MedWorm: Diprivan

  Provocative Test with Propofol: Experience in Patients with Cerebral Arteriovenous Malformations Who Underwent Neuroendovascular Procedures [INTERVENTIONAL]

CONCLUSIONS: Propofol use during provocative testing in AVM embolization procedures represents an effective alternative to barbiturate testing and can have a positive impact in improving safety under sedation. (Source: American Journal of Neuroradiology)

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  Remifentanil versus fentanyl compared in a target-controlled infusion of propofol anesthesia: quality of anesthesia and recovery profile

Conclusion  We concluded that in propofol-based TCI anesthesia under BIS supervision for septorhinoplasty operations, remifentanil was better than fentanyl, especially with respect to emergence from total intravenous anesthesia (TIVA). Furthermore, the durations of anesthesia and operation were rather short, which indicates that fentanyl can be safely used. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s00540-010-0898-1Authors Demet Coskun, Gazi University Faculty of Medicine Department of Anesthesiology and Reanimation 06500 Ankara TurkeyHulya Celebi, Gazi University Faculty of Medicine Department of Anesthesiology and Reanimation 06500 Ankara TurkeyGozde Karaca, Gazi University Faculty of Medicine Department of Anesthesiology and Reanimation 0650...

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  Safe and effective sedation in endoscopic submucosal dissection for early gastric cancer: a randomized comparison between propofol continuous infusion and intermittent midazolam injection

Conclusion  Based on our results, the ESDs for EGC performed under sedation using propofol continuous infusion were as safe as those performed using intermittent MDZ injection. Propofol-treated patients had a quicker recovery profile than those treated with MDZ. We therefore recommend the use of continuous propofol sedation for ESD, but sedation guidelines for the use of propofol are necessary. Content Type Journal ArticleCategory Original Article—Alimentary TractDOI 10.1007/s00535-010-0222-8Authors Shinsuke Kiriyama, National Cancer Center Hospital Department of Endoscopy Tokyo JapanTakuji Gotoda, National Cancer Center Hospital Department of Endoscopy Tokyo JapanHiromi Sano, Cancer Institute Hospital Anesthesiology Department Tokyo JapanIchiro Oda, National Cance...

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  Study of the time course of the clinical effect of propofol compared with the time course of the predicted effect-site concentration: performance of three pharmacokinetic-dynamic models

Conclusions Targeting CePROP at which patients lose consciousness with effect-site-controlled TCI does not translate into an immediate constant effect. (Source: British Journal of Anaesthesia)

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  Reduced effect of propofol at human {alpha}1{beta}2(N289M){gamma}2 and {alpha}2{beta}3(N290M){gamma}2 mutant GABAA receptors

Conclusions We demonstrate that N289M or N290M mutation in human GABAA β2 and β3 subunits increases sensitivity to GABA, which is in contrast to the corresponding rat N265M mutation. Furthermore, the N289M and N289M mutations reduce both the potentiation of GABA-induced currents and the direct effect of propofol on channels incorporating either of the mutated subunits, which confirms earlier findings concerning the corresponding mutation in rat receptors and knock-in mice. (Source: British Journal of Anaesthesia)

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  Induction of anesthesia in coronary artery bypass graft surgery: the hemodynamic and analgesic effects of ketamine

OBJECTIVE: The aim of this prospective, randomized study was to evaluate the hemodynamic and analgesic effects of ketamine by comparing it with propofol starting at the induction of anesthesia until the end of sternotomy in patients undergoing coronary artery bypass grafting surgery. INTRODUCTION: Anesthetic induction and maintenance may induce myocardial ischemia in patients with coronary artery disease. A primary goal in the anesthesia of patients undergoing coronary artery bypass grafting surgery is both the attenuation of sympathetic responses to noxious stimuli and the prevention of hypotension. METHODS: Thirty patients undergoing coronary artery bypass grafting surgery were randomized to receive either ketamine 2 mg.kg-1 (Group K) or propofol 0.5 mg.kg-1 (Group P) during induction of...

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  Numerous Classes of General Anesthetics Inhibit Etomidate Binding to {gamma}-Aminobutyric Acid Type A (GABAA) Receptors [Protein Structure and Folding]

Enhancement of -aminobutyric acid type A receptor (GABAAR)-mediated inhibition is a property of most general anesthetics and a candidate for a molecular mechanism of anesthesia. Intravenous anesthetics, including etomidate, propofol, barbiturates, and neuroactive steroids, as well as volatile anesthetics and long-chain alcohols, all enhance GABAAR function at anesthetic concentrations. The implied existence of a receptor site for anesthetics on the GABAAR protein was supported by identification, using photoaffinity labeling, of a binding site for etomidate within the GABAAR transmembrane domain at the β- subunit interface; the etomidate analog [3H]azietomidate photolabeled in a pharmacologically specific manner two amino acids, 1Met-236 in the M1 helix and βMet-286 in the M3 heli...

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  Corrigendum to "Potential mechanism of cell death in the developing rat brain induced by propofol anesthesia"International Journal of Developmental Neuroscience 27(3) 279-287 (2009).

Authors: Pesić V, Milanović D, Tanić N, Popić J, Kanazir S, Jevtović-Todorović V, Ruzdijić S PMID: 20211421 [PubMed - in process] (Source: International Journal of Developmental Neuroscience)

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  Total intravenous anesthesia and spontaneous respiration for airway endoscopy in children – a prospective evaluation

Conclusion: TIVA and spontaneous respiration is an effective technique to manage anesthesia for airway endoscopy and surgery in children. (Source: Pediatric Anesthesia)

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  Intensive care unit-acquired infection as a side effect of sedation

Conclusions: Prolongation of exposure to risk factors for infection, microaspiration, gastrointestinal motility disturbances, microcirculatory effects, and immunomodulatory effects are main mechanisms by which sedation may favour infection in critically ill patients. Future studies should compare the effect of different sedative agents, and the impact of progressive opioid discontinuation compared with abrupt discontinuation on ICU-acquired infection rates. (Source: BioMed Central)

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  Bispectral index correlates well with Richmond agitation sedation scale in mechanically ventilated critically ill patients

Conclusion  Our results illustrate that BIS correlates well with RASS when assessing the level of sedation in mechanically ventilated critically ill patients. BIS reliably differentiates inadequate from adequate sedation. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s00540-010-0915-4Authors Kunal Karamchandani, Anesthesiology Institute, Cleveland Clinic Foundation 9500 Euclid Avenue Cleveland OH 44195 USAVimi Rewari, All India Institute of Medical Sciences Department of Anaesthesiology and Intensive Care Ansari Nagar New Delhi 110029 IndiaAnjan Trikha, All India Institute of Medical Sciences Department of Anaesthesiology and Intensive Care Ansari Nagar New Delhi 110029 IndiaRavinder Kumar Batra, All India Institute of Medical Sciences Department of...

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  Prediction of Propofol Clearance in Children from an Allometric Model Developed in Rats, Children and Adults versus a 0.75 Fixed-Exponent Allometric Model

(Source: Clinical Pharmacokinetics)

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  Comparison of propofol versus propofol-ketamine combination for sedation during spinal anesthesia in children: randomized clinical trial of efficacy and safety

Conclusions: Propofol-ketamine combination provided better quality of sedation with lesser complications than propofol alone and thus can be a good option for sedation during spinal anesthesia in children. (Source: Pediatric Anesthesia)

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  Investigation of escalating and large bolus doses of a novel, nano-droplet, aqueous 1% propofol formulation in cats

Conclusions Larger doses of a novel, nano-droplet propofol formulation can produce SAEs similar to those reported for lipid emulsion formulations.Clinical relevance Systemic arterial blood pressure should be monitored in cats administered IV propofol. (Source: Veterinary Anaesthesia and Analgesia)

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  Cardiopulmonary effects of a new inspiratory impedance threshold device in anesthetized hypotensive dogs

Conclusion and clinical relevance Impedance threshold device in dogs during isoflurane-induced hypotension improved CI and SAP but had negative effects on RC and ResR. (Source: Veterinary Anaesthesia and Analgesia)

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  Pleth variability index predicts hypotension during anesthesia induction

The pleth variability index (PVI) is a new algorithm used for automatic estimation of respiratory variations in pulse oximeter waveform amplitude, which might predict fluid responsiveness. Because anesthesia-induced hypotension may be partly related to patient volume status, we speculated that pre-anesthesia PVI would be able to identify high-risk patients for significant blood pressure decrease during anesthesia induction. We measured the PVI, heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial pressure (MAP) in 76 adult healthy patients under light sedation with fentanyl to obtain pre-anesthesia control values. Anesthesia was induced with bolus administrations of 1.8 mg/kg propofol and 0.6 mg/kg rocuronium. During the 3-min period from the st...

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  A clinical prospective comparison of anesthetics sensitivity and hemodynamic effect among patients with or without obstructive jaundice

To compare isoflurane anesthesia in patients with or without hyperbilirubinemia undergoing hepatobiliary surgery. Forty-two patients with obstructive jaundice and 40 control patients with normal liver function scheduled for hepatobiliary surgery under isoflurane anesthesia were studied. Anesthesia was induced with propofol (1.5[ndash]2 mg/kg) and remifentanil (2 [mu]g/kg). After tracheal intubation, anesthesia was titrated using isoflurane in oxygen-enriched air, adjusted to maintain a bispectral index (BIS) value of 46[ndash]54. Ephedrine, atropine and remifentanil were used to maintain hemodynamic parameters within 30% of the baseline. The mean arterial blood pressure (MAP), heart rate (HR), drug doses and the time taken to recover from anesthesia were recorded. Demographic data, duratio...

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  When Propofol Is Administered By Trained Professional Adverse Events Rate Is Low

Propofol is safe for advanced endoscopic procedures with a low rate of sedation-related adverse events when administered by a trained professional, according to a new study in Clinical Gastroenterology and Hepatology, the official journal of the American Gastroenterological Association (AGA) Institute. "This is the first paper to report the frequency of airway modifications (AMs) associated with propofol use in endoscopy... (Source: Health News from Medical News Today)

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  When Propofol Is Administered By Trained Professional Adverse Events Rate Is Low

Propofol is safe for advanced endoscopic procedures with a low rate of sedation-related adverse events when administered by a trained professional, according to a new study in Clinical Gastroenterology and Hepatology, the official journal of the American Gastroenterological Association (AGA) Institute... (Source: Pain / Anesthetics News From Medical News Today)

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  Adverse events rate is low when propofol is administered by trained professional

(American Gastroenterological Association) Propofol is safe for advanced endoscopic procedures with a low rate of sedation-related adverse events when administered by a trained professional. (Source: EurekAlert! - Medicine and Health)

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  Correlation between Bispectoral Index and Predicted Effect-site Concentration of Propofol in Different Levels of Target-Controlled, Propofol Induced Sedation in Healthy Volunteers.

CONCLUSION: Both Bispectral Index and effect site concentration of propofol indicate a good estimate of sedation levels; however their correlations are significant and negative only at moderate and deep sedation levels, and during the induction of sedation. PMID: 20187667 [PubMed - in process] (Source: Archives of Iranian Medicine)

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  Propofol: Seizures: 5 case reports

(Source: Reactions)

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  Safety, Efficacy of Propofol During Endoscopy Evaluated

With careful attention paid to maintaining clear and effective airways, the sedative propofol can be safely used to induce deep sedation in patients for advanced endoscopic procedures, according to a study in the February issue of Clinical Gastroenterology and Hepatology. (Source: Modern Medicine)

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  A Beat-by-Beat Cardiovascular Index, CARDEAN: A Prospective Randomized Assessment of Its Utility for the Reduction of Movement During Colonoscopy.

CONCLUSION: With BIS <60, CARDEAN-guided opioid administration is associated with a reduction of 51% of clinically unpredictable movements in unparalyzed patients undergoing colonoscopy. More studies are required to refine the role of CARDEAN in surgical settings. PMID: 20185655 [PubMed - in process] (Source: Anesthesia and Analgesia)

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  Endoscopic sedation training in gastroenterology fellowship

Sedation in endoscopy has recently been much debated, yet it is not usually a topic formally addressed during fellowship. Recommendations recently published in a consensus statement will inevitably steer changes in sedation practices. In this month's Fellows' Corner, Dr. Tyler Berzin, a gastroenterology fellow at Beth Israel Deaconess Medical Center, experienced in the study of endoscopic sedation, summarizes the key elements stirring the propofol controversy and offers advice on training in the safe administration of anesthesia. (Source: Gastrointestinal Endoscopy)

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  A Residue in Loop 9 of the {beta}2-Subunit Stabilizes the Closed State of the GABAA Receptor [Signal Transduction]

In -aminobutyric acid type A (GABAA) receptors, the structural elements that couple ligand binding to channel opening remain poorly defined. Here, site-directed mutagenesis was used to determine if Loop 9 on the non-GABA binding site interface of the β2-subunit may be involved in GABAA receptor activation. Specifically, residues Gly170-Gln185 of the β2-subunit were mutated to alanine, co-expressed with wild-type 1- and 2S-subunits in human embryonic kidney (HEK) 293 cells and assayed for their activation by GABA, the intravenous anesthetic propofol and the endogenous neurosteroid pregnanolone using whole cell macroscopic recordings. Three mutants, G170A, V175A, and G177A, produced 2.5-, 6.7-, and 5.6-fold increases in GABA EC50 whereas one mutant, Q185A, produced a 5.2-fold decre...

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  Effectiveness of the timing principle with high-dose rocuronium during rapid sequence induction with lidocaine, remifentanil and propofol

Conclusion  Application of the timing principle with 1 mg kg−1 rocuronium is beneficial for rapid tracheal intubation. Co-administered lidocaine, remifentanil and propofol can definitely suppress cardiovascular responses during laryngoscopy and intubation. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s00540-010-0880-yAuthors Takahiro Suzuki, Surugadai Nihon University Hospital Department of Anesthesiology 1-8-13, Kanda-Surugadai, Chiyoda-ku Tokyo 101-8309 JapanMayu Aono, Surugadai Nihon University Hospital Department of Anesthesiology 1-8-13, Kanda-Surugadai, Chiyoda-ku Tokyo 101-8309 JapanNaoko Fukano, Surugadai Nihon University Hospital Department of Anesthesiology 1-8-13, Kanda-Surugadai, Chiyoda-ku Tokyo 101-8309 JapanMakiko Kobayas...

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  The breast feeding mother and xenon anaesthesia: four case reports. Breast feeding and xenon anaesthesia

Background: Four nursing mothers consented to anaesthesia for urgent surgery only on condition that their ability to breast feed would not be impaired. Methods: Following induction of general anaesthesia with propofol and remifentanil, 65-69% xenon supplemented with remifentanil was used as an inhalational anaesthetic for maintenance. Results: After finishing surgery the women could be extubated between 2:52 and 7:22 minutes. The women were fully alert just minutes after extubation and spent about 45 minutes in the recovery room before discharge to a regular ward. They resumed regular breast feeding some time later. The propofol concentration in the blood was measured after 0, 30, 90, and 300 minutes and in the milk after 90 and 300 minutes. Just 90 minutes after extubation, the concentrat...

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  Successful bilateral deep brain stimulation of the globus pallidus internus for persistent status dystonicus and generalized chorea.

Authors: Apetauerova D, Schirmer CM, Shils JL, Zani J, Arle JE The authors report the cases of 2 young male patients (aged 16 and 26 years) with dystonic cerebral palsy of unknown origin, who developed status dystonicus, an acute and persistent combination of generalized dystonia and chorea. Both patients developed status dystonicus after undergoing general anesthesia, and in 1 case, after administration of metoclopramide. In attempting to control this acute hyperkinetic movement disorder, multiple medication trials failed in both cases and patients required prolonged intubation and sedation with propofol. Bilateral deep brain stimulation of the globus pallidus internus (4 and 2 months after the onset of symptoms in the first and second case, respectively) produced immediate resolution...

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  Propofol: Increased heart rate and unpleasant sensation following inadvertent intra-arterial administration: case report

(Source: Reactions)

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  Michael Jackson toxicology report released

This week, the Los Angeles medical examiner’s office released the autopsy report on Michael Jackson. Included in the release are toxicology findings, and a discussion by an anesthesiologist concerning the effects and proper administration of propofol. The cause of death was listed as “acute propofol intoxication”, with the “benzodiazepine effect” contributing.  The toxicology tests determined the following: Propofol:                   Heart blood – 3.2 mcg/ml;       Hospital blood – 4.1 mcg/ml;         Femoral blood – 2.6 mcg/ml Lidocaine:                Heart blood  - 0.68 mcg/ml;   Hospital blood – 0.5 mcg/ml;         Femoral blood – 0.34 mcg/ml Lorazepam:              Heart blood – 0....

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  Association between nitrous oxide and the incidence of postoperative nausea and vomiting in adults: a systematic review and meta-analysis

Some, but not all studies have suggested intra-operative use of nitrous oxide is correlated with postoperative nausea and vomiting. We performed a meta-analysis of randomised controlled trials to compare the incidence of nausea and vomiting in adults following general anaesthesia with or without nitrous oxide. We retrieved 30 studies (incorporating 33 separate trials) that investigated a 'nitrous oxide group' (total 2297 patients) vs a 'no-nitrous oxide group' (2301 patients). Omitting nitrous oxide significantly reduced postoperative nausea and vomiting (pooled relative risk 0.80, 95% CI 0.71[ndash]0.90, p = 0.0003). However, the absolute incidence of nausea and vomiting was high in both the nitrous oxide and no-nitrous oxide groups (33% vs 27%, respectively). In subgroup analysis, the ma...

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  Topical lidocaine improves conditions for laryngeal mask airway insertion.

CONCLUSION: Topical lidocaine 40 mg followed by propofol 2 mg.kg(-1) can provide optimal insertion conditions of the LMA-Classic comparable to those of propofol 3 mg.kg(-1), with fewer hemodynamic changes and a lower incidence of apnea. PMID: 20151341 [PubMed - as supplied by publisher] (Source: Canadian Journal of Anaesthesia)

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  Pharmacokinetic profile in relation to anaesthesia characteristics after a 5% micellar microemulsion of propofol in the horse

Conclusions Caution is warranted when propofol is used for continuous infusion due to variable kinetics, myoclonal activity, poor analgesia, and less desirable recovery quality. (Source: British Journal of Anaesthesia)

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  Intra-uterine bupivacaine and levobupivacaine

Conclusion: Intrauterine levobupivacaine or bupivacaine is effective in decreasing the pain associated with the endometrial biopsy and curettage under propofol sedation. (Source: The Australian and New Zealand Journal of Obstetrics and Gynaecology)

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  Propofol: Propofol infusion syndrome due to diethylene glycol contamination?: case report

(Source: Reactions)

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  Validated assay for studying activity profiles of human liver UGTs after drug exposure: inhibition and induction studies.

Authors: Donato MT, Montero S, Castell JV, Gómez-Lechón MJ, Lahoz A UDP-glucuronsyltransferases (UGTs) are a family of conjugating enzymes that participate in the metabolism of many drugs. The study of potential drug-drug interactions involving UGTs has been largely hindered by the limited availability of selective functional assays for individual UGT enzymes. We propose a sensitive and reproducible procedure for the activity measurements of four major human hepatic UGT forms. The assays are based on analysis and quantification by high-performance liquid chromatography-tandem mass spectrometry of glucuronides formed from selective probe substrates, namely, beta-estradiol (UGT1A1, 3-glucuronide), 1-naphthol (UGT1A6), propofol (UGT1A9), and naloxone (UGT2B7). The analytical met...

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  Cardiovascular effects following epidural injection of romifidine in isoflurane-anaesthetized dogs

Conclusion Epidural romifidine in isoflurane-anaesthetized dogs caused significant cardiovascular effects similar to those reportedly produced by systemic romifidine administration.Clinical relevance Similar cardiovascular monitoring is required after epidural and systemically administered romifidine. Further studies are required to evaluate the analgesic effects of epidural romifidine. (Source: Veterinary Anaesthesia and Analgesia)

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  A Rare Case of Propofol-Induced Acute Liver Failure and Literature Review

Case Rep Gastroenterol 2010;4:57–65 (DOI:10.1159/000262448) (Source: Karger Publishers)

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  Effort, safety, and findings of routine preoperative endoscopic evaluation of morbidly obese patients undergoing bariatric surgery

Conclusions  Upper gastrointestinal endoscopy can be performed safely. However, careful monitoring and anesthesiological support are required for patients with concomitant diseases and those receiving sedation. Because 80% of the patients with pathological findings were asymptomatic, every morbidly obese patient should undergo endoscopy before bariatric surgery because there may be findings that might change the surgical strategy. Content Type Journal ArticleDOI 10.1007/s00464-010-0893-5Authors M. A. Küper, Tübingen University Hospital Department of General, Visceral and Transplant Surgery Hoppe-Seyler-Strasse 3 72076 Tübingen GermanyT. Kratt, Tübingen University Hospital Department of General, Visceral and Transplant Surgery Hoppe-Seyler-Strasse 3 72076 Tübingen...

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  Cardiopulmonary and isoflurane-sparing effects of epidural or intravenous infusion of dexmedetomidine in cats undergoing surgery with epidural lidocaine

Conclusions and clinical relevance Epidural and CRI of DEX significantly decreased isoflurane consumption and resulted in recovery of better quality and longer duration, despite bradycardia, without changes in systemic blood pressure. (Source: Veterinary Anaesthesia and Analgesia)

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  Total intravenous anesthesia with propofol and S(+)-ketamine in rabbits

Conclusions and clinical relevance S(+)-ketamine potentiates propofol-induced anesthesia in rabbits, providing better maintenance of heart rate. All of these techniques were accompanied by clinically significant respiratory depression. (Source: Veterinary Anaesthesia and Analgesia)

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  Clinical evaluation of the anaesthetic sparing effect of brachial plexus block in cats

Conclusion and Clinical relevance In cats undergoing orthopaedic surgery of the thoracic limb, BPB reduced intra-operative isoflurane requirement and pain during the early post-operative period when compared with procedures without a BPB. BPB is a useful adjunct to anaesthesia in such cases. (Source: Veterinary Anaesthesia and Analgesia)

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  Endoscopic Sedation and Monitoring Practice in Germany: Results from the First Nationwide Survey.

CONCLUSION: Besides the common administration of short-acting benzodiazepines, sedation with propofol is also gaining ground in Germany; it is applied mainly in low doses (up to 150 mg). German endoscopists are highly satisfied with these sedation regimens, with propofol significantly leading the score. Patient monitoring predominantly follows currently prevailing guidelines. PMID: 20140841 [PubMed - as supplied by publisher] (Source: Zeitschrift fur Gastroenterologie)

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  An Animal Model to Investigate Effectiveness and Safety of Conducted Energy Weapons (Including TASER(R) Devices)*

Authors: Jauchem JR Conducted energy weapons (CEWs) are used by law-enforcement personnel to incapacitate individuals quickly and effectively, without causing lethality. CEWs have been deployed for relatively long or repeated exposures during law-enforcement operations. The purpose of this technical note is to describe, in detail, some aspects of an anesthetized swine model used in our laboratory and to answer specific questions related to the model. In particular, tiletamine/zolazepam-induced, propofol-maintained anesthesia appears to be a useful technique for studying effects of CEW applications on muscle contraction and blood factors such as muscle enzymes. Because effects of CEWs on breathing have not been fully elucidated, a spontaneously breathing model is preferable to one in wh...

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  [EEG-adjusted target-controlled infusion : Propofol target concentration with different doses of remifentanil.]

CONCLUSIONS: The study demonstrates that remifentanil has both analgetic and hypnotic effects. With increasing remifentanil dose the propofol requirement decreased and in this context EEG monitoring is useful to adapt the target concentrations of propofol to the patients' age and gender. PMID: 20127058 [PubMed - as supplied by publisher] (Source: Der Anaesthesist)

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  Can BIS monitoring be used to assess the depth of propofol anesthesia in the treatment of refractory status epilepticus?

Discussion: The cEEG can be considered as the primary monitoring technique in the assessment of the depth of anesthesia in the treatment of RSE. If cEEG is not available, the BIS monitor can be used to guide the level of anesthesia, targeting BS in patients with RSE. (Source: Epilepsia)

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  EC50 of remifentanil to prevent withdrawal movement associated with injection of rocuronium

Conclusion  The EC50 of remifentanil to blunt the withdrawal responses to rocuronium injection was 1.37–1.5 ng/ml during 3 μg/ml propofol TCI anesthesia. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s00540-010-0868-7Authors Ji Young Yoon, Pusan National University Department of Anesthesia and Pain Medicine, School of Medicine 1-10 Ami-dong, Seo-gu Busan 602-739 KoreaHae Kyu Kim, Pusan National University Department of Anesthesia and Pain Medicine, School of Medicine 1-10 Ami-dong, Seo-gu Busan 602-739 KoreaJae Young Kwon, Pusan National University Department of Anesthesia and Pain Medicine, School of Medicine 1-10 Ami-dong, Seo-gu Busan 602-739 KoreaSang Wook Shin, Pusan National University Department of Anesthesia and Pain Medicine, Sch...

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  Green urine

Life in the Fast Lane has posted an interesing case of drug-induced green urine.  I won’t spoil the surprising by revealing the causative agent. (Source: The Poison Review)

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  Evaluation of the analgesic effect of intracameral lidocaine hydrochloride injection on intraoperative and postoperative pain in healthy dogs undergoing phacoemulsification.

Conclusions and Clinical Relevance-Intracameral lidocaine injection had significant analgesic effects in dogs undergoing cataract surgery. Results of this study suggest the value of intracameral lidocaine injection as an analgesic for intraocular surgery in dogs. PMID: 20113230 [PubMed - in process] (Source: American Journal of Veterinary Research)

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  Safety of Propofol Sedation for Pediatric Outpatient Procedures: Larsen R, Galloway D, Wadera S, et al. Clin Pediatr 2009;48:819–23

Propofol is frequently used for sedation in both inpatient and outpatient pediatric procedures. Most available studies demonstrate its safety when given by Anesthesiology staff. This retrospective study examined the safety of propofol for sedation when administered by pediatric intensivists. In total, 4716 procedures over a 6-year period were included in this study. (Source: The Journal of Emergency Medicine)

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  [Effect of doxapram on the respiratory rhythmical discharge activity in the brainstem slice of neonatal rats.]

CONCLUSION: Doxapram (>5 micromol/L ) can directly stimulate the RRDA and prevent propofol-induced inhibitory effects in the brainstem slice of neonatal rats, and the effects are mediated by its actions upon the inspiratory neurons in the mNRF. PMID: 20159691 [PubMed - in process] (Source: Journal of Southern Medical University)

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  The frequency of fentanyl-induced cough in children and its effects on tracheal intubation

Conclusion: Fentanyl at doses of one and two μg/kg may induce coughing in pediatric patients. (Source: Journal of Clinical Anesthesia)

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  Ouch! My hand burns

We read with interest the report of Austin and Parke , regarding the comparative effects of admixtures of propofol 1% with either ephedrine hydrochloride (HCL) or lidocaine HCl on infusion pain and hemodynamic tolerance to anesthesia induction. Based on the theory that a reduction in pH of the propofol emulsion results in more unionized, lipid-phase drug and less free, aqueous phase drug to bind to vascular receptors (which causes injection pain), the authors hypothesized that an admixture of propofol 1% and ephedrine HCl 3% (either one mg or 1.5 mg ephedrine per mL of propofol) would be as effective as adding lidocaine HCl (one mg lidocaine per mL of propofol) in reducing injection pain. Indeed, their hypothesis appears correct, as the occurrence of infusion pain was similar among three g...

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  Diphenhydramine-induced Brugada pattern

We wish to describe a case of diphenhydramine-induced Brugada pattern, which resolved following therapy with intravenous sodium bicarbonate. A 29-year-old male with a history of depression and hypercholesterolemia ingested 25,000mg of diphenhydramine in a suicide attempt. He was found by family members approximately 30min post ingestion. Emergency Medical Services (EMS) was activated, and found the patient unresponsive. Upon arrival in the emergency department, he was afebrile with a temperature of 37.4. His heart rate was 153beats/min, with a blood pressure of 155/64mmHg. Shortly after arrival, he had a generalized tonic–clonic seizure which resolved spontaneously. He was emergently intubated with etomidate and succinylcholine. An initial 12-lead electrocardiogram demonstrated sinus ta...

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  [Influence of the fascia iliaca compartment block on postoperative cognitive status in the elderly.]

CONCLUSION: Postoperative analgesia by iliaca compartment block with catheter seems to provide a decrease in the incidence of POCD after hip surgery in elderly patients. STUDY DESIGN: Prospective, observational study. PMID: 20122812 [PubMed - as supplied by publisher] (Source: Annales Francaises d'Anesthesie et de Reanimation)

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  Randomised trial of a protocol of no sedation for critically ill patients receiving mechanical ventilation

Source: Lancet Area: News Sedation for mechanically ventilated patients aims to reduce distress, ease adaption to the ventilator, reduce oxygen consumption and carbon dioxide production, and protect patients with brain injury from development of oedema or ischaemia. However, there have been concerns from many quarters that sedation is often overused. This paper published early online in The Lancet reports the use of a protocol of no sedation for patients receiving mechanical ventilation in the ICU.   The study was conducted in the general ICU of a University Hospital in Denmark, and aimed to establish whether duration of mechanical ventilation could be reduced with a protocol of no sedation versus daily interruption of sedation. The study involved 140 critically ill adult patient...

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  Anaesthesia for radiation therapy - Gliwice experience.

In conclusion we demonstrated the feasibility and safety of anaesthesia applied in our radiotherapy patients. The custom designed mobile anaesthesia workstation allowed us to provide safe and efficient anaesthesia in any place outside the Department of Anaesthesiology. Keywords: anaesthesia for radiotherapy, paediatric radiotherapy, brachytherapy, intraoperative radiotherapy, childhood cancers. PMID: 20099980 [PubMed - in process] (Source: Neoplasma)

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  Absence of corneal endothelium injury in non-human primates treated with and without ophthalmologic drugs and exposed to 2.8 GHz pulsed microwaves

Microwave-induced corneal endothelial damage was reported to have a low threshold (2.6 W/kg), and vasoactive ophthalmologic medications lowered the threshold by a factor of 10-0.26 W/kg. In an attempt to confirm these observations, four adult male Rhesus monkeys (Macaca mulatta) under propofol anesthesia were exposed to pulsed microwaves in the far field of a 2.8 GHz signal (1.43 ± 0.06 µs pulse width, 34 Hz pulse repetition frequency, 13.0 mW/cm2 spatial and temporal average, and 464 W/cm2 spatial and temporal peak (291 W/cm2 square wave equivalent) power densities). Corneal-specific absorption rate was 5.07 W/kg (0.39 W/kg/mW/cm2). The exposure resulted in a 1.0-1.2 °C increase in eyelid temperature. In Experiment I, exposures were 4 h/day, 3 days/week for 3 weeks (nine exposures and ...

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  Combined sedation with midazolam / propofol for gastrointestinal endoscopy in elderly patients

Conclusions: In this study on elderly patients with high level co-morbidity, a favourable safety profile was observed for a combined sedation with midazolam / propofol with a higher sensitivity to propofol in the elderly. (Source: BMC Gastroenterology)

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  Positive Intravascular Test Dose Criteria in Children During Total Intravenous Anesthesia With Propofol And Remifentanil Are Different Than During Inhaled Anesthesia

This important paper demonstrates that the same criteria should not be used to detect a positive test dose in children fortotal intravenous anesthesia (TIVA) as for inhalational anesthesia. Faculty of 1000 Medicine (Source: Medscape Nephrology Headlines)

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  Can intravenous atropine prevent bradycardia and hypotension during induction of total intravenous anesthesia with propofol and remifentanil?

This study was conducted to examine whether pretreatment with intravenous atropine could prevent bradycardia and hypotension during induction of total intravenous anesthesia with propofol and remifentanil in a prospective randomized placebo-controlled manner. Seventy patients, aged 24–78 years, were randomly divided into two groups, and received 0.5 mg atropine or placebo saline 1 min before induction of intravenous anesthesia with remifentanil at 0.4 μg/kg/min, propofol at a target blood concentration of 3 μg/ml, and vecuronium 1.5 mg/kg. Immediately after tracheal intubation, the infusion rate of remfentanil and the target concentration of propofol were reduced to and kept at 0.1 μg/kg/min and 2 μg/ml, respectively, for 10 min. Noni...

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  Advanced Endoscopic Tracheoplasty: Endoscoscopic Segmental Tracheal Ring Resection

Conclusions: Endoscopic segmental tracheal ring resection is a technically feasible procedure and can be performed with a standard therapeutic bronchoscope. Clinical Implications: This advanced tracheoplasty technique may be feasible in patients with benign tracheal stenosis who have failed more conventional endoscopic tracheoplasty. The addition of endobronchial ultrasound may add an additional layer of safety when performing this technique. Additional studies will be needed to study long-term outcomes. (Source: Journal of Surgical Research)

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  Mesenchymal Stem Cells Augment Wound VEGF Content, Blood Flow, and Increase Tensile Strength

Conclusion: When compared to fibroblast controls, both aMSC and nMSC significantly increased tensile wound strength. Activation of MSC appears to lower the number of cells by one log required for biologic effect (50,000 vs 500,000) suggesting that this may be a more feasible therapy for enhanced healing of large tissue defects. In diabetic monkeys, the addition of MSC to scaffold increased wound VEGF content and was associated with increased wound bed blood flow. Together, these data provide encouraging support for the development of aMSC engineered scaffolds for large tissue defects requiring tissue regeneration in concert with epithelialization. (Source: Journal of Surgical Research)

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  A comparison of the effectiveness of dexmedetomidine versus propofol target-controlled infusion for sedation during fibreoptic nasotracheal intubation

This study aimed to compare the effectiveness of dexmedetomidine vs target controlled propofol infusion in providing sedation during fibreoptic intubation. Forty patients with anticipated difficult airways and due to undergo tracheal intubation for elective surgery were enrolled and randomly allocated into the dexmedetomidine group (1.0 [mu]g.kg[minus]1 over 10 min) (n = 20) or the propofol target controlled infusion group (n = 20). Intubating conditions and patient tolerance as graded by a scoring system were evaluated as primary outcomes. Intubation was successful in all patients. Satisfactory intubating conditions were found in both groups (19/20 in each group). The median (IOR [range]) comfort score was 2 (1[ndash]2 [1[ndash]4]) in the dexmedetomidine group and 3 (2[ndash]4 [2[ndash]5]...

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  Monitoring masseter muscle evoked responses enables faster tracheal intubation

Conclusion  Tactual evaluation of muscle paralysis of the MM during induction of anesthesia is clinically useful since it leads to faster tracheal intubation. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s00540-009-0848-yAuthors Osamu Kitajima, Social Insurance Sagamino Hospital Department of Anesthesia 1-2-30 Futinobe Sagamihara Kanagawa 229-0006 JapanTakahiro Suzuki, Surugadai Nihon University Hospital Department of Anesthesiology 1-8-13 Kanda-Surugadai, Chiyoda-Ku Tokyo 101-8309 JapanNaoto Watanabe, Social Insurance Sagamino Hospital Department of Anesthesia 1-2-30 Futinobe Sagamihara Kanagawa 229-0006 JapanTakeshi Maeda, Social Insurance Sagamino Hospital Department of Anesthesia 1-2-30 Futinobe Sagamihara Kanagawa 229-0006 JapanYoshikazu Noda, S...

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  Significant decrease in postoperative delirium in elderly patients, study finds

A recent study demonstrates that in elderly patients undergoing hip fracture repair under spinal anesthesia with propofol sedation, the prevalence of delirium can be decreased by 50 percent with light sedation, compared to deep sedation. (Source: ScienceDaily Headlines)

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  Remifentanil in children

Remifentanil has gained the confidence of anesthesiologists and has given a real opportunity to change the way anesthesia is given. It can be considered the ideal opioid despite many obstacles to pediatric use: the condition of 'off-label', the lack of wide randomized clinical trials, and the fear of adverse events because of its high potency. Experiences in the field with this opioid over the years encouraged its use. Use has been associated with N20 and volatile agents for general anesthesia and with propofol for total intravenous anesthesia (TIVA). It seems very useful for sedation inside and outside the operating room and in intensive care for both short painful procedures and synchronization with mechanical ventilation. However, its unique pharmacokinetic characteristics causing rapid...

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  A randomized trial of propofol consumption and recovery profile with BIS-guided anesthesia compared to standard practice in children.

Conclusions: Our study showed no benefit of BIS-guided propofol administration on anesthetic consumption or recovery compared to standard anesthetic practice. PMID: 20078813 [PubMed - in process] (Source: Paediatric Anaesthesia)

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  Pharmacokinetic models for propofol: defining and illuminating the devil in the detail

(Source: British Journal of Anaesthesia)

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  Raised triglycerides and propofol infusion in H1N1 patients

(Source: British Journal of Anaesthesia)

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  Effect of desflurane at less than 1 MAC on QT interval prolongation induced by tracheal intubation

Conclusions The administration of desflurane at an inspiratory concentration of 1 MAC during manually controlled ventilation after anaesthesia induction with propofol did not affect tracheal intubation-induced QTc prolongation. (Source: British Journal of Anaesthesia)

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  Monitoring of the responsiveness to noxious stimuli during anaesthesia with propofol and remifentanil by using RIII reflex threshold and bispectral index

Conclusions RIII threshold and BIS are both influenced dose-dependently by remifentanil at those concentrations that suppress reactions to noxious stimuli. The susceptibility of the parameters to remifentanil concentration seems to be of a similar quality. Under different ratios of propofol and remifentanil concentrations, the RIII threshold correlates with non-responsiveness better than the BIS. (Source: British Journal of Anaesthesia)

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  Pharmacological prevention of sevoflurane- and desflurane-related emergence agitation in children: a meta-analysis of published studies

Conclusions This meta-analysis found that propofol, ketamine, fentanyl, and preoperative analgesia had a prophylactic effect in preventing EA. The analgesic properties of these drugs do not seem to have a role in this effect. (Source: British Journal of Anaesthesia)

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  Fentanyl/propofol/sevoflurane: Anosmia (first report with fentanyl and sevoflurane): case report

(Source: Reactions)

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  Propofol abuse: Brugada-like ECG pattern and death following recreational propofol abuse: case report

(Source: Reactions)

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  Decrease In Postoperative Delirium In Elderly Patients

A recent study, published in the January issue of Mayo Clinic Proceedings , demonstrates that in elderly patients undergoing hip fracture repair under spinal anesthesia with propofol sedation, the prevalence of delirium can be decreased by 50 percent with light sedation, compared to deep sedation. "These data show that, for every 3.5 to 4.7 patients treated in this manner, one incident of delirium will be prevented," says Frederick Sieber, M.D., primary investigator of the study from the Department of Anesthesiology and Critical Care Medicine, Johns Hopkins Medicine in Baltimore... (Source: Health News from Medical News Today)

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  Decrease In Postoperative Delirium In Elderly Patients

A recent study, published in the January issue of Mayo Clinic Proceedings , demonstrates that in elderly patients undergoing hip fracture repair under spinal anesthesia with propofol sedation, the prevalence of delirium can be decreased by 50 percent with light sedation, compared to deep sedation. "These data show that, for every 3.5 to 4... (Source: Seniors / Aging News From Medical News Today)

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  Mayo Clinic Proceedings: Study Finds Significant Decrease in Postoperative Delirium in Elderly Patients

A recent study, published in the January issue of Mayo Clinic Proceedings, demonstrates that in elderly patients undergoing hip fracture repair under spinal anesthesia with propofol sedation, the prevalence of delirium can be decreased by 50 percent with light sedation, compared to deep sedation. (Source: Mayo Clinic Research News)

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  Mayo Clinic Proceedings: Study Finds Significant Decrease in Postoperative Delirium in Elderly Patients

A recent study, published in the January issue of Mayo Clinic Proceedings, demonstrates that in elderly patients undergoing hip fracture repair under spinal anesthesia with propofol sedation, the prevalence of delirium can be decreased by 50 percent with light sedation, compared to deep sedation. (Source: News from Mayo Clinic)

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  Mayo Clinic Proceedings: Study finds decrease in postoperative delirium in elderly patients

(Mayo Clinic) A recent study, published in the January issue of Mayo Clinic Proceedings, demonstrates that in elderly patients undergoing hip fracture repair under spinal anesthesia with propofol sedation, the prevalence of delirium can be decreased by 50 percent with light sedation, compared to deep sedation. (Source: EurekAlert! - Social and Behavioral Science)

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  Propofol-induced sleep: Polysomnographic evaluation of patients with obstructive sleep apnea and controls

Conclusions: These preliminary results allow us to infer that sedation with propofol changes sleep architecture but permits respiratory evaluation, because the main respiratory parameters evaluated in OSA are maintained. These preliminary results support the view that nasoendoscopy under propofol sedation is a promising examination for management of this disease. (Source: Otolaryngology - Head and Neck Surgery)

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  Nurse-administered propofol sedation: Differences in perspective

No abstract. (Source: Hepatology)

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  Preventive effects of propofol and ketamine on renal injury in unilateral ureteral obstruction

Conclusions  Propofol as an anesthetic agent may attenuate NO-induced renal tubular cell apoptosis by downregulating the expression of iNOS in an animal model of unilateral UO. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s00540-009-0861-1Authors Bayazit Dikmen, The Ministry of Health Ankara Research and Training Hospital Clinic of Anesthesiology and Reanimation Ankara TurkeyHatice Yagmurdur, The Ministry of Health Ankara Research and Training Hospital Clinic of Anesthesiology and Reanimation Ankara TurkeyTurgay Akgul, The Ministry of Health Ankara Research and Training Hospital Clinic of Urology Ankara TurkeyMuzeyyen Astarci, The Ministry of Health Ankara Research and Training Hospital Department of Pathology Ankara TurkeyHuseyin Ustun, The Ministry...

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  Evaluation of topical lidocaine spray as premedication to upper gastrointestinal endoscopy in children

CONCLUSIONS: Topic anesthetic medication reduces the time spent in the procedure room without increasing the incidence of side effects (NCT00521703). (Source: Revista Paulista de Pediatria)

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  Effects of anesthetic protocols on normal canine brain uptake of 18f-fdg assessed by pet/ct

The purpose of this study was to assess the effects of four anesthetic protocols on normal canine brain uptake of 2-deoxy-2-[18F]fluoro-d-glucose (FDG) using positron emission tomography/computed tomography (PET/CT). Five clinically normal beagle dogs were anesthetized with (1) propofol/isoflurane, (2) medetomidine/pentobarbital, (3) xylazine/ketamine, and (4) medetomidine/tiletamine[ndash]zolazepam in a randomized cross-over design. The standard uptake value (SUV) of FDG was obtained in the frontal, parietal, temporal and occipital lobes, cerebellum, brainstem and whole brain, and compared within and between anesthetic protocols using the Friedman test with significance set at P (Source: Veterinary Radiology & Ultrasound)

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  Effects of anesthetic protocol on normal canine brain uptake of 18f-fdg assessed by pet/ct

The purpose of this study was to assess the effects of four anesthetic protocols on normal canine brain uptake of 2-deoxy-2-[18F]fluoro-d-glucose (FDG) using positron emission tomography/computed tomography (PET/CT). Five clinically normal beagle dogs were anesthetized with (1) propofol/isoflurane, (2) medetomidine/pentobarbital, (3) xylazine/ketamine, and (4) medetomidine/tiletamine[ndash]zolazepam in a randomized cross-over design. The standard uptake value (SUV) of FDG was obtained in the frontal, parietal, temporal and occipital lobes, cerebellum, brainstem and whole brain, and compared within and between anesthetic protocols using the Friedman test with significance set at P (Source: Veterinary Radiology & Ultrasound)

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  Lidocaine/propofol: Fat embolism syndrome: case report

(Source: Reactions)

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  Propofol: Anaphylaxis: case report

(Source: Reactions)

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  Propofol: First report of breast milk discolouration: case report

(Source: Reactions)

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  Propofol: Prolonged myoclonus: case report

(Source: Reactions)

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  Propofol: Propofol infusion syndrome: 3 case reports

(Source: Reactions)

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  Propofol and the electroencephalogram.

Authors: San-Juan D, Chiappa KH, Cole AJ Propofol is an emulsion formulation of 2,6 diisopropylphenol developed in 1975. Widely recognized, it offers beneficial effects compared with other sedative drugs. Propofol is used in several clinical situations including multiple surgical procedures and critical-care medical conditions. Since technological advances over recent years have allowed an ever-increasing number of patients undergoing propofol therapy to be monitored by using continuous digital EEG, it is important to have a complete understanding of the effects of propofol on EEG in diverse clinical scenarios. This paper presents a review of the effects of propofol in electroencephalograms and discusses proconvulsive, anticonvulsive proprieties and the EEG findings in different medica...

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  Somatic paravertebral block decreases opioid requirements in children undergoing appendectomy.

CONCLUSIONS: In children undergoing appendectomy, SPVB provides better pain relief than no block and reduces opioid requirements. Side effects were not statistically different between groups. PMID: 20063137 [PubMed - as supplied by publisher] (Source: Canadian Journal of Anaesthesia)

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  Optimal remifentanil dose for laryngeal mask airway insertion when co-administered with a single standard dose of propofol.

CONCLUSIONS: The required dose of remifentanil is 1.32 (95% CI 0.99-2.46) microg.kg(-1) to achieve excellent LMA insertion conditions in 95% of patients when co-administered with propofol 2.5 mg.kg(-1) in healthy premedicated female patients undergoing elective ambulatory surgery. PMID: 20063135 [PubMed - as supplied by publisher] (Source: Canadian Journal of Anaesthesia)

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  Propofol Infusion Syndrome: Case Report and Literature Review

Learn about a rare and life-threatening adverse reaction to propofol. American Journal of Health-System Pharmacy (Source: Medscape Today Headlines)

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  Endoscopist-directed administration of propofol shows good safety profile

Researchers suggest that propofol can be effectively administered by endoscopists for gastrointestinal endoscopy. (Source: MedWire News - Anesthesiology)

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  A systematic review and meta-analysis of randomized, controlled trials of moderate sedation for routine endoscopic procedures

Source: DARE Area: Evidence > Disease Focused Reviews CRD Summary: This review concluded that moderate sedation provided high levels of satisfaction and low risk of serious adverse events in patients undergoing esphagogastroduodenoscopy or colonoscopy. Midazolam-based regiments had longer sedation and recovery times than propofol. The search was limited, studies were generally poor quality and the appropriateness of the synthesis was unclear. Thus, the reliability of the conclusions was unclear. [Included studies assessed the following interventions: diazepam, midazolam, propofol or narcotic; and combinations of these agents with each other or with diphenhydramine or droperidol. ] CRD Commentary: The review question and the inclusion criteria were clear and specific. The authors sear...

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  Rapid sequence induction for appendectomies: a retrospective case-review analysis.

CONCLUSION: An RSI with opioid, induction agent, and succinylcholine is the technique of choice for appendectomies at our institution. The frequency of airway complications is too low to recommend a change in practice. PMID: 20049576 [PubMed - as supplied by publisher] (Source: Canadian Journal of Anaesthesia)

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  Abstracts from Around the World

The administration of propofol by nonanesthesiologists for gastrointestinal endoscopic procedures remains highly controversial. This statement, issued jointly by our 4 societies, is based upon a systematic literature review from an experienced, 4 member committee. To date, over 460,000 published cases of nonanesthesiologist administered propofol (NAAP) have been reported. Of these, there have been 3 deaths, all of which occurred during or after upper endoscopy. No mortalities have been reported in those undergoing colonoscopy or in those classified as American Society of Anesthesiology (ASA) Class I or II. When examining economic models, cost effectiveness appears to be improved for gastroenterologist administered propofol for advanced procedures (eg, endoscopic retrograde cholangiopancrea...

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  Effects of hypercapnia, hypocapnia, and hyperoxemia on blood oxygenation level-dependent signal intensity determined by use of susceptibility-weighted magnetic resonance imaging in isoflurane-anesthetized dogs.

Conclusions and Clinical Relevance-In isoflurane-anesthetized dogs, certain regions of gray matter appeared to have greater cerebrovascular responses to changes in PaCO(2) and PaO(2) than did others. Both PaO(2) and PaCO(2) should be controlled during magnetic resonance imaging procedures that involve BOLD signaling and taken into account when interpreting findings. PMID: 20043777 [PubMed - as supplied by publisher] (Source: American Journal of Veterinary Research)

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  Optimizing the surgical field in pediatric functional endoscopic sinus surgery: A new evidence-based approach

Conclusion: Improving the quality of the surgical field and providing a bloodless FESS in children is attainable with TIVA. TIVA using a combination of remifentanil and propofol is superior to BA, even with the use of additional potent hypotensive agents such as esmolol. Both techniques are safe and effective in inducing controlled hypotension in children at a target mean arterial blood pressure of 50 mm Hg. (Source: Otolaryngology - Head and Neck Surgery)

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  The protective effects of propofol and citicoline combination in experimental head injury in rats.

CONCLUSION: Atherapeutic benefit of the propofol and citicolin combination in head trauma has not been previously demonstrated. We examined the possible potential protective effect of propofol and citicolin against oxidative damage in experimental head trauma in the present study. PMID: 20066623 [PubMed - in process] (Source: Turkish Neurosurgery)

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  [Effect of sevoflurane versus propofol-remifentanil anesthesia on neuromuscular blockade by continuous cisatracurium infusion.]

CONCLUSION: During the maintenance of stable neuromuscular blockade by continuous cisatracurium infusion, both sevoflurane and propofol-remifentanil anesthesia can time-dependently enhance the effect of cisatracurium without producing significant differences in the recovery properties. PMID: 20118012 [PubMed - in process] (Source: Journal of Southern Medical University)

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  Optimizing sustained use of sedation in mechanically ventilated patients: focus on safety.

Authors: Arnold HM, Hollands JM, Skrupky LP, Mice ST Optimizing sustained use of ICU sedation in mechanically ventilated patients requires careful consideration of drug-specific characteristics (E.G. pharmacokinetics), consideration of potential adverse effects in susceptible patients, and utilization of sedation-minimizing strategies. In the era of anxiolytic dosing protocols adjusted to specific patient behaviors as defined by sedation scales in conjunction with daily interruption, midazolam is a reasonable option for long-term sedation. Propofol is an appealing agent for ICU sedation due to it's pharmacokinetic profile and a reduced propensity to result in prolonged sedation. However, care should be taken to monitor for potential devastating adverse effects including hypertriglyceri...

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  Application of a Narcotrend-assisted monitor for depth of anesthesia on microwave coagulation for the patients with liver cancer during total intravenous anesthesia with propofol and fentanyl.

Conclusion: For patients with liver cancer, monitoring the depth of anesthesia with Narcotrend on microwave coagulation can contribute to lower dosage of propofol and shorten duration of recovery during total intravenous anesthesia with propofol and fentanyl. PMID: 20038323 [PubMed - in process] (Source: Ai Zheng)

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  Sedation Depth During Spinal Anesthesia and the Development of Postoperative Delirium in Elderly Patients Undergoing Hip Fracture Repair

CONCLUSION: The use of light propofol sedation decreased the prevalence of postoperative delirium by 50% compared with deep sedation. Limiting depth of sedation during spinal anesthesia is a simple, safe, and cost-effective intervention for preventing postoperative delirium in elderly patients that could be widely and readily adopted. Trial Registration: clinicaltrials.gov Identifier: NCT00590707 (Source: Mayo Clinic Proceedings)

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  EFNS guideline on the management of status epilepticus in adults

The objective of the current article was to review the literature and discuss the degree of evidence for various treatment strategies for status epilepticus (SE) in adults. We searched MEDLINE and EMBASE for relevant literature from 1966 to January 2005 and in the current updated version all pertinent publications from January 2005 to January 2009. Furthermore, the Cochrane Central Register of Controlled Trials (CENTRAL) was sought. Recommendations are based on this literature and on our judgement of the relevance of the references to the subject. Recommendations were reached by informative consensus approach. Where there was a lack of evidence but consensus was clear, we have stated our opinion as good practice points. The preferred treatment pathway for generalised convulsive status epil...

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  Gasless balloon laparoscopy

Discussion  B-LSC is technically practicable with good imaging qualities and without requiring pneumoperitoneum. It is tolerated in great extent under slight sedation and particularly well under deep sedation. The procedure is suitable for diagnostics of unclear abdominal conditions, as a second-look LSC and also as a staging LSC. Content Type Journal ArticleDOI 10.1007/s00464-009-0812-9Authors Michael Volland, Sana-Hospital Gerresheim Department of General and Visceral Surgery Düsseldorf GermanyMark Lienert, Sana-Hospital Gerresheim Department of General and Visceral Surgery Düsseldorf GermanyOlaf Horstmann, Sana-Hospital Gerresheim Department of General and Visceral Surgery Düsseldorf Germany Journal Surgical EndoscopyOnline ISSN 1432-2218Print ISSN 0930-27...

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  Propofol protects against hydrogen peroxide-induced oxidative stress and cell dysfunction in human umbilical vein endothelial cells.

In this study, we studied hydrogen peroxide (H(2)O(2))-induced oxidative stress and cell dysfunction in human umbilical vein endothelial cells (HUVECs) and especially, their modulation by propofol. HUVECs were treated with different concentrations (0.1 and 0.5 mM) of H(2)O(2) for different times (1, 3, and 6 h). Then HUVECs were pretreated with different concentrations of propofol (10, 25, and 50 muM), followed by H(2)O(2) treatment (0.5 mM, 3 h). In another set of experiments, we pretreated cells with p38 mitogen-activated protein kinase (p38 MAPK) inhibitor SB203580, followed by H(2)O(2) treatment (0.5 mM, 3 h). After treatment, oxidative stress, p38 MAPK phosphorylation, transcription factor NF-kappaB activation, nitric oxide synthase (NOS) expression, nitric oxide (NO) production, and ...

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  The intravenous anesthetic propofol inhibits lipopolysaccharide-induced hypoxia-inducible factor 1 activation and suppresses the glucose metabolism in macrophages

Conclusion  Our experimental results indicate that propofol inhibits HIF-1 activation and downstream gene expression induced by LPS and suppressed HIF-1-dependent glucose metabolic reprogramming. HIF-1 suppression by propofol in macrophages may explain molecular mechanisms behind the inhibitory effect of propofol on cellular inflammatory responses. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s00540-009-0829-1Authors Tomoharu Tanaka, Kyoto University Hospital Department of Anesthesia 54 Shogoin-Kawaracho, Sakyo-Ku Kyoto 6060-8507 JapanSatoshi Takabuchi, Kyoto University Hospital Department of Anesthesia 54 Shogoin-Kawaracho, Sakyo-Ku Kyoto 6060-8507 JapanKenichiro Nishi, Kansai Medical University Department of Anesthesiology Moriguchi Osaka JapanSei...

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  Ketamine eliminates propofol pain but does not affect hemodynamics during induction with double-lumen tubes

Conclusions  One milligram per kilogram of ketamine completely eliminated pain associated with propofol injection without affecting hemodynamics during induction of anesthesia and oxygenation during OLV. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s00540-009-0833-5Authors Masato Iwata, Nara Medical University Department of Anesthesiology 840 Shijo-cho, Kashihara Nara 634-8522 JapanSatoki Inoue, Nara Medical University Department of Anesthesiology 840 Shijo-cho, Kashihara Nara 634-8522 JapanMasahiko Kawaguchi, Nara Medical University Department of Anesthesiology 840 Shijo-cho, Kashihara Nara 634-8522 JapanToshitaka Kimura, Nara Medical University Departments of Thoracic and cardiovascular Surgery Nara JapanTakashi Tojo, Nara Medical University Depart...

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  Cerebral and Systemic Hemodynamic Effects of Intravenous Bolus Administration of Propofol in Neonates.

Conclusions: Propofol-induced decrease in HR, SaO(2) and cerebral oxygenation is short lasting while a decrease in MABP is observed up to 60 min. The variability in the effects of propofol is influenced by PNA, comedication or cardiopathy. Near-infrared spectroscopy can be used to assess hemodynamic effects of hypnotics on the cerebral oxygenation. PMID: 20051696 [PubMed - as supplied by publisher] (Source: Neonatology)

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  Cerebral and Systemic Hemodynamic Effects of Intravenous Bolus Administration of Propofol in Neonates

Neonatology 2010;98:57-63 (DOI:10.1159/000271224) (Source: Karger Publishers)

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  Nurse-Administered Propofol Sedation: Feasibility and Safety in Bronchoscopy

Respiration (DOI:10.1159/000271604) (Source: Respiration)

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  Propofol interruption of ECT seizure to reduce side-effects: A pilot study

Abstract: Fifteen depressed subjects received six bitemporal electroconvulsive therapy (ECT) treatments under etomidate anesthesia. They were randomized to blindly either receive propofol 0.5mg/kg 15s post-stimulus or not. Propofol infusion significantly prevented long seizures, and prevented cognitive decrements in most neuropsychological tests, several significantly. Propofol interruption may clinically help reduce ECT side-effects. (Source: Psychiatry Research)

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  Anaesthesia for the obese patient with special emphasis on propofol, rocuronium and inspiratory oxygen fraction

(Source: Acta Anaesthesiologica Scandinavica)

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  Auditory evoked potentials for monitoring during anaesthesia: A study of data quality

Conclusion: Obtaining good quality MLR data in awake subjects is challenging. Data quality improves during clinical anaesthesia and with advanced stimulation methods, but reliable detection of changes in the MLR for clinical monitoring remains a challenge. (Source: Medical Engineering and Physics)

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  Propofol Superior to Midazolam for Bronchoscopy and Doesn't Require Anesthesiologist

Titrated sedation with propofol, performed by a non-anesthesiologist physician, provides faster recovery and better tolerance than midazolam in patients undergoing flexible bronchoscopy, say researchers in the December European Respiratory Journal. Reuters Health Information (Source: Medscape Today Headlines)

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  Predictive ability of propofol effect–site concentrations during fast and slow infusion rates

This study compares the predictive ability of three effect[ndash]site pharmacokinetic models during fast and slow infusion rates, utilizing the cerebral state index (CSI) as a monitor of consciousness. Sixteen healthy volunteers, 21[ndash]45 years of age, were randomly assigned to receive either a bolus dose of propofol 1.8 mg/kg at a rate of 1200 ml/h or an infusion of 12 mg/kg/h until 3[ndash]5 min after loss of consciousness (LOC). After spontaneous recovery of the CSI, the bolus was administered to patients who had first received the infusion and vice versa. The study was completed after spontaneous recovery of CSI following the second dose scheme. LOC was assessed and recorded when it occurred. Adequacies of model predictions during both administration schemes were assessed by compari...

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  Diethylene Glycol in Propofol Infusion Syndrome?

(Source: Drug Safety)

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  Single dose of preoperative analgesia with gabapentin (600 mg) is safe and effective in monitored anesthesia care for nasal surgery

This study was aimed to compare the intraoperative sedative and perioperative analgesic drug requirements and the incidences of postoperative side effects on the patients who received preoperative gabapentin or placebo. Sixty patients undergoing nasal septal or nasal sinus surgery were included. The patients received either 600 mg gabapentin (Group G) or placebo (Group P) orally, 1 h before surgery. The scores for sedation and pain were recorded at 5, 15, 30, 45 and 60 min, intraoperatively and at 30 min, 1, 2, 4, 6, 9, 12, 16, 20, 24 h, postoperatively. Sedation was achieved with an IV bolus of propofol and continuous infusion of remifentanil. There were significant differences between gabapentin and placebo groups with regard to total consumptions of remife...

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  Single dose of preoperative analgesia with gabapentin (600 mg) is safe and effective in monitored anesthesia care for nasal surgery

This study was aimed to compare the intraoperative sedative and perioperative analgesic drug requirements and the incidences of postoperative side effects on the patients who received preoperative gabapentin or placebo. Sixty patients undergoing nasal septal or nasal sinus surgery were included. The patients received either 600 mg gabapentin (Group G) or placebo (Group P) orally, 1 h before surgery. The scores for sedation and pain were recorded at 5, 15, 30, 45 and 60 min, intraoperatively and at 30 min, 1, 2, 4, 6, 9, 12, 16, 20, 24 h, postoperatively. Sedation was achieved with an IV bolus of propofol and continuous infusion of remifentanil. There were significant differences between gabapentin and placebo groups with regard to total consumptions of remife...

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  Guidelines Issued for Nonanesthesiologist Administration of Propofol for GI Endoscopy

Medscape Medical News (Source: Medscape Today Headlines)

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  Efficacy of bispectral index monitoring as an adjunct to propofol deep sedation for ERCP: a randomized controlled trial

Endoscopy 2009; 41: 1046-1051DOI: 10.1055/s-0029-1215342 We sought to determine whether bispectral index (BIS) monitoring is a useful adjunct to the administration of propofol titrated to deep sedation, as measured by reductions of doses of propofol administered during endoscopic retrograde cholangiopancreatography (ERCP).[...]© Georg Thieme Verlag KG Stuttgart · New YorkGet connected:Table of contents  |  Abstract  |  Full text (Source: Endoscopy)

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  Use of Propofol–Xylazine and the Anderson Sling Suspension System for Recovery of Horses from Desflurane Anesthesia

To characterize the behavior of horses recovering in the Anderson Sling Suspension System after 4 hours of desflurane anesthesia and postdesflurane intravenous (IV) administration of propofol and xylazine. Experimental study. Healthy horses (n=6), mean±SEM age 12.3±1.8 years; mean weight 556±27 kg. Each horse was anesthetized with xylazine, diazepam, and ketamine IV and anesthesia was maintained with desflurane in O2. At the end of 4 hours of desflurane, each horse was positioned in the sling suspension system and administered propofol[ndash]xylazine IV. Recovery events were quantitatively and qualitatively assessed. Venous blood was obtained before and after anesthesia for biochemical and propofol analyses. Anesthetic induction and maintenance were without incident. Apnea commonly acco...

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  Propofol: Fatal propofol infusion syndrome: case report

(Source: Reactions)

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  Pain on injection from propofol may be avoided by changing its formulation

After using propofol for a decade, pain on injection had been considered routine by patients and medical personnel. When given propofol from a different manufacturer, patients did not complain. Two preparations of propofol were compared. A comparative, double-blind, randomized study was conducted in 22 adult patients undergoing pain relief procedures; they received sedation by an intravenous injection of 1.7 mg/kg of propofol and then were treated with paravertebral injections. Pain on injection was assessed by verbal complaint, movement of the extremity, of the whole body and recollection of pain at induction, when discharged. Propofol from Baxter Laboratories, mixed with either 5 ml of 2% lidocaine or 5 ml of NaCl 0.9%, was compared with propofol Laboratorios Gray, which was similarly mi...

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  The propofol infusion syndrome: more puzzling evidence on a complex and poorly characterized disorder

The propofol infusion syndrome is a potentially devastating cardiovascular and metabolic derangement that has been described in both pediatric and adult patients sedated with propofol. Despite a large number of case reports that have appeared in the literature since 1992, the precise clinical features and pathophysiology of this disorder remain uncertain. Historically, the syndrome has been characterized by the occurrence of lactic acidosis, rhabdomyolysis and circulatory collapse after several days of high-dose propofol infusion. The affected patients were typically young and critically ill, and the reported mortality was high. More recently, a number of atypical cases have been reported with favourable outcomes. These occurred after short-term or lower-dose infusions, in non-critically i...

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  Gastroenterology/Hepatology Societies Issue Recommendations On Nonanesthesiologist Administration Of Propofol For GI Endoscopy

The worldwide safety experience of endoscopist-administered propofol sedation now exceeds 600,000 patients... (Source: Pain / Anesthetics News From Medical News Today)

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  Gastroenterology/Hepatology Societies Issue Recommendations On Nonanesthesiologist Administration Of Propofol For GI Endoscopy

The worldwide safety experience of endoscopist-administered propofol sedation now exceeds 600,000 patients. The low rate of serious adverse events underscores the safety of nonanesthesiologist-administered propofol (NAAP) for gastrointestinal (GI) procedures, provided that it is administered by a team of individuals who have received training specific to the administration of propofol according to the "Position statement: nonanesthesiologist administration of propofol for GI endoscopy" issued by the four major gastroenterology and hepatology societies... (Source: Health News from Medical News Today)

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  Gastroenterology/Hepatology Societies Issue Recommendations On Nonanesthesiologist Administration Of Propofol For GI Endoscopy

The worldwide safety experience of endoscopist-administered propofol sedation now exceeds 600,000 patients... (Source: GastroIntestinal News From Medical News Today)

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  DIPRIVAN (Propofol) Injection, Emulsion [APP Pharmaceuticals, LLC]

Updated Date: Dec 4, 2009 EST (Source: DailyMed Drug Label Updates for the last seven days (since May 20, 2007 EST))

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  DIPRIVAN (Propofol) Injection, Emulsion [APP Pharmaceuticals, LLC]

Updated Date: Dec 4, 2009 EST (Source: DailyMed Drug Label Updates for the last seven days (since May 20, 2007 EST))

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  Midazolam More Effectively Suppresses Sympathetic Activations and Reduces Stress Feelings During Mental Arithmetic Task Than Propofol

Conclusions: These results suggest that midazolam more effectively suppresses sympathetic nervous activation and reduces subjective stress feelings during a mental arithmetic task than propofol. (Source: Journal of Oral and Maxillofacial Surgery)

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  No Anesthesiologist Needed for Propofol in GI Endoscopy, Report Says (CME/CE)

Although the powerful sedative propofol (Diprivan) was implicated in singer Michael Jackson's death in June, administration of the drug by a nonanesthesiologist is safe in trained hands, four major gastroenterology and hepatology societies asserted today. (Source: MedPage Today Gastroenterology)

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  Phenylephrine but not Ephedrine Reduces Frontal Lobe Oxygenation Following Anesthesia-Induced Hypotension

Conclusions  The utilization of phenylephrine to correct hypotension induced by anesthesia has a negative impact on ScO2 while ephedrine maintains frontal lobe oxygenation potentially related to an increase in CO. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s12028-009-9313-xAuthors Peter Nissen, Rigshospitalet 2041, University of Copenhagen Department of Anesthesia Blegdamsvej 9 2100 Copenhagen Ø DenmarkPatrice Brassard, Rigshospitalet 2041, University of Copenhagen Department of Anesthesia Blegdamsvej 9 2100 Copenhagen Ø DenmarkThomas B. Jørgensen, Rigshospitalet 2041, University of Copenhagen Department of Anesthesia Blegdamsvej 9 2100 Copenhagen Ø DenmarkNiels H. Secher, Rigshospitalet 2041, University of Copenhagen Department of Anesthesia Bl...

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  Gastroenterology/hepatology societies issue recommendations on nonanesthesiologist administration of propofol for GI endoscopy

(American Society for Gastrointestinal Endoscopy) The worldwide safety experience of endoscopist-administered propofol sedation now exceeds 600,000 patients. The low rate of serious adverse events underscores the safety of nonanesthesiologist-administered propofol (NAAP) for gastrointestinal (GI) procedures, provided that it is administered by a team of individuals who have received training specific to the administration of propofol according to the "Position statement: nonanesthesiologist administration of propofol for GI endoscopy" issued by the four major gastroenterology and hepatology societies. (Source: EurekAlert! - Medicine and Health)

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  Gastroenterology, hepatology societies issue recommendations on nonanesthesiologist administration of propofol for GI endoscopy

The worldwide safety experience of endoscopist-administered propofol sedation now exceeds 600,000 patients. The low rate of serious adverse events underscores the safety of nonanesthesiologist-administered propofol (NAAP) for gastrointestinal (GI) procedures, provided that it is administered by a team of individuals who have received training specific to the administration of propofol according to the "Position statement: nonanesthesiologist administration of propofol for GI endoscopy" issued by the four major gastroenterology and hepatology societies. (Source: ScienceDaily Headlines)

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  The Effect of Aminophylline on Loss of Consciousness, Bispectral Index, Propofol Requirement, and Minimum Alveolar Concentration of Desflurane in Volunteers.

Conclusion: Aminophylline decreases the sedative effects of propofol but does not affect MAC of desflurane as determined by tetanic electrical stimulation. PMID: 19955506 [PubMed - as supplied by publisher] (Source: Anesthesia and Analgesia)

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  Effects of intravenous administration of perzinfotel, fentanyl, and a combination of both drugs on the minimum alveolar concentration of isoflurane in dogs.

Conclusions and Clinical Relevance-IV administration of perzinfotel, fentanyl, or a perzinfotel-fentanyl combination reduced isoflurane MAC in dogs and increased arterial blood pressure. PMID: 19951116 [PubMed - in process] (Source: American Journal of Veterinary Research)

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  Position Statement: Nonanesthesiologist Administration of Propofol for GI Endoscopy

This statement on the use of nonanesthesiologist-administered propofol (NAAP) for GI endoscopy is issued jointly by The American Association for the Study of Liver Diseases, American College of Gastroenterology, American Gastroenterological Association, and American Society for Gastrointestinal Endoscopy. A 4-member committee, composed of a representative from each society, prepared the first draft of this document, which was then reviewed and approved by the governing board of each organization. This document is designed to provide an evidence-based assessment of propofol-mediated sedation by properly trained gastroenterologists and other nonanesthesiologists. The safety, efficacy, cost-effectiveness, and training issues involved with nonanesthesiologist administration of propofol for GI ...

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  Position statement: nonanesthesiologist administration of propofol for GI endoscopy

This statement on the use of nonanesthesiologist-administered propofol (NAAP) for GI endoscopy is issued jointly by The American Association for the Study of Liver Diseases, American College of Gastroenterology, American Gastroenterological Association, and American Society for Gastrointestinal Endoscopy. A 4-member committee, composed of a representative from each society, prepared the first draft of this document, which was then reviewed and approved by the governing board of each organization. This document is designed to provide an evidence-based assessment of propofol-mediated sedation by properly trained gastroenterologists and other nonanesthesiologists. The safety, efficacy, cost-effectiveness, and training issues involved with nonanesthesiologist administration of propofol for GI ...

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  Propofol protects rat astroglial cells against tert-butyl hydroperoxide-induced cytotoxicity; the effect on histone and cAMP-response-element-binding protein (CREB) signalling.

In this study effect of propofol on astroglial signalling in oxidative stress was evaluated. Ten days old cultures of rat astroglial cells were treated for 1 hour with t-butyl hydroperoxide (tBHP) to induce oxidative stress following by 1 hour propofol. We measured cytotoxicity, changes in cell growth and apoptosis as well as alterations in expression and acetylation of chromatin core H3 and H4 histone proteins and changes in native and phosphorylated cAMP-response-element-binding protein (CREB). tBHP induced limited cytotoxicity, increased apoptosis, decreased glutamine synthetase and enolase activities, decreased nuclear CREB, CREB-P and histone proteins but unchanged cytosolic CREB and histone acetyltransferase (HDAC) expression. Propofol clearly protected the cells against tBPH-induced...

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  Propofol: Fatal propofol infusion syndrome in a child: case report

(Source: Reactions)

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  Effect of propofol on human fetal placental circulation

Conclusions: Propofol induced vasodilatation and inhibited the vasoconstrictive effects of BK and PGF2α, in the human placenta. These findings suggest that propofol may not reduce fetal placental blood flow. Since propofol reduced the vasoconstricting effect of KCl but not that of AngII, we propose that the vasodilatory effect of propofol in the human placenta involves inhibition of Ca2+ channels. (Source: International Journal of Obstetric Anesthesia)

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  Anesthesiology and Gastroenterology

A successful population-based colorectal cancer screening requires efficient colonoscopy practices that incorporate high throughput, safety, and patient satisfaction. There are several different modalities of nonanesthesiologist-administered sedation currently available and in development that may fulfill these requirements. Modern-day gastroenterology endoscopic procedures are complex and demand the full attention of the attending gastroenterologist and the complete cooperation of the patient. Many of these procedures will also require the anesthesiologist's knowledge, skills, abilities, and experience to ensure optimal procedure results and good patient outcomes. The goal of this review is (1) to provide a gastroenterology perspective on the use of propofol in gastroenterology endoscopic...

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  Early administration of propofol protects against endotoxin-induced acute lung injury in rats by inhibiting the TGF-β1-Smad2 dependent pathway

Conclusions  In the endotoxic rat model, pretreatment and simultaneous treatment with propofol provided protection against acute lung injury by inhibiting the TGF-β1-Smad2 dependent pathway. Content Type Journal ArticleCategory Original Research PaperDOI 10.1007/s00011-009-0110-yAuthors Ju Gao, Second Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine Department of Anesthesiology 111 Da De Road 510120 Guangzhou Guangdong ChinaWei-Xian Zhao, Second Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine Department of Anesthesiology 111 Da De Road 510120 Guangzhou Guangdong ChinaFu-Shan Xue, Chinese Academy of Medical Sciences and Peking Union Medical College Department of Anesthesiology, Plastic Surgery Hospital Beijing China...

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  The effect of Diprivan (propofol) on phosphorylcholine surfaces during cardiopulmonary bypass - an in vitro investigation.

Authors: Myers GJ, Voorhees C, Eke B, Johnstone R It is well known that extracorporeal surfaces have the ability to bind such drugs as fentanyl, nitroglycerine and propofol. Adsorption of the injectable anesthetic agent Diprivan(R) (propofol) onto uncoated and heparin-coated extracorporeal surfaces during cardiopulmonary bypass (CPB) has been previously investigated; however, propofol adsorption onto synthetic-coated extracorporeal surfaces has not been published previously. The focus of this investigation was on the interaction of propofol and the synthetic biomimetic coating from the Sorin Group called Mimesys(R) (phosphorylcholine (PC)). A randomized series of six in vitro experiments were done with propofol using both PC-coated circuits without arterial filters and those with arter...

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  Randomized clinical trial of perianal surgery performed under spinal saddle block versus total intravenous anaesthesia

The aim of this randomized clinical trial was to determine whether spinal saddle block (SSB) is superior to total intravenous anaesthesia (TIVA) in perianal surgery.Suitable patients aged 18-75 years (American Society of Anesthesiologists grade I or II) scheduled to undergo perianal surgery were randomized to SSB (1·0 ml 0·5 per cent hyperbaric bupivacaine) or TIVA with propofol and fentanyl by means of a laryngeal mask. Cumulative consumption of analgesics within 24 h after surgery was recorded, and postoperative recovery and patient satisfaction were evaluated.A total of 201 patients were randomized. Supplemental analgesia within 24 h after surgery was required by 31 of 101 patients having SSB and 58 of 100 who had TIVA (P < 0·001). Median monitoring time in the recovery room was 5 (r...

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