British journal of anaesthesia
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Multicenter Study Clinical Trial Observational Study
Predictors for postoperative nausea and vomiting after xenon-based anaesthesia.
The incidence of post-operative nausea and vomiting is about 30% lower following xenon anesthesia compared with traditional volatile anesthesia.
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Researchers induced awake paralysis in 10 volunteers using separately both suxamethonium and rocuronium. Both the BIS A2000 (2003) and BIS Vista monitor (2013) were tested.
BIS decreased immediately after paralysis and did not fully recover until muscle recovery. BIS values decreased to as low as 44, despite the subject being awake.
In more than half of the 20 trials the BIS value decreased to below 60 at some point. In one case this lasted for almost 4 minutes, representing 76% of the total paralysis time for that subject.
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Review Meta Analysis
Benefits and risks of epidural analgesia in cardiac surgery†.
Epidural analgesia reduces all-cause mortality after cardiac surgery, at the cost of a 1 in 3,500 risk of epidural hematoma.
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Editorial Comment
Restrict relaxants, be aware, and know the limitations of your depth of anaesthesia monitor.
Interesting editorial accompanying Dr Peter Schuller's excellent study of BIS values in awake, paralysed volunteers.
The editors make a very interesting point critiquing the probabilistic, database-based approach to processed-EEG awareness monitors like BIS: (emphasis added)
summary"This database-driven approach may have limitations, in particular for the detection of intraoperative wakefulness: it is very unlikely that data from an awake and paralyzed subject are included in this database. Therefore, the resulting anaesthesia index has not been trained with a dataset that contains this clinical situation..."