Continuous Analgesia Research Articles

Analgesic and Sedative Effects of Different Doses of Dexmedetomidine Combined with Butorphanol in Continuous Analgesia after a Cesarean Section

ObjectiveThe present study is designed to study the analgesic and sedative effect of different doses of dexmedetomidine combined with butorphanol in continuous analgesia after a cesarean section.MethodsA total of 60 puerperae undergoing a cesarean section recruited from a single center were divided into three groups according to the postoperative continuous analgesia protocol: control group (100 mL of normal saline containing 10 µg/kg fentanyl and 0.25 mg of palonosetron, 2 mL/h for continuous analgesia for 48 h), DB1 group (100 mL of normal saline containing 1.0 µg/kg dexmedetomidine, 4 mg of butorphanol, 10 µg/kg fentanyl, and 0.25 mg of palonosetron, 2 mL/h for continuous analgesia for 48 h), and DB2 group (100 mL normal saline containing 2.0 µg/kg dexmedetomidine, 4 mg of butorphanol, 10 µg/kg fentanyl, and 0.25 mg of palonosetron, 2 mL/h for continuous analgesia for 48 h). We compared the blood pressure, heart rate, oxygen saturation, VAS score, Ramsay score, and adverse reactions of puerperae among the three groups after surgery.ResultsThe baseline data all have no significant difference in the three groups (p > 0.05). Compared with those in the control group, the systolic blood pressure, diastolic blood pressure, heart rate, and VAS score of the puerperae in the DB1 group and DB2 group were significantly decreased at 6, 24, and 48 h (P < 0.05), while the Ramsay scores of the puerperae in DB1 group and DB2 group were significantly increased at 6, 24, and 48 h (p < 0.05). At the same time, the systolic blood pressure, diastolic blood pressure, heart rate, and VAS score of the puerperae in the DB2 group were significantly lower than those in the DB1 group (P < 0.05), while the Ramsay scores of the puerperae in DB2 group were significantly higher than those in the DB1 group (P < 0.05). Also, there is no significant difference in oxygen saturation and adverse reactions of puerperae among the three groups after surgery (p > 0.05).ConclusionDexmedetomidine combined with butorphanol can improve the analgesic and sedative effects in continuous analgesia after a cesarean section, and the analgesic and sedative effects of dexmedetomidine in the high-dose group are better than those in the low-dose group.

Comparing the Experiences of Parturient Women With Remifentanil Analgesia and Elective Cesarean Section and Providing Improver Strategies: A Sequential Explanatory Mixed Method Study Protocol

Objectives: Women’s experience during childbirth can affect various aspects (psychological and physical), which has not yet been done accurately. The current study aimed to compare experiences of parturient women with remifentanil analgesia and elective cesarean section (C-section) and provide improver strategies for women living in Tabriz, Iran. Methods: This is a mixed-method study with an explanatory sequential approach. The first stage is quantitative and longitudinal. Participants will be divided into two groups of elective C-sections and parturient women who receive remifentanil. They will be matched concerning social class, type of provider, and birth rank. In the first stage, data will be collected using a socio-demographic questionnaire, Edinburgh’s Depression during pregnancy questionnaire, Labor Agentry Scale, and midwifery-neonatal outcomes checklist within 24 hours after delivery. Participants will be followed up to 30 days after delivery to complete the Edinburgh Postpartum Depression questionnaire. The second stage is a qualitative study to explain the perceptions of parturient women who had either elective C-section or painless delivery (using remifentanil), including factors related to labor experiences. In the third stage, a mixed study will be performed to provide strategies for improving labor experiences. Discussion: Women’s experiences during cesarean section can have different effects on maternal and neonatal outcomes; Following the use of two methods of continuous analgesia with remifentanil and spinal anesthesia and analgesia caused by these methods in cesarean section, women’s experiences may be different; The protocol presented in this study is a clinical guide to present this important issue (experiences of women during cesarean section looking for an appropriate method of analgesia). Ethical Code: IR.TBZMED.REC.1399.521, Pazhoohan Code: 65454.

Continuous Unilateral Erector Spinae Plane Block versus Intravenous Analgesia in Minimally Invasive Cardiac Surgery: A Randomized Controlled Trial

Objectives: the study was conducted to assess the safety and efficacy of anesthesia under the erector spinae plane block (ESPB) in minimally invasive cardiac surgery (MICS). Methods: a prospective, randomized controlled trial was carried out in 56 adult patients who underwent MICS via a right thoracic incision at Vietnam National Heart Institute, Bach Mai hospital, Vietnam. Patients were randomly allocated into two groups: ESPB and conventional analgesia (intravenousmorphine patient-controlled analgesia, PCA). Patients in ESPB group received ultrasound-guided unilateral ESPB at the T4/T5 transverse process level, and the tip of the catheter was advanced 5cm beyond the tip of the needle; injected with 20 ml ropivacaine 0.5%. At the cardiac ICU, patients received paracetamol (1g every 6 hours), continuous infusion ropivacaine 0.1% 0.2ml/kg/hour. Patients in the PCA group received paracetamol (1g every 6 hours) and intravenous morphine PCA. All patients were followed for 72 hours after being extubated. Results: the resting VAS score was significantly lower in ESPB group at the time H4, H8, H12, H16, H36, H42, H48, H54, H60, H66 after extubated compared to that of the PCA group (p&lt; 0.05). The dynamic VAS score at was also significantly lower in the ESPB group at all measured time points (p&lt;0.05). Only 4 patients in the ESPB group required intravenous morphine PCA with the mean amount morphine were statistically lower in the ESPB group compared to the PCA group at 24 hours, 48 ​​hours, 72 hours postoperative. No serious adverse events such as neurological complications, bleeding or infection were observed in both groups. Conclusion: ESPB is an effective analgesic for MICS via thoracic incision in reducing the VAS score and the morphine required. It is also a safe method with no severe ESPB-related complications.

Analgesic Efficacy of Transverse Abdominis Plane Block and Quadratus Lumborum Block in Laparoscopic Sleeve Gastrectomy: A Randomized Double-Blinded Clinical Trial.

IntroductionThe analgesic effect and safety of transversus abdominis plane block (TAPB) is still controversial in various abdominal procedures. Quadratus lumborum block (QLB) has been considered to provide a widespread and long-lasting analgesic effect in gynecological surgeries. However, the analgesic effects of these two techniques in patients with extreme obesity undergoing laparoscopic sleeve gastrectomy (LSG) are still unknown.MethodsA total of 225 patients with obesity were randomly assigned to group TAPB (n = 76, 30 ml 0.33% ropivacaine with dexmedetomidine 1 μg kg−1), group QLB (n = 76, 30 ml 0.33% ropivacaine with dexmedetomidine 1 μg kg−1), or general anesthesia alone (GA, n = 73, 30 ml 0.9% saline). During the 48-h postoperative period, patients received continuous intravenous patient-controlled analgesia (PCA) containing sufentanil 2 μg kg−1, dexmedetomidine 2 μg kg−1, and granisetron 3 mg. The scores of visual analogue scale (VAS) in surgical incision and viscera, considering as the primary outcomes, were continuously recorded at postoperative 0, 0.5, 1, 2, 6, 12, 24, 48 h and discharge.ResultsComparing with patients in the GA group, VAS scores of incision and viscera were consistently reduced during the initial 6–12 h after LSG in TAPB and QLB groups, and they received less propofol and remifentanil (P < 0.001) as well. In the QLB group, patients had longer duration for the first rescue analgesia, and fewer requirements of the rescue analgesia within 24 h than the GA group (P < 0.05). In addition, there were fewer PCA requirements in QLB group than GA and TAPB groups (P < 0.05).ConclusionsUltrasound-guided transversus abdominis plane block and quadratus lumborum block could provide comparable analgesic effects for a laparoscopic sleeve gastrectomy in obese patients.Trial RegistrationChinese Clinical Trial Registry; ChiCTR1800019236.Supplementary InformationThe online version contains supplementary material available at 10.1007/s40122-022-00373-1.

Multimodal continuous approach to pain management in oncological patients (clinic’s first experience)

In current conditions, increased life expectancy led to increased cancer morbidity. Presence of pain syndrome with significant intensity caused development of numerous guidelines on its treatment. Currently, pain management is based on the stepwise multimodal approach of the World Health Organization. In our opinion, wide application of narcotic analgesics is a disadvantage of this method. This pharmaceutical group has a significant number of adverse effects including addiction, development of hyperalgesia, and potential effect of increased rate of cancer recurrence.The study objective is to optimize the stepwise approach by addition of continuous multimodal analgesia. We aim to develop the principles of complex approach to pain management including new combinations of pharmaceuticals of different modalities and new techniques of continuous safe administration using innovative devices.The article presents a prospective description of a series of clinical cases in which new combinations of pharmaceuticals were administered in the context of complex treatment of pain syndrome of significant intensity. Objective evaluation of pain syndrome was performed using the Numeric Rating Scale.Multimodal intravenous pain management using mobile devices administering a mixture of pharmaceuticals in conjunction with basic peroral therapy and widely accepted discrete stepwise approach of the World Health Organization showed first positive results. In our opinion, further studies will allow to 1) decrease the rate of chronic pain syndrome in oncological patients; 2) treat pain syndrome of almost any intensity with preserved quality of life.The first results are encouraging; they show satisfactory effectiveness of the method and its safety. It is necessary to continue studies to develop and standardize the intravenous mixture composition for pain management in the context of the main clinical syndromes determining pain.

Effects of an Acute Pain Service on Planned Ventral Wall Hernia Repair in a Matched Retrospective Cohort

Background: An Acute Pain Service (APS) has been shown to improve patient outcomes and decrease complications by achieving adequate pain control and decreasing opioid use. However, it is less obvious if having a dedicated APS postoperatively directly translates to patient-centered or hospital cost benefits. This study aimed to determine if there was a cost benefit between a matched cohort of patients with and without a dedicated APS after a planned ventral wall hernia repair. Methods: A historical cohort study was conducted. After 1:1 matching, 40 patients were included for analysis. The non-APS group received a thoracic epidural postoperatively managed by the anesthesiology department. The APS group received various continuous peripheral nerve blocks and analgesia exclusively managed by a dedicated APS. Data was recorded for each group regarding surgical techniques, postoperative complications, opioid use and induced side effects, hospital length of stay, and resource utilization for both groups. Results: Compared to the non-APS group, adjusted opioid consumption per day was almost half in the APS group (P= 0.0067). The average hospital length of stay was 3.4 days less (P= 0.0401) , and there was a statistically significant reduction in several recovery milestones that likely contributed to a timely discharge in the APS group. After factoring costs of APS utilization, the APS was shown to save an average of $5,440.59 of total cost per patient. Discussion: The addition of a dedicated postoperative APS significantly reduced opioid consumption and improved outcomes of patients and resulted in reduced healthcare costs.

Femoral nerve inguinal approach versus proximal femoral triangle ap proach for continuous regional analgesia in active rehabilitation after total knee arthroplasty: A prospective, randomised study

BackgroundA catheter in femoral nerve block (F-Cath) is an effective regional analgesia technique in total knee arthroplasty (TKA) but results in significant quadriceps weakness. The femoral triangle catheter (FTB-Cath) seems to be an interesting alternative. In this study, we aim to demonstrate that the nerve block administration for analgesic purposes via an FTB-Cath results in less quadriceps weakness than via an F-Cath. MethodsThis study included patients scheduled for TKA performed under general anaesthesia. The patients were randomised to receive either an F-Cath or an FTB-Cath. A unique regimen of 0.2% ropivacaine was administrated for 72 h. The primary endpoint was quadriceps strength assessed clinically on postoperative day (POD) 2 by the Manual Muscle Test (MMT) using a motor grading scores (0–5). The secondary endpoints were quadriceps strength measured by a dynamometer, the Timed Up and Go (TUG) test, the 30-m walk test (30MWT) and pain scores. ResultsForty-four patients were analysed (22 in each group). On POD 2, 77.3% of the patients in the FTB-Cath group had MMT scores ≥ 4 and 13.6% in the F-Cath group (p < 0.001). During the first four POD assessments, quadriceps strength evaluated with a dynamometer was less diminished in the FTB-Cath group (p < 0,001). There was no difference between groups regarding pain scores, TUG test results and 30MWT assessment. ConclusionThe FTB-Cath provided a better preservation of quadriceps strength than the F-Cath in TKA, with a similar pain relief.

A Comparison of Puncture and Continuous Pump Analgesia With Two Different Approaches to Thoracic Paravertebral Block for Thoracic Surgery.

BackgroundThis study aims to compare the success rate of thoracic paravertebral block (TPVB) and the effect of postoperative analgesia between two approaches.MethodsA total of 34 patients with American Society of Anesthesiology (ASA) physical status score II–III, undergoing an optional thoracoscopic surgery, were randomly assigned to a parasagittal approach group (group P, n = 17) and a transverse intercostal approach group (group T, n = 17). The catheterization time, success rate of the puncture and catheterization, block plane and effect at the surgical site were compared between two groups. The mean arterial pressure and heart rate were recorded, as well as the cold tactile block plane and numeric rating scale (NRS) at 0.5, 2, 4, 8, 12, 24, and 48 h after surgery. The study was registered at http://www.chictr.org.cn/showproj.aspx?proj=9624 (Registration number: ChiCTR2100054642).ResultsThe catheterization time in group P was significantly longer than that in group T (P < 0.05). The success rate of catheterization in group P was lower than that in group T, but no statistical significance (P = 0.085). There was no significant difference in the success rate of Puncture and blocking effect of the surgical site at 30 min post-injection between two groups (P > 0.05). There was no significant difference in the cold tactile block plane and NRS scores during coughing between two groups at 0.5, 2, 4, 8, 12, 24, and 48 h postoperatively (P > 0.05).ConclusionThis study suggests that there is no significant difference in postoperative block level or pain score during coughing for thoracoscopic surgery between ultrasound-guided parasagittal and transverse intercostal approach, but the parasagittal approach takes longer and has a higher failure rate.

Optimal location for continuous catheter analgesia among the femoral triangle, proximal, or distal adductor canal after total knee arthroplasty: a randomized double-blind controlled trial

BackgroundPain management after total knee arthroplasty is essential to improve early mobilization, rehabilitation, and recovery. Continuous adductor canal (AC) block provides postoperative analgesia while preserving quadriceps strength. However, there have...

Outcomes of Extubated COVID and Non-COVID Patients Receiving Awake Venovenous Extracorporeal Membrane Oxygenation.

Cessation of continuous analgesia and sedation in patients with acute respiratory distress syndrome (ARDS) receiving venovenous (VV) extracorporeal membrane oxygenation (ECMO) facilitates early extubation, family, patient and provider engagement, and mobility. Outcomes associated with an awake ECMO strategy have not been well described in the literature. The purpose of this study was to evaluate outcomes in patients receiving this strategy. This was a retrospective review of ARDS patients receiving awake VV ECMO. The primary outcome was survival to hospital discharge. Secondary outcomes included days requiring ECMO, time from cannulation to extubation, complications, patients requiring tracheostomy, hospital and intensive care unit (ICU) length of stay (LOS), and discharge disposition. In a subgroup analysis, outcomes were compared between non-COVID and COVID ECMO patients. Sixty-two patients were included with a survival to hospital discharge of 85.5%. Days requiring ECMO was 33.0 (0.0-75.0) and cannulation to extubation was 6.0 (4.0-11.0). Three patients received a tracheostomy (4.8%). Bleeding and infection were reported in 80.6% and 82.3% of patients, respectively. Intensive care unit length of stay was 46.0 days (29.0-90.0) and hospital LOS was 51.0 days (32.0-91.0). Over half of the patients (51.6%) were discharged to an acute rehabilitation facility and 27.4% were discharged home. There was similar survival to hospital discharge between the COVID and non-COVID awake ECMO patients (85% in both groups, p = 1.000). This study highlights the impact of an awake ECMO approach on survival to hospital discharge. Future studies are needed to evaluate this approach as compared to current practice to determine if this should become the standard.

Associated Factors of High Sedative Requirements within Patients with Moderate to Severe COVID-19 ARDS.

The coronavirus pandemic continues to challenge global healthcare. Severely affected patients are often in need of high doses of analgesics and sedatives. The latter was studied in critically ill coronavirus disease 2019 (COVID-19) patients in this prospective monocentric analysis. COVID-19 acute respiratory distress syndrome (ARDS) patients admitted between 1 April and 1 December 2020 were enrolled in the study. A statistical analysis of impeded sedation using mixed-effect linear regression models was performed. Overall, 114 patients were enrolled, requiring unusual high levels of sedatives. During 67.9% of the observation period, a combination of sedatives was required in addition to continuous analgesia. During ARDS therapy, 85.1% (n = 97) underwent prone positioning. Veno-venous extracorporeal membrane oxygenation (vv-ECMO) was required in 20.2% (n = 23) of all patients. vv-ECMO patients showed significantly higher sedation needs (p < 0.001). Patients with hepatic (p = 0.01) or renal (p = 0.01) dysfunction showed significantly lower sedation requirements. Except for patient age (p = 0.01), we could not find any significant influence of pre-existing conditions. Age, vv-ECMO therapy and additional organ failure could be demonstrated as factors influencing sedation needs. Young patients and those receiving vv-ECMO usually require increased sedation for intensive care therapy. However, further studies are needed to elucidate the causes and mechanisms of impeded sedation.

Effects of continuous goal-directed analgesia on fluid resuscitation of massive burn patients during shock

Effects of continuous goal-directed analgesia on fluid resuscitation of massive burn patients during shock

Maternal Fever Associated With Continuous Spinal Versus Epidural Labor Analgesia: A Single-Center Retrospective Study.

Neuraxial labor analgesia is associated with elevations in maternal temperature; the mechanism responsible is unknown. Proposed mechanisms have included infection, altered thermoregulation, and inflammation, potentially triggered by local anesthetics. Studies of the association between neuraxial labor analgesia and maternal fever have focused on epidural analgesia, and there have been no comparisons of the rate of maternal fever between continuous spinal and epidural labor analgesia. We performed a retrospective study to compare the rate of maternal fever between patients who received continuous spinal versus epidural labor analgesia between June 2012 and March 2020. Each patient who received continuous spinal analgesia was matched to 2 patients who received epidural analgesia and had the same nulliparous status. The primary outcome of our study was the incidence of intrapartum maternal fever, which we defined as any temperature ≥38 °C before delivery and compared between the continuous spinal and epidural groups using Fisher exact test. We identified 81 patients who received continuous spinal analgesia and 162 matched controls who received epidural analgesia. Demographic and obstetric characteristics of the patients were similar between groups. While the duration of analgesia did not significantly differ, there was markedly increased bupivacaine consumption in women with epidural analgesia. Eight of 81 (9.9%; 95% confidence interval [CI], 5.1-18.3) women with continuous spinal analgesia developed an intrapartum fever compared to 18 of 162 (11.1%; 95% CI, 7.1-16.9) of women with epidural analgesia ( P = .83; Fisher exact test). There was no significant difference in the rate of maternal fever between women with continuous spinal compared to epidural labor analgesia. While the route of administration and dose of bupivacaine differs between epidural and spinal labor analgesia, they are titrated to produce similar levels of neuraxial blockade. Our results are consistent with a model in which epidural related maternal fever is due to altered thermoregulation from a central neuraxial block and argue against a direct effect of bupivacaine or fentanyl, although we cannot rule out a concentration-independent effect of bupivacaine or fentanyl or an inflammatory effect of the catheter itself. These retrospective results highlight the importance of prospective and mechanistic study of neuraxial analgesia-related maternal fever.

Intraoperative ultrasound-guided serratus anterior plane catheter for postoperative analgesia after breast surgery in a morbidly obese patient

Inter-fascial plane blocks play a great role as part of the multimodal analgesic regimen for breast surgery. Fascial plane blocks are effective for immediate analgesia, but their use for prolonged postoperative analgesia is not yet explored. We present a hybrid technique of successful placement of intraoperative ultrasound-guided deep serratus anterior plane (SAP) catheter for continuous postoperative analgesia in a morbidly obese patient undergoing breast surgery. A sexagenarian morbidly obese female patient with left carcinoma breast was posted for modified radical mastectomy. The deep serratus anterior fascial plane was more than 9 cms deep and was poorly visualized. Hence, intraoperative catheter was placed under ultrasound guidance and used effectively for 5 days. The static and dynamic pain scores were <4 at all-time points with local anesthetics and nonopioid systemic analgesics. We observed that intraoperative ultrasound-guided SAP catheter can be effectively used for continuous postoperative analgesia in morbidly obese patients undergoing breast surgery.

Pupil Light Reflex for the Assessment of Analgesia in Critically Ill Sedated Patients With Traumatic Brain Injury: A Preliminary Study.

BACKGROUND: Analgesia monitoring is essential to preserve comfort in critically ill sedated patients with traumatic brain injury (TBI). Although pupil dilation (PD) and pain behaviors can be used to assess analgesia, these indicators require application of noxious stimulations for elicitation. Recently, the pupillary light reflex (PLR) has emerged as a nonnoxious parameter that may be used to predict analgesia requirements in non-brain-injured patients. Here, we explored whether PLR can be used for the purpose of analgesia monitoring in critically ill sedated TBI patients. METHODS: Fifteen mechanically ventilated TBI patients (11 men; 54 ± 20 years) under continuous analgesia and sedation infusions were assessed at predefined time within 72 hours of intensive care unit admission. Data collection was performed using video-pupillometry and the Behavioral Pain Scale. At each assessment, pupil size and PLR at rest were recorded followed immediately by the documentation of PD and pain behaviors elicited by a calibrated noxious stimulus. Blood concentrations of analgesics/sedatives were monitored. RESULTS: One hundred three assessments were completed. PLR resulted in an average decrease of 19% in pupil diameter, and PD resulted in an average increase of 10% in pupil diameter. Variations in PLR and PD were more pronounced in subjects who showed a Behavioral Pain Scale score greater than 3 (a recognized sign of subanalgesia) compared with those with no behavioral reaction. Multiple regression analyses suggest a significant overlap between fluctuations in pupillary reflexes and blood levels of fentanyl, not propofol. CONCLUSION: In our sample, percentages of variation in PLR and PD were found to be directly representative of TBI patients' fentanyl blood concentration. Considering information about blood drug concentration is generally not available at bedside, PLR could be used as a proxy to assess analgesia requirements before a nociceptive procedure in critically ill sedated TBI patients who are vulnerable to stress.

Incidence and characteristics of major adverse events in continuous peripheral nerve block analgesia: A single-centre outcome analysis of 10 638 cases in a tertiary care teaching hospital.

Incidence and characteristics of major adverse events in continuous peripheral nerve block analgesia: A single-centre outcome analysis of 10 638 cases in a tertiary care teaching hospital.

Exploring patients’ experiences of analgesia after major lower limb amputation: a qualitative study

ObjectivesTo explore patient experiences, understanding and perceptions of analgesia following major lower limb amputation.DesignQualitative interview study, conducted as part of a randomised controlled feasibility trial.SettingParticipants were recruited from two general...

Clinical observation on horizontal penetration needling combined with rizatriptan monobenzoate tablets for migraine without aura in acute stage

To observe the therapeutic effect of horizontal penetration needling combined with rizatriptan monobenzoate tablets, simple horizontal penetration needling and simple rizatriptan monobenzoate tablets for migraine without aura in acute stage. A total of 99 patients with migraine without aura in acute stage were randomized into an acupuncture plus medication group, an acupuncture group and a western medication group, 33 cases in each one. In the acupuncture group, horizontal penetration needling was applied once at Hanyan (GB 4) to Xuanli(GB 6), Shenting (GV 24) to Yintang (GV 29), Baihui (GV 20) to Qianding (GV 21), etc. for 2 h. In the western medication group, oral rizatriptan monobenzoate tablets for 10 mg were given once. In the acupuncture plus medication group, treatment of acupuncture combined with rizatriptan monobenzoate tablets were given, the application was the same as the acupuncture group and the western medication group. Before treatment and 0.5, 2, 24 h after treatment, the visual analogue scale (VAS) score was observed, the remission rate and the disappearance rate of migraine of 2, 24 h after treatment were compared in the 3 groups. Compared before treatment, the VAS scores of each time point after treatment were decreased in the 3 groups (P<0.05), and the changes in the acupuncture plus medication group were greater than those in the acupuncture group and the western medication group (P<0.05). The remission rates of 24 h after treatment and the disappearance rates of migraine of 2, 24 h after treatment in the acupuncture plus medication group were higher than those in the acupuncture group and the western medication group (P<0.05). Horizontal penetration needling combined with rizatriptan monobenzoate tablets have significant therapeutic effect on rapid analgesia and continuous analgesia for migraine without aura in acute stage, its effect is superior to simple horizontal penetration needling and simple rizatriptan monobenzoate tablets.

Impact of Propofol Bolus Administration on the Nociceptive Flexion Reflex Threshold and Bispectral Index in Children—A Case Series

We analyzed the impact of propofol administration during continuous sedation and analgesia on the nociceptive flexion reflex threshold (NFRT) and Bispectral Index (BIS) in ventilated children. We examined patients who received propofol before planned endotracheal suctioning. Patients were clinically assessed using the modified Face, Legs, Activity, Cry, Consolability (mFLACC) scale and COMFORT-B (Comfort Behavior) scale. We continuously recorded the NFRT and BIS. We recorded 23 propofol administrations in eight patients with an average age of 8.6 ± 3.5 years. The median (minimum-maximum) scores for the mFLACC scale and COMFORT-B scale were 0 (0–5) and 6 (6–17), respectively, before the bolus. The administration of a weight-adjusted propofol bolus of 1.03 ± 0.31 mg/kg resulted in an increase in NFRT and burst-suppression ratio; BIS and electromyogram values decreased. Changes from baseline (95% CI) after propofol bolus administration were BIS −23.9 (−30.8 to −17.1), EMG -10.5 dB (−13.3 to −7.7), SR 14.8 % (5.6 to 24.0) and NFRT 13.6 mA (5.5 to 21.7). Further studies are needed to determine whether sedated children may benefit from objective pain and sedation monitoring with BIS and NFRT.

The Cognitive Neuraxis: Epidurals and Postoperative Delirium

Editorial| August 2021 The Cognitive Neuraxis: Epidurals and Postoperative Delirium Phillip E. Vlisides, M.D.; Phillip E. Vlisides, M.D. Search for other works by this author on: This Site PubMed Google Scholar George A. Mashour, M.D., Ph.D. George A. Mashour, M.D., Ph.D. Search for other works by this author on: This Site PubMed Google Scholar Author and Article Information From the Department of Anesthesiology (P.E.V., G.A.M.), the Center for Consciousness Science (P.E.V., G.A.M.), and the Neuroscience Graduate Program (G.A.M.), University of Michigan Medical School, Ann Arbor, Michigan. This editorial accompanies the article on p. 218. This article has a related Infographic on p. A19. Accepted for publication April 16, 2021. Address correspondence to Dr. Mashour: gmashour@med.umich.edu Anesthesiology August 2021, Vol. 135, 197–199. https://doi.org/10.1097/ALN.0000000000003824 Connected Content Commentary: Delirium in Older Patients after Combined Epidural–General Anesthesia or General Anesthesia for Major Surgery: A Randomized Trial Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Twitter LinkedIn Cite Icon Cite Get Permissions Search Site Citation Phillip E. Vlisides, George A. Mashour; The Cognitive Neuraxis: Epidurals and Postoperative Delirium. Anesthesiology 2021; 135:197–199 doi: https://doi.org/10.1097/ALN.0000000000003824 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search Search nav search search input Search input auto suggest search filter All ContentAll PublicationsAnesthesiology Search Advanced Search Topics: axon, postoperative delirium, delirium Delirium is a distressing syndrome that affects many surgical patients. Postoperative delirium is associated with falls, cognitive and functional decline, and prolonged hospitalization.1 Indeed, delirium is a major public health issue, and postoperative delirium serves as a target for surgical quality improvement.2 A promising strategy for reducing risk involves sustained interventions that simultaneously target multiple risk factors.3 Epidural analgesia is one such candidate intervention that has been demonstrated to reduce key delirium risk factors: pain, opioid consumption, and inflammation.4–6 Furthermore, epidural therapy can be continued over multiple days, particularly during time windows of peak delirium risk. Taken together, it seems plausible that such a sustained intervention, which simultaneously targets multiple risk factors, could reduce risk of postoperative delirium. As reported in this issue of Anesthesiology, Li et al. sought to determine whether combined general-epidural anesthesia, with continued postoperative epidural analgesia, would reduce the risk of... You do not currently have access to this content.