely to receive partial intravenous anesthesia in addition to inhalant anesthesia (P = 0.01). No horse in the blocked group received additional sedation/analgesia compared to the majority of non-blocked horses (75%) based on the anesthetist's perception of anesthetic quality and early recovery movement. No difference in recovery quality was observed between groups (P > 0.99). Cervical spinal nerve locoregional anesthesia appears well-tolerated and useful in reducing cumulative anesthetic agent requirement and may decrease the need for additional sedation/analgesia in horses undergoing anesthetized prosthetic laryngoplasty.

show abstract

Environmental and Occupational Considerations of Anesthesia: A Narrative Review and Update

Varughese

Ahmed

2021

Anesthesia &Amp; Analgesia

100

View full text Add to dashboard Cite

With an estimated worldwide volume of 266 million surgeries in 2015, the call for general inhalation anesthesia is considerable. However, widely used volatile anesthetics such as N 2 O and the highly fluorinated gases sevoflurane, desflurane, and isoflurane are greenhouse gases, ozone-depleting agents, or both. Because these agents undergo minimal metabolism in the body during clinical use and are primarily (≥95%) eliminated unchanged via exhalation, waste anesthetic gases (WAGs) in operating rooms and postanesthesia care units can pose a challenge for overall elimination and occupational exposure. The chemical properties and global warming impacts of these gases vary, with atmospheric lifetimes of 1−5 years for sevoflurane, 3−6 years for isoflurane, 9−21 years for desflurane, and 114 years for N 2 O. Additionally, the use of N 2 O as a carrier gas for the inhalation anesthetics and as a supplement to intravenous (IV) anesthetics further contributes to these impacts. At the same time, unscavenged WAGs can result in chronic occupational exposure of health care workers to potential associated adverse health effects. Few adverse effects associated with WAGs have been documented, however, when workplace exposure limits are implemented. Specific measures that can help reduce occupational exposure and the environmental impact of inhaled anesthetics include efficient ventilation and scavenging systems, regular monitoring of airborne concentrations of waste gases to remain below recommended limits, ensuring that anesthesia equipment is well maintained, avoiding desflurane and N 2 O if possible, and minimizing fresh gas flow rates (eg, use of low-flow anesthesia). One alternative to volatile anesthetics may be total intravenous anesthesia (TIVA). While TIVA is not associated with the risks of occupational exposure or atmospheric pollution that are inherent to volatile anesthetic gases, clinical considerations should be weighed in the choice of agent. Appropriate procedures for the disposal of IV anesthetics must be followed to minimize any potential for negative environmental effects. Overall, although their contributions are relatively low compared with those of other human-produced substances, inhaled anesthetics are intrinsically potent greenhouse gases and pose a risk to operating-room personnel if not properly managed and scavenged. Factors to reduce waste and minimize the future impact of these substances should be considered.

show abstract

The effect of multimodal analgesia on minimum alveolar concentration of isoflurane for skin incision at constant bispectral index

Cited by 6 publications

References 20 publications

A preoperative bupivacaine retrobulbar block offers superior antinociception compared with an intraoperative splash block in dogs undergoing enucleation

A preoperative bupivacaine retrobulbar block offers superior antinociception compared with an intraoperative splash block in dogs undergoing enucleation

Clinical Assessment of an Ipsilateral Cervical Spinal Nerve Block for Prosthetic Laryngoplasty in Anesthetized Horses

Environmental and Occupational Considerations of Anesthesia: A Narrative Review and Update

Contact Info

Product

Resources

About