Intravenous Administration Of Propofol Research Articles

Comparison of human smartwatch and transmittance pulse oximetry for evaluating peripheral oxygen saturation in anesthetized dogs.

Pulse oximetry is a valuable tool for monitoring animals during anesthesia and assessing the adequacy of administered oxygen therapy. To compare the pulse oximeter readings obtained by the Garmin Fenix 5X plus (GF5Xp) smartwatch and transmittance pulse oximetry (TPO) in anesthetized dogs. Twelve clinical canine patients requiring anesthesia for castration were prospectively enrolled in this study. The animals were premedicated with intramuscular dexmedetomidine at a dose of 5 µg/kg. Anesthesia was induced through intravenous administration of propofol and maintained using sevoflurane. The arterial hemoglobin oxygen saturation (SpO2) readings obtained from the tongue using TPO (238 readings) were compared with measurements taken over the lateral side of the tibia using a GF5Xp smart wearable device (238 readings). This comparison was performed using a Bland-Altman plot, where the differences (%) between the methods were plotted against their mean SpO2 (Gold standard - Device), and the limits of agreement were represented as the mean ± 1.96 times the standard deviation. The SpO2 levels in dogs were overestimated by the GF5Xp relative to the readings obtained by the TPO, with the bias of -0.3% (95% CI: -3.1%-2.5%). GF5Xp may be interchangeable with TPO in dogs. Further studies are required to validate the accuracy of the GF5Xp in non-anesthetized dogs or dogs outside the physiological range.

Wide-Awake Olecranon Fracture Fixation: Is it Possible?

The wide-awake local anesthesia no tourniquet technique has been widely performed in hand and wrist surgery with remarkable results. However, its use on the elbow has rarely been reported. Here we describe the use of wide-awake local anesthesia no tourniquet in olecranon fracture fixation in 4 cases. Tumescent anesthesia was injected from the proximal ulna to approximately 10 cm distally and into the periosteum and fracture site, approximately 25 minutes before skin incision. The fracture underwent closed reduction and was fixed using a long 6.5-mm cancellous screw with a washer through a small incision. No tourniquet was applied and none or mild sedation was administered. At the end of the operation, patients were asked to perform active elbow flexion-extension and forearm pronosupination movements under an image intensifier to test the range of motion and fracture stability. The surgical procedure was completed in all 4 cases. Two patients reported mild pain during ulnar medullary canal reaming, with pain scores of 3 and 4 on a 10-point scale, respectively. One case was resolved with additional local anesthetic injection. The other case required the administration of intravenous propofol. Both patients were able to actively move the elbow at the end of the operation. The use of wide-awake local anesthesia no tourniquet for olecranon fracture fixation has the advantage of obviating the need for an arm tourniquet, general anesthesia or heavy sedation, preoperative tests, and discontinuing routine medications (including anticoagulants). The stability of the elbow fixation was tested by active motion during surgery. This simple, safe, low-cost, and reproducible technique may be a good option for patients with contraindications or high risk of general or regional nerve block anesthesia. Therapeutic IV.

Changes in mean systemic filling pressure as an estimate of hemodynamic response to anesthesia induction using propofol

BackgroundEven a small change in the pressure gradient between the venous system and the right atrium can have significant hemodynamic effects. Mean systemic filling pressure (MSFP) is the driving force of the venous system. As a result, MSFP has a significant effect on cardiac output. We aimed to test the hypothesis that the hemodynamic instability during induction of general anesthesia by intravenous propofol administration is caused by changes in MSFP.MethodsWe prospectively collected data from 15 patients undergoing major surgery requiring invasive hemodynamic monitoring. Hemodynamic parameters, including MSFP, were measured before and after propofol administration and following intubation, using venous return curves at a no-flow state induced by a pneumatic tourniquet.ResultsA significant decrease in MSFP was observed in all study patients after propofol administration (median (IQR) pressure 17 (9) mmHg compared with 25 (7) before propofol administration, p = 0.001). The pressure gradient for venous return (MSFP – central venous pressure; CVP) also decreased following propofol administration from 19 (8) to 12 (6) mmHg, p = 0.001. Central venous pressure did not change.ConclusionsThese results support the hypothesis that induction of anesthesia with propofol causes a marked reduction in MSFP. A possible mechanism of propofol-induced hypotension is reduction in preload due to a decrease in the venous vasomotor tone.

PRETREATMENT WITH ONDANSETRON IN PREVENTION OF PAIN ON PROPOFOL INJECTION

Background: Pain on intravenous injection of propofol is seen in almost 70% of patients without any pretreatments. This study was conducted to evaluate the effect of ondanse­tron in reducing the occurrence of pain on intravenous injection of propofol. Methods: Two hundred and thirty-two patients aged between 18- 60 years of either sex belong­ing to ASA status I and II, scheduled for laparoscopic cholecystectomy under general anesthesia at Chitwan Medical College, Bharatpur, Nepal, from from September 1, 2020 to March 31, 2021 were recruited in this study. They were assigned randomly into two groups with 116 participants in each, where Group 1 received 2 ml (4 mg) of ondansetron and Group 2 received 2 ml of 0.9% saline (placebo) intravenously as the pretreatment solution prior to injection of propofol for induction of general anesthesia. The overall incidence of pain in the saline group was 84.5% compared to 48.3% in the ondansetron group (P < 0.001). Result: Pain was of mild intensity in most patients who belonged to the ondansetron group (33.6%) whereas it was of moderate intensity in most participants of the saline group (54.3%). Few patients in the study group experienced severe pain (0.9%) as compared to the placebo group (9.5%) with P < 0.001. Conclusion: Therefore, it was concluded that pretreatment with ondansetron may be a useful intervention in reducing the incidence of pain on intravenous propofol administration without any adverse effects in significant number of patients.

Two-dimensional shear wave elastography of liver in healthy dogs: anaesthesia as a source of variability

ABSTRACT Two-dimensional shear wave elastography (2D-SWE) is a non-invasive method to quantitatively evaluate the liver stiffness (LS), allowing the detection of hepatic pathological changes in both dogs and humans. In dogs, some factors such as patient movement and respiration can cause artefacts and potential errors of measurements. Therefore, anaesthesia has been suggested to reduce the effect of the movement on 2D-SWE in dogs. This study was performed to evaluate the influence of an anaesthetic protocol on 2D-SWE measurements for assessment of LS in healthy dogs. Forty-five dogs were included and subjected to anaesthesia: in 11 dogs, the 2D-SWE was performed both before and under anaesthesia, in 19 dogs, the 2D-SWE was performed only when they were awake and in 15 dogs, the examination was carried out only under anaesthesia. The anaesthetic protocol was composed of intramuscular injection of a combination of dexmedetomidine, methadone and ketamine and intravenous administration of propofol for induction and isoflurane for maintenance. The variability of 2D-SWE values according to anaesthesia was evaluated. Median 2D-SWE values were significantly higher in anesthetized dogs compared to awake dogs either by considering separately the dogs in which the examination was performed both awake and under anaesthesia and by considering all dogs included. According to our study, anaesthesia helped to avoid challenges related to patient movement and respiration; however, it was a source of variability on 2D-SWE values, and this factor should be considered before performing 2D-SWE under anaesthesia.

Biochemical markers of surgical stress in endoscopic rhinosinus surgery under combined anesthesia in children

BACKGROUND: Endoscopic rhinosinus surgery in children is associated with a high anesthetic risk because of intraoperative stress. This study aimed to, considering the dynamic picture of the biochemical markers of surgical stress, to assess the effectiveness of regional methods of combined anesthesia in rhinosinus surgery in children.
 MATERIALS AND METHODS: A comparative study was conducted in parallel groups composed of 100 patients aged 617 years who had undergone an assessment of their physical condition using the ASA I-II scales and planned endoscopic endonasal surgery lasting up to 2 h under combined anesthesia. In all groups, the introductory anesthesia was combined, i.e., inhalation of sevoflurane in an oxygenair mixture in combination with intravenous administration of propofol. To ensure the patency of the respiratory tract, endotracheal anesthesia was administered. Patients were divided into two groups of 50 people each, depending on the method of maintaining anesthesia. Group 1 received inhalation of sevoflurane in an airoxygen mixture with a target value of the minimum alveolar concentration of (MAC) 0.70.9, and regional blockage was performed bilaterally, i.e., pterygopalatine anesthesia with palatine access (palatinal) and infra-orbital intraoral access with ropivacaine solution. Group 2 received inhalation of sevoflurane in an airoxygen mixture with a target value of 1.5 МАС, and 5% tramadol solution was used intravenously for analgesia.
 RESULTS: Data on the dynamics of glucose, lactate, and cortisol levels in both groups proved the effectiveness and stability of the anesthesia methods used. However, the concentration of the inhaled anesthetic agent in the tramadol group was used was twice as high as the concentration in the regional anesthetic group.
 DISCUSSION: The dynamics and deviations of biochemical markers of surgical stress were not significantly different in the intergroup and intragroup interstage parameters beyond the reference values.
 CONCLUSIONS: The proposed anesthesia methods did not induce stress reactions to surgical intervention, and the anesthesia methods in both groups were adequate and effective.

Predicting hypotension during anesthesia: Variation in pulse oximetry plethysmography predicts propofol‐induced hypotension in children

The development of hypotension on administration of intravenous propofol is common and independently associated with adverse outcomes. Identifying patients with a high risk for anesthesia-induced hypotension may help anesthesiologists prepare for such an event. The authors hypothesized that propofol-induced hypotension is predictable by variables related to fluid responsiveness and investigated such variables to determine the factors which can predict hypotensive events. Patients 3-6years of age who underwent general were included. Intravenous midazolam 0.1mg kg-1 was administered as premedication, and preoperative noninvasive blood pressure, heart rate, perfusion index, pleth variability index, and respiratory variation of pulse oximetry plethysmographic waveform were measured. Intravenous propofol 2.5mg kg-1 was given, and blood pressure was measured 5 times at 1-min intervals. Subjects with significant hypotension (mean blood pressure decrease ≥20%) were allocated to the hypotensive group; those without significant hypotension were allocated to the relatively normotensive group. Of 77 patients, 50 (64.9%) developed significant hypotension. Patients in the hypotensive group exhibited significantly higher respiratory variation of pulse oximetry plethysmographic waveform (mean difference 11 [3.3] [95% confidence interval 4.9-18.1]; p=.001) and higher pleth variability index (mean difference 7.1 [2.8] [95% confidence interval 1.6-12.6]; p=.013) than the normotensive group. The areas under the receiver operating characteristic curve for respiratory variation of pulse oximetry plethysmographic waveform and pleth variability index were 0.722 and 0.649, respectively. High preoperative respiratory variation of pulse oximetry plethysmographic waveform and pleth variability index were both independently associated with propofol-induced hypotension in children.

A robust model predictive control framework for the regulation of anesthesia process with Propofol

AbstractIn this work, we present a robust Model Predictive Control (MPC) strategy based on linear matrix inequalities (LMIs) for the intravenous administration of Propofol, a drug which is used for anesthesia during surgeries. The controller is designed for a population of patients and takes into account constraints on the amount of administered drug and on the drug concentration profile. A detailed compartmental mathematical model available in the literature is adjusted to the available data and provides the future predictions of the process. In the context of the application, only the depth of anesthesia (BIS index) is assumed to be measured—as it is common in practice. The state of the system (drug amount in organs) is estimated in real‐time by incorporating a state observer. The derived control scheme, along with the designed state observer are able to deal with major challenges in controlling the depth of anesthesia which are inter‐ and intra‐patient variability, model nonlinearity, and model uncertainty. The controller is able to satisfy the divergent characteristics of the patients of the dataset, while satisfying in parallel all the imposed constraints. Moreover, we show that by considering smaller groups of patients with similar characteristics the corresponding responses are significantly improved.

Hypersensitivity in Chicken (Gallus gallus domesticus) due to the Association of Lidocaine and Bupivacaine in Neural-Guided Femoral and Sciatic Nerve Block

Background: Osteosyntheses, orthopedic surgeries that cause highly painful stimulation, are increasingly common in veterinary medicine. Epidural anesthesia is used to provide intraoperative and postoperative analgesia in mammals undergoing pelvic limb surgery. In birds, the synsacrum, the bone originating from the fusion of the lumbar and sacral vertebrae, makes this route inapplicable, thus peripheral nerve block is an easier option in this species. This report describes a case of local hypersensitivity following the association of lidocaine and bupivacaine in anesthetic blocks of the femoral and sciatic nerves in chickens (Gallus gallus domesticus).Case: A study was conducted in chickens evaluating the effectiveness of anesthetic sciatic and femoral nerve blocks, guided by a neural stimulator. Thirty-two 42-day-old male chickens of the species Gallus gallus domesticus, double breasted, weighing 1.86 ± 0.5 kg, were randomly divided into four groups: control (CG), lidocaine (LG), bupivacaine (BC) and the association of lidocaine and bupivacaine (LBG). The doses used were 4 mg/kg of 2% lidocaine and 2 mg/kg of 0.5% bupivacaine, without vasoconstrictor. For CG, 0.9% NaCl solution was used, respecting the total volume of 1 mL/kg. Only one bird from the LBG showed side effects, presenting sensory and motor loss for 24 h after the administration of these drugs, before euthanasia was performed using anesthetic induction with isoflurane through a face mask, followed by the intravenous administration of propofol and then potassium chloride. The chicken was submitted to a necropsy and macroscopically, soft, irregular, brownish lesions with a grayish focus were observed, indicating areas of necrosis in the muscles adjacent to the femoral and sciatic nerves. Histopathological examination showed mild, active inflammatory migration with perivascular organization, highlighting the presence of lymphocytes, plasmocytes, segmented heterophiles, and areas of hemorrhagic foci. The pairs of nerves evaluated showed edematous areas, but no inflammatory infiltrate, a histopathological finding that is considered to be nonspecific.Discussion: In the case of the chicken with side effects, histopathological examination showed vasculitis and hemorrhagic areas, which were correlated with ischemia and focal tissue necrosis, together with edematous lesions in the nerves evaluated, and extremities that showed an inflammatory response. These changes are related to acute hypersensitivity lesions, the drug response and drug hypersensitivity. Local anesthetics have been widely used in birds, but there are reports of reactions, including neurotoxicity and local myotoxicity, and bupivacaine is the drug that shows the highest cytotoxicity. However, long-term, repeated applications of bupivacaine on the sciatic nerve do not induce degenerative neural lesions in rats, rabbits, and dogs. The reactions described here are proportional to the concentration of the anesthetic injected, and in the case reported, the recommended dose for birds of 4 mg/kg of 2% lidocaine and 2 mg/kg of 0.5% bupivacaine, without vasoconstrictor, was adhered to. These findings suggest a reaction specific to the bird described; however, further studies regarding the local adverse effects of these anesthetics in birds should be conducted to make the practice of peripheral nerve block safer by testing different concentrations, associations and doses of the variety of drugs available.Keywords: birds, local block, drug hypersensitivity.

Effects of intravenous administration of propofol and midazolam on pentylenetetrazole kindled seizures in rats

To date, studies examining the proconvulsants or anticonvulsants in chronic epileptic models in rat are rare. Propofol has conflicting reports regarding the pro- or anti-convulsant effects on chronic seizures. Midazolam is considered another anesthetic option that used in combination with propofol and has documented anticonvulsant properties. The present study was undertaken to examine the effects of intravenous administration of various doses of propofol, in comparison to midazolam, on seizures activity in chronically epileptic rats, using PTZ seizures kindled model. Kindling in control and experimental rats was induced by intraperitoneal sub - convulsive dose of PTZ (35 mg/kg) every alternate day. After each injection of PTZ, rats were monitored for 30 minutes for behavioral seizures occurrence. Seizure scores were rated according to Racin scale. Once kindled, animals were treated with different doses of midazolam or propofol prior to PTZ challenge and were subsequently observed. The present study showed that, propofol or midazolam intravenous administration suppressed PTZ seizures in kindled rats and led to a significant, dose dependent decrease of behavioral seizures score and increased the percent inhibition of PTZ kindled seizures stage. The ED50 of propofol for percent inhibition of PTZ kindled seizures stage was 5.36 mg/kg, whereas the ED50 of midazolam was 1.85 mg/kg, suggesting that the anticonvulsant effects of midazolam against PTZ kindled seizures are more profound. In conclusion, the current study showed that propofol protected against PTZ kindled seizures and provided further evidence for its anticonvulsant effects reported in other chronic animal seizures, namely amygdala-kindled convulsions in rats.

Effects of propofol on intracranial pressure and prognosis in patients with severe brain diseases undergoing endotracheal suctioning

BackgroundTo investigate whether the administration of intravenous propofol before endotracheal suctioning (ES) in patients with severe brain disease can reduce the sputum suction response, improve prognosis, and accelerate recovery.MethodsA total of 208 severe brain disease patients after craniocerebral surgery were enrolled in the study. The subjects were randomly assigned to the experimental group (n = 104) and the control group (n = 104). The experimental group was given intravenous propofol (10 ml propofol with 1 ml 2% lidocaine), 0.5–1 mg/kg, before ES, while the control group was subjected to ES only. Changes in vital signs, sputum suction effect, the fluctuation range of intracranial pressure (ICP) before and after ES, choking cough response, short-term complications, length of stay, and hospitalization cost were evaluated. Additionally, the Glasgow Outcome Scale (GOS) prognosis score was obtained at 6 months after the operation.ResultsAt the baseline, the characteristics of the two groups were comparable (P > 0.05). The increase of systolic blood pressure after ES was higher in the control group than in the experimental group (P < 0.05). The average peak value of ICP in the experimental group during the suctioning (15.57 ± 12.31 mmHg) was lower than in the control group (18.24 ± 8.99 mmHg; P < 0.05). The percentage of patients experiencing cough reaction- during suctioning in the experimental group was lower than in the control group (P < 0.05), and the fluctuation range of ICP was increased (P < 0.0001). The effect of ES was achieved in both groups. The incidence of short-term complications in the two groups was comparable (P > 0.05). At 6 months after the surgery, the GOS scores were significantly higher in the experimental than in the control group (4–5 points, 51.54% vs. 32.64%; 1–3 points, 48.46% vs. 67.36%; P < 0.05). There was no significant difference in the length of stay and hospitalization cost between the two groups.ConclusionsPropofol sedation before ES could reduce choking cough response and intracranial hypertension response. The use of propofol was safe and improved the long-term prognosis.The study was registered in the Chinese Clinical Trial Registry on May 16, 2015 (ChiCTR-IOR-15006441).

Effects of anesthetic method on inflammatory response in patients with Parkinson\u2019s disease: a randomized controlled study

BackgroundThe pathogenesis of Parkinson’s disease (PD) involves degeneration of dopaminergic neurons, which is influenced by innate and adaptive immunity. IL-17 is a characteristic cytokine secreted by Th17 cells, which acts as a powerful stimulator of neutrophil migration and infiltration and promotes the secretion of inflammatory cytokines. General anesthesia and surgical stress induce immune and inflammatory responses that activate the immunosuppressive mechanism in the perioperative period. The present study investigated changes in levels of inflammatory cytokines, such as IL-17, IL-1β, and TNF-α, in patients with PD undergoing general anesthesia with inhalational anesthetics or TIVA.MethodsAdult patients, aged 40–75 years, scheduled for cerebral stimulator implantation were enrolled. Upon arrival at the operating theater, patients were allocated to the inhalational (I) or TIVA (T) group using block randomization. In group I, anesthesia was induced by tracheal intubation 1–2 min after intravenous administration of propofol (1–2 mg/kg) and rocuronium (0.6–1 mg/kg). Thereafter, anesthesia was maintained with 1–2 vol% sevoflurane, 0.01–0.2 μg/kg/min remifentanil, and O2/air (FiO2 0.4). In group T, propofol (3–6 μg/mL), remifentanil (2–6 ng/mL), and rocuronium (0.6–1 mg/kg) were administered using target controlled infusion (TCI) for induction of anesthesia. Blood samples were obtained preoperatively (T0), 2 h after induction of anesthesia (T1), and 24 h after surgery (T2). IL-17, IL-1β, and TNF-α levels were evaluated by ELISA.ResultsSerum levels of IL-17 were elevated at T2 in group I compared to group T but the difference was not statistically significant. IL-1β tended to be greater in group I compared to group T, but the differences were not significant. TNF-α was slightly higher at all time points in group T and showed a tendency to increase at T2 in both groups, but this was not statistically significant.ConclusionsTIVA may be useful for inhibiting neuroinflammation by inhibiting the increase in serum levels of IL-17 24 h after implantation surgery. Serum IL-17 level may be used as a biomarker for PD progression.Trial registrationClinical Research Information Service of Korea National Institute of Health (CRIS) Identification number: KCT0002061. Registered 25 October 2019 - Retrospectively registered, https://cris.nih.go.kr/cris/search/search_result_st01.jsp?seq=15125

Multi-drug therapy for epilepsy influenced bispectral index after a bolus propofol administration without affecting propofol\u2019s pharmacokinetics: a prospective cohort study

Some previous studies have indicated that valproate (VPA) might change the pharmacokinetics and enhance the effects of propofol. We evaluated whether clinical VPA therapy affected the propofol blood level, the protein-unbound free propofol level, and/or the anesthetic effects of propofol in the clinical setting. The subjects were divided into the control group (not medicated with antiepileptics), the mono-VPA group (medicated with VPA alone), and the poly-VPA group (medicated with VPA, other antiepileptics, and/or psychoactive drugs). General anesthesia was induced via the administration of a single bolus of propofol and a remifentanil infusion, and when the bispectral index (BIS) exceeded 60 sevoflurane was started. There were no significant differences in the total blood propofol level at 5, 10, 15, and 20 min or the protein-unbound free propofol level at 5 min after the intravenous administration of propofol between the 3 groups. However, the minimum BIS was significantly lower and the time until the BIS exceeded 60 was significantly longer in the poly-VPA group. In the multivariate regression analysis, belonging to the poly-VPA group was found to be independently associated with the minimum BIS value and the time until the BIS exceeded 60. Clinical VPA therapy did not influence the pharmacokinetics of propofol. However, multi-drug therapy involving VPA might enhance the anesthetic effects of propofol.

The effect of intravenous administration of propofol, thiopental, or propofol plus thiopental mixture in dogs undergoing experimentally liver insufficiency

The effect of intravenous administration of propofol, thiopental, or propofol plus thiopental mixture in dogs undergoing experimentally liver insufficiency

Propofol decreases spike firing frequency with an increase in spike synchronization in the cerebral cortex

Little is known about how propofol modulates the spike firing correlation between excitatory and inhibitory cortical neurons in vivo. We performed extracellular unit recordings from rat insular cortical neurons, and classified neurons with high spontaneous firing frequency, bursting, and short spike width as high frequency with bursting neurons (HFB; pseudo fast-spiking GABAergic neurons) and other neurons with low spontaneous firing frequency and no bursting were classified as non-HFB. Intravenous administration of propofol (12 mg/kg) from the caudal vein reduced the firing frequency of HFB, whereas propofol initially increased (within 30 s) and then decreased the firing frequency of non-HFB. Both HFB and non-HFB spontaneous action potential discharge was depressed by propofol with a greater depression seen for HFB. Cross-correlograms and auto-correlograms demonstrated propofol-induced increases in the ratio of the peak, which were mostly observed around 0–10 ms divided to baseline amplitude. The analysis of interspike intervals showed a decrease in spike firing at 20–100 Hz and a relative increase at 8–15 Hz. These results suggest that propofol induces a larger suppression of firing frequency in HFB and an enhancement of synchronized neural activities in the α frequency band in the cerebral cortex (192 words).

Acute pancreatitis associated with intravenous administration of propofol: evaluation of causality in a systematic review of the literature.

Acute pancreatitis (AP) associated with intravenous administration of propofol has been described with unknown causal relation. We therefore assessed this causality in a systematic review. Multiple databases were searched on 16 August 2017; studies were appraised and selected by two reviewers based on a priori criteria. Propofol causality was evaluated with the Naranjo scale and Badalov classification.We identified 18 studies from 11 countries with a total of 21 patients, and the majority had adequate methodological quality. The median age was 35 years (range, 4–77) and 10 (48%) were males. Overall, propofol was administrated in 8 patients as sedative along with induction/maintenance of anesthesia in 13 patients; median dose was 200 mg, with intermediate latency (1–30 days) in 14 (67%). Serum triglycerides were >1000 mg/dL in four patients. Severe AP was observed in four patients (19%). AP recurrence occurred in one out of two patients who underwent rechallenge. Mortality related to AP was 3/21(14%). Propofol was the probable cause of AP according to the Naranjo scale in 19 patients (89%).Propofol-induced AP has a probable causal relation and evidence supports Badalov class Ib. Hypertriglyceridemia is not the only mechanism by which propofol illicit AP. Propofol-induced AP was severe in 19% of patients with a mortality rate related to AP of 14%. Future research is needed to delineate whether this risk is higher if combined with other procedures that portend inherent risk of pancreatitis such as endoscopic retrograde cholangiopancreatography.

S108. Effect of propofol on somatosensorial evoked potentials of long latency, N70

Introduction The aim of the study was to describe the morphological changes of long-latency somatosensory evoked potentials (SEPs) N70 after administration of intravenous propofol in neurologically healthy patients. This allows us to know if the use of this drug is capable of changing its morphology. The knowledge of this fact, will avoid a misinterpretation when using it as a prognostic marker in sedated patients with propofol with postanoxic neurological damage and traumatic brain injury. Methods Observational, descriptive, follow-up study of SEPs of long latency N70 before and after the administration of propofol in neurologically healthy patients in Hospital Espanol from May to October 2017. We used a Cadwell electromyograph equipment, Sierra Wave software version 11.0.116, with registration on C3′ and C4′, reference Fz (SI 10/20), filters 1 Hz and 10 Hz, gain 10 mV, sweep 20 ms, pulse width 100 ms and repetition rate of 1.41 Hz, stimulation on both median nerves. For sedation, we calculated the target plasma concentration of 4 mcg/ml and objectified by the bisespectral index or spectral entropy, anyone available in operating room. We included subjects aged 18–70, indistinct gender, admitted to a surgical procedure that does not involve the central or peripheral nervous system between May and October 2017 with previous complete neurological examination and general laboratories without alterations. We excluded everyone who refused to sign the informed consent.The data was analyzed in the statistical package STATA version 14.1 with Student “t” test was used for related samples. Results We performed SEPs N70 in 11 subjects. The results of this study showed a statistically significant difference in amplitude (p Conclusion Propofol is an agonist of GABA A receptors and blocker of the NMDA receptors reducing glutamatergic activity, that affect the signals of the ascending activating reticular system and the cortico-subcortical association relays, causing statistically significant morphological changes in the replicability of the SEPs of long latency N70 of healthy subjects, mainly in their amplitudes. If we do not considered measurable the replicability of the amplitude, ideally it should be marked as absence of potential.

P007: Safety and effectiveness of a care protocol to treat migraine with Propofol in the emergency department

Introduction: An evidence-based care protocol to treat migraine with low-dose Propofol was implemented in May 2014 at the emergency department (ED) of the CHUL (Québec city). Given potential side effects of Propofol, we aimed to evaluate the safety and effectiveness of this protocol. Methods: We reviewed charts of all patients aged 16 years and older who received Propofol between May 2014 and August 2017 for a migraine headache with or without aura, as defined in the International Headache Society Classification. The care protocol consisted of: 1) administration of intra-venous Propofol 20 mg each 5 to 10 minutes as needed (maximum of 6 doses); 2) sets of vital signs before and after each dose; and 3) continuous cardiac and saturation monitoring. Our primary outcome measures were the incidence (95%CI) of the following side effects: low arterial pressure (&lt; 90 systolic or &lt; 65 mean), desaturation (SaO2&lt;92%), excessive sedation (scores 3 or 4 on the Pasero scale), and any arrhythmia. We also compared the mean reduction (95%CI) of pain pre- and post-treatment (visual analogous scale VAS 0-10) and the proportion (95%CI) of rescue medication among patients who received Propofol as first-line medication to a matched cohort of patients who had Metoclopramide first. The two cohorts were paired for gender, age, triage priority, and month/year of ED visit. Results: Over the 3-year study period, 45 patients with migraine received Propofol through the care protocol, either as a first-line or a rescue therapy. In this cohort, hypotension, bradycardia (&lt;60/min) and desaturation occurred in 17.8% (8.0-32.1), 13.3% (5.1-26.8) and 6.7% (1.4-18.3) of cases respectively; no excessive sedation was reported. An intervention was undertaken in 4 cases [8.9% (2.5-21.2) 3 iv fluid bolus, 1 supplemental oxygen] to palliate the side effects of Propofol. A statistically significant mean reduction of 3.6 points (2.8-4.4) on the VAS scale was observed in patients treated with Propofol as first-line therapy (n=35). However, patients managed with first-line Metoclopramide (n=100) experienced a significantly higher mean reduction of their VAS score [5.3 (4.6-6.0)] than the Propofol group (p=0.003). The proportion of patients requiring the use of rescue medication was higher among patients first treated with Propofol [77.1% (63.2-91.1) vs. 29.0% (20.1-37.9); p&lt;0.001]. Conclusion: Our care protocol to treat migraine with low doses of Propofol appears to be safe and to cause very few side effects prompting corrective interventions. Continuous (as opposed to intermittent) heart and saturation monitoring is probably not indicated. Given the effectiveness of Propofol compared to Metoclopramide, our care protocol will be used as a second-line therapy.

Multi-model robust control of depth of hypnosis

Abstract This paper presents a multi-model robust control scheme to control the depth of hypnosis during intravenous administration of propofol. The objective of the proposed control scheme is to provide an adequate drug administration regime for propofol to avoid overdosing and underdosing of patients. The proposed scheme is designed to withstand the patient's inherent drug response variability, to achieve good output disturbance and sensor noise rejection, and to attain a good set point response. A comprehensive simulation study of 44 patients is presented to assess the performance of the proposed control scheme.

Prospects of minimally invasive methods of anesthesia for laparoscopic bariatric interventions in patients with morbid obesity, according to the principle of accelerated rehabilitation

This clinical article presents clinical examples of the successful implementation of the program for accelerated management of the postoperative period in patients with morbid obesity after laparoscopic stomach longitudinal resection , using combined anesthesia based on intravenous administration of propofol, inhalation low flow anesthesia with sevoflurane, and peri operative multimodal analgesia.The objective. Was optimization of methods of general anesthesia of bariatric surgical interventions in patients with morbid obesity.Patients and methods. 26 patients with a BMI of 36-45 took part in the study, who underwent laparoscopic stomach longitudinal resection with the use of combined low flow anesthesia with sevoflurane and multimodal analgesia. All patients underwent the concept of minimally invasive intraoperative anesthetic monitoring and an accelerated postoperative rehabilitation program.Results. The dynamics of the values of central hemodynamics showed a high hemodynamic stability at all stages of the operation, with a tendency towards normalization of initially elevated blood pressure. The indices of the adequacy of oxygenation and ventilation (SpO2 and EtCO2) corresponded to normal values and did not differ from the level of stress norm. In all patients, recovery of spontaneous breathing occurred on average 8 minutes after the end of the operation. Extubation was performed on the operating table in 8±2 minutes (p=0,05), therefore, prolonged artificial ventilation was not required. At that, the level of postoperative pain on the operating table by VAS was minimal – 0–2 points. In the early postoperative period, the pain level according to the VAS in patients was on average 3±2 points (p=0.05). Accordingly, there was no need for narcotic analgesics. All patients were activated within the first 24 hours after the operation. Patients were discharged on 2,9±0,25 days after the operation (p=0,05).Conclusion. Inhalation low flow anesthesia based on sevoflurane with the use of multimodal analgesia during laparoscopic stomach longitudinal resection in patients with morbid obesity does not require prolonged ventilation and is a worthy alternative to combined epidural anesthesia. Rejection of invasive monitoring allows early activation of patients and a shortened stay in the hospital.