“
“Background:
Emergence following termination of a general anesthetic depends on the effect site concentration (C(e)) of the drug declining to an awakening value (C(e)-awake). C(e)-awake has been described in adults, but is unknown in children.
Objectives: To determine C(e)-awake in children following a target-controlled infusion (TCI) of propofol and to assess a C(e)-driven TCI system’s ability to predict times to emergence from anesthesia.
Methods: Subjects undergoing elective surgery, aged 3 months to <10 years were recruited into three age-stratified groups. A target C(e) of 3-4 mu g.ml(-1) was selected for induction and subsequently titrated to patient response and surgical stimulus. Preoperative AZD9291 cell line acetaminophen, a remifentanil infusion and regional anesthesia were permitted for supplemental analgesia. State Entropy (SE) was monitored from induction to emergence. Emergence was defined as the time of first purposeful spontaneous movement (PSM). Time zero was defined as the end of propofol infusion. Based on a pilot study, a C(e)-awake of 1.9 mu g.ml(-1) was
chosen as the wake-up threshold used by the software to predict emergence times.
Results: Data was collected for 90 of 104 recruited patients. PSM occurred at a mean (SD) C(e) of 2.0 (0.5) mu g.ml(-1) and an SE of 79 (11). There were no differences between age groups. A wide variation in emergence time was observed, with a mean (SD) of 16.9 (7) min, and a trend to more rapid emergence in older subjects.
Conclusion: A predicted C(e)-awake of 2.0 mu g.ml(-1) in children aged 3 months to <10 years was identified with the selected Selleckchem IPI-549 model. For expert users
of propofol in children, during shorter surgical learn more procedures, TCI predicted emergence times do not offer significant clinical advantages.”
“Assessment of the integrity of the multifidus muscles and corresponding nerve roots, post-open (OSS) versus minimally invasive spinal surgery (MISS) for lumbar spine fractures.
We investigated the first six patients undergoing MISS in our institution and age- and sex-matched them with 6 random patients who previously had OSS. All had a similar lumbar fracture configuration without evidence of spinal cord injury. All were assessed using ultrasound muscle quantification and electromyographic studies at a minimum of 6 months post-operatively. Mean cross-sectional area (CSA) was measured at sequential levels within and adjacent to the operative field. Concentric needle electromyography was performed at instrumented and adjacent non-instrumented levels in each patient.
Mean CSA across all lumbar multifidus muscles was 4.29 cm(2) in the MISS group, 2.26 cm(2) for OSS (p = 0.08). At the instrumented levels, mean CSA was 4.21 cm(2) for MISS and 2.03 cm(2) for OSS (p = 0.12). At non-instrumented adjacent levels, mean CSA was 4.46 cm(2) in the MISS group, 2.87 cm(2) for OSS (p = 0.05).
Related posts: