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Related Concept Videos

General Anesthesia: Overview01:24

General Anesthesia: Overview

274
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.
General anesthesia induces unconsciousness in the whole body, while the others target specific areas or sensations. It is administered to minimize adverse effects, maintain...
274
Parenteral Anesthetics: Overview01:24

Parenteral Anesthetics: Overview

188
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.
188
Stages of General Anesthesia01:22

Stages of General Anesthesia

632
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...
632
Local Anesthetics: Clinical Application as Spinal Anesthesia01:11

Local Anesthetics: Clinical Application as Spinal Anesthesia

743
Spinal anesthetics are given during lower abdomen and limb surgeries to block sensory and motor neurons. They are administered in the mid to low lumbar regions, primarily acting on the cauda equina's nerve roots. The blockade level depends on the local anesthetic (LA) concentration. Usually, low LA concentrations are sufficient to block sensory fibers, while only high LA concentrations block motor fibers. Other factors like injection volume and speed, the patient's posture, and the drug...
743
Local Anesthetics: Clinical Application as Epidural Anesthesia01:29

Local Anesthetics: Clinical Application as Epidural Anesthesia

489
Epidural anesthetics are administered in the fat-filled epidural space, the outermost part of the spinal canal. This technique is commonly employed for pain management and anesthesia during lower abdomen and pelvis surgeries or labor and delivery.
Since epidural anesthetics can be infused through an epidural catheter, all types of drugs, including short-acting ones, can be administered. Chloroprocaine and lidocaine are examples of short and long-duration anesthetics, respectively. Bupivacaine...
489
Local Anesthetics: Adverse Effects01:12

Local Anesthetics: Adverse Effects

485
While local anesthetics are generally safe and well-tolerated, they can occasionally cause adverse effects that vary in severity. Local anesthetics can induce toxicity at two distinct levels. They can either produce local effects through direct contact with the neural elements or be absorbed into the bloodstream from the injection site, leading to systemic effects.
Once absorbed into the systemic circulation, local anesthetics can affect the organs that depend on the functioning of sodium...
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Intra-Operative Neural Monitoring of Thyroid Surgery in a Porcine Model
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Fosaprepitant Does Not Interfere With Commonly Used Intraoperative Neuromonitoring Modalities Under General

Jaime R López1, Richard A Jaffe2, Isabella R López3

  • 1Department of Neurology.

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|August 25, 2022
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Fosaprepitant, an NK-1 receptor antagonist, does not interfere with intraoperative neurophysiologic monitoring like EEG, SSEP, and TcMEP during propofol anesthesia. This finding supports its safe use in neurosurgical patients requiring such monitoring.

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Area of Science:

  • Anesthesiology
  • Neuroscience
  • Pharmacology

Background:

  • Fosaprepitant (Emend®) is an NK-1 receptor antagonist effective for preventing postoperative nausea and vomiting (PONV).
  • NK-1 receptors are prevalent in the central and peripheral nervous systems.
  • Its use in neurosurgical patients necessitates understanding potential impacts on intraoperative neurophysiologic monitoring.

Purpose of the Study:

  • To evaluate the effect of fosaprepitant on commonly used intraoperative neurophysiologic monitoring modalities.
  • To determine if fosaprepitant interferes with electroencephalogram (EEG), transcranial motor evoked potentials (TcMEP), and somatosensory evoked potentials (SSEP).

Main Methods:

  • Eleven patients undergoing propofol-based general anesthesia for interventional neuroradiology received 150 mg fosaprepitant intravenously.
  • Baseline EEG, TcMEP, and SSEP recordings were obtained prior to fosaprepitant administration.
  • Neuromonitoring data were recorded at 30, 60, and 90 minutes post-administration and compared to baseline.

Main Results:

  • Fosaprepitant showed no significant impact on SSEP or TcMEP amplitudes, latencies, or TcMEP morphology.
  • No significant changes were observed in EEG voltage, frequency, or symmetry.
  • The drug did not markedly alter the monitored neurophysiologic parameters.

Conclusions:

  • Fosaprepitant does not appear to significantly interfere with SSEP, TcMEP, or EEG monitoring during propofol-based general anesthesia.
  • This suggests fosaprepitant can be safely administered to patients undergoing neurosurgical procedures requiring these neurophysiologic monitoring techniques.
  • Further research may explore its effects in different anesthetic contexts.