Change of the temperature balance of the brain in various types of general anesthesia

A.V. Butrov, K.A. Salimova, B.J. Torosyan, G.R. Makhmutova, P.P. Davydov

Peoplesʼ Friendship University of Russia, Moscow

For correspondence: Salimova Kamila Azatovna — resident Peoplesʼ Friendship University of Russia, Moscow, Moscow; e-mail: telluriya@mail.ru

For citation: Butrov AV, Salimova KA, Torosyan BJ, Makhmutova GR, Davydov PP. Change of the temperature balance of the brain in various types of general anesthesia. Alexander Saltanov Intensive Care Herald. 2018;3:72–6.

DOI: 10.21320/1818-474X-2018-3-72-76


Under the influence of general anesthesia various functions of the body can change depending on the main and concomitant diseases, the type and volume of the surgical intervention. General anesthesia is traditionally associated with the loss of normal thermoregulatory mechanisms. The intracranial temperature of 32 patients were measured in this study. These patients were divided into 3 groups depending on the type of general anesthesia. The brain temperature of all patients were measured by recording the strength of the electromagnetic radiation from deep brain tissues and also, the axillary and tympanic temperatures were measured. According to the thermometry results of the brain, it was evident that when using Propofol, the temperature of the brain during anesthesia decreased by 1.21 ± 0.19 °C. During the maintenance of inhalational anesthesia the temperature of the brain decreased by 0.69 ± 0.15 °C. There was a decrease of brain temperature in all patients from all 3 groups and the temperature gradient of the brain/axillary region increased. Therefore, we concluded that the decrease in brain temperature occurs not only because of thermoregulatory center temperature decrease, but also because of reduced brain metabolism and/or cerebral blood flow. Propofol in a greater degree causes brain temperature decrease which may be important for the prevention or treatment of conditions that are accompanied by an increase in brain temperature or perfusion-metabolic balance disturbances (for example in neuroanesthesiology and in operations on the main cerebral vessels).

Keywords: brain temperature, temperature balance, microwave thermometry, propofol, sevoflurane, general anesthesia

Received: 02.04.2018


References

  1. Choi J.W., Kim D.K., Kim J.K., et al. A retrospective analysis on the relationship between intraoperative hypothermia and postoperative ileus after laparoscopic colorectal surgery.PLoS One. 2018; 13(1): e0190711.
  2. Rogers A.D., Saggaf M., Ziolkowski N. A quality improvement project incorporating preoperative warming to prevent perioperative hypothermia in major burns. Burns. 2018; 44(5): 1279–1286.
  3. Cohen B., Meilik B., Weiss-Meilik A., et al. Intraoperative factors associated with postoperative complications in body contouring surgery. J. Surg. Res. 2018; 221: 24–29.
  4. Trescher K., Gleiss A., Boxleitner M., et al. Short-term clinical outcomes for intermittent cold versus intermittent warm blood cardioplegia in 2200 adult cardiac surgery patients. J. Cardiovasc. Surg (Torino). 2017; 58(1): 105–112.
  5. Young C.C., Sladen R.N. Temperature monitoring. Int. Anestesiol. Clin. 1996; 34(3): 149–174.
  6. Маршак М.Е. Термоэлектрические методы исследования регионарного кровообращения в острых и хронических опытах. Современные методы исследования функций сердечно-сосудистой системы. М., 1962: 179–188. [Marshak M.E. Termoelektricheskiye metodi issledovaniya regionarnogo krovoobrasheniya v ostrich I khronicheskikh opitakh. Sovremennie metodi issledovaniya funkciy cerdechno-sosudistoy sistemi. (Thermoelectric methods of investigation regional blood circulation in acute and chronic experiments. Modern methods of studying the functions of the cardiovascular system.) Moscow, 1962: 179–188. (In Russ)]
  7. Гречин В.Б. Применение терморезисторов в стереотаксической нейрохирургии. Вопросы нейрохирургии. 1972; 1: 57–60. [Grechin V.B. Primeneniye termorezistrov v stereotoksicheskoy neyrokhirurgii. Voprosi neyrokhirurgii. 1972; 1: 57–60. (In Russ)]
  8. Mayers P.O., Sadowski M.I., Barrett A.H. Microwave thermography. Principles, methods and clinical applications. J. of Microwave Power. 1979; 14(2): 105–115.
  9. В.А. Березовский. Измерение температуры различных участков коры больших полушарий головного мозга собаки как показатель функционального состояния нервной ткани. Автореф. дис. … канд. мед. наук. Киев, 1962. [V.A. Berezovskiy. Izmereniye temperaturi razlichnikh uchastkov kori bolshikh polushariy golovnogo mozga sobaki kak pokazatel funkcionalnogo sostoyaniya nervnoy tkani. (Measurement of the temperature of various parts of cortex of cerebral hemispheres of the dogʼs brain as an indicator of the functional state of the nerve tissue.) [dissertation] Kiev, 1962. (In Russ)]
  10. Koutsoupidou M., Groumpas E., Karanasiou I.S., et al. The effect of using a dielectric matching medium in focused microwave radiometry: an anatomically detailed head model study. Med. Biol. Eng. Comput. 2018; 56(5): 809–816.
  11. Stauffer P.R., Snow B.W., Rodrigues D.B., et al. Non-Invasive Measurement of Brain Temperature with Microwave Radiometry: Demonstration in a Head Phantom and Clinical Case. Neuroradiol. J. 2014; 27(1): 3–12.
  12. Цейтлин А.М., Лубнин А.Ю. Применение пропофола в нейроанестезиологии [электронный документ]. URL: http://www.neuroanesth.narod.ru/j/199/4.htm. (Дата обращения: 18.08.2018.) [Ceytlin A.M., Lubnin A.U. Primeneniye propofola v neyroanesteziologii. (The use of propofol in neuroanesthesiology.) [Internet] URL: http://www.neuroanesth.narod.ru/j/199/4.htm. (In Russ)]

Morphine Epidural Analgesia in Spine Deformity Surgery

K.Yu. Ukolov, V.L. Aizenberg, N.I. Arzhakova

FGBU «CITO named after N.N. Priorov» of Ministry of Health of Russian Federation, Moscow

For correspondence: Ukolov Konstantin Iurievich — Candidate of Science, Central Institute of Traumatology and Orthopedics named after N.N. Priorov of the Russian Ministry of Health, Moscow; e-mail: ukolov_doc@mail.ru

For citation: Ukolov KYu, Aizenberg VL, Arzhakova NI. Morphine Epidural Analgesia in Spine Deformity Surgery. Intensive Care Herald. 2017;1:32–36.


Introduced comparative analysis of two methods of anesthesia during surgery dorsal correction of the spine deformity in 123 patients. The quality of analgesia was assessed using hemodynamic parameters, biochemistry markers of stress, blood loss value and frequency of early postoperative complications. Total 42 patient underwent surgery under general anesthesia with mechanical ventilation, using sevoflurane and fentanyl. In 81 patients used general anesthesia, combined with epidural analgesia using 15 morphine (100 mcg/kg in 10–12 ml of saline). Use of morphine epidural analgesia in addition to general anesthesia increase quality of nociception defence, significantly decrease consumption of narcotic analgesics, anesthetics and relaxants, decrease blood loss by 10 % and frequency of complications by 20 %.

Keywords: spine deformity, scoliosis surgery, dorsal correction, general anesthesia, morphine general anesthesia

Received: 24.22.2017


References

  1. Айзенберг В.Л., Уколов К.Ю., Диордиев А.В. Методы анестезии при оперативном лечении сколиоза у детей. Анестезиология и реаниматология. 2010; 1: 57–60. [Aizenberg V.L., Ukolov K.Yu., Diordiev A.V. Metody anestezii pri operativnom lechenii skolioza u detei. Anest. i reanim. 2010; 1: 57–60. (In Russ)]
  2. Айзенберг В.Л., Ульрих Г.Э., Цыпин Л.Е., Заболотский Д.В. Регионарная анестезия в педиатрии: Монография. СПб.: Синтез Бук, 2011. [Aizenberg V.L., Ulrih G.E., Tsypin L.E, Zabolotskii L.V. Regionarnaya anesteziya v pediatrii: Monograph. Saint-Petersburg: Sintez Book, (In Russ)]
  3. Анестезия в педиатрии: Пер. с англ. Под ред. Дж.А. Грегори. М.: Медицина, 2003: 797–832. [Anesteziya v pediatrii: Transl. from En. Ed.: J.A. Gregory. Moscow: Medicine, 2003. (In Russ)]
  4. Лебедева М.Н. Анестезиологическое обеспечение одномоментной двухэтапной хирургической коррекции сколиоза: Автореф. дис. … канд. мед. наук. Новосибирск, 2001. [Lebedeva M.N. Anesteziologicheskoe obespechenie odnomomentnoi dvuhetapnoi hirurgicheskoi korrektsii skolioza: Avtoref. dis. … kand. med. nauk. Novosibirsk, 2001. (In Russ)]
  5. Behar M., Magora F., Davidson S.T. Epidural morphine in treatment of pain. Lancet. 1979; 1(8): 527–528. doi: 10.1016/S0140-6736(79)90947-4.
  6. Ravish M., Muldowney B., Becker A. et al. Pain management in patients with adolescent idiopathic scoliosis undergoing posterior spinal fusion: combined intrathecal morphineand continuous epidural versus PCA. J. Pediatr. Orthop. 2012; 32: 799–804. doi: 10.1097/BPO.0b013e3182694f00.
  7. Tobias J.D. A review of intrathecal and epidural analgesia after spinal surgery in children. Anesth. Analg. 2004; 98(4): 956–965 doi: 10.1213/01.ANE.0000107938.80562.75.
  8. Wiggins G.C., Shaffrey C.I., Abel M.F., Menezes A.N. Pediatric spinal deformations. Neurosurg. Focus. 2003; 15: 14–15. doi: 10.3171/foc.2003.14.1.4.

Critical Incidents and Safety of Xenon Anesthesia in Abdominal Surgery

A.Yu. Kulikov1, O.V. Kuleshov1, 2, K.M. Lebedinskiy2

1 Saint-Petersburg Multiprofile Сenter, Saint-Petersburg

2 Ilya I. Mechinkov North-Western State Medical University, Saint-Petersburg

For correspondence: Kulikov Alexey Yurievich — anaesthetist, Saint-Petersburg,; e-mail: alexeykulikov1987@yandex.ru

For citation: Kulikov AYu, Kuleshov OV, Lebedinskiy KM. Critical Incidents and Safety of Xenon Anesthesia in Abdominal Surgery. Intensive Care Herald. 2016;3:22–26.


Xenon is the most promising anesthetic of the XXI century, in many ways close to the ideal. The aim of this study was to investigate the safety of the balanced general and combined xenon anesthesia by analysis of intraoperative critical incidents (CI). A retrospective data analysis of anesthesia with extended hemodynamic monitoring in 80 patients, underwent elective abdominal surgery, was done. Depending on the anesthesia’s type and basic inhalation agent (xenon or sevoflurane), patients were divided into 3 groups. The structure and frequency of intraoperative CI was observed. Under balanced general and combined xenon anesthesia main hemodynamic incidents were decrease in cardiac output and bradycardia, while in the sevoflurane group decrease of cardiac output and hypotension prevailed. The frequency of other CI did not differ significantly. Xenon anesthesia is safe and effective in patients undergoing abdominal surgery.

Keywords: xenon, sevoflurane, general anesthesia, critical incident, safety

Received: 09.08.2016


References

  1. Aitkenhead A.R., Smith G. (eds) Textbook of anaesthesia (3rd). N-Y: Churchill Livingstone/Elsevier, 1996.
  2. Кровообращение и анестезия. Под ред. К.М.Лебединского.СПб.: Человек, 2012: 567. [Lebedinskiy K.M. (ed) Krovoobrashchenie i anesteziya. (Anesthesia and blood circulation.) Saint-Petersburg: Chelovek Publ.; 2012: (In Russ)]
  3. Щеголев А.В., Цыганков К.А., Лахин Р.Е. и др. Анализ частоты критических инцидентов при плановых оперативных вмешательствах на органах брюшной полости. Вестник Российской военно-медицинской академии. 2016; 1(53): 29–32. [Shchegolev A.V., Tsygankov K.A., LakhinR.E. et al. Critical incidents frequency analysis in elective abdominal surgery. Vestnik Rossiiskoi Voenno-Meditsinskoi akademii. 2016; 1(53): 29–32. (In Russ)]
  4. Руденко М.И. Сочетанная анестезия в абдоминальной хирургии у больных пожилого возраста. Вестник интенсивной терапии. 2010; 2: 27–32. [Rudenko M.I. Combined anesthesia in elderly patients undergoing abdominal surgery. Vestnik intensivnoi terapii. 2010; 2: 27–32. (InRuss)]
  5. Al Tmimi L., Van Hemelrijck J., Van de Velde M. et al. Xenon anaesthesia for patients undergoing off-pump coronary artery bypass graft surgery: a prospective randomized controlled pilot trial. Br. J. Anaesth. 2015; 4(115): 550–559.
  6. Langesaeter E., Rosseland L.A., Stubhaug A. Continuous invasive blood pressure and cardiac output monitoring during cesarean delivery: a randomized, double-blind comparison of low-dose versus high-dose spinal anesthesia with intravenous phenylephrine or placebo infusion. Anesthesiology. 2008; 109(5): 856–863.
  7. Рылова А.В., Лубнин А.Ю. Ксеноновая анестезия по закрытому контуру: печальный и радостный опыт. Обзор аппаратуры. Вестник интенсивной терапии. 2008; 4: 17–22. [Rylova A.V., Lubnin A.Y. Xenon anesthesia on closed cicuit: a sad and pleasurable experience. Vestnik intensivnoi terapii. 2008; 4: 17–22. (In Russ)]
  8. Nicholson G., Hall G.M., Burrin J.M. Peri‐operative steroid supplementation. Anaesthesia. 1998; 53: 1091–109

Level of consciousness evaluation during anesthesia in pediatric patients (review)

L.E. Tsypin, A.A. Ovchinnikova

GBOY VPO “RNIMU named after N.I. Pirogov” Ministry of Health of Russia, Moscow

For citation: Tsypin LE, Ovchinnikova AA. Level of consciousness evaluation during anesthesia in pediatric patients (review). Intensive Care Herald. 2016;1:12–16.


The review is based on the data from PudMed, Scopus, Medline, peer-reviewed medical journals, guidelines and clinical manuals. Up-to-date and previous clinical practice, technology, equipment and methods of assessing the level of consciousness during anesthesia in children are discussed. Particular attention is paid to the reliability of the data and the age limits of discussed techniques.

Keywords: general anesthesia, entropy, BIS-index, level of consciousness, pediatric patients.


References

  1. M.M, Todd. EEGs, EEG processing, and the bispectral index. 1998: Anesthesiology.
  2. Andradel J., Deeprose C., Barker I. Awareness and memory function during paediatricanaesthesia.- б.м.: British Journal of Anaesthesia, 2008.
  3. Ивахненко Ю.И., Электроэнцефалографический мониторинг во время анестезии галогенсодержащими ингаляционными анестетиками у детей.- б.м.: Автореф. дисс. канд. мед. наук, 2011.
  4. Бунятян A.A., Мизиков В.М. Анестезиология: национальное руководство.- б.м.: ГЭОТАР-Медиа, 2011.
  5. Морган Дж. Э., Мэгид С.М., Марри М. Дж. Клиническая анестезиология.- Москва: БИНОМ, 2011.
  6. Иванов Л.Б., Прикладная компьютерная электроэнцефалография.- Москва: ПБОЮЛ Т.М. Андреева, 2004.
  7. Ефуни С.Н., Электроэнцефалография в клинической анестезиологии.- Москва: Медгиз, 1961.
  8. Sigl J.C., Chamoun N.G. An introduction to bispectral analysis for the electroencephalogram. Journal of Clinical Monitoring. 1994.
  9. Лекманов А.У., Карпович C.B., Михайлова Е.В., Суворов С.Г. Оценка гипнотического компонента на основании BIS-мониторинга при сбалансированной анестезии у детей. Анестезиология и реаниматология.- 2007,- №1.
  10. Лекманов А.У., Суворов С.Г., Гегуева E.H. Применение BIS-мониторинга у детей при интенсивной терапии тяжелой черепно-мозговой травмы. Анестезиология и реаниматология.- 2011,- №1.
  11. Choudhry D.K., Brenn B.R. Bispectral index monitoring: a comparison between normal children and children with quadriplegic cerebral palsy. Anesth. Analg. 2002.
  12. Bannister C.F., Brosius K.K., Sigl J.C., Meyer B.J., Sebel P.S. The effect of bispectral index monitoring on anesthetic use and recovery in children anesthetized with sevoflurane in nitrous oxide. Anesth. Analg. 2001.
  13. Flaishon R., Windsor A., Sigl J., Sebel P.S. Recovery of consciousness after thiopental or propofol: bispectral index and the isolated forearm technique. Anesthesiology. 1997 г.
  14. Лазарев B.B., Субботин B.B. Биспектральный индекс ЭЭГ как показатель электрической активности центральной нервной системы при анестезиологическом обеспечении и интенсивной терапии у детей. Анестезиология и реаниматология.- 2009,- №1.
  15. Толасов К.Р. Применение современных ингаляционных анестетиков при «малых» оперативных вмешательствах у детей.- Москва: Автореф. дисс. канд. мед. наук, 2009.
  16. Sebel P.S., Lang E., Rampil I.J. et al. A multicenter study of bispectral electroencephalogram analysis for monitoring anesthetic effect. Anesth. Analg. 1997.
  17. Degoute C., Macabeo C., Dubreuil C. et al. EEG bispectral index and hypnotic component of anaesthesia induced by sevof-lurane: comparison between children and adults. British Journal of Anaesthesia. 2001.- 1.
  18. Jinks S.L., Martin J.T., Carstens E., Jung S.-W., Antognini J.F. eri-MAC depression of a nociceptive withdrawal reflex is accompanied by reduced dorsal horn activity with halothane but not isoflurane. Anesthesiology. 2003.
  19. Зарайская С.М., Таулуев А.М. О применении метода вызванных потенциалов в клинике неврологических заболеваний. МРЖ.- 1996.- №5.
  20. Гнездицкий В.В. Вызванные потенциалы мозга в клинической практике.- Москва: б.н., 2003.
  21. Lloyd T.A., Cole P.V., Prior P.F. uantitative EEG and brainstem auditory evoked potentials: comparison of isoflurane with halothane using the cerebral function analysing monitor. British Journal of Anaesthesia. 1990.
  22. McCann M.E., Bacsik J., Davidson A., Auble S., Sullivan L., Laussen P. he correlation of bispectral index with end-tidal sevoflurane concentration and haemodynamic parameters in preschoolers. Pediatric Anesthesia. 2002.
  23. Kertai M.D., Palanca B.J., Pal N. et al. Bispectral index monitoring, duration of bispectral index below 45, patient risk factors, and intermediate-term mortality after noncardiac surgery in the B-Unaware Trial. Anesthesiology. 2011.
  24. Мощев Д.А., Сазонова О.Б., Огурцова A.A., и др. Влияние севофлурана на спонтанную биоэлектрическую активность мозга у нейрохирургических больных. Анестезиология и реаниматология.- 2008.
  25. Kain Z.N., Caldwell-Andrews A.A., Weinberg M.E., Mayes L.C., Wang S.M., Gaal D., Saadat H., Maranets I. Sevoflurane versus halothane: postoperative maladaptive behavioral changes. Anesthesiology. 2005.
  26. Cravero J., Surgenor S., Whalen K. Emergence agitation in paediatric patients after sevoflurane and no surgery: a comparison with halothane. Paediatr. Anaesth. 2000.
  27. Bannister C.F., Brosius K.K., Sigl J.C., Meyer B.J., Sebel P.S. The effect of bispectral index monitoring on anesthetic use and recovery in children anesthetized with sevoflurane in nitrous oxide. Anesth. Analg. 2001.