Original contributionAnesthesia with 1.5 minimum alveolar concentration sevoflurane is not altered by physostigmine as measured by bispectral and clinical indices
Introduction
The exact mechanism by which volatile anesthetics produce general anesthesia has not been delineated to date. However, in the central nervous system, volatile anesthetics inhibit acetylcholine release [1] and α4β2 nicotinic receptors [2], and they suppress cholinergic pathways [3]. On the other hand, physostigmine has been used to reverse central anticholinergic syndrome by increasing the acetylcholine concentration in the brain [4], [5]. In a previous study, we failed to demonstrate a reversal of 0.25 minimum alveolar concentration (MAC) sevoflurane anesthesia by physostigmine [6] as assessed by bispectral index (BIS) values and clinical indices.
The aim of the present study was to investigate whether physostigmine affects enhancing recovery from 1.5 MAC anesthesia and increase performance of clinical test in the early recovery period.
Section snippets
Materials and methods
After obtaining approval of the Aretaieion Hospital's institutional review board, 40 ASA physical status I and II female patients scheduled for breast biopsy were recruited to be studied in a prospective, double-blinded manner. Written, informed consent was obtained from all the patients. Patients with hepatic, cardiac, pulmonary, renal, thyroid disease, or obesity; those taking sedatives or alcohol; and those who were possibly pregnant were excluded from the study. Potentially pregnant women
Results
Age (31 ± 6 and 29 ± 8 years), body weight (58 ± 7 and 55 ± 7 kg), height (164 ± 6 and 162 ± 5 cm), and duration of anesthesia (48 ± 9 and 43 ± 7 minutes) for the PHYSO and NS groups were similar. Bispectral index at 0, 5, 8, and 10 minutes after the intervention and immediately after LMA removal did not differ between the 2 groups (29 ± 4, 32 ± 6, 31 ± 6, 30 ± 7, and 84 ± 11 in the PHYSO group vs 29 ± 6, 30 ± 6, 30 ± 5, 31 ± 5, 86 ± 7 in the NS group; Fig. 1). No difference in Etsevo was
Discussion
Our results show that physostigmine has no effect on sevoflurane anesthesia 1.5 MAC at steady-state values, a finding consistent with our previous work showing that physostigmine did not affect 0.6% end-tidal sevoflurane anesthesia [6]. Rapid elimination of 0.3 MAC of sevoflurane might be associated with the similar BIS values and recovery times between the PHYSO and the NS groups. Although the interaction of an inhalational anesthetic with another drug may be dose-dependent, the data available
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