Anesthesia and analgesia
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Anesthesia and analgesia · Mar 2013
The effects of anesthetics on chronic pain after breast cancer surgery.
The incidence and predictive factors for chronic pain after breast cancer surgery have been widely studied. Because it negatively affects patients' daily lives, methods to prevent and reduce chronic pain and its severity should be developed. Our previous study showed that propofol anesthesia has an antihyperalgesic effect under remifentanil-induced hyperalgesia and reduced acute pain compared with sevoflurane anesthesia. In this study, we investigated the hypothesis that propofol would prevent the development and severity of chronic pain after breast cancer surgery, as in acute pain. ⋯ This study showed that propofol anesthesia was associated with a lower incidence of chronic pain after breast cancer surgery than sevoflurane anesthesia. However, propofol did not have a significant effect on severity and duration of chronic pain. Further prospective studies are needed to confirm the validity of these provocative findings.
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Anesthesia and analgesia · Mar 2013
The response of the composite variability index to a standardized noxious stimulus during propofol-remifentanil anesthesia.
Recently the Composite Variability Index (CVI) was developed to quantify nociception. This index is derived from the standard deviations (s) of the Bispectral Index (sBIS) and the electromyogram (sEMG). The primary aim of our study was to compare CVI before and after a noxious stimulus. As secondary end points, we investigated the influence of remifentanil on the CVI and tested the ability of the CVI to indicate patient movement after a noxious stimulus under changing remifentanil concentrations. Furthermore, we measured the increase in CVI after a noxious stimulus in comparison to other clinical variables (BIS, sBIS, sEMG, heart rate [HR], and systolic blood pressure [BP(sys)]). ⋯ In paralyzed patients, ΔsEMG and ΔCVI might help identify inadequately low levels of analgesia with an acceptable sensitivity and specificity. The impact of profound neuromuscular block on the CVI should be investigated in further studies.