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[PMID]:29049165
[Au] Autor:Yu H; Wu D
[Ad] Endereço:Department of Anesthesiology, Beijing Luhe Hospital, Capital Medical University, Beijing, China.
[Ti] Título:Effects of different methods of general anesthesia on intraoperative awareness in surgical patients.
[So] Source:Medicine (Baltimore);96(42):e6428, 2017 Oct.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:The purpose of the study was to investigate the effects of total intravenous anesthesia (TIVA) and combined of intravenous and inhaled anesthesia (CIIA) on intraoperative awareness in surgical patients.A total of 678 patients were recruited in the CIIA group, while TIVA group included 566 patients. The clinical characteristics and the occurrence of intraoperative awareness were compared between the groups. Mini-Mental State Examination, Generalized Anxiety Disorder 7, and Patient Health Questionnaire 9 tests were performed to estimate cognitive and psychological functions of the patients. In addition, logistic regression analysis was applied to identify the risk factors for intraoperative awareness in surgical patients.In CIIA group, 3 patients (0.44%) were confirmed with intraoperative awareness, while 11 patients (1.94%) in TIVA group underwent intraoperative awareness. The occurrence rate of intraoperative awareness was significantly higher in VITA group than that in the CIIA group (P = .029). Awareness classification demonstrated that intraoperative awareness mainly included auditory, tactile, and pain perceptions. Moreover, 4 patients showed distress after operation. Patients with intraoperative awareness exhibited poor performance in cognitive and psychological tests (P < .001 for all). Logistic regression analysis demonstrated that CIIA (odds ratio [OR] = 0.198, 95% confidence interval [CI] = 0.047-0.827), age (OR = 0.951, 95% CI = 0.908-0.997), midazolam application (OR = 0.158, 95% CI = 0.034-0.736), awareness history (OR = 10.131, 95% CI = 2.206-45.517), and duration of surgery (OR = 1.016, 95% CI = 1.001-1.032) were significantly associated with intraoperative awareness.Intraoperative awareness can significantly influence the cognitive and psychological functions of surgical patients. CIIA and midazolam application may lower the risk of intraoperative awareness.
[Mh] Termos MeSH primário: Anestesia Geral/efeitos adversos
Anestesia Geral/psicologia
Consciência no Peroperatório/psicologia
Complicações Pós-Operatórias/psicologia
Estresse Psicológico/psicologia
[Mh] Termos MeSH secundário: Adulto
Anestesia Geral/métodos
Anestesia por Inalação/efeitos adversos
Anestesia por Inalação/psicologia
Anestesia Intravenosa/efeitos adversos
Anestesia Intravenosa/psicologia
Anestésicos Inalatórios/administração & dosagem
Anestésicos Inalatórios/efeitos adversos
Feminino
Seres Humanos
Modelos Logísticos
Masculino
Éteres Metílicos/administração & dosagem
Éteres Metílicos/efeitos adversos
Meia-Idade
Duração da Cirurgia
Complicações Pós-Operatórias/induzido quimicamente
Período Pós-Operatório
Propofol/administração & dosagem
Propofol/efeitos adversos
Estresse Psicológico/induzido quimicamente
Resultado do Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Anesthetics, Inhalation); 0 (Methyl Ethers); 38LVP0K73A (sevoflurane); YI7VU623SF (Propofol)
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171122
[Lr] Data última revisão:
171122
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:171020
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000006428


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[PMID]:28673212
[Au] Autor:Leslie K; Culwick MD; Reynolds H; Hannam JA; Merry AF
[Ad] Endereço:Honorary Professorial Fellow, Anaesthesia, Perioperative and Pain Medicine Unit, Melbourne Medical School, and Department of Pharmacology and Therapeutics, University of Melbourne; Honorary Adjunct Professor, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria.
[Ti] Título:Awareness during general anaesthesia in the first 4,000 incidents reported to webAIRS.
[So] Source:Anaesth Intensive Care;45(4):441-447, 2017 07.
[Is] ISSN:0310-057X
[Cp] País de publicação:Australia
[La] Idioma:eng
[Ab] Resumo:The aim of this study was to analyse the incidents related to awareness during general anaesthesia in the first 4,000 cases reported to webAIRS-an anaesthetic incident reporting system established in Australia and New Zealand in 2009. Included incidents were those in which the reporter selected "neurological" as the main category and "awareness/dreaming/nightmares" as a subcategory, those where the narrative report included the word "awareness" and those identified by the authors as possibly relevant to awareness. Sixty-one awareness-related incidents were analysed: 16 were classified as "awareness", 31 were classified as "no awareness but increased risk of awareness" and 14 were classified as "no awareness and no increased risk of awareness". Among 47 incidents in the former two categories, 42 (89%) were associated with low anaesthetic delivery and 24 (51%) were associated with signs of intraoperative wakefulness. Memory of intraoperative events caused significant ongoing distress for five of the 16 awareness patients. Patients continue to be put at risk of awareness by a range of well-described errors (such as syringe swaps) but also by some new errors related to recently introduced anaesthetic equipment, such as electronic anaesthesia workstations.
[Mh] Termos MeSH primário: Consciência no Peroperatório/epidemiologia
[Mh] Termos MeSH secundário: Adolescente
Adulto
Idoso
Idoso de 80 Anos ou mais
Austrália/epidemiologia
Criança
Pré-Escolar
Feminino
Seres Humanos
Incidência
Consciência no Peroperatório/etiologia
Masculino
Meia-Idade
Nova Zelândia/epidemiologia
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170912
[Lr] Data última revisão:
170912
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170705
[St] Status:MEDLINE


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[PMID]:28398893
[Au] Autor:Dent PC; Bagnall NM
[Ad] Endereço:Consultant General and Endocrine Surgeon, Department of Surgery, Croydon University Hospital, Croydon Health Services NHS Trust, Croydon CR7 7YE.
[Ti] Título:Litigation in thyroid surgery in England.
[So] Source:Br J Hosp Med (Lond);78(4):213-218, 2017 Apr 02.
[Is] ISSN:1750-8460
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:Thyroid surgery has the potential for significant life-changing postoperative complications. Since 1995, the NHS Litigation Authority has handled litigation claims in England. This article reviews all thyroid surgery litigation claims between 1995 and 2012 and looks at potential strategies to minimize future claims.
[Mh] Termos MeSH primário: Doença Iatrogênica
Imperícia/legislação & jurisprudência
Complicações Pós-Operatórias
Tireoidectomia/legislação & jurisprudência
[Mh] Termos MeSH secundário: Queimaduras
Diagnóstico Tardio/legislação & jurisprudência
Erros de Diagnóstico/legislação & jurisprudência
Inglaterra
Seres Humanos
Consentimento Livre e Esclarecido/legislação & jurisprudência
Consciência no Peroperatório
Jurisprudência
Responsabilidade Legal
Cuidados Pós-Operatórios/legislação & jurisprudência
Traumatismos do Nervo Laríngeo Recorrente
Estudos Retrospectivos
Medicina Estatal
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1706
[Cu] Atualização por classe:170615
[Lr] Data última revisão:
170615
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170412
[St] Status:MEDLINE
[do] DOI:10.12968/hmed.2017.78.4.213


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[PMID]:28235537
[Au] Autor:Han SS; Han S; Kim BG; Kim DH; Ryu JH
[Ad] Endereço:Zero Pain Clinic, Seoul, South Korea.
[Ti] Título:The concentration of desflurane preventing spectral entropy change during surgical stimulation: A prospective randomized trial.
[So] Source:J Clin Anesth;37:86-91, 2017 Feb.
[Is] ISSN:1873-4529
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:STUDY OBJECTIVE: To determine the concentration of desflurane necessary to blunt changes in spectral entropy during surgical incision when two different target-controlled effect-site concentrations of remifentanil (1 and 3ng/ml) were infused. DESIGN: Prospective, randomized controlled study. SETTING: Operating room of a university hospital. INTERVENTIONS: Forty-two patients undergoing general anesthesia for elective surgery were enrolled and randomly allocated to the R1 (1ng/ml of remifentanil, n=21) or R3 (3ng/ml of remifentanil, n=21) group. After at least a 10-min administration of target-controlled remifentanil concentration and predetermined end-tidal desflurane following endotracheal intubation, changes in spectral entropy in response to surgical incision were evaluated. MEASUREMENTS: Concentration of desflurane necessary to blunt changes in spectral entropy during surgical incision for each group was determined using Dixon's up-and-down method. Hemodynamic variables including mean arterial pressure (MAP) and heart rate (HR) were measured. MAIN RESULTS: Concentration of desflurane necessary to blunt changes in spectral entropy during surgical incision in 50% of patients (EC ) was 4.1% (95% CI: 3.5-4.7%) for the R1 group and 3.4% (95% CI: 3.0-3.8%) for the R3 group (P=0.033). Additionally, the calculated EC values using the logistic regression analysis for the R1 and R3 groups were 5.8% (95% CI: 5.0-10.8%) and 5.1% (95% CI: 4.3-10.6%), respectively. MAPs and HRs were significantly higher in the R1 than in the R3 group after surgical incision. CONCLUSIONS: Desflurane 4.1% with remifentanil 1ng/ml and desflurane 3.4% with remifentanil 3ng/ml significantly blunt the change in spectral entropy after surgical incision in 50% of patients.
[Mh] Termos MeSH primário: Anestésicos Inalatórios/administração & dosagem
Hipnóticos e Sedativos/administração & dosagem
Consciência no Peroperatório/prevenção & controle
Monitorização Neurofisiológica Intraoperatória
Isoflurano/análogos & derivados
Piperidinas/administração & dosagem
[Mh] Termos MeSH secundário: Adulto
Anestesia Geral/métodos
Pressão Sanguínea/efeitos dos fármacos
Procedimentos Cirúrgicos Eletivos/efeitos adversos
Eletroencefalografia
Feminino
Frequência Cardíaca/efeitos dos fármacos
Seres Humanos
Isoflurano/administração & dosagem
Masculino
Meia-Idade
Estudos Prospectivos
[Pt] Tipo de publicação:JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
[Nm] Nome de substância:
0 (Anesthetics, Inhalation); 0 (Hypnotics and Sedatives); 0 (Piperidines); CRS35BZ94Q (desflurane); CYS9AKD70P (Isoflurane); P10582JYYK (remifentanil)
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170914
[Lr] Data última revisão:
170914
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170226
[St] Status:MEDLINE


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[PMID]:28235515
[Au] Autor:Askin T; Unver S; Oguz D; Kutay K
[Ad] Endereço:Dr. Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital, Ankara, Turkey. Electronic address: dr.tugba.askin@gmail.com.
[Ti] Título:Case report: Neuromuscular block induced by rocuronium following sugammadex administration.
[So] Source:J Clin Anesth;37:166-167, 2017 Feb.
[Is] ISSN:1873-4529
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:We present a case in which rocuronium was applied for muscle relaxation following the administration of sugammadex. An emergency surgery under general anesthesia was planned for a 43-year-old male patient due to an L1 vertebral corpus and right tibia-fibula shaft fracture. Anesthesia was induced with fentanyl, propofol and lidocaine. After applying only 30mg of the total induction dose of rocuronium, it was learned that the neurological examination should be controlled again from the surgeon because of the controversial of the neurological deficit. As a result, patient awakened from anesthesia. We administered 2mg/kg sugammadex and spontaneous breathing of patient returned immediately. The patient became conscious and orientated immediately afterwards. The neurological examination of the lower extremities was performed. The patient was anesthetized once again and 0.6mg/kg rocuronium was given in order to gain neoromuscular block approximately 10min after sugammadex administration. 2min later, the patient was smoothly intubated. Neuromuscular monitorization was not used because of emergency. We administered 2mg/kg sugammadex at the end of the procedure and the patient was extubated. The most suitable time for the re-establishment of rocuronium following sugammadex is currently unclear. This case showed that neuromuscular block can be effectively re-induced by rocuronium following the reversal of rocuronium-induced neuromuscular block with sugammadex. In this case, we consider that the ability to effectively reuse normal induction doses of rocuronium is an important clinical observation.
[Mh] Termos MeSH primário: Androstanóis/administração & dosagem
Relaxamento Muscular/efeitos dos fármacos
Bloqueio Neuromuscular/métodos
Fármacos Neuromusculares não Despolarizantes/administração & dosagem
gama-Ciclodextrinas/administração & dosagem
[Mh] Termos MeSH secundário: Acidentes por Quedas
Adulto
Anestesia Geral
Seres Humanos
Consciência no Peroperatório/tratamento farmacológico
Vértebras Lombares/lesões
Masculino
Fraturas da Coluna Vertebral/etiologia
Fraturas da Coluna Vertebral/cirurgia
Fraturas da Tíbia/etiologia
Fraturas da Tíbia/cirurgia
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Androstanols); 0 (Neuromuscular Nondepolarizing Agents); 0 (gamma-Cyclodextrins); 361LPM2T56 (Sugammadex); WRE554RFEZ (rocuronium)
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170914
[Lr] Data última revisão:
170914
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170226
[St] Status:MEDLINE


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[PMID]:28222645
[Au] Autor:Xu R; Zhou S; Yang J; Li H; Zhang Q; Zhang G; Xu S; Peng Q
[Ad] Endereço:1 Department of Anesthesiology, Zhujiang Hospital, Southern medical University, Guangzhou, Guangdong, China.
[Ti] Título:Total intravenous anesthesia produces outcomes superior to those with combined intravenous-inhalation anesthesia for laparoscopic gynecological surgery at high altitude.
[So] Source:J Int Med Res;45(1):246-253, 2017 Feb.
[Is] ISSN:1473-2300
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:Objective We compared efficacy and adverse outcomes following totally intravenous anesthesia (TIVA) versus combined intravenous-inhalation anesthesia (CIVIA) on hemodynamics and postoperative recovery following laparoscopic gynecological (LG) surgery at high altitudes. Methods We enrolled 80 ASA I or II patients scheduled for LG surgery and randomly assigned them to TIVA with propofol (group P, n = 40) or CIVIA with isoflurane (group I, n = 40). Mean arterial pressure, heart rate, pulse oxygen saturation, and partial pressure of end-tidal carbon dioxide were measured at various time points. Outcome measures were interval to spontaneous ventilation, eye opening, return to consciousness, extubation, operating room duration. Intraoperative awareness and postoperative nausea/vomiting were assessed at follow-up. Results No differences in hemodynamic parameters were detected in either group. Group P had a significantly shorter postoperative anesthetic recovery time and lower incidence of postoperative nausea/vomiting. Conclusion TIVA is superior to CIVIA for GL surgery at high altitudes.
[Mh] Termos MeSH primário: Anestésicos Inalatórios
Anestésicos Intravenosos
Procedimentos Cirúrgicos em Ginecologia
Isoflurano
Dor/prevenção & controle
Propofol
[Mh] Termos MeSH secundário: Adolescente
Adulto
Altitude
Período de Recuperação da Anestesia
Anestesia Intravenosa
Pressão Sanguínea/fisiologia
Feminino
Frequência Cardíaca/fisiologia
Hemodinâmica/fisiologia
Seres Humanos
Consciência no Peroperatório/diagnóstico
Laparoscopia
Meia-Idade
Duração da Cirurgia
Dor/fisiopatologia
Náusea e Vômito Pós-Operatório/diagnóstico
Náusea e Vômito Pós-Operatório/fisiopatologia
Estudos Prospectivos
Tibet
Resultado do Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Anesthetics, Inhalation); 0 (Anesthetics, Intravenous); CYS9AKD70P (Isoflurane); YI7VU623SF (Propofol)
[Em] Mês de entrada:1705
[Cu] Atualização por classe:171004
[Lr] Data última revisão:
171004
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170223
[St] Status:MEDLINE
[do] DOI:10.1177/0300060516687230


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[PMID]:28131116
[Au] Autor:Hsu N; Gaiser RR
[Ad] Endereço:Department of Anesthesiology and Critical Care, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA. Electronic address: Nathaniel.Hsu@uphs.upenn.edu.
[Ti] Título:Awareness and Aortocaval Obstruction in Obstetric Anesthesia.
[So] Source:Anesthesiol Clin;35(1):145-155, 2017 Mar.
[Is] ISSN:1932-2275
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Awareness during general anesthesia for cesarean delivery continues to be a major problem. The key to preventing awareness is strict attention to anesthetic technique. The prevalence and implications of aortocaval compression have been firmly established. Compression of the vena cava is a real occurrence when assuming the supine position. Relief of this compression most likely does not occur until the patient is turned 30°, which is not feasible for performing cesarean delivery. Although it is still wise to tilt the patient, the benefit of this tilt may not be as great as once thought.
[Mh] Termos MeSH primário: Anestesia Obstétrica
Aorta Abdominal/fisiopatologia
Consciência no Peroperatório/prevenção & controle
Complicações do Trabalho de Parto/prevenção & controle
Veias Cavas/fisiopatologia
[Mh] Termos MeSH secundário: Constrição Patológica/prevenção & controle
Feminino
Seres Humanos
Posicionamento do Paciente
Postura
Gravidez
Fatores de Risco
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Em] Mês de entrada:1702
[Cu] Atualização por classe:170213
[Lr] Data última revisão:
170213
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170130
[St] Status:MEDLINE


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[PMID]:27797096
[Au] Autor:Gaszynski T; Wieczorek A
[Ad] Endereço:Department of Emergency Medicine and Disaster Medicine, Medical University of Lódz, Poland. tomasz.gaszynski@umed.lodz.pl.
[Ti] Título:A comparison of BIS recordings during propofol-based total intravenous anaesthesia and sevoflurane-based inhalational anaesthesia in obese patients.
[So] Source:Anaesthesiol Intensive Ther;48(4):239-247, 2016.
[Is] ISSN:1731-2515
[Cp] País de publicação:Poland
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Intraoperative awareness is a rarely occurring phenomenon. Obesity is considered as one of the factors increasing the probability of intraoperative awareness due to problems with the dosing of anaesthetics. In a randomized prospective study we compared bispectral index (BIS) recordings during propofol-based total intravenous anaesthesia (TIVA) and sevoflurane-based inhalation anaesthesia in morbidly obese patients as a sign of possible intraoperative awareness. METHODS: 120 morbidly obese patients were randomly allocated into two subgroups: TIVA or SEVO. Propofol TIVA was performed following the Servin formula, while sevoflurane was administered based on the age of the patients. The physician administering anaesthesia was blinded to the BIS recordings while the evaluation of the depth of anaesthesia was conducted based on the clinical symptoms of adequate anaesthesia. BIS recordings were evaluated for periods of BIS > 60. Blinded structured interviews were conducted 2 hours after anaesthesia was administrated. RESULTS: The incidence of BIS > 60 occurred in 90% vs. 91.67% of patients while the mean duration of periods of BIS > 60 was 13.74 ± 21.74% vs. 14.21 ± 18.78% of the duration of anaesthesia in TIVA and SEVO groups, respectively (P > 0.05). There was no correlation between the BMI value and the duration of elevated BIS values observed during anaesthesia in both studied methods of anaesthesia, nor between the total time of anaesthesia and the duration of elevated BIS values above 60 in this study. No patient complained of intraoperative awareness when asked in the post-operative period, probably due to the administration of midasolam. CONCLUSIONS: Although the incidence of BIS > 60 are very common in obese patients, true awareness during anaesthesia infrequent in this group of patients despite the type of anaesthesia, whether intravenous or inhalation.
[Mh] Termos MeSH primário: Anestesia por Inalação/métodos
Anestesia Intravenosa/métodos
Anestésicos Inalatórios
Anestésicos Intravenosos
Monitores de Consciência
Éteres Metílicos
Obesidade Mórbida/cirurgia
Propofol
[Mh] Termos MeSH secundário: Adolescente
Adulto
Cirurgia Bariátrica/métodos
Índice de Massa Corporal
Feminino
Seres Humanos
Consciência no Peroperatório/epidemiologia
Masculino
Meia-Idade
Estudos Prospectivos
Medição de Risco
Adulto Jovem
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Anesthetics, Inhalation); 0 (Anesthetics, Intravenous); 0 (Methyl Ethers); 38LVP0K73A (sevoflurane); YI7VU623SF (Propofol)
[Em] Mês de entrada:1703
[Cu] Atualização por classe:170817
[Lr] Data última revisão:
170817
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:161101
[St] Status:MEDLINE
[do] DOI:10.5603/AIT.2016.0044


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[PMID]:27755648
[Au] Autor:Messina AG; Wang M; Ward MJ; Wilker CC; Smith BB; Vezina DP; Pace NL
[Ad] Endereço:The Alliance for Medical Management Education, School of Management, University of Texas at Dallas, Box 233, 1920 N. Coit Road, Richardson, TX, USA, 75080.
[Ti] Título:Anaesthetic interventions for prevention of awareness during surgery.
[So] Source:Cochrane Database Syst Rev;10:CD007272, 2016 Oct 18.
[Is] ISSN:1469-493X
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: General anaesthesia is usually associated with unconsciousness. 'Awareness' is when patients have postoperative recall of events or experiences during surgery. 'Wakefulness' is when patients become conscious during surgery, but have no postoperative recollection of the period of consciousness. OBJECTIVES: To evaluate the efficacy of two types of anaesthetic interventions in reducing clinically significant awareness:- anaesthetic drug regimens; and- intraoperative anaesthetic depth monitors. SEARCH METHODS: We searched the Cochrane Central Register of Controlled Trials (CENTRAL, ISSUE 4 2016); PubMed from 1950 to April 2016; MEDLINE from 1950 to April 2016; and Embase from 1980 to April 2016. We contacted experts to identify additional studies. We performed a handsearch of the citations in the review. We did not search trial registries. SELECTION CRITERIA: We included randomized controlled trials (RCTs) of either anaesthetic regimens or anaesthetic depth monitors. We excluded volunteer studies, studies of patients prior to skin incision, intensive care unit studies, and studies that only randomized different word presentations for memory tests (not anaesthetic interventions).Anaesthetic drug regimens included studies of induction or maintenance, or both. Anaesthetic depth monitors included the Bispectral Index monitor, M-Entropy, Narcotrend monitor, cerebral function monitor, cerebral state monitor, patient state index, and lower oesophageal contractility monitor. The use of anaesthetic depth monitors allows the titration of anaesthetic drugs to maintain unconsciousness. DATA COLLECTION AND ANALYSIS: At least two authors independently scanned abstracts, extracted data from the studies, and evaluated studies for risk of bias. We made attempts to contact all authors for additional clarification. We performed meta-analysis statistics in packages of the R language. MAIN RESULTS: We included 160 studies with 54,109 enrolled participants; 53,713 participants started the studies and 50,034 completed the studies or data analysis (or both). We could not use 115 RCTs in meta-analytic comparisons because they had zero awareness events. We did not merge 27 of the remaining 45 studies because they had excessive clinical and methodological heterogeneity. We pooled the remaining 18 eligible RCTs in meta-analysis. There are 10 studies awaiting classification which we will process when we update the review.The meta-analyses included 18 trials with 36,034 participants. In the analysis of anaesthetic depth monitoring (either Bispectral Index or M-entropy) versus standard clinical and electronic monitoring, there were nine trials with 34,744 participants. The overall event rate was 0.5%. The effect favoured neither anaesthetic depth monitoring nor standard clinical and electronic monitoring, with little precision in the odds ratio (OR) estimate (OR 0.98, 95% confidence interval (CI) 0.59 to 1.62).In a five-study subset of Bispectral Index monitoring versus standard clinical and electronic monitoring, with 34,181 participants, 503 participants gave awareness reports to a blinded, expert panel who adjudicated or judged the outcome for each patient after reviewing the questionnaires: no awareness, possible awareness, or definite awareness. Experts judged 351 patient awareness reports to have no awareness, 87 to have possible awareness, and 65 to have definite awareness. The effect size favoured neither Bispectral Index monitoring nor standard clinical and electronic monitoring, with little precision in the OR estimate for the combination of definite and possible awareness (OR 0.96, 95% CI 0.35 to 2.65). The effect size favoured Bispectral Index monitoring for definite awareness, but with little precision in the OR estimate (OR 0.60, 95% CI 0.13 to 2.75).We performed three smaller meta-analyses of anaesthetic drugs. There were nine studies with 1290 participants. Wakefulness was reduced by ketamine and etomidate compared to thiopental. Wakefulness was more frequent than awareness. Benzodiazepines reduces awareness compared to thiopental, ketamine, and placebo., Also, higher doses of inhaled anaesthetics versus lower doses reduced the risk of awareness.We graded the quality of the evidence as low or very low in the 'Summary of findings' tables for the five comparisons.Most of the secondary outcomes in this review were not reported in the included RCTs. AUTHORS' CONCLUSIONS: Anaesthetic depth monitors may have similar effects to standard clinical and electrical monitoring on the risk of awareness during surgery. In older studies comparing anaesthetics in a smaller portion of the patient sample, wakefulness occurred more frequently than awareness. Use of etomidate and ketamine lowered the risk of wakefulness compared to thiopental. Benzodiazepines compared to thiopental and ketamine, or higher doses of inhaled anaesthetics versus lower doses, reduced the risk of awareness.
[Mh] Termos MeSH primário: Anestesia
Anestésicos
Consciência no Peroperatório/prevenção & controle
Monitorização Intraoperatória/métodos
[Mh] Termos MeSH secundário: Benzodiazepinas/administração & dosagem
Monitores de Consciência
Eletroencefalografia/métodos
Etomidato
Seres Humanos
Ketamina
Rememoração Mental
Monitorização Intraoperatória/instrumentação
Ensaios Clínicos Controlados Aleatórios como Assunto
Tiopental/administração & dosagem
Vigília
[Pt] Tipo de publicação:JOURNAL ARTICLE; META-ANALYSIS; RESEARCH SUPPORT, NON-U.S. GOV'T; REVIEW
[Nm] Nome de substância:
0 (Anesthetics); 12794-10-4 (Benzodiazepines); 690G0D6V8H (Ketamine); JI8Z5M7NA3 (Thiopental); Z22628B598 (Etomidate)
[Em] Mês de entrada:1611
[Cu] Atualização por classe:171116
[Lr] Data última revisão:
171116
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:161102
[St] Status:MEDLINE


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[PMID]:27752170
[Au] Autor:Quan LX; An HX; Wang DX
[Ad] Endereço:Department of Anesthesiology, Zhengzhou Orthopedic Hospital, Zhengzhou 450052,China.
[Ti] Título:[Impact of dexmedetomidine-sevoflurane anesthesia on intraoperative wake-up test in children patients undergoing scoliosis surgery].
[So] Source:Beijing Da Xue Xue Bao Yi Xue Ban;48(5):855-859, 2016 10 18.
[Is] ISSN:1671-167X
[Cp] País de publicação:China
[La] Idioma:chi
[Ab] Resumo:OBJECTIVE: To observe the effects of 0.4 µg/(kg×h) dose of dexmedetomidine on intra-operative wake-up test in children patients undergoing scoliosis surgery. METHODS: Sixty patients for posterior scoliosis correction (ASA I-II, aged 5-16 years) from March 2013 to April 2015 were enrolled in this prospective, double-blinded, randomized, placebo-controlled study, The patients were randomly classified into two groups to receive dexmedetomidine (group RD, n=30) or saline solution (group R, n=30). In group RD, dexmedetomidine [0.4 µg/(kg×h)] was administered after tracheal intubation, while the equal volume saline solution was given instead in group R. Anesthesia was induced with midazolam, propofol, sufentanyl and cisatracurium, and anesthesia was maintained with sevoflurane inhalation and a continuous intravenous infusion of remifentanil in the both groups.BIS (bispectral index, BIS) value was maintained at 40-60,and mean arterial pressure (MAP) was maintained at ≥ 60 mmHg before the wake-up test.When the wake-up test was performed, immediately the dexmedetomidine and remifentanil infusion were stopped, and the end-tidal concentration of sevoflurane was adjusted to 0. Mean arterial pressure, and heart rate (HR) were recorded before anesthesia and at 5-minute intervals during the wake-up test. The wake-up test time, arousal quality and sedation scores were recorded also.In addition, the data were also gathered on the dosage of ephedrine and atropine were used, as well as the intraoperative awareness in the patients who were followed up on the first day after the operation. RESULTS: There were no differences between group RD and group R with regard to HR and MAP at getting into the operation room (t=-1.460, P=0.150;t =-1.015, P=0.315). In group RD, no evidence was found for a difference in HR and MAP at awakening up versus at getting into the operation room (t=0.974, P=0.340; t=-1.449, P=0.161), while in group R, an increase in HR and MAP occurred at awakening versus at getting into the operation room (t=-2.106, P=0.044; t=-2.352, P=0.026). There were no significant differences in sedation scores and wake-up test time between the two groups (t=1.986, P=0.052; t=0.392, P=0.697). The wake-up test quality was significantly better in group RD than in group R (t=-2.098,P=0.041). HR in group RD was significantly lower than that in group R at any time point during the wake-up test (P<0.05). Four patients had awareness occurrence during the operation in group R, and no awareness occurrence in group RD. CONCLUSION: Dexmedetomidine, when administered at a rate of 0.4 µg/(kg×h) as an adjuvant of sevoflurane inhalational anesthesia, could improve the wake-up test quality, and maintain hemodynamic stability during scoliosis surgery.
[Mh] Termos MeSH primário: Adjuvantes Anestésicos/farmacologia
Anestesia Geral/métodos
Dexmedetomidina/uso terapêutico
Frequência Cardíaca/efeitos dos fármacos
Consciência no Peroperatório/tratamento farmacológico
Éteres Metílicos/uso terapêutico
[Mh] Termos MeSH secundário: Adjuvantes Anestésicos/administração & dosagem
Adjuvantes Anestésicos/uso terapêutico
Adolescente
Período de Recuperação da Anestesia
Pressão Arterial/efeitos dos fármacos
Atracúrio/análogos & derivados
Criança
Pré-Escolar
Método Duplo-Cego
Feminino
Seres Humanos
Intubação Intratraqueal
Masculino
Midazolam
Piperidinas
Propofol
Estudos Prospectivos
Escoliose/cirurgia
Sufentanil
[Pt] Tipo de publicação:CLINICAL TRIAL; JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
[Nm] Nome de substância:
0 (Adjuvants, Anesthesia); 0 (Methyl Ethers); 0 (Piperidines); 2GQ1IRY63P (Atracurium); 38LVP0K73A (sevoflurane); 67VB76HONO (Dexmedetomidine); AFE2YW0IIZ (Sufentanil); P10582JYYK (remifentanil); QX62KLI41N (cisatracurium); R60L0SM5BC (Midazolam); YI7VU623SF (Propofol)
[Em] Mês de entrada:1709
[Cu] Atualização por classe:171116
[Lr] Data última revisão:
171116
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:161019
[St] Status:MEDLINE



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