The Experts below are selected from a list of 303 Experts worldwide ranked by ideXlab platform
B. Ozyar - One of the best experts on this subject based on the ideXlab platform.
-
Remifentanil versus alfentanil in Total Intravenous Anaesthesia for day case surgery.
European Journal of Anaesthesiology, 2005Co-Authors: Isik Alper, Elvan Erhan, Gulden Ugur, B. OzyarAbstract:Background and objective: We assessed the intraoperative haemodynamic responses and recovery profiles of Total Intravenous Anaesthesia with remifentanil and alfentanil for outpatient surgery. Methods: Patients in Group 1 (n = 20) received alfentanil 20 μg kg -1 followed by 2 μg kg -1 min -1 Intravenously; patients in Group 2 (n = 20) received remifentanil 1 μg kg -1 followed by 0.5 μg kg -1 min -1 Intravenously. Both groups then received propofol 2 mg kg -1 followed by 9 mg kg -1 h -1 Intravenously. Five minutes after skin incision, infusion rates were decreased, and at the end of surgery, all infusions were discontinued. Early recovery was assessed by the Aldrete score, whereas intermediate recovery was assessed with the postanaesthetic discharge scoring system (PADS). Results: Perioperative arterial pressure was similar in both groups; heart rate was lower in Group 2 (P < 0.05). The times to spontaneous and adequate respiration, response to verbal commands, extubation and times for Aldrete score ≥9 were shorter in Group 2 patients (P < 0.05). Pain scores were higher in Group 2 patients (P < 0.05). Overall times for postanaesthetic discharge scores ≥9 were similar. Conclusions: Early recovery of patients after day surgery is significantly shorter after Total Intravenous Anaesthesia with remifentanil compared with that with alfentanil but postoperative pain management must be planned ahead.
-
Remifentanil versus alfentanil in Total Intravenous Anaesthesia for day case surgery
European Journal of Anaesthesiology, 2003Co-Authors: Isik Alper, Elvan Erhan, Gulden Ugur, B. OzyarAbstract:WOS: 000180664000011PubMed ID: 12553390Background and objective: We assessed the intraoperative haemodynamic responses and recovery profiles of Total Intravenous Anaesthesia with remifentanil and alfentanil for outpatient surgery. Methods: Patients in Group 1 (n = 20) received alfentanil 20 mug kg(-1) followed by 2 mug kg(-1) min(-1) Intravenously; patients in Group 2 (n = 20) received remifentanil 1 mug kg(-1) followed by 0.5 mug kg(-1) min(-1) Intravenously. Both groups then received propofol 2 mg kg(-1) followed by 9 mg kg(-1) h(-1) Intravenously. Five minutes after skin incision, infusion rates were decreased, and at the end of surgery, all infusions were discontinued. Early recovery was assessed by the Aldrete score, whereas intermediate recovery was assessed with the postanaesthetic discharge scoring system (PADS). Results: Perioperative arterial pressure was similar in both groups; heart rate was lower in Group 2 (P < 0.05). The times to spontaneous and adequate respiration, response to verbal commands, extubation and times for Aldrete score &GE;9 were shorter in Group 2 patients (P < 0.05). Pain scores were higher in Group 2 patients (P < 0.05). Overall times for postanaesthetic discharge scores &GE;9 were similar. Conclusions: Early recovery of patients after day surgery is significantly shorter after Total Intravenous Anaesthesia with remifentanil compared with that with alfentanil but postoperative pain management must be planned ahead
I F Russell - One of the best experts on this subject based on the ideXlab platform.
-
the ability of bispectral index to detect intra operative wakefulness during Total Intravenous Anaesthesia compared with the isolated forearm technique
Anaesthesia, 2013Co-Authors: I F RussellAbstract:It has been suggested that monitoring during Total Intravenous Anaesthesia should include aspects of brain function. The current study used a manually adjusted target-controlled infusion of propofol for Anaesthesia, guided to a bispectral index range of 55-60. Intra-operative responsiveness, as assessed by the isolated forearm technique, was compared with whether the bispectral index predicted/identified a patient's appropriate hand movements in responses to commands. Twenty-two women underwent major gynaecological surgery with Total Intravenous Anaesthesia, propofol, remifentanil and atracurium. Sixteen women responded, on 80 occasions, with appropriate hand movements to commands during surgery, of which the bispectral index detected 47 (sensitivity 59%). The bispectral index suggested consciousness 220 times in the absence of movement responses (specificity 85%). The positive predictive value of a bispectral index response was 18%. While two women had vague recall about squeezing fingers, none had recall of surgery. For patients who responded more than once during surgery the bispectral index value associated with a response was not constant. Although there was no difference in the median (IQR [range]) effect site propofol concentration between intra-operative responses (2.0 (1.5-2.3 [1.2-4.0]) μg.ml(-1)) and eye opening after surgery (2.1 (1.7-2.8 [1.5-3.9]) μg.ml(-1)), the median (IQR [range]) bispectral index value at eye opening after surgery was significantly higher than that associated with responses during surgery: 75 (70-78 [51-93]) vs 61 (52-67 [37-80]) respectively, (p < 0.001). The manual control of propofol Intravenous Anaesthesia to target a bispectral index range of 55-60 may result in an unacceptable number of patients who are conscious during surgery (albeit without recall).
-
The ability of bispectral index to detect intra‐operative wakefulness during Total Intravenous Anaesthesia compared with the isolated forearm technique
Anaesthesia, 2013Co-Authors: I F RussellAbstract:It has been suggested that monitoring during Total Intravenous Anaesthesia should include aspects of brain function. The current study used a manually adjusted target-controlled infusion of propofol for Anaesthesia, guided to a bispectral index range of 55-60. Intra-operative responsiveness, as assessed by the isolated forearm technique, was compared with whether the bispectral index predicted/identified a patient's appropriate hand movements in responses to commands. Twenty-two women underwent major gynaecological surgery with Total Intravenous Anaesthesia, propofol, remifentanil and atracurium. Sixteen women responded, on 80 occasions, with appropriate hand movements to commands during surgery, of which the bispectral index detected 47 (sensitivity 59%). The bispectral index suggested consciousness 220 times in the absence of movement responses (specificity 85%). The positive predictive value of a bispectral index response was 18%. While two women had vague recall about squeezing fingers, none had recall of surgery. For patients who responded more than once during surgery the bispectral index value associated with a response was not constant. Although there was no difference in the median (IQR [range]) effect site propofol concentration between intra-operative responses (2.0 (1.5-2.3 [1.2-4.0]) μg.ml(-1)) and eye opening after surgery (2.1 (1.7-2.8 [1.5-3.9]) μg.ml(-1)), the median (IQR [range]) bispectral index value at eye opening after surgery was significantly higher than that associated with responses during surgery: 75 (70-78 [51-93]) vs 61 (52-67 [37-80]) respectively, (p < 0.001). The manual control of propofol Intravenous Anaesthesia to target a bispectral index range of 55-60 may result in an unacceptable number of patients who are conscious during surgery (albeit without recall).
-
absence of memory for intra operative information during surgery with Total Intravenous Anaesthesia
BJA: British Journal of Anaesthesia, 2001Co-Authors: I F Russell, M. WangAbstract:While using the isolated forearm technique, we wished to determine whether patients who did not respond to commands during general Anaesthesia with a Total Intravenous technique (propofol and alfentanil with atracurium) had any evidence of post-operative explicit or implicit memory. Forty women undergoing major gynaecological surgery were randomized, in a double-blind design, to hear two different tapes during surgery. Psychological tests of explicit and implicit memory were conducted within 2 h of surgery. There was no evidence of implicit or explicit memory, nor any recall, in the seven women who responded to commands during surgery. We conclude that during Total Intravenous Anaesthesia with propofol and alfentanil, there is no evidence that learning takes place when Anaesthesia is adequate. Furthermore, with this anaesthetic technique, it would seem that'provided any period of patient responsiveness is short and that unconsciousness is induced rapidly again'there is no evidence of implicit or explicit memory.
-
Absence of memory for intra‐operative information during surgery with Total Intravenous Anaesthesia†
British journal of anaesthesia, 2001Co-Authors: I F Russell, M. WangAbstract:While using the isolated forearm technique, we wished to determine whether patients who did not respond to commands during general Anaesthesia with a Total Intravenous technique (propofol and alfentanil with atracurium) had any evidence of post-operative explicit or implicit memory. Forty women undergoing major gynaecological surgery were randomized, in a double-blind design, to hear two different tapes during surgery. Psychological tests of explicit and implicit memory were conducted within 2 h of surgery. There was no evidence of implicit or explicit memory, nor any recall, in the seven women who responded to commands during surgery. We conclude that during Total Intravenous Anaesthesia with propofol and alfentanil, there is no evidence that learning takes place when Anaesthesia is adequate. Furthermore, with this anaesthetic technique, it would seem that'provided any period of patient responsiveness is short and that unconsciousness is induced rapidly again'there is no evidence of implicit or explicit memory.
-
A RANDOMISED, DOUBLE BLIND INVESTIGATION OF POSTOPERATIVE MEMORY FOR INFORMATION PRESENTED INTRAOPERATIVELY DURING Total Intravenous Anaesthesia
Memory and Awareness in Anaesthesia IV, 2000Co-Authors: I F Russell, M. WangAbstract:Forty women were randomised in a double blind manner to hear two different tapes during major gynaecological surgery under Total Intravenous Anaesthesia. Intra-operative wakefulness was detected by use of the Isolated Forearm technique. Postoperatively, there was no evidence of recall for this intraoperative information. It is concluded that adequate Anaesthesia, such that intraoperative wakefulness is prevented (or limited to a very short time), prevents postoperative recall of intraoperative information.
Isik Alper - One of the best experts on this subject based on the ideXlab platform.
-
Remifentanil versus alfentanil in Total Intravenous Anaesthesia for day case surgery.
European Journal of Anaesthesiology, 2005Co-Authors: Isik Alper, Elvan Erhan, Gulden Ugur, B. OzyarAbstract:Background and objective: We assessed the intraoperative haemodynamic responses and recovery profiles of Total Intravenous Anaesthesia with remifentanil and alfentanil for outpatient surgery. Methods: Patients in Group 1 (n = 20) received alfentanil 20 μg kg -1 followed by 2 μg kg -1 min -1 Intravenously; patients in Group 2 (n = 20) received remifentanil 1 μg kg -1 followed by 0.5 μg kg -1 min -1 Intravenously. Both groups then received propofol 2 mg kg -1 followed by 9 mg kg -1 h -1 Intravenously. Five minutes after skin incision, infusion rates were decreased, and at the end of surgery, all infusions were discontinued. Early recovery was assessed by the Aldrete score, whereas intermediate recovery was assessed with the postanaesthetic discharge scoring system (PADS). Results: Perioperative arterial pressure was similar in both groups; heart rate was lower in Group 2 (P < 0.05). The times to spontaneous and adequate respiration, response to verbal commands, extubation and times for Aldrete score ≥9 were shorter in Group 2 patients (P < 0.05). Pain scores were higher in Group 2 patients (P < 0.05). Overall times for postanaesthetic discharge scores ≥9 were similar. Conclusions: Early recovery of patients after day surgery is significantly shorter after Total Intravenous Anaesthesia with remifentanil compared with that with alfentanil but postoperative pain management must be planned ahead.
-
Remifentanil versus alfentanil in Total Intravenous Anaesthesia for day case surgery
European Journal of Anaesthesiology, 2003Co-Authors: Isik Alper, Elvan Erhan, Gulden Ugur, B. OzyarAbstract:WOS: 000180664000011PubMed ID: 12553390Background and objective: We assessed the intraoperative haemodynamic responses and recovery profiles of Total Intravenous Anaesthesia with remifentanil and alfentanil for outpatient surgery. Methods: Patients in Group 1 (n = 20) received alfentanil 20 mug kg(-1) followed by 2 mug kg(-1) min(-1) Intravenously; patients in Group 2 (n = 20) received remifentanil 1 mug kg(-1) followed by 0.5 mug kg(-1) min(-1) Intravenously. Both groups then received propofol 2 mg kg(-1) followed by 9 mg kg(-1) h(-1) Intravenously. Five minutes after skin incision, infusion rates were decreased, and at the end of surgery, all infusions were discontinued. Early recovery was assessed by the Aldrete score, whereas intermediate recovery was assessed with the postanaesthetic discharge scoring system (PADS). Results: Perioperative arterial pressure was similar in both groups; heart rate was lower in Group 2 (P < 0.05). The times to spontaneous and adequate respiration, response to verbal commands, extubation and times for Aldrete score &GE;9 were shorter in Group 2 patients (P < 0.05). Pain scores were higher in Group 2 patients (P < 0.05). Overall times for postanaesthetic discharge scores &GE;9 were similar. Conclusions: Early recovery of patients after day surgery is significantly shorter after Total Intravenous Anaesthesia with remifentanil compared with that with alfentanil but postoperative pain management must be planned ahead
J. Cosgrove - One of the best experts on this subject based on the ideXlab platform.
-
Propofol and alfentanil Total Intravenous Anaesthesia: a comparison of techniques for major thoracic surgery.
Acta anaesthesiologica Scandinavica, 1998Co-Authors: T. J. Trinder, J. R. Johnston, K. G. Lowry, A. S. Phillips, J. CosgroveAbstract:Background: Previous work has highlighted the disadvantages of propofol as a sole agent for Total Intravenous Anaesthesia (TIVA). This randomised study investigated three combinations of propofol and alfentanil as TIVA for major thoracic surgery. Methods: In 73 patients undergoing elective thoracic surgery, Anaesthesia was conducted either with sodium thiopentone induction and inhalational maintenance (incorporating isoflurane) or with TIVA using propofol with alfentanil (by infusion at one of two rates or in incremental doses). Vital signs and recovery characteristics were recorded. Results: There were no significant differences in heart rate or blood pressure between groups during either induction or maintenance. Depth of Anaesthesia was controlled satisfactorily in all groups. Recovery characteristics were similar between treatment groups, although there was a trend towards earlier orientation in the group which received the highest infusion rate of alfentanil. Conclusion: Continuous infusions of propofol and alfentanil provide safe and reliable TIVA for major thoracic surgery. TIVA was found to be a satisfactory technique in more elderly patients than previously described. The higher of the two alfentanil infusion rates may result in a better combination of propofol and alfentanil with respect to recovery times than the lower.
Gulden Ugur - One of the best experts on this subject based on the ideXlab platform.
-
Remifentanil versus alfentanil in Total Intravenous Anaesthesia for day case surgery.
European Journal of Anaesthesiology, 2005Co-Authors: Isik Alper, Elvan Erhan, Gulden Ugur, B. OzyarAbstract:Background and objective: We assessed the intraoperative haemodynamic responses and recovery profiles of Total Intravenous Anaesthesia with remifentanil and alfentanil for outpatient surgery. Methods: Patients in Group 1 (n = 20) received alfentanil 20 μg kg -1 followed by 2 μg kg -1 min -1 Intravenously; patients in Group 2 (n = 20) received remifentanil 1 μg kg -1 followed by 0.5 μg kg -1 min -1 Intravenously. Both groups then received propofol 2 mg kg -1 followed by 9 mg kg -1 h -1 Intravenously. Five minutes after skin incision, infusion rates were decreased, and at the end of surgery, all infusions were discontinued. Early recovery was assessed by the Aldrete score, whereas intermediate recovery was assessed with the postanaesthetic discharge scoring system (PADS). Results: Perioperative arterial pressure was similar in both groups; heart rate was lower in Group 2 (P < 0.05). The times to spontaneous and adequate respiration, response to verbal commands, extubation and times for Aldrete score ≥9 were shorter in Group 2 patients (P < 0.05). Pain scores were higher in Group 2 patients (P < 0.05). Overall times for postanaesthetic discharge scores ≥9 were similar. Conclusions: Early recovery of patients after day surgery is significantly shorter after Total Intravenous Anaesthesia with remifentanil compared with that with alfentanil but postoperative pain management must be planned ahead.
-
Remifentanil versus alfentanil in Total Intravenous Anaesthesia for day case surgery
European Journal of Anaesthesiology, 2003Co-Authors: Isik Alper, Elvan Erhan, Gulden Ugur, B. OzyarAbstract:WOS: 000180664000011PubMed ID: 12553390Background and objective: We assessed the intraoperative haemodynamic responses and recovery profiles of Total Intravenous Anaesthesia with remifentanil and alfentanil for outpatient surgery. Methods: Patients in Group 1 (n = 20) received alfentanil 20 mug kg(-1) followed by 2 mug kg(-1) min(-1) Intravenously; patients in Group 2 (n = 20) received remifentanil 1 mug kg(-1) followed by 0.5 mug kg(-1) min(-1) Intravenously. Both groups then received propofol 2 mg kg(-1) followed by 9 mg kg(-1) h(-1) Intravenously. Five minutes after skin incision, infusion rates were decreased, and at the end of surgery, all infusions were discontinued. Early recovery was assessed by the Aldrete score, whereas intermediate recovery was assessed with the postanaesthetic discharge scoring system (PADS). Results: Perioperative arterial pressure was similar in both groups; heart rate was lower in Group 2 (P < 0.05). The times to spontaneous and adequate respiration, response to verbal commands, extubation and times for Aldrete score &GE;9 were shorter in Group 2 patients (P < 0.05). Pain scores were higher in Group 2 patients (P < 0.05). Overall times for postanaesthetic discharge scores &GE;9 were similar. Conclusions: Early recovery of patients after day surgery is significantly shorter after Total Intravenous Anaesthesia with remifentanil compared with that with alfentanil but postoperative pain management must be planned ahead
