Stress reducing strategies are useful in patients undergoing surgery. Hypnosis is also known to alleviate acute and chronic pain. We therefore compared the effectiveness of these two psychological approaches for reducing perioperative discomfort during conscious sedation for plastic surgery. Sixty patients scheduled for elective plastic surgery under local anesthesia and intravenous sedation (midazolam and alfentanil upon request) were included in the study after providing informed consent.
Some patients are anxious about routine dental treatment; others, who may be able to cope with uncomplicated treatment, are worried by more unpleasant procedures such as minor oral surgery. Management approaches to anxiety vary according to its severity, the age of the patient, the degree of cooperation and the patient's medical history. Psychological approaches have been widely used and range from informal and common-sense methods to formal relaxation training and hypnosis. These techniques are safe, free from adverse effects and give the patient a sense of control.
Since its introduction in clinical use more than ten years ago, propofol is well appreciated for sedation and supplemental hypnosis in anaesthesia. However the substance is approved only for anaesthesia in children elder than three years. As can be substantiated by many data reported in literature, there are no pharmacokinetic or pharmacodynamic reasons whatsoever to withhold propofol from the younger children; this applies both to the use as a narcotic supplement and as a short term hypnotic for diagnostic and therapeutic interventions.
We investigated the effect of adenosine on hypnosis induced by thiopentone, propofol and midazolam in mice. The onset and duration of hypnosis were determined by the loss of righting reflex. Adenosine and 2-chloroadenosine caused a significant shortening of onset of sleep-time and prolongation of duration of sleep-time in all groups (p < 0.05). Dipyridamole administration before combined intravenous anaesthetic-adenosine or intravenous anaesthetic-2-chloroadenosine administration produced similar effects to adenosine (p < 0.05).
OBJECTIVE: To assess transplacental passage of propofol by measuring the levels in maternal and foetal plasma, and the possible relationship between the latter and the neonatal effects when propofol is used as an induction agent in obstetric anaesthesia for performing a caesarean section to terminate pregnancy. METHODS: Intravenous propofol was administered as an anaesthesia-inducing agent at doses of 2 mg/kg in 10 healthy women (ASA I-II). The propofol concentrations were measured by high-performance liquid chromatography (HPLC).
BACKGROUND: Clinical studies suggest that midazolam and propofol interact synergistically to induce hypnosis, but these drugs do not interact synergistically to prevent movement in response to noxious stimuli. The mechanisms underlying these interactions are not certain but may occur at the level of the gamma-aminobutyric acid A (GABA(A)) receptor. METHODS: The authors evaluated the interactions between propofol and midazolam in modulating GABA(A) receptor activity in embryonic hippocampal neurons.
BACKGROUND: We studied the effect of variable doses of ketamine on the endpoints of hypnosis, e.g., unresponsiveness to verbal commands (UVC), loss of eyelash reflex (LER), and inhibition of body movement response with or without sneezing to nasal membrane stimulation (INBMR), and processed EEG variables, e.g., bispectral index (BIS), 95% spectral edge frequency (SEF) and median frequency (MF) during propofol infusion.
One may have to use a monitor of cortical suppression to maintain the optimal level of sedation and hypnosis. The bispectral index (BIS), a processed EEG parameter, which incorporates coupling along with the frequency and amplitude of EEG waveforms, has been proposed as a measure of the pharmacodynamic anaesthetic effect on the central nervous system. The numerical value of BIS varies from 0 to 100 (no cerebral activity to fully awake patient).
We studied nociception-associated arousal following laryngoscopy and intubation in patients scheduled for elective open heart surgery, using EEG power spectra and hemodynamics. Either fentanyl (7 micrograms/kg; n = 30) or sufentanil (1 microgram/kg; n = 30) were given in a randomized fashion to induce anesthesia in heavily premedicated patients, followed by pancuronium bromide (100 micrograms/kg).
The Journal of Pharmacology and Experimental Therapeutics
The influence of hypovolemia (removal of 30% of the blood volume) on the pharmacokinetics and pharmacodynamics of etomidate was investigated in the rat. Chronically instrumented animals were randomly allocated to either a control (n = 9) or a hypovolemia (n = 9) group, and etomidate was infused (50 mg/kg/h) until isoelectric periods of 5 s or longer were observed in the electroencephalogram. The changes observed in the electroencephalogram were quantified using aperiodic analysis in the 2.5- to 7.5-Hz frequency band and used as a surrogate measure of hypnosis.