COMPARING THE EFFECT OF TWO METHODS OF ANESTHESIA INDUCTION ON CONSCIOUSNESS DURING ORTHOPEDIC SURGERY
Objectives: Consciousness during anesthesia is a non-reversible complication that may expose the patient to severe, long-term, emotional injuries and post-traumatic stress. Therefore, this study aimed to compare the effect of two methods of induction maintenance of anesthesia with thiopental sodiumâ€“remifentanil and propofolâ€“alfentanil on consciousness during orthopedic surgery using a bispectral index (BIS) device.
Methods: In this triple-blind clinical trial, 111 patients who underwent orthopedic surgery in Dezful Hospital (southwestern Iran) were investigated. Patients were randomly assigned into two groups: The intervention Group â€œAâ€ received thiopental for the induction of and fentanyl for maintenance and intervention Group â€œBâ€ received propofol and alfentanil. The patients underwent BIS monitoring before the end of surgery, and the BIS value was recorded. The Brice questionnaire was used to measure the consciousness. The data were analyzed using repeated Measure ANOVA test.
Results: In the intervention Groups A and B, the mean BIS score was 63.71 and 60.62 in the first 5 min after surgery, reaching 65.25 and 67.73 60 min after surgery, respectively. The results of repeated measures ANOVA test showed that the mean BIS score was significantly different from the preoperative value (baseline) group during repeated measurements after surgery (5, 10, 15, 30, 40, and 60 min) (p<0.001). According to the Brice questionnaire, the prevalence of hearing loss during surgery showed a statistically significant difference between the two intervention Groups (A and B), and the incidence of hearing during surgery in intervention Group â€œBâ€ was approximately 3 times higher than intervention Group â€œAâ€ (odds ratio=3.22, 95% confidence interval: 1.32â€“7.79).
Conclusion: The results indicate that none of the induction and maintenance pharmacologic methods have any superiority in terms of optimal depth of anesthesia in patients undergoing orthopedic surgery.
2. Yu H, Wu D. Effects of different methods of general anesthesia on intraoperative awareness in surgical patients. Medicine (Baltimore) 2017;96:e6428.
3. Singla D, Mangla M. Incidence of awareness with recall under general anesthesia in rural india: An observational study. Anesth Essays Res 2017;11:489-94.
4. Lopes-Pimentel P, Koo M, Bocos J, SabatÃ© A. The bilateral bispectral and the composite variability indexes during anesthesia for unilateral surgical procedure. Saudi J Anaesth 2017;11:49-53.
5. Whitlock EL, Villafranca AJ, Lin N, Palanca BJ, Jacobsohn E, Finkel KJ, et al. Relationship between bispectral index values and volatile anesthetic concentrations during the maintenance phase of anesthesia in the B-unaware trial. Anesthesiology 2011;115:1209-18.
6. Payas A, Kaygusuz K, DÃ¼ger C, Ä°sbir AC, Kol Ä°Ã–, GÃ¼rsoy S, et al. The effects of bispectral index and neuromuscular blockade monitoring on the depth of anaesthesia and recovery in cardiac patients under desflurane anaesthesia. Turk J Anaesthesiol Reanim 2013;41:211-5.
7. Jiang Y, Qiao B, Wu L, Lin X. Application of narcotrendÂ® monitor for evaluation of depth of anesthesia in infants undergoing cardiac surgery: A prospective control study. Braz J Anesthesiol 2013;63:273-8.
8. Kamali A, Shokrpour M, Sh P, Moshiri E, Taheri-Nejad MR, Dadashpour N, et al. Determining the effect of BIS monitoring on level of awareness during anesthesia in women undergoing elective caesarean section. Arak Med Univ J 2015;17:56-63.
9. Szostakiewicz KM, Tomaszewski D, Rybicki Z, Rychlik A. Intraoperative awareness during general anaesthesia: Results of the observational survey. Anaesthesiol Inten Ther 2014;46:23-8.
10. Liu W, Thorp T, Graham S, Aitkenhead A. Incidence of awareness with recall during general anaesthesia. Anaesthesia 1991;46:435-7.
11. Flaishon R, Windsor A, Sigl J, Sebel P. Recovery of consciousness after thiopental or propofolbispectral index and the isolated forearm technique. J Am Soc Anesthesiol 1997;86:613-9.
12. Nasiri E, Padashi S, Majd MK. Awareness during general anesthesia for caesarian section. J Mazandaran Univ Med Sci 2006;16:57-64.
13. Nasiri E, Padashi S, Majd MK. Awareness during general anesthesia for caesarian section. J Mazandaran Univ Med Sci 2006;16:57-64.
14. Sebel PS, Bowdle TA, Ghoneim MM, Rampil IJ, Padilla RE, Gan TJ, et al. The incidence of awareness during anesthesia: A multicenter United States study. Anesth Analg 2004;99:833-9.
15. Myles P, Symons J, Leslie K. Anaesthetistsâ€™ attitudes towards awareness and depth-of-anaesthesia monitoring. Anaesthesia 2003;58:11-6.
16. Cohen NH. Anesthetic depth is not (yet) a predictor of mortality! Anesth Analg 2005;100:1-3.
17. Tavakolian A, Ghodrati Z, Zand F, Jahanmiri F. Assessment of the incidence of awareness during general anaesthesia in open heart surgery in the hospitals of Shiraz university of medical sciences. J Iran Soc Anasthesiol Inten Care 2011;2:39-46.
18. Arefian N, Fathi M. Evaluation of prevalence of awareness during general anesthesia for cesarean section during 2005-2006 in Shohada hospital. JAUMS 2007;5:1267-71.
19. Rezanejad JB, Farzan B. Study of incidence rate of awakening and remembering during general anesthesia. Yafteh 2006;4:???.
20. Ashworth J, Smith I. Comparison of desflurane with isoflurane or propofol in spontaneously breathing ambulatory patients. Anesth Analg 1998;87:312-8.
21. Mehmandoost M, Naghibi K. Comparative study of the effects of two anesthetic methods with propofol and isoflurane on motherâ€™s awareness during the operation and APGAR score in the newborns delivered by elective cesarean section. J Isfahan Med Sch 2013;31:228.
22. Abboud T, Zhu J, Richardson M, Silva E, Donovan M. Intravenous propofol vs thiamylal-isoflurane for caesarean section, comparative maternal and neonatal effects. Acta Anaesthesiol Scand 1995;39:205-9.
23. Shahi S, Fard MF, Sadeghi M, Shoeibi G. The incidence of awareness during general anesthesia. Anesthesiol Pain 2013;4:47-54.
24. Nalini, R Ezhilramya J. A comparative study of efficacy and safety of lornoxicam and diclofenac as postoperative analgesics after mastoidectomy surgery. Int J Pharm Pharm Sci 2017;9:77-83.
25. Brethis CS, Thamizharasan S, Sridevi SA, Kalaiselvi B, Singh MB, Vijaykumar K. A prospective study of the pattern of use of antimicrobial agents in surgical PROPHYLAXIS in a tertiary care centre. Int J Pharm Pharm Sci 2017;9:283-7.
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