European journal of anaesthesiology
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Randomized Controlled Trial Comparative Study Clinical Trial
Bispectral index-guided administration of anaesthesia: comparison between remifentanil/propofol and remifentanil/isoflurane.
The bispectral index of the electroencephalogram is a measure of the hypnotic component of anaesthesia and can be used to guide the administration of anaesthesia. This study compares bispectral index-guided anaesthesia with remifentanil and either propofol or isoflurane. ⋯ Bispectral index-guided anaesthesia with remifentanil plus propofol or isoflurane results in the absence of postoperative recall and a fast recovery with both drug combinations. In our patients, at comparable bispectral index-levels, haemodynamic control requires higher doses of remifentanil with propofol than with isoflurane.
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Randomized Controlled Trial Comparative Study Clinical Trial
General anaesthesia or spinal anaesthesia for outpatient urological surgery.
A variety of drugs and techniques have been introduced into ambulatory anaesthesia. The technique as well as the drugs used may hasten or delay home discharge. We compared recovery profiles and side-effects of spinal anaesthesia and total intravenous anaesthesia. ⋯ In healthy unpremedicated men undergoing minor urological operations, total intravenous anaesthesia with remifentanil and propofol provided as safe and effective anaesthesia as spinal block with the advantage of earlier home readiness.
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Randomized Controlled Trial Comparative Study Clinical Trial
Comparison of the effects of sevoflurane and total intravenous anaesthesia in percutaneous nephrolithotomy.
Although percutaneous nephrolithotomy has many advantages over open surgery, some endocrine and haemodynamic responses have been reported. However, the effects of anaesthetic agents on these responses have not previously been reported. This study compared the effects of sevoflurane and total intravenous anaesthesia using propofol and alfentanil on the haemodynamic and hormonal changes during percutaneous nephrolithotomy. ⋯ In the sevoflurane group, the concentrations of renin, aldosterone and adrenocorticotrophic hormone were significantly higher after 15 min of irrigation compared with the total intravenous anaesthesia group. Although the clinical significance of this difference was not clear, these changes should be considered in certain patient groups.
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The use of muscle relaxants, considered until recently as common practice in current neurosurgical anaesthesia protocols, becomes increasingly more questionable today. The reasons rely on the evolution of neurosurgery including the advent of new surgical techniques, the evolution of anaesthesia having the benefit of new drugs and devices, and the rationale for using muscle relaxants balanced against their potential side-effects and possible pharmacodynamic alterations in neurosurgical patients.
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Clinical Trial Controlled Clinical Trial
Elimination of alfentanil delivered by infusion is not altered by the chronic administration of atorvastatin.
Statins are prescribed for patients with hypercholesterolemia. Atorvastatin is metabolized by cytochrome P4503A4 and inhibits P4503A4 activity in vitro. Alfentanil is a potent opioid used in clinical anaesthetic practice and is also metabolized by P4503A4. This study tested the hypothesis that chronic atorvastatin administration inhibits the metabolism of alfentanil. ⋯ Concurrent atorvastatin administration does not alter the pharmacokinetics of alfentanil in patients undergoing elective surgery.