Bispectral Index Score Research Articles

Effects of propofol, ketamine-propofol mixture in pediatric dental patients undergoing intravenous sedation: a clinical study

This study aimed to evaluate the clinical effects, complications (peri- and postoperative), depth of sedation, recovery times, and changes in anxiety levels in paediatric dental patients receiving intravenous sedation with propofol and ketamine–propofol mixtures. This prospective clinical study included 69 healthy children (ASA 1) aged 3–7 years. The patients were assigned randomly to propofol group (n = 23), which received propofol; 1:3 ketofol group (n = 23), which received 1:3 ketofol; or 1:4 ketofol group (n = 23), which received 1:4 ketofol. The bispectral index (BIS) and Ramsay Sedation Scale (RSS) score were recorded at intervals of 5 min to measure the depth of sedation, and vital signs were evaluated. Peri- and postoperative complications and recovery times were recorded. Anxiety levels were also evaluated using the Facial Image Scale (FIS) and changes in saliva cortisol levels (SCLs) before and after the intravenous sedation procedure. The Kruskal‒Wallis test and Wilcoxon signed-rank test were used to determine pre- and posttreatment parameters. Dunn’s test for post hoc analysis was used to determine the differences among groups. Children’s pre- and posttreatment anxiety levels did not differ significantly according to FIS scores, and increases in SCLs were detected in 1:3 ketofol and 1:4 ketofol groups after dental treatment was completed. Compared with those in the other groups, the BIS values of the patients in 1:4 ketofol indicated a slightly lower depth of sedation. The recovery time of the patients in 1:3 ketofol was longer than that of patients in propofol and 1:4 ketofol. The incidence of postoperative complications (agitation, hypersalivation, nausea/vomiting, and diplopia) did not differ among the groups. Ketamine–propofol combinations provided effective sedation similar to that of propofol infusion without any serious complications during dental treatment performed under intravenous sedation. The ketofol infusion increased the anxiety level of paediatric dental patients to a greater extent than the propofol infusion.

Intravenous Ganaxolone: Pharmacokinetics, Pharmacodynamics, Safety, and Tolerability in Healthy Adults.

Ganaxolone, a neuroactive steroid anticonvulsant that modulates both synaptic and extrasynaptic γ-aminobutyric acid type A (GABAA ) receptors, is in development for treatment of status epilepticus (SE) and rare epileptic disorders, and has been approved in the United States for treatment of seizures associated with cyclin-dependent kinase-like 5 deficiency disorder in patients ≥2 years old. This phase 1 study in 36 healthy volunteers evaluated the pharmacokinetics, pharmacodynamics, and safety of intravenous ganaxolone administered as a (i) single bolus, (ii) infusion, and (iii) bolus followed by continuous infusion. After a single bolus over 2 minutes (20mg) or 5 minutes (10 or 30mg), ganaxolone was detected in plasma with a median Tmax of 5 minutes, whereas a 60-minute infusion (10 or 30mg) or a bolus (6mg over 5minutes) followed by infusion (20mg/h) for 4 hours achieved a median Tmax of approximately 1 and 3 hours, respectively. Cmax was dose and administration-time dependent, ranging from 73.8ng/mL (10mg over 5minutes) to 1240ng/mL (30mg over 5minutes). Bolus doses above 10mg of ganaxolone markedly influenced the bispectral index score with a rapid decline; smaller changes occurred on the Modified Observer's Assessment of Alertness/Sedation scale and in quantitative electroencephalogram. Most adverse events were of mild severity, with 2 events of moderate severity; none were reported as serious. No effects on systemic hemodynamics or respiratory functions were reported. Overall, ganaxolone was generally well tolerated at the doses studied and demonstrated pharmacokinetic and pharmacodynamic properties suitable to treat SE.

Identification of an effective and safe bolus dose and lockout time for patient-controlled sedation (PCS) using dexmedetomidine in dental treatments: a randomized clinical trial.

This study investigated a safe and effective bolus dose and lockout time for patient-controlled sedation (PCS) with dexmedetomidine for dental treatments. The depth of sedation, vital signs, and patient satisfaction were investigated to demonstrate safety. Thirty patients requiring dental scaling were enrolled and randomly divided into three groups based on bolus doses and lockout times: group 1 (low dose group, bolus dose 0.05 µg/kg, 1-minute lockout time), group 2 (middle dose group, 0.1 µg/kg, 1-minute), and group 3 (high dose group, 0.2 µg/kg, 3-minute) (n = 10 each). ECG, pulse, oxygen saturation, blood pressure, end-tidal CO2, respiratory rate, and bispectral index scores (BIS) were measured and recorded. The study was conducted in two stages: the first involved sedation without dental treatment and the second included sedation with dental scaling. Patients were instructed to press the drug demand button every 10 s, and the process of falling asleep and waking up was repeated 1-5 times. In the second stage, during dental scaling, patients were instructed to press the drug demand button. Loss of responsiveness (LOR) was defined as failure to respond to auditory stimuli six times, determining sleep onset. Patient and dentist satisfaction were assessed before and after experimentation. Thirty patients (22 males) participated in the study. Scaling was performed in 29 patients after excluding one who experienced dizziness during the first stage. The average number of drug administrations until first LOR was significantly lower in group 3 (2.8 times) than groups 1 and 2 (8.0 and 6.5 times, respectively). The time taken to reach the LOR showed no difference between groups. During the second stage, the average time required to reach the LOR during scaling was 583.4 seconds. The effect site concentrations (Ce) was significantly lower in group 1 than groups 2 and 3. In the participant survey on PCS, 8/10 in group 3 reported partial memory loss, whereas 17/20 in groups 1 and 2 recalled the procedure fully or partially. PCS with dexmedetomidine can provide a rapid onset of sedation, safe vital sign management, and minimal side effects, thus facilitating smooth dental sedation.

Correlation between bispectral index and FOUR score in critically ill patients with traumatic brain injury: A cross-sectional study

ABSTRACT Introduction For neurological testing and monitoring of traumatic brain injury (TBI) patients whose verbal component of the Glasgow Coma Scale (GCS) cannot be assessed, the Full Outline of Unresponsiveness (FOUR) score has been established. In order to determine the degree of awareness in patients with traumatic brain injury, this study will correlate the FOUR score with the bispectral index (BIS) and global consciousness score (GCS). Methods Twenty TBI patients with traumatic brain injury who were hospitalised to the surgical ICU at Cairo University Hospital participated in our prospective observational research. An observer who was blind to the BIS values assessed each of the FOUR scores and GCS (Covidien BIS complete monitoring system, Mansfield, MA, USA). Each patient provided four sets of readings. Spearman’s correlation coefficient was used to perform a correlation between the FOUR score, GCS, and BIS (r). Results There was a significant correlation between BIS and FOUR score (r = 0.854, 95% confidence interval: 0.780–0.904) (P < 0.001). There was also a significant correlation between BIS and GCS (r = 0.864, 95% confidence interval: 0.795–0.911) (P < 0.001). Conclusion There is a strong correlation between FOUR score, GCS, and BIS values in patients with traumatic brain injury. FOUR score seems a reliable alternative for GCS and BIS in the assessment of degree of consciousness, especially in intubated patients.

The effect of Dexmedetomidine on suppression of the bispectral index score and hemodynamic response during laryngoscopy and intubation in addicted patients in supratentorial brain tumor surgery, a randomized double-blinded controlled trial

BackgroundDexmedetomidine is an α2-adrenoceptor agonist with good sedative effects with no cardiovascular instability or respiratory depression, and it might help facilitate endotracheal intubation and inhibit hemodynamic responses. AimThe current study assessed how intravenous Dexmedetomidine affected cardiovascular response and endotracheal intubation in opium-addict patients. Materials and methodsThis study is a clinically randomized, double-blind, controlled trial. One hundred patients diagnosed with supratentorial brain tumors undergoing tumor resection surgery with general anesthesia entered this study. One group received Dexmedetomidine (1/μg/kg for 10 min) before induction of anesthesia. The exact amount of normal saline (placebo) was administered in the second group. The two groups were analyzed statistically regarding blood pressure, heart rate, and bispectral index score, recorded 1 min before and 1 min after intubation. The statistical tests used for analysis are the student T-test, Mann-Whitney non-parametric test, the chi-square test, and Fisher's exact test. ResultsThe intervention group's heart rate, systolic blood pressure, and bispectral index score decreased 1 min after anesthesia induction and intubation compared to the control group. Diastolic blood pressure after induction of anesthesia was not significantly different between the two groups; however, it decreased following the intervention after intubation (p > 0.05). ConclusionCompared to the control group, Dexmedetomidine suppressed hemodynamic response and bispectral index score in opium-addict patients.

Does Endotracheal Suctioning Affect Bispectral Index and Ramsay Sedation Scores in Pediatric Intensive Care Patients?

Does Endotracheal Suctioning Affect Bispectral Index and Ramsay Sedation Scores in Pediatric Intensive Care Patients?

Drug-drug interaction of ciprofol injectable emulsion with mefenamic acid capsules in healthy subjects.

To investigate the drug-drug interaction (DDI) of ciprofol injectable emulsion and mefenamic acid capsules in healthy subjects. Twenty healthy subjects were enrolled in this single-centre, open-label, two-period DDI study. Ciprofol (0.4mg kg-1 ) was administered as a single dose on days 1 and 5. A 500-mg oral loading dose of mefenamic acid was given on day 4 followed by a 250-mg maintenance dose every 6h (a total of eight doses). Blood samples for pharmacokinetic analyses were collected. Depth of anaesthesia was monitored using the Modified Observer's Assessment of Alertness and Sedation (MOAA/S) scale and Bispectral Index scores (BISs). Compared with administration of ciprofol alone, administration with mefenamic acid showed no significant difference in exposure. The geometric mean ratios (GMRs) and their 90% confidence intervals (CIs) for maximum plasma concentration (Cmax ), area under the plasma concentration-time curve calculated from 0 to the last measurement point (AUC0-last ) and AUC to infinity (AUC0-inf ) were 91.6% (86.5-96.9%), 103.3% (100.3-106.4%) and 107.0% (101.2-113.2%), respectively. The MOAA/S and BIS curves for the two treatment periods essentially coincided, indicating that the anaesthesia effect of ciprofol was not affected by mefenamic acid. Seven subjects (35%) reported eight adverse events (AEs) when ciprorol was administered alone and 12 subjects (60%) reported 18 AEs when ciprofol was administered in combination with mefenamic acid. All AEs were mild. Mefenamic acid, a UGT1A9 inhibitor, had no significant effect on the pharmacokinetics and pharmacodynamics of ciprofol in healthy subjects. Ciprofol was safe and well tolerated when administered with mefenamic acid.

Development of a Bispectral index score prediction model based on an interpretable deep learning algorithm

BackgroundProper maintenance of hypnosis is crucial for ensuring the safety of patients undergoing surgery. Accordingly, indicators, such as the Bispectral index (BIS), have been developed to monitor hypnotic levels. However, the black-box nature of the algorithm coupled with the hardware makes it challenging to understand the underlying mechanisms of the algorithms and integrate them with other monitoring systems, thereby limiting their use. ObjectiveWe propose an interpretable deep learning model that forecasts BIS values 25 s in advance using 30 s electroencephalogram (EEG) data. Material and methodsThe proposed model utilized EEG data as a predictor, which is then decomposed into amplitude and phase components using fast Fourier Transform. An attention mechanism was applied to interpret the importance of these components in predicting BIS. The predictability of the model was evaluated on both regression and binary classification tasks, where the former involved predicting a continuous BIS value, and the latter involved classifying a dichotomous status at a BIS value of 60. To evaluate the interpretability of the model, we analyzed the attention values expressed in the amplitude and phase components according to five ranges of BIS values. The proposed model was trained and evaluated using datasets collected from two separate medical institutions. Results and conclusionThe proposed model achieved excellent performance on both the internal and external validation datasets. The model achieved a root-mean-square error of 6.614 for the regression task, and an area under the receiver operating characteristic curve of 0.937 for the binary classification task. Interpretability analysis provided insight into the relationship between EEG frequency components and BIS values. Specifically, the attention mechanism revealed that higher BIS values were associated with increased amplitude attention values in high-frequency bands and increased phase attention values in various frequency bands. This finding is expected to facilitate a more profound understanding of the BIS prediction mechanism, thereby contributing to the advancement of anesthesia technologies.

Comparison of vital sign stability and cost effectiveness between midazolam and dexmedetomidine during third molar extraction under intravenous sedation

To compare the vital sign stability and cost of two commonly used sedatives, midazolam (MDZ) and dexmedetomidine (DEX). Patients and. This retrospective study targeted patients who underwent mandibular third molar extractions under intravenous sedation using MDZ or DEX. The predictor variable was the type of sedative used. The primary outcome variables were vital signs (heart rate and blood pressure), vital sign outliers, and cost of the sedatives. A vital sign outlier was defined as a 30% or more change in vital signs during sedation; the fewer changes, the higher the vital sign stability. The secondary outcome variables included the observer's assessment of alertness/sedation scale, level of amnesia, patient satisfaction, and bispectral index score. Covariates were sex, age, body mass index, sleeping time, dental anxiety score, and Pederson scale. Descriptive statistics were computed including propensity score matching (PSM). The P-value was set at 0.05. The study enrolled 185 patients, 103 in the MDZ group and 82 in the DEX group. Based on the data after PSM, the two samples had similar baseline covariates. The sedative effect of both agents was satisfactory. Heart rate outliers were more common with MDZ than with DEX (49.3% vs 22.7%, P=0.001). Heart rate was higher with MDZ (P=0.000). The cost was higher for DEX than for MDZ (29.27±0.00 USD vs 0.37±0.04 USD, P=0.000). DEX showed more vital sign stability, while MDZ was more economical. These results could be used as a reference to guide clinicians during sedative selection.

To Compare the Safety and Efficacy of Conscious Sedation with Dexmedetomidine and Propofol Infusion for Endoscopic Discectomy.

Endoscopic discectomy is a minimally invasive, day care spine surgery. Patient comfort is of utmost importance as it is performed under local anaesthesia and in prone position. Propofol and dexmedetomidine are titrable and short-acting and commonly used for conscious sedation. The objectives of the study are to study the effect of dexmedetomidine and propofol infusion on cardiorespiratory parameters and to evaluate the efficacy of dexmedetomidine and propofol infusion for conscious sedation. This is a prospective, randomized, patient-blinded study. Sixty adult patients were randomly recruited to 2 groups of 30 each, to receive an infusion of dexmedetomidine or propofol, titrated to bispectral index score 70-80. The intra-operative cardiorespiratory parameters and level of sedation, postoperative visual analogue scale score, time to discharge from post-anaesthesia care unit, and patient satisfaction were monitored. Both groups were comparable with respect to demographic parameters and surgical duration. The heart rate was significantly lower with dexmedetomidine whereas the intraoperative mean arterial pressure was higher with dexmedetomidine. Though the level of intraoperative sedation was higher with propofol, the respiratory parameters were comparable. Postoperative visual analogue scale score was significantly higher with propofol. Dexmedetomidine and propofol provide adequate sedation without any cardiorespiratory compromise when used for conscious sedation for minimally invasive spine surgeries performed in prone position. Dexmedetomidine provides an added advantage of postoperative analgesia and better patient satisfaction.

Application of oxycodone in anesthesia induction and overall management of Da Vinci robot-assisted nephrectomy: A randomized controlled trial.

Background:This study aimed to evaluate the application of oxycodone in anesthesia induction and overall management of Da Vinci robot-assisted nephrectomy.Methods:A total of 42 patients undergoing Da Vinci robot-assisted nephrectomy with general anesthesia were selected. They were randomly divided into 2 groups: patients were induced with oxycodone (oxycodone group) and were induced with sufentanil (sufentanil group). The vital signs at the following time points were recorded: after injection of induced drugs (T1), during glottis exposure (T2), immediately after intubation (T3), 1 minute (T4), 2 minute (T5), 3 minute (T6), 5 minute (T7), 10 minute (T8) after intubation, during skin incision (T9), at the end of suturing skin (T10), during extubation (T11), and during hemodynamic fluctuations intraoperatively (T`). Numerical rating scale, facial affective scale and monitoring of adverse events (visual analogue scale, NVAS) were evaluated postoperatively at 1 hour (T’“1), 3 hours (T”“2), 6 hours (T”“3), 12 hours (T”“4), 24 hours (T”“5), and 48 hours (T”‘6).Results:The systolic blood pressure, the diastolic blood pressure and the mean arterial blood pressure showed no statistically different changes between the 2 groups. There were no statistical differences in heart rate and respiratory rate among various timepoints intraoperatively. There were statistical differences in Bispectral index (BIS) scores in T6 between the 2 groups. The numerical rating scale and facial affective scale scores were significantly lower in oxycodone group. Anesthetized with oxycodone, the pain did not affect the sleep of patients after operation. Also, the postoperative QoR-40 scores were lower in oxycodone group.Conclusion:Compared with sufentanil, anesthesia induction with 0.3 mg/kg oxycodone in Da Vinci robot-assisted nephrectomy can achieve mild pain and mild adverse responses in patients postoperatively.

Comparison of Analgesic Efficacy of Local Anesthetic Infiltration and Ultrasound-guided Abdominal Wall Nerve Block in Children Undergoing Ambulatory Inguinal Hernia Repair

PurposePlacement of local anesthetics either as infiltration (LAI) or as abdominal wall nerve block (AWNB) has been shown to reduce postoperative pain following laparoscopic surgery. We aimed to compare intraoperative remifentanil consumption and postoperative pain of AWNB and LAI in children undergoing ambulatory two-port laparoscopic inguinal hernia surgery with propofol-remifentanil based general anesthesia. DesignRandomized controlled trial. MethodsChildren aged between 1 and 6 years undergoing two-port laparoscopic inguinal hernia repair were enrolled for analysis. These children received one of the three anesthesia regimens (1) standard general anesthesia (SGA); (2) SGA with preemptive LAI; (3) SGA with preemptive AWNB; and were categorized accordingly. Primary outcome variable were intraoperative average infusion rate of remifentanil and postoperative FLACC (Face, Legs, Activity, Cry, and Consolability) pain score. Secondary outcome data included demographics, intraoperative variables (hemodynamics and bispectral index score recorded at three different time points), and duration of surgery. FindingsA total of 90 children (30 in each group) were included in the analysis. General information, intraoperative hemodynamic variables, bispectral index score, and duration of surgery were not significantly different among groups. The intragroup variation of hemodynamic variables were less stable in the SGA group compared with the other two groups, while BIS score was similar among groups. The intraoperative infusion rate of remifentanil was significantly lower in the AWNB group than in the SGA or the LAI group (median [25th to 75th centiles]: 0.11[0.11 to 0.11] µg/kg/min, 0.33[0.33 to 0.33] µg/kg/min; 0.17[0.17 to 0.20] µg/kg/min, respectively, P < .001 for both), and lower in the LAI group than in the SGA group (P < .001). The postoperative FLACC pain score was significantly lower in the AWNB group than in the SGA or the LAI group (P < .001 for both). ConclusionsAWNB is associated with a lower intraoperative remifentanil requirement and a lower postoperative FLACC pain score compared with LAI in children undergoing laparoscopic inguinal hernia repair with propofol-remifentanil based general anesthesia.

Effects of Thoracic Paravertebral Blockon Inflammatory Response, Stress Response, Hemodynamics and Anesthesia Resuscitation inGallbladder Carcinoma.

The study aimed to explore the effects of the ultrasound-guided thoracic paravertebral block (TPVB) on the inflammatory response, stress response, hemodynamics and anesthesia resuscitation in gallbladder carcinoma. Eighty gallbladder carcinoma patients undergoing open cholecystectomy in Heilongjiang Provincial Hospital from February 2016 to April 2019 were selected and divided into observation group (n=40) and control group (n=40) using a random number table. All patients underwent open cholecystectomy under general anesthesia and tracheal intubation. Patient-controlled intravenous analgesia was adopted after the operation in the control group, while right TPVB was performed before general anesthesia in the observation group. The changes in inflammatory factors and oxidative stress factors were compared between the two groups, the anesthesia resuscitation indexes, and the changes in the bispectral index (BIS) and Ramsay score during anesthesia resuscitation were recorded, and the changes in the hemodynamic indexes in perianesthesia and anesthesia resuscitation-related complications were analyzed. At 15 min after anesthesia, the observation group had lower levels of inflammatory factors high-sensitivity C-reactive protein (hs-CRP) and interleukin-6 (IL-6) (p<0.05), malondialdehyde (MDA) (p<0.05) and a higher level of superoxide dismutase (SOD) (p<0.05) than the control group. The anesthesia resuscitation time was shorter in the observation group than that in the control group (p<0.05). At 10 min, 20 min and 30 min after anesthesia, both BIS and Ramsay scores were significantly higher in the observation group than those in the control group (p<0.05). Moreover, the proportion of circulatory function-related complications and anesthesia resuscitation-related complications were lower in the observation group than that in the control group (p<0.05). The NRS score in the observation group was lower than that in the control group after anesthesia (p<0.05). TPVB in perianesthesia for gallbladder carcinoma patients can effectively lower the body's inflammatory and stress responses, promote anesthesia resuscitation, reduce complications in perianesthesia, and relieve postoperative pain.

The Requirement of Isoflurane and Remifentanil During Liver Transplantation Using Bispectral Index and Surgical Pleth Index: An Observational Study

During liver transplantation (LT), patients and surgical factors potentially influence the pharmacokinetics of the anesthetic agents. The aim of this study was to investigate the requirement of isoflurane and remifentanil according to severity of liver disease during LT under balanced anesthesia. We enrolled 44 patients undergoing LT. Anesthetic depth was maintained within the bispectral index score of 40 to 60 and Surgical Pleth Index of 20 to 60. Patients were divided into 2 groups according to their median Model for End-Stage Liver Disease (MELD) score: low MELD group and high MELD group. We compared end-tidal inhaled anesthetics and remifentanil consumption. Patients were divided into 2 groups according to median value of MELD score: MELD score <16 (low MELD group; n=20) or MELD ≥16 (high MELD group; n=20). There was no significant difference between the 2 groups in end-tidal concentration of isoflurane during 3 phases. However, the remifentanil requirement was lower in the high MELD group during the dissection and anhepatic phases (mean (SD), 0.105 (0.067) vs 0.064 (0.055) µg/kg/min; P=.037, and 0.167 (0.096) vs 0.108 (0.079) µg/kg/min; P=.039, respectively; low MELD group vs high MELD group) with no significant difference during the neohepatic phase. The severity of liver dysfunction based on MELD score affected the intraoperative remifentanil requirement during LT. Patients with cirrhosis are required to use analgesics appropriate to their individual patient characteristics in clinical practice.

Monitoring the effects of automated gas control of sevoflurane versus target-guided propofol infusion on hemodynamics of liver patients during liver resection. A randomized controlled trial.

Cirrhotic patients are prone to hypotension during anesthesia. The primary aim of the study was to compare the effects of automated gas control (AGC) of sevoflurane and target-controlled infusion (TCI) of propofol on systemic and cardiac hemodynamics in hepatitis C cirrhotic patients undergoing surgery. The secondary aim was to compare the recovery, complications, and costs between the two groups. This was a randomized controlled trial in adults with hepatitis C cirrhosis (Child A) who underwent open liver resection and received AGC (n = 25) or TCI (n = 25). AGC was initially set at FiO2 40% and end-tidal sevoflurane (ET SEVO) at 2.0% with a fresh gas flow of 300 mL/min. TCI of propofol was given using Marsh pharmacokinetic mode with an initial propofol target concentration (Cpt) of 4 μg/mL. Bispectral index score (BIS) was maintained between 40 and 60. Invasive arterial blood pressure (IBP), electrical cardiometry (EC), cardiac output (CO), and systemic vascular resistance (SVR), Fi SEVO, ET SEVO, propofol Cpt, and effect-site concentration (Ce) were recorded. IBP and EC CO, and SVR were least affected by TCI propofol. Only one (4.00%) patient required vasopressors with TCI vs. 4 (16.00%) with AGC (χ2 (Y) (df = 1) = 0.88, P (Y) = 0.34). There was no delayed recovery, hypoxia, or awareness; however, ICU stay was shorter with TCI, (P = 0.006). BIS and EC guided median of ET SEVO was 1.90%, Fi SEVO was 2.10% with AGC, and propofol Cpt and Ce were 3.00 μg/dL with TCI. Only 0.14 [0.12-0.15] mL/min of SEVO was consumed with AGC and 0.87 [0.85-0.97] mL/min propofol with TCI. The cost was higher with TCI, P < 0.00. Both techniques are well tolerated hemodynamically, but TCI-propofol was found to be hemodynamically better. The recovery and complications were comparable in both groups, but TCI Propofol infusion was costlier.

The Effects of Ketamin-Midazolam and Ketamin-Propofol on Bispectral Index Score as Sedatives During Bone Marrow Puncture Procedure Among Pediatrics

Background: Bone Marrow Puncture (BMP) is an invasive procedure associated with pain and anxiety. The ketamine-midazolam and the ketamine-propofol is an effectivecombination with minimal side effects. This study of the study aims to compare the effect of the combination of ketamine-midazolam and ketamine- propofol on sedation depth based on BIS in pediatric leukemia patients undergoing BMP.&#x0D; Methods: This study was a randomized controlled trial that was done single-blinded. The population was all pediatric patients diagnosed with leukemia who underwent BMP at RSMH and performed sedation. The research sample is the population that fulfill the inclusion and exclusion criteria. The sample size for each group was 25, with 50 Subjects in total. Sampling was done by block randomization.&#x0D; Results: This study found no differences in sex, age, and body weight between the two groups ([p=1.000], [p=0.845], and [p=0.147], respectively). In this study, there was no difference in mean MAP (p=0.592), oxygen saturation (p=0.164), heart rate (p=0.098), and respiratory rate (p=0.252) before intervention between the two groups. BIS value of the two groups had significant difference before and after the intervention where the two groups could reduce BIS to reach the optimal value of sedation &lt;60 (p &lt;0.05) There was no difference in BIS before intervention in the two groups (p=0.385). In this study, it was found that hypersalivation occurred more frequently in the ketamine-midazolam combination group.&#x0D; Conclusion: The combination of ketamine-midazolam and ketamine-propofol was equally good for sedation as indicated by a decrease in the mean BIS in patients undergoing BMP.

Bispectral index scores predicting complications after tracheal intubation

BackgroundTracheal intubation is a procedure that may cause various complications. The primary aim of this study is to investigate whether the Bispectral Index™ (BIS) can predict tracheal intubation complications sooner than other monitoring parameters. MethodsA total of 55 consecutive patients were intubated. Sociodemographic data, the reason for tracheal intubation, diagnosis, starting dose or dose increase of a vasopressor drug, use of sedatives and muscle-relaxing agents, vital signs, BIS scores, and end-tidal CO2 values before the procedure, during laryngoscopy, and within 30 min after tracheal intubation were recorded along with their tracheal intubation-related complications. ResultsThe mean age of the patients was 75.1 ± 14.4 years. Pneumonia (n = 17, 30.9%) and sepsis (n = 14, 25.5%) were found to be the two most prominent diagnoses. The most common indications for intubation were a low Glasgow Coma Scale score of ≤8 (67.3%) and respiratory failure (61.8%). Postintubation hemodynamic instability developed in 38 patients (69.1%).The BIS value obtained at minute 3 was the lowest among all measurements. Significantly lower values of BIS (minute 3) were found for patients with postintubation hemodynamic instability (46 vs. 72, p = 0.039). Using ketamine (OR = 8.99, 95% CI: 1.60–50.47, p = 0.013) and systoloc blood pressure (OR = 1.03, 95% CI: 1.01–1.05, p = 0.017) were found to be significant risk factors for the development of postintubation hemodynamic instability. ConclusionIn this study, the lowest BIS values were detected at minute three after intubation. The BIS values obtained at minute three were found to be significantly associated with the development of postintubation hemodynamic instability.

Prospective evaluation of remifentanil-propofol mixture for total intravenous anesthesia: A randomized controlled study.

Application of total intravenous anesthesia (TIVA) may be considered as unpractical when compared with inhalational anesthesia. Although it is mostly not recommended, mixing intravenous agents is popular in clinical practice. The aim of the present study was to investigate the suitability of using remifentanil-propofol mixture (MIXTIVA) for TIVA. Adult patients with an American Society of Anesthesiologists grade of I-II scheduled for elective thyroidectomy were randomly allocated to 3 groups (n=32 for each) to receive TIVA with remifentanil and propofol infusions separately (control group, Group I) or with MIXTIVA infusion that contained remifentanil/propofol at a proportion of 2/1,000 or 3/1,000 (remifentanil concentration, 20 or 30 µg/ml in 1% propofol in Group II or Group III, respectively). The extubation time (the primary outcome of the study), the orientation time and number of patients in whom intraoperative hypotension, hypertension or bradycardia episodes were encountered during anesthesia were comparable among the groups. The mean remifentanil infusion rate in Group III was significantly higher than that in the other groups. The mean propofol infusion rates and mean bispectral index (BIS) scores during anesthesia were comparable among groups. Hypotension accompanied with a high BIS was encountered in one patient in Group III. In conclusion, compared to the standard TIVA technique using separate drug infusions, MIXTIVA infusion used for thyroidectomies did not result in any statistically significant difference in recovery and clinical outcomes. This technique may be considered as a practical implementation for busy ambulatory centers performing general anesthesia. The present study was retrospectively registered at clinicaltrials.gov (trial registration no. NCT04394897).

Effect of Different Doses of Propofol and Nerve block Combined with General Anesthesia on The Intraoperative Anesthesia and Postoperative Awakening and Cognitive Function in Elderly Patients with Knee Osteoarthritis

Objective. To explore the effect of different doses of propofol and nerve block combined with general anesthesia on the intraoperative anesthesia and postoperative awakening and cognitive function in elder patients with knee osteoarthritis (OA). Methods. According to the inclusion criteria for research object, we selected 98 elderly patients with knee OA who needed surgery and were admitted to our hospital from January 2019 to January 2021 for the study. Patients were divided into the low dose group (given 2 mg/kg propofol by pumping under constant speed during surgery) and the high dose group (given 4 mg/kg propofol by pumping during surgery) by the number table method to compare their indicators including the intraoperative anesthesia effect, with 49 cases in each group. Results. No between-group difference was shown in the anesthesia time and postoperative VAS scores, but the awakening time of the low dose group was significantly shorter than that of the high dose group (P&lt;0.05); the differences in heart rate (HR) values at various time points between the two groups were not obvious, but the high dose group obtained significantly higher HR values at T4 than the low dose group; the mean arterial pressure (MAP) values of both groups were significantly reduced at Ti and then returned to the level before anesthesia (P&gt;0.05); the bispectral index scores (BIS) of both groups experienced a marked drop at Ti and then recovered gradually, but failed to return to the level at T0 till the end, and a between-group difference in BIS indexes presented at Ti; the plasma corticosterone (CORT) concentration at Ti of both groups were significantly lowered and then returned to the level at T0, with no between-group difference; and compared with the low dose group, the high dose group achieved slightly lower mini-mental state examination (MMSE) scores at 24-72 h after surgery, with no significant difference between them (P&gt;0.05). Conclusion. The therapy of different doses of propofol and nerve block combined with general anesthesia has no significant effect on the cognitive function in elderly knee OA patients after surgery. With the nerve block improving the analgesic effect, a low dose of propofol is good for the postoperative awakening of patients. Different doses of propofol inhibited the stress response to a different degree and produced good anesthesia outcomes in elderly patients, but comparatively speaking, a low-dose propofol ensures more smooth indexes and less effect on the intraoperative hemodynamics.

Effects of repairing ventricular septal defects with right vertical infra-axillary mini-incision on lung function and postoperative analgosedation.

The present study aimed to assess the effects of repairing ventricular septal defects (VSDs) with right vertical infra-axillary mini-incision (RVAI). A total of 116 patients with VSDs were prospectively enrolled and underwent cardiac surgery between June 2017 and December 2018 at the cardiac intensive care unit of Shanghai Children's Medical Center (Shanghai, China). Of these, 58 patients underwent the RVAI procedure and 58 patients matched 1:1 underwent the standard median sternotomy incision (MSI) procedure and were designated as the control group. The demographic data and clinical outcomes intra- and postoperatively were compared. A bedside lung ultrasound was performed to evaluate the degree of lung injury and the number of B-lines was quantified and compared between the two groups. The sedation and analgesia levels were also assessed after the operation. No significant difference was identified between the two groups regarding the overall cardiopulmonary bypass or aortic cross-clamp time. All patients were extubated within 8 h. The RVAI group had shorter incision lengths (median, 4.6 cm) and less drainage (median, 15 ml) than the MSI group. Furthermore, compared to the MSI group, the RVAI group had a significantly higher number of B-lines in the right lung regions immediately after surgery and at 12 h postsurgery (24.1 and 5.2%, respectively) but eventually exhibited no differences at 24 and 36 h postsurgery; by contrast, there were no differences in the left lung regions. The bedside bispectral index score and the Face, Legs, Activity, Cry, Consolability scale score exhibited no significant differences after the operation. In conclusion, the RVAI procedure appears to be a safe alternative for repairing VSDs in addition to satisfactory cosmetic results and the incision does not interfere with postoperative analgosedation.