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Parenteral Anesthetics: Overview01:24

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Intravenous anesthetics are drugs administered parenterally to induce anesthesia or sedation. Propofol is a widely used agent formulated as a 1% emulsion in soybean oil, glycerol, and egg phosphatide. It induces rapid anesthesia primarily due to its rapid distribution from the bloodstream to target tissues and is metabolized in the liver. However, it can cause significant pain on injection and hypertriglyceridemia. Fospropofol, a water-based prodrug of propofol, lacks these adverse effects.
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Anesthesia is a medical procedure that uses drugs for CNS suppression to enable painless surgeries and procedures. The selection of anesthetics is influenced by their pharmacokinetic properties, side effects, and patient characteristics. Various types of anesthesia include general, local, regional, spinal, and inhalational.
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Various sedation levels offer significant advantages in facilitating procedural interventions for patients undergoing medical or invasive surgical procedures. These levels span from anxiolysis to general anesthesia, providing a spectrum of sedative effects to cater to specific patient needs. Anxiolysis reduces anxiety and is achieved through minimal sedation, enabling patients to remain awake and responsive while feeling more at ease during the procedure. This level can benefit minor...
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Inhalation anesthetics are drugs that induce general anesthesia upon inhalation. They work by increasing the sensitivity of GABAA receptors or inhibiting NMDA receptors, leading to a decrease in central nervous system activity. The depth of anesthesia can be rapidly adjusted by changing the concentration of the inhaled gas. Some common examples of inhalational anesthetics include volatile liquids like isoflurane, desflurane, sevoflurane and gases like xenon and nitrous oxide. Isoflurane, a...
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The potency and duration of action of local anesthetics (LAs) are determined by their pharmacokinetics. Pharmacokinetics describes how LAs are absorbed, distributed, metabolized, and eliminated from the body. When administered to the vascular tissues, LAs are quickly absorbed and enter the systemic circulation, reducing their localized effects. Adding vasoconstrictors such as epinephrine to LAs reduces their absorption into the systemic circulation, making them clinically effective. The...
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Does a hypnosis session reduce the required propofol dose during closed-loop anaesthesia induction?: A randomised

Aurélien Bataille1, Avit Guirimand, Barbara Szekely

  • 1From the Department of Anaesthesia, Burn and Critical Care, University Hospitals Saint Louis Lariboisière (AB), University Paris Diderot (AB), Department of Anaesthesia, Foch Hospital, Paris (AG, BS, MM-C, VD, NL, TC, MF, MLG) and University Versailles Saint-Quentin en Yvelines, Versailles, France (AG, BS, MM-C, VD, NL, TC, MF, MLG).

European Journal of Anaesthesiology
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Summary

Hypnosis did not significantly alter propofol consumption for anaesthetic induction in female patients undergoing gynaecological surgery. This study found no difference in propofol dosage between hypnosis and routine care groups.

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Area of Science:

  • Anesthesiology
  • Psychology
  • Medical Technology

Background:

  • Hypnosis is recognized for its positive impact on managing peri-operative anxiety and pain.
  • Automated propofol administration guided by the bispectral index (BIS) offers a controlled approach to anaesthetic induction.

Purpose of the Study:

  • To evaluate the effect of a formal deep hypnosis session on propofol consumption during anaesthetic induction.
  • To assess hypnosis's influence when automated propofol delivery is guided by BIS in a closed-loop system.

Main Methods:

  • A randomized controlled trial involving female adult patients undergoing outpatient gynaecological surgery.
  • Patients were assigned to either a deep hypnosis session or routine care before surgery.
  • Anaesthetic induction utilized automated propofol administration, without opioids, guided by BIS in a closed loop.

Main Results:

  • Analysis included 31 patients in the hypnosis group and 35 in the control group.
  • No statistically significant difference was observed in the mean propofol dose required for anaesthetic induction between the groups (2.06 mg/kg vs. 1.79 mg/kg).
  • The primary endpoint, defined as achieving a BIS < 60 for at least 30 seconds, showed no difference in propofol requirements.

Conclusions:

  • A formal deep hypnosis session did not alter the required propofol dose for anaesthetic induction when using automated, BIS-guided propofol administration.
  • The study failed to demonstrate a significant impact of hypnosis on propofol consumption in this specific anaesthetic setting.
  • Further research may explore other hypnotic techniques or patient populations to ascertain potential benefits.