Book contents
- Taking on TIVA
- Taking on TIVA
- Copyright page
- Contents
- Contributors
- Foreword
- Power to the People: the Rationale of a Practical Text
- Chapter 1 Why Bother?
- Chapter 2 You Say ‘PK’ and I Say ‘No Way!’; You Say ‘Keo’ and I Say ‘Time to Go!’
- Chapter 3 TCI and TIVA: What a Good Idea!
- Chapter 4 Milk of Amnesia
- Chapter 5 A Catwalk with a Difference
- Chapter 6 Let’s Get Started
- Chapter 7 Let’s Get Pumped!
- Chapter 8 ‘But I’m Used to MAC!’
- Chapter 9 Be Aware, Unaware and Confusion Everywhere
- Chapter 10 Do You Want Fries with That?
- Chapter 11 Intra- and Post-operative Analgesia for TIVA
- Chapter 12 Wakey Wakey!
- Chapter 13 Under Pressure
- Chapter 14 Ankle Biters
- Chapter 15 Old Timers
- Chapter 16 Big Can Be Beautiful!
- Chapter 17 A Bun in the Oven
- Chapter 18 Saving the Whales by Taking on TIVA
- Chapter 19 TIVA Drugs for Sedation
- Chapter 20 Skiing Off-Piste and Other Assorted Goodies
- Index
- References
Chapter 10 - Do You Want Fries with That?
The Role and Effects of Adjuvant Medications in TIVA
Published online by Cambridge University Press: 18 November 2019
Book contents
- Taking on TIVA
- Taking on TIVA
- Copyright page
- Contents
- Contributors
- Foreword
- Power to the People: the Rationale of a Practical Text
- Chapter 1 Why Bother?
- Chapter 2 You Say ‘PK’ and I Say ‘No Way!’; You Say ‘Keo’ and I Say ‘Time to Go!’
- Chapter 3 TCI and TIVA: What a Good Idea!
- Chapter 4 Milk of Amnesia
- Chapter 5 A Catwalk with a Difference
- Chapter 6 Let’s Get Started
- Chapter 7 Let’s Get Pumped!
- Chapter 8 ‘But I’m Used to MAC!’
- Chapter 9 Be Aware, Unaware and Confusion Everywhere
- Chapter 10 Do You Want Fries with That?
- Chapter 11 Intra- and Post-operative Analgesia for TIVA
- Chapter 12 Wakey Wakey!
- Chapter 13 Under Pressure
- Chapter 14 Ankle Biters
- Chapter 15 Old Timers
- Chapter 16 Big Can Be Beautiful!
- Chapter 17 A Bun in the Oven
- Chapter 18 Saving the Whales by Taking on TIVA
- Chapter 19 TIVA Drugs for Sedation
- Chapter 20 Skiing Off-Piste and Other Assorted Goodies
- Index
- References
Summary
Propofol is a potent anaesthetic agent and may be used as a sole agent for sedation. Although it reduces post-operative pain, probably via its anti-oxidant and anti-inflammatory properties, it is not an analgesic. Consequently, to produce anaesthesia with no response to noxious stimuli a very large dose is required.[1–3] Therefore it is important to use an analgesic agent (usually an opioid) to produce surgical anaesthesia and decrease propofol requirements.[3] In some ways, this differs from inhalational anaesthetic drugs, which tend to have analgesic as well as hypnotic properties. Apart from opioids, which are the most potent analgesic agents, there are many other drugs that can be added to propofol and opioid-based anaesthesia. Among these are dexmedetomidine, magnesium, ketamine and lidocaine. The advantages and logic of mixing these agents with TIVA are discussed in this chapter.
- Type
- Chapter
- Information
- Taking on TIVADebunking Myths and Dispelling Misunderstandings, pp. 73 - 79Publisher: Cambridge University PressPrint publication year: 2019
References
Irwin, M.G., Hui, T.W., Milne, S.E., Kenny, G.N.. Propofol effective concentration 50 and its relationship to bispectral index. Anaesthesia 2002; 57: 242–8.Google Scholar
Milne, S.E., Troy, A., Irwin, M.G., Kenny, G.N.. Relationship between bispectral index, auditory evoked potential index and effect-site EC50 for propofol at two clinical end-points. Br J Anaesth 2003; 90: 127–31.CrossRefGoogle ScholarPubMed
Scott, H.B., Choi, S.W., Wong, G.T., Irwin, M.G.. The effect of remifentanil on propofol requirements to achieve loss of response to command vs. loss of response to pain. Anaesthesia 2017; 72: 479–87.CrossRefGoogle ScholarPubMed
Ellis, T.A., 2nd, Narr, B.J., Bacon, D.R.. Developing a specialty: J.S. Lundy’s three major contributions to anesthesiology. J Clin Anesth 2004; 16: 226–9.CrossRefGoogle ScholarPubMed
Tonner, P.H.. Balanced anaesthesia today. Best Pract Res Clin Anaesthesiol 2005; 19: 475–84.Google Scholar
Sanders, R.D., Tononi, G., Laureys, S., Sleigh, J.W.. Unresponsiveness does not equal unconsciousness. Anesthesiology 2012; 116: 946–59.CrossRefGoogle ScholarPubMed
White, N.S., Alkire, M.T.. Impaired thalamocortical connectivity in humans during general-anesthetic-induced unconsciousness. Neuroimage 2003; 19: 402–11.CrossRefGoogle ScholarPubMed
Massimini, M., Ferrarelli, F., Huber, R., Esser, S.K., Singh, H., Tononi, G.. Breakdown of cortical effective connectivity during sleep. Science 2005; 309: 2228–32.Google Scholar
Alkire, M.T., Haier, R.J., Fallon, J.H.. Toward a unified theory of narcosis: brain imaging evidence for a thalamocortical switch as the neurophysiologic basis of anesthetic-induced unconsciousness. Conscious Cogn 2000; 9: 370–86.Google Scholar
Lee, U., Mashour, G.A., Kim, S., Noh, G.J., Choi, B.M.. Propofol induction reduces the capacity for neural information integration: implications for the mechanism of consciousness and general anesthesia. Conscious Cogn 2009; 18: 56–64.Google Scholar
Esser, S.K., Hill, S., Tononi, G.. Breakdown of effective connectivity during slow wave sleep: investigating the mechanism underlying a cortical gate using large-scale modeling. J Neurophysiol 2009; 102: 2096–111.CrossRefGoogle ScholarPubMed
Mhuircheartaigh, R.N., Rosenorn-Lanng, D., Wise, R., Jbabdi, S., Rogers, R., Tracey, I.. Cortical and subcortical connectivity changes during decreasing levels of consciousness in humans: a functional magnetic resonance imaging study using propofol. J Neurosci 2010; 30: 9095–102.Google Scholar
Coull, J.T., Buchel, C., Friston, K.J., Frith, C.D.. Noradrenergically mediated plasticity in a human attentional neuronal network. Neuroimage 1999; 10: 705–15.CrossRefGoogle Scholar
Nelson, L.E., Guo, T.Z., Lu, J., Saper, C.B., Franks, N.P., Maze, M.. The sedative component of anesthesia is mediated by GABA(A) receptors in an endogenous sleep pathway. Nat Neurosci 2002; 5: 979–84.Google Scholar
Zecharia, A.Y., Nelson, L.E., Gent, T.C., et al. The involvement of hypothalamic sleep pathways in general anesthesia: testing the hypothesis using the GABAA receptor beta3N265 M knock-in mouse. J Neurosci 2009; 29: 2177–87.Google Scholar
Mason, K.P., O’Mahony, E., Zurakowski, D., Libenson, M.H.. Effects of dexmedetomidine sedation on the EEG in children. Paediatr Anaesth 2009; 19: 1175–83.CrossRefGoogle ScholarPubMed
Mason, K.P., Lubisch, N., Robinson, F., Roskos, R., Epstein, M.A.. Intramuscular dexmedetomidine: an effective route of sedation preserves background activity for pediatric electroencephalograms. J Pediatr 2012; 161: 927–32.CrossRefGoogle ScholarPubMed
Huupponen, E., Maksimow, A., Lapinlampi, P., et al. Electroencephalogram spindle activity during dexmedetomidine sedation and physiological sleep. Acta Anaesthesiol Scand 2008; 52: 289–94.Google Scholar
Nelson, L.E., Lu, J., Guo, T., Saper, C.B., Franks, N.P., Maze, M.. The alpha2-adrenoceptor agonist dexmedetomidine converges on an endogenous sleep-promoting pathway to exert its sedative effects. Anesthesiology 2003; 98: 428–36.Google Scholar
Ramsay, M.A., Luterman, D.L.. Dexmedetomidine as a total intravenous anesthetic agent. Anesthesiology 2004; 101: 787–90.CrossRefGoogle ScholarPubMed
Ramsay, M.A., Saha, D., Hebeler, R.F.. Tracheal resection in the morbidly obese patient: the role of dexmedetomidine. J Clin Anesth 2006; 18: 452–4.Google Scholar
Hsu, Y.W., Cortinez, L.I., Robertson, K.M., et al. Dexmedetomidine pharmacodynamics: Part I: Crossover comparison of the respiratory effects of dexmedetomidine and remifentanil in healthy volunteers. Anesthesiology 2004; 101: 1066–76.Google Scholar
Ebert, T., Maze, M.. Dexmedetomidine: another arrow for the clinician’s quiver. Anesthesiology 2004; 101: 568–70.Google Scholar
Dutta, S., Karol, M.D., Cohen, T., Jones, R.M., Mant, T.. Effect of dexmedetomidine on propofol requirements in healthy subjects. J Pharm Sci 2001; 90: 172–81.3.0.CO;2-J>CrossRefGoogle ScholarPubMed
Kang, W.-S., Kim, S.-Y., Son, J.-C., et al. The effect of dexmedetomidine on the adjuvant propofol requirement and intraoperative hemodynamics during remifentanil-based anesthesia. Korean J Anesthesiol 2012; 62: 113–18.CrossRefGoogle ScholarPubMed
Kim, K.N., Lee, H.J., Kim, S.Y., Kim, J.Y.. Combined use of dexmedetomidine and propofol in monitored anesthesia care: a randomized controlled study. BMC Anesthesiol 2017; 17: 34.Google Scholar
Ebert, T.J., Hall, J.E., Barney, J.A., Uhrich, T.D., Colinco, M.D.. The effects of increasing plasma concentrations of dexmedetomidine in humans. Anesthesiology 2000; 93: 382–94.CrossRefGoogle ScholarPubMed
Bloor, B.C., Ward, D.S., Belleville, J.P., Maze, M.. Effects of intravenous dexmedetomidine in humans. II. Hemodynamic changes. Anesthesiology 1992; 77: 1134–42.Google Scholar
Li, A., Yuen, V., Goulay-Dufaÿ, S., et al. Pharmacokinetic and pharmacodynamic study of intranasal and intravenous dexmedetomidine. Br J Anaesth 2018.Google Scholar
Yu, C.K., Yuen, V.M., Wong, G.T., Irwin, M.G.. The effects of anaesthesia on the developing brain: a summary of the clinical evidence. F1000Res 2013; 2: 166.CrossRefGoogle Scholar
Gallego-Ligorit, L., Vives, M., Valles-Torres, J., Sanjuan-Villarreal, T.A., Pajares, A., Iglesias, M.. Use of dexmedetomidine in cardiothoracic and vascular anesthesia. J Cardiothorac Vasc Anesth 2017.Google Scholar
Kocoglu, H., Ozturk, H., Ozturk, H., Yilmaz, F., Gulcu, N.. Effect of dexmedetomidine on ischemia-reperfusion injury in rat kidney: a histopathologic study. Ren Fail 2009; 31: 70–4.Google Scholar
Taoda, M., Adachi, Y.U., Uchihashi, Y., Watanabe, K., Satoh, T., Vizi, E.S.. Effect of dexmedetomidine on the release of [3H]-noradrenaline from rat kidney cortex slices: characterization of alpha2-adrenoceptor. Neurochem Int 2001; 38: 317–22.Google Scholar
Rouch, A.J., Kudo, L.H., Hebert, C.. Dexmedetomidine inhibits osmotic water permeability in the rat cortical collecting duct. J Pharmacol Exp Ther 1997; 281: 62–9.Google ScholarPubMed
Si, Y., Bao, H., Han, L., et al. Dexmedetomidine protects against renal ischemia and reperfusion injury by inhibiting the JAK/STAT signaling activation. J Transl Med 2013; 11: 141.CrossRefGoogle ScholarPubMed
Gu, J., Sun, P., Zhao, H., et al. Dexmedetomidine provides renoprotection against ischemia-reperfusion injury in mice. Crit Care 2011; 15: R153.CrossRefGoogle ScholarPubMed
Shi, R., Tie, H.T.. Dexmedetomidine as a promising prevention strategy for cardiac surgery-associated acute kidney injury: a meta-analysis. Crit Care 2017; 21: 198.CrossRefGoogle ScholarPubMed
Liu, Y., Sheng, B., Wang, S., Lu, F., Zhen, J., Chen, W.. Dexmedetomidine prevents acute kidney injury after adult cardiac surgery: a meta-analysis of randomized controlled trials. BMC Anesthesiology 2018; 18: 7.CrossRefGoogle ScholarPubMed
Ji, F., Li, Z., Young, J.N., Yeranossian, A., Liu, H.. Post-bypass dexmedetomidine use and postoperative acute kidney injury in patients undergoing cardiac surgery with cardiopulmonary bypass. PLoS One 2013; 8: e77446.CrossRefGoogle ScholarPubMed
Wijeysundera, D.N., Naik, J.S., Beattie, W.S.. Alpha-2 adrenergic agonists to prevent perioperative cardiovascular complications: a meta-analysis. Am J Med 2003; 114: 742–52.Google Scholar
Ji, F., Li, Z., Nguyen, H., et al. Perioperative dexmedetomidine improves outcomes of cardiac surgery. Circulation 2013; 127: 1576–84.CrossRefGoogle ScholarPubMed
Sanders, R.D., Sun, P., Patel, S., Li, M., Maze, M., Ma, D.. Dexmedetomidine provides cortical neuroprotection: impact on anaesthetic-induced neuroapoptosis in the rat developing brain. Acta Anaesthesiol Scand 2010; 54: 710–16.Google Scholar
Sanders, R.D., Xu, J., Shu, Y., et al. Dexmedetomidine attenuates isoflurane-induced neurocognitive impairment in neonatal rats. Anesthesiology 2009; 110: 1077–85.Google Scholar
Perez-Zoghbi, J., Zhu, W., Grafe, M., Brambrink, A.. Dexmedetomidine-mediated neuroprotection against sevoflurane-induced neurotoxicity extends to several brain regions in neonatal rats. Br J Anaesth 2017; 119: 506–16.Google Scholar
Koo, E., Oshodi, T., Meschter, C., Ebrahimnejad, A., Dong, G.. Neurotoxic effects of dexmedetomidine in fetal cynomolgus monkey brains. J Toxicol Sci 2014; 39: 251–62.CrossRefGoogle ScholarPubMed
Duan, X., Li, Y., Zhou, C., Huang, L., Dong, Z.. Dexmedetomidine provides neuroprotection: impact on ketamine-induced neuroapoptosis in the developing rat brain. Acta Anaesthesiol Scand 2014; 58: 1121–6.Google Scholar
Jiang, L., Hu, M., Lu, Y., Cao, Y., Chang, Y., Dai, Z.. The protective effects of dexmedetomidine on ischemic brain injury: A meta-analysis. J Clin Anesth 2017; 40: 25–32.Google Scholar
Yuen, V.M., Hui, T.W., Irwin, M.G., Yuen, M.K.. A comparison of intranasal dexmedetomidine and oral midazolam for premedication in pediatric anesthesia: a double-blinded randomized controlled trial. Anesth Analg 2008; 106: 1715–21.Google Scholar
Yuen, V.M., Hui, T.W., Irwin, M.G., Yao, T.J., Wong, G.L., Yuen, M.K.. Optimal timing for the administration of intranasal dexmedetomidine for premedication in children. Anaesthesia 2010; 65: 922–9.Google Scholar
Yuen, V.M., Hui, T.W., Irwin, M.G., et al. A randomised comparison of two intranasal dexmedetomidine doses for premedication in children. Anaesthesia 2012; 67: 1210–16.CrossRefGoogle ScholarPubMed
Dube, L., Granry, J.C.. The therapeutic use of magnesium in anesthesiology, intensive care and emergency medicine: a review. Can J Anaesth 2003; 50: 732–46.Google Scholar
Fawcett, W.J., Haxby, E.J., Male, D.A.. Magnesium: physiology and pharmacology. Br J Anaesth 1999; 83: 302–20.CrossRefGoogle ScholarPubMed
James, M.F., Cronjé, L.. Pheochromocytoma crisis: the use of magnesium sulfate. Anesth Analg 2004; 99: 680–6.CrossRefGoogle ScholarPubMed
Albrecht, E., Kirkham, K., Liu, S., Brull, R.. Peri‐operative intravenous administration of magnesium sulphate and postoperative pain: a meta‐analysis. Anaesthesia 2013; 68: 79–90.Google Scholar
Schulz‐Stübner, S., Wettmann, G., Reyle‐Hahn, S., Rossaint, R.. Magnesium as part of balanced general anaesthesia with propofol, remifentanil and mivacurium: a double‐blind, randomized prospective study in 50 patients. Eur J Anaesthesiol 2001; 18: 723–9.Google Scholar
Telci, L., Esen, F., Akcora, D., Erden, T., Canbolat, A., Akpir, K.. Evaluation of effects of magnesium sulphate in reducing intraoperative anaesthetic requirements. Br J Anaesth 2002; 89: 594–8.Google Scholar
Jee, D., Lee, D., Yun, S., Lee, C.. Magnesium sulphate attenuates arterial pressure increase during laparoscopic cholecystectomy. Br J Anaesth 2009; 103: 484–9.CrossRefGoogle ScholarPubMed
James, M., Beer, R.E., Esser, J.D.. Intravenous magnesium sulfate inhibits catecholamine release associated with tracheal intubation. Anesth Analg 1989; 68: 772–6.Google Scholar
Swaminathan, R.. Magnesium metabolism and its disorders. Clin Biochem Rev 2003; 24: 47.Google Scholar
Jahnen-Dechent, W., Ketteler, M.. Magnesium basics. Clin Kidney J 2012; 5: i3–i14.CrossRefGoogle ScholarPubMed
Trimmel, H., Helbok, R., Staudinger, T., et al. S (+)–ketamine. Wien Klin Wochenschr 2018: 1–11.Google Scholar
Persson, J.. Wherefore ketamine? Curr Opin Anesthesiol 2010; 23: 455–60.CrossRefGoogle ScholarPubMed
Oye, I., Paulsen, O., Maurset, A.. Effects of ketamine on sensory perception: evidence for a role of N-methyl-D-aspartate receptors. J Pharmacol Exp Ther 1992; 260: 1209–13.Google Scholar
Visser, E., Schug, S.. The role of ketamine in pain management. Biomed Pharmacother 2006; 60: 341–8.Google ScholarPubMed
Stubhaug, A., Breivik, H., Eide, P., Kreunen, M., Foss, A.. Mapping of punctuate hyperalgesia around a surgical incision demonstrates that ketamine is a powerful suppressor of central sensitization to pain following surgery. Acta Anaesthesiol Scand 1997; 41: 1124–32.Google Scholar
Pogatzki-Zahn, E.M., Segelcke, D., Schug, S.A.. Postoperative pain: from mechanisms to treatment. Pain Rep 2017; 2: e588.CrossRefGoogle ScholarPubMed
Laskowski, K., Stirling, A., McKay, W.P., Lim, H.J.. A systematic review of intravenous ketamine for postoperative analgesia. Can J Anesth 2011; 58: 911.Google Scholar
Elia, N., Tramer, M.R.. Ketamine and postoperative pain: a quantitative systematic review of randomised trials. Pain 2005; 113: 61–70.Google Scholar
Joly, V., Richebe, P., Guignard, B., et al. Remifentanil-induced postoperative hyperalgesia and its prevention with small-dose ketamine. Anesthesiology 2005; 103: 147–55.CrossRefGoogle ScholarPubMed
Wu, L., Huang, X., Sun, L.. The efficacy of N-methyl-D-aspartate receptor antagonists on improving the postoperative pain intensity and satisfaction after remifentanil-based anesthesia in adults: a meta-analysis. J Clin Anesth 2015; 27: 311–24.CrossRefGoogle ScholarPubMed
Himmelseher, S., Durieux, M.E.. Ketamine for perioperative pain management. Anesthesiology 2005; 102: 211–20.Google Scholar
Dunn, L.K., Durieux, M.E.. Perioperative use of intravenous lidocaine. Anesthesiology 2017; 126: 729–37.Google Scholar