Articles: propofol.
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The Bispectral Index (BIS) and the Patient State Index (PSI) are commonly used measures to assess intraoperative sedation depth. However, model differences lead to different results, which in turn interferes with clinicians' judgment on the depth of anesthesia. Remimazolam tosilate (RT) for injection is a new benzodiazepine used in sedation. In its clinical application, there are few effective indicators for sedation depth monitoring. To close this gap, this study aims to compare BIS and PSI in measuring the sensitivity and specificity of intraoperative RT and to explore the safety of RT for intraspinal anesthesia in elderly patients. ⋯ BIS and PSI are strongly associated for monitoring the sedation of RT intraoperatively. Both methods can accurately reflect sedation depth. According to correlation analyses with MOAA/S scale and ROC curves, BIS is more accurate than PSI during such intraoperative monitoring. In addition, RT can be safely used in elderly patients under intraspinal anesthesia for supportive sedation, with stable vital signs and sound kidney and liver safety profiles.
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Patients who undergo gastrointestinal endoscopy often require propofol-based sedation combined with analgesics. At present, the efficacy and safety of esketamine as an adjunct to propofol for sedation during endoscopic procedures in patients remains controversial. Moreover, there is no universal agreement regarding the appropriate dose of esketamine supplementation. This study aimed to assess the efficacy and safety of esketamine as an adjunct to propofol for sedation during endoscopic procedures in patients. ⋯ Esketamine as an adjunct to propofol, is an appropriate effective alternative for sedation in participants undergoing gastrointestinal endoscopy. However, considering the possibility of its psychotomimetic effects, esketamine should be used with caution.
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Anesthesia and analgesia · Jun 2023
Anesthetic Management and Deep Sedation After Emergence From General Anesthesia: A Retrospective Cohort Study.
Residual deep sedation during anesthesia recovery may predict postoperative complications. We examined the incidence and risk factors for deep sedation after general anesthesia. ⋯ Likelihood of deep sedation after recovery increased with intraoperative use of halogenated agents with higher solubility and increased further when propofol was concomitantly used. Patients who experience deep sedation during anesthesia recovery have an increased risk of opioid-induced respiratory complications on general care wards. These findings may be useful for tailoring anesthetic management to reduce postoperative oversedation.
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J Clin Monit Comput · Jun 2023
Letter Case ReportsStimulation artefact on EEG trace with BIS monitoring during D-wave recording.
The D-wave reflects the corticospinal fibre potentials and is frequently recorded intraoperatively for intramedullary spinal tumours to ensure maximum safe resection. A 38-year-old male had an intramedullary spinal cord tumour surgically removed while being monitored with D-wave from a single distal electrode technique. ⋯ Regular spike artefacts were observed in the EEG signal recorded by the BIS® monitor during the application of the single-pulse transcranial electrical stimulus and were used as a visual indicator of stimulus delivery. Finally, we propose a novel method of confirming stimulus delivery during D-wave recording based on stimulation artefacts in the EEG signal recorded by the BIS® monitor.