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Combined general-epidural anesthesia decreases the desflurane requirement for equivalent A-line ARX index in colorectal surgery.
Acta Anaesthesiol Scand. 2005 Sep; 49(8):1063-7.AA

Abstract

BACKGROUND

The present study used the A-line ARX index, derived from auditory evoked potential measurements, to examine the effect of epidural lidocaine on the end-tidal concentration of desflurane during general anesthesia.

METHODS

Thirty ASA I-II patients scheduled for elective colorectal surgery were included and randomized, in a double-blinded fashion, to receive general anesthesia, and 15 ml of either 2% lidocaine (group GE, n=15) or normal saline (group GS, n=15) was administered epidurally with a maintenance infusion rate of 6 ml h-1. After a 10-min high-flow oxygen wash-in period, desflurane was titrated to a target A-line ARX index (AAI) of 20+/-5.

RESULTS

Epidural lidocaine reduced the end-tidal concentration of desflurane required to maintain an adequate clinical effect by 42% compared to general anesthesia alone (2.6% vs. 4.5%, respectively; P<0.001). The initial mean value of AAI was 87.8 (range 78-99) in group GE and 88.13 (79-99) in group GS before general anesthesia induction, the AAI values were approximately 19.7 (15-25) in group GE and 20.2 (16-25) in group GS during anesthesia maintenance, and returned to 84.53 (77-98) in group GE and 86.87 (79-98) in group GS when the patients regained consciousness in the recovery room. No statistical difference in the AAI values was observed either before, during, or after emergence of anesthesia. No patient reported intraoperative awareness.

CONCLUSIONS

Lower-than-expected concentrations of volatile anesthetics are sufficient to maintain appropriate a clinical anesthesia effect during combined general-epidural anesthesia under auditory-evoked potential monitoring.

Authors+Show Affiliations

Department of Anesthesiology, Tri-Service General Hospital and National Defense Medical Center, Taipei, Taiwan.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

16095444

Citation

Lu, C-H, et al. "Combined General-epidural Anesthesia Decreases the Desflurane Requirement for Equivalent A-line ARX Index in Colorectal Surgery." Acta Anaesthesiologica Scandinavica, vol. 49, no. 8, 2005, pp. 1063-7.
Lu CH, Borel CO, Wu CT, et al. Combined general-epidural anesthesia decreases the desflurane requirement for equivalent A-line ARX index in colorectal surgery. Acta Anaesthesiol Scand. 2005;49(8):1063-7.
Lu, C. H., Borel, C. O., Wu, C. T., Yeh, C. C., Jao, S. W., Chao, P. C., & Wong, C. S. (2005). Combined general-epidural anesthesia decreases the desflurane requirement for equivalent A-line ARX index in colorectal surgery. Acta Anaesthesiologica Scandinavica, 49(8), 1063-7.
Lu CH, et al. Combined General-epidural Anesthesia Decreases the Desflurane Requirement for Equivalent A-line ARX Index in Colorectal Surgery. Acta Anaesthesiol Scand. 2005;49(8):1063-7. PubMed PMID: 16095444.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Combined general-epidural anesthesia decreases the desflurane requirement for equivalent A-line ARX index in colorectal surgery. AU - Lu,C-H, AU - Borel,C O, AU - Wu,C-T, AU - Yeh,C-C, AU - Jao,S-W, AU - Chao,P-C, AU - Wong,C-S, PY - 2005/8/13/pubmed PY - 2005/11/9/medline PY - 2005/8/13/entrez SP - 1063 EP - 7 JF - Acta anaesthesiologica Scandinavica JO - Acta Anaesthesiol Scand VL - 49 IS - 8 N2 - BACKGROUND: The present study used the A-line ARX index, derived from auditory evoked potential measurements, to examine the effect of epidural lidocaine on the end-tidal concentration of desflurane during general anesthesia. METHODS: Thirty ASA I-II patients scheduled for elective colorectal surgery were included and randomized, in a double-blinded fashion, to receive general anesthesia, and 15 ml of either 2% lidocaine (group GE, n=15) or normal saline (group GS, n=15) was administered epidurally with a maintenance infusion rate of 6 ml h-1. After a 10-min high-flow oxygen wash-in period, desflurane was titrated to a target A-line ARX index (AAI) of 20+/-5. RESULTS: Epidural lidocaine reduced the end-tidal concentration of desflurane required to maintain an adequate clinical effect by 42% compared to general anesthesia alone (2.6% vs. 4.5%, respectively; P<0.001). The initial mean value of AAI was 87.8 (range 78-99) in group GE and 88.13 (79-99) in group GS before general anesthesia induction, the AAI values were approximately 19.7 (15-25) in group GE and 20.2 (16-25) in group GS during anesthesia maintenance, and returned to 84.53 (77-98) in group GE and 86.87 (79-98) in group GS when the patients regained consciousness in the recovery room. No statistical difference in the AAI values was observed either before, during, or after emergence of anesthesia. No patient reported intraoperative awareness. CONCLUSIONS: Lower-than-expected concentrations of volatile anesthetics are sufficient to maintain appropriate a clinical anesthesia effect during combined general-epidural anesthesia under auditory-evoked potential monitoring. SN - 0001-5172 UR - https://www.unboundmedicine.com/medline/citation/16095444/Combined_general_epidural_anesthesia_decreases_the_desflurane_requirement_for_equivalent_A_line_ARX_index_in_colorectal_surgery_ L2 - https://doi.org/10.1111/j.1399-6576.2005.00726.x DB - PRIME DP - Unbound Medicine ER -