Résumé
BACKGROUND: Bispectral index (BIS) monitoring reduces the cases of intraoperative awareness. Several factors can alter BIS readings without affecting the depth of anesthesia. We conducted a study to assess the impact of beach chair position (sitting position) on BIS readings. METHODS: General anesthesia was administered to 30 patients undergoing arthroscopic shoulder surgery. Patients were kept in neutral position (supine) for 10 minutes and BIS readings, mean arterial blood pressure, heart rate, end-tidal carbon dioxide, and end-tidal sevoflurane were recorded. Patients were then shifted to beach chair position. After 15 minutes, data were recorded. RESULTS: A significant decrease in BIS values (P < 0.01) associated with a position change from neutral position to beach chair position was evident. CONCLUSIONS: BIS values are significantly decreased in the beach chair position compared with the neutral position and might affect interpretation of the depth of anesthesia.
Sujets)
Humains , Anesthésie , Anesthésie générale , Pression artérielle , Dioxyde de carbone , Rythme cardiaque , Conscience peropératoire , Lecture , ÉpauleRésumé
A 6-year-old male patient who was suffering from a cold and a transient ischemic attack was scheduled to undergo encephalo-duro-arterio-synangiosis for treating his moyamoya disease. Acute brain edema occurred just after opening the dura mater. Head elevation, reduction of the head rotation and hyperventilation were done. The inhalational agents were discontinued and total intravenous anesthesia was started. The swelling was reduced after intravenously infusing mannitol. An abrupt return from hypocapnia to normocapnea during the induction of general anesthesia was thought to be the cause of the acute brain swelling. In conclusion, correction of hypocapnea needs to be performed gradually during the induction of anesthesia and when performing an operation for treating a patient with moyamoya disease.
Sujets)
Enfant , Humains , Mâle , Anesthésie , Anesthésie générale , Anesthésie intraveineuse , Encéphale , Oedème cérébral , Revascularisation cérébrale , Basse température , Dure-mère , Tête , Hyperventilation , Hypocapnie , Accident ischémique transitoire , Mannitol , Maladie de Moya-Moya , Stress psychologiqueRésumé
Seventy-one years old, ASA physical status III, male patient underwent laparoscopic cholecystectomy due to acute cholecystitis with gall bladder (GB stone). He had undergone right pneumonectomy nine years ago. Moderate obstructive and restrictive pattern was found on PFT and hypokinesia of apical anterior and septum segments was seen on echocardiography. Due to patient's refusal of receiving general anesthesia, we decided to perform regional anesthesia. Epidural catheter was inserted at 10th thoracic intervertebral space and segmental spinal anesthesia was performed at L2-L3 intervertebral space with 5 mg of hyperbaric bupivacaine 0.5% and 20 ug of fentanyl. A segmental sensory block, extending from T3 through L2 dermatomes, was obtained. Surgery was performed smoothly and uneventfully. Patient discharged from hospital at 3 days after surgery.