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Vlassakova B.G.,Perioperative Medicine and Pain | Emmanouil D.E.,National and Kapodistrian University of Athens
Current Opinion in Anaesthesiology | Year: 2016

Purpose of review Children with autism often present a challenge to the anesthesiologist. This review summarizes the current experiences and recommendations for the perioperative management of this unique group of patients. Recent findings Autism is the fastest growing neurodevelopmental disorder in the world. Increased recognition and public awareness of the disease is driven largely by the advances in research. A large body of evidence exists that identifies the role of genetic, environmental, biological, and developmental factors in the origin of autism. The anesthesia literature consists mostly of case reports. Recent publications are reporting management strategies and evaluation of this patient population's perioperative experiences. Summary Patients with autism spectrum disorder are a heterogeneous group and often need general anesthesia for different procedures and studies. Familiarity with each patient's behavioral specifics and efforts to alleviate stress is of paramount importance for a smooth perioperative course with minimal adverse events. © 2016 Wolters Kluwer Health, Inc. All rights reserved.

Ahmed A.,Perioperative Medicine and Pain | Sengupta S.,Perioperative Medicine and Pain | Das T.,Perioperative Medicine and Pain | Rudra A.,Perioperative Medicine and Pain | Iqbal A.,Perioperative Medicine and Pain
Indian Journal of Anaesthesia | Year: 2012

Background: Propofol is one of the widely used intravenous (i.v.) anaesthetics, although pain on injection still remains a considerable concern for the anaesthesiologists. A number of techniques has been tried to minimize propofol-induced pain with variable results. Recently, a 5-HT 3 antagonist, ondansetron pre-treatment, has been shown to reduce propofol-induced pain. The aim of our randomized, placebo-controlled, double-blinded study was to determine whether pre-treatment with intravenous granisetron, which is routinely used in our practice for prophylaxis of post-operative nausea and vomiting, would reduce propofol-induced pain. Methods: Eighty-two women, aged 18-50 years, American society of Anaesthesiologist grading (ASA) I-II, scheduled for various surgeries under general anaesthesia were randomly assigned to one of the two groups. One group received 2 mL 0.9% sodium chloride while the other group received 2 mL granisetron (1 mg/mL), and were accompanied by manual venous occlusion for 1 min. Then, 2 mL propofol was injected through the same cannula. Patients were asked by a blinded investigator to score the pain on injection of propofol with a four-point scale: 0=no pain, 1=mild pain, 2=moderate pain, 3=severe pain. Results: Twenty-four patients (60%) complained of pain in the group pre-treated with normal saline as compared with six (15%) in the group pre-treated with granisetron. Pain was reduced significantly in the granisetron group (P<0.05). Severity of pain was also lesser in the granisetron group compared with the placebo group (2.5% vs. 37.5%). Conclusion: We conclude that pre-treatment with granisetron along with venous occlusion for 1 min for prevention of propofol-induced pain was highly successful.

Sengupta S.,Perioperative Medicine and Pain | Ghosh S.,Perioperative Medicine and Pain | Rudra A.,Perioperative Medicine and Pain | Kumar P.,Perioperative Medicine and Pain | And 2 more authors.
Middle East Journal of Anesthesiology | Year: 2011

Background: The Bispectral Index (BIS) helps in the assessment of the depth of hypnosis. N-methyl-D-aspartic acid antagonist, ketamine, has been used in various doses to decrease postoperative morphine consumption. The purpose of our study was to compare the effects of two different doses (0.5 mg/kg and 0.2 mg/kg) of ketamine on BIS values. Methods: Forty-five ASA I or II patients undergoing general anesthesia were included in this double-blind, prospective, control trial and randomly allocated into three groups. After induction of anesthesia and tracheal intubation, a propofol infusion was started and titrated to attain BIS values of around 40. After five minutes of stable BIS values and in the absence of any surgical stimulus, patients received either 0.5 mg/kg of ketamine (Group K1) or 0.2 mg/kg of ketamine (Group K2) or normal saline (Group N) as bolus intravenously. BIS values were recorded for the next 15 minutes, at five-minutes interval. Results: Mean BIS values were significantly increased in Group K1 (63.5) while Group K2 (42.0) failed to show any significant rise. BIS values in Group K2 were comparable to those in Group N. Conclusion: Thus, under stable propofol anesthesia, a bolus of ketamine 0.5 mg/kg increases BIS values while ketamine 0.2 mg/kg does not.

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