Awareness in Old Aged Patients During Laryngoscopy and Intubation Using Isolated Forearm Technique
Awareness, Anesthesia, Recall Phenomenon, Inhalation; Gas
About this trial
This is an interventional diagnostic trial for Awareness, Anesthesia focused on measuring TIVA, Isoflurane, old age
Eligibility Criteria
Inclusion Criteria:
- 50 American society of anesthesiologists- Physical status (ASA-PS) I and II patients,
- aged 60 to 80 years,
- 70-80 kg,
- both sexes,
- with intact hearing,
- undergoing elective day case surgery were included in the study.
Exclusion Criteria:
- Uncooperative patients,
- Language barrier problems,
- Psychological disorders,
- Suspected difficult intubation,
- History of awareness under anesthesia,
- History of substance abuse,
- The inability to have tourniquet on arm for the IFT (e.g., lymphedema or operative site)
- Neuromuscular disorders.
- Advanced renal, hepatic, cardiac, respiratory or neurological dysfunction
- If rapid sequence induction was indicated (not suitable for inhalation induction).
Sites / Locations
- Ain Shams University
Arms of the Study
Arm 1
Arm 2
Active Comparator
Active Comparator
Group A
Group B
In group A: The researcher, who supervised the anesthesia, explained the concept of the study to all patients before induction, and then a tourniquet was placed around the dominant arm of the patients after placing a cotton bandage; to be inflated to 200mmHg or 40 mmHg above the systolic blood pressure of the patient; immediately before administration of the muscle relaxant later on. Patients received inhalation induction using sevoflurane 8% and fentanyl 2 µg/kg was administered intravenously. After loss of consciousness, and BIS value of 50 or less, the tourniquet cuff was inflated then atracurium 0.5 mg/kg was given intravenously and sevoflurane reduced to 2%, then laryngoscopy and intubation were done when action of neuromuscular blocker (NMB) was confirmed by the disappearance of T3,T4. During this time, mask assisted ventilation with 100% oxygen was used to achieve normocapnia
In group B: The researcher, who supervised the anesthesia, explained the concept of the study to all patients before induction, and then a tourniquet was placed around the dominant arm of the patients after placing a cotton bandage; to be inflated to 200mmHg or 40 mmHg above the systolic blood pressure of the patient; immediately before administration of the muscle relaxant later on. In group B: propofol 1.5 mg/kg and fentanyl 2 µg/kg were administered intravenously. After loss of consciousness, and BIS value of 50 or less, the tourniquet cuff was inflated and then atracurium 0.5 mg/kg was given intravenously. Propofol infusion 6 mg/kg/hr was started, until action of neuromuscular blocker (NMB) was confirmed by disappearance of T3,T4, then laryngoscopy and intubation were done. The used dosing regimen is according to previous guidelines [8] [9].No inhalational agent was used. Mask assisted ventilation was used to achieve normocapnia.