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Biomedical subjects

Tiberiu Ezri

Publications and source records attributed to Tiberiu Ezri.

At least 19 recordsLinked to original sources
PubMed2005

Gluteal stab wound is a frequent and potentially dangerous injury.

BACKGROUND: Stab wounds to the gluteal area are a frequent injury in an urban trauma centre. These injuries may appear innocuous but is potentially life threatening. Therefore they deserve timely evaluation and management. The purpose of this study was to evaluate our experience with this type of injury and to propose a treatment protocol. METHODS: During the last 5 years 269 patients with stab injuries, were admitted to our Department of Emergency Medicine (DEM). Thirty-nine patients (14%) who had gluteal penetration were included in this study. Patients' charts were retrospectively reviewed for demographic data, type of injury and additional injuries, evaluation, management and outcome. RESULTS: Stab wound of the gluteal region was the most frequent injury after chest and abdominal injuries. Thirty patients presented with soft tissue damage only and nine were severely injured. Seven of the severely injured patients had significant bleeding; two of them were treated by embolisation. One patient suffered a rectal injury and one a small bowel perforation, both treated surgically. There was no post-operative complication or mortality. CONCLUSIONS: Penetration of the gluteal is a potentially life threatening injury. Meticulous observation and high level of suspicion ensure early treatment and can prevent mortality.

Adolescent↗
PubMed2005

Remifentanil: a novel systemic analgesic for labor pain.

In a double-blind, randomized, controlled clinical trial, we compared the analgesic effect of remifentanil in patient-controlled IV analgesia (PCIA) during labor and delivery with the effect of an IV infusion of meperidine. Eighty-eight healthy term parturients who requested IV analgesia for labor pain were enrolled in the study and were randomly assigned to receive either increasing doses (0.27-0.93 microg/kg per bolus) of PCIA remifentanil (n=43) or an IV infusion of meperidine 150 mg (range, 75-200 mg) per patient (n=45). Remifentanil by the PCIA device was more effective and reliable analgesia for labor and delivery than IV infusion of meperidine. The visual analog score was lower (35.8 +/- 10.2 versus 58.8 +/- 12.8; P <0.001) and the patient satisfaction score higher (3.9 +/- 0.6 versus 1.9 +/- 0.4; P <0.001), with less of a sedative effect (1.2 +/- 0.1 versus 2.9 +/- 0.1; P <0.001) and less hemoglobin desaturation (97.5% +/- 1.0 versus 94.2% +/- 1.5; P <0.007). The percentage of analgesia failure (the rate of crossover from opiate to epidural analgesia) was less for remifentanil compared with meperidine (10.8% versus 38.8%; P <0.007). There were no significant differences between groups in the mode of delivery or neonatal outcome. There were fewer nonreassuring abnormal fetal heart rate patterns, i.e., higher variability and reactivity with fewer decelerations, under remifentanil therapy as compared with meperidine (P <0.001). In conclusion, an intermittent incremental regimen with repeated small-dose PCIA boluses of remifentanil provided effective and reliable analgesia during labor and delivery.

Adult↗
PubMed2004

Nasal versus oral fiberoptic intubation via a cuffed oropharyngeal airway (COPA) during spontaneous ventilation.

STUDY OBJECTIVE: To compare the success rate of nasal versus oral fiberoptic intubation in anesthetized patients breathing spontaneously via the cuffed oropharyngeal airway (COPAtrade mark). DESIGN: Prospective, randomized, controlled study. SETTING: Two university-affiliated hospitals. PATIENTS: Patients scheduled for general or plastic surgery of the torso or extremities. INTERVENTIONS: Nasal (n=20) and oral (n=20) fiberoptic intubation were performed in patients while breathing spontaneously via the COPA during standardized anesthesia. MEASUREMENTS: Demographic data, mean arterial pressure, heart rate, end-tidal carbon dioxide (ETCO2), oxygen saturation (SpO2), COPA size, difficult airway predictors, rate of failed ventilation via COPA, and frequency of hypoxemia (SpO2 < 90%) during the procedure, and perioperative untoward events were recorded. MAIN RESULTS: The background, airway difficulty, vital signs and untoward effects were similar in the two groups. Nasal fiberoptic laryngeal view (scale 1-4) was better than the oral grading (3 [median] vs. 2, respectively; p <0.05). Eighty percent of the nasal intubations were successful compared with 40% of the oral intubations (p <0.05). Nasal intubations were accomplished within 153 +/- 15 SD seconds compared with 236 +/- 22 seconds (p <0.05) for the oral intubations, and less propofol was needed in the nasal intubations during the procedures (240 +/- 27 mg [nasal] vs. 277+/- 39 mg [oral]; p <0.05). CONCLUSIONS: Nasal fiberoptic laryngoscopy is more successful and easy than the oral approach in anesthetized patients who are breathing spontaneously through the COPA.

Administration, Inhalation↗
PubMed2004

Patient-controlled epidural analgesia for labor pain: effect on labor, delivery and neonatal outcome of 0.125% bupivacaine vs 0.2% ropivacaine.

The objective was to evaluate the influence of patient-controlled epidural analgesia (PCEA) using low doses of bupivacaine vs. ropivacaine, on labor pain, motor blockade, progression of labor, delivery and neonatal outcome. This randomized double blind study included 565 parturients. All received a 5-mL/h infusion and PCEA (5-mL boluses with a 20-min lockout, maximum volume 20 mL/h) of either 0.125% bupivacaine (n = 313: 165 nulliparous, 148 parous) or 0.2% ropivacaine (n = 252: 113 nulliparous, 139 parous). Pain score, lower limb motor block, sensory levels, local analgesic doses required, hemodynamic parameters, side effects and complications were assessed. Obstetric variables included cervical dilation at epidural insertion, incidence of ruptured membranes and their duration, use of oxytocin, fetal heart rate changes, duration of labor, mode and outcome of delivery, and use of invasive and non-invasive fetal monitoring. Neonatal characteristics included birth weight, Apgar scores, umbilical artery pH, serum bilirubin, hypoglycemia, need for assisted ventilation, sepsis or sepsis study, feeding difficulties and respiratory distress syndrome. Ropivacaine 0.2% was equianalgesic with 0.125% bupivacaine, but produced less motor block (P < 0.0001). There were no significant differences, however, in duration of labor, delivery type or neonatal outcome.

Adult↗
PubMed2004

Milrinone and nitric oxide: combined effect on pulmonary artery pressures after cardiopulmonary bypass in children.

OBJECTIVE: To investigate the effect of milrinone combined with nitric oxide (NO) on the pulmonary artery pressures (PAP) after cardiopulmonary bypass (CPB), for repair of congenital heart defects (CHD) in children. DESIGN: Prospective, randomized, double-blind study. SETTING: University affiliated community hospital. PARTICIPANTS: Ninety children with pulmonary hypertension and repair of CHD. INTERVENTIONS: After weaning from CPB, patients (30 in each group) received 3 drug regimens: group 1, nitric oxide (NO); group 2, a continuous infusion of milrinone; and group 3, a combination of the 2. Drugs were started after CPB and given for 20 minutes. MEASUREMENTS AND MAIN RESULTS: Pulmonary and systemic pressures, PaCO(2), SaO(2), and pH values were recorded before bypass, after weaning from CPB, 10 and 20 minutes after starting each regimen, and 10 minutes after the cessation of treatment. Mean systemic blood pressure was lower (p < 0.05) in the combined treatment group after discontinuation of the drugs. Although mean PAP values were lower in the combined group (p < 0.05), no difference was recorded with regard to pH, PaCO(2), and PaO(2). The ratio between pre- and post-treatment mean PAP was highest in group 3(1.26 +/- 0.5) and lowest in group 2 (0.99 +/- 0.3, p < 0.001). The mean PAP recorded after discontinuation of the drug was lower than the baseline value in groups 1 and 3 (p < 0.05). CONCLUSIONS: The combination of milrinone and NO produced a more pronounced decrease in PAP than milrinone alone.

Blood Pressure↗
PubMed2004

Pseudocholinesterase deficiency associated with HELLP syndrome.

We report a case of decreased plasma pseudocholinesterase activity in a patient with hemolysis, elevated liver enzymes, and low platelets (HELLP) syndrome. The pseudocholinesterase activity returned to normal with concomitant recovery of HELLP syndrome. This possible association is significant when general anesthesia is provided to patients with HELLP syndrome.

Adult↗
PubMed2004

Human immunodeficiency virus: anesthetic and obstetric considerations.

The pandemic of acquired immune deficiency syndrome (AIDS) is on the threshold of its third decade of existence. The World Health Organization-United Nations statistics show that human immunodeficiency virus (HIV)/AIDS pandemia is set to get much worse. Women of reproductive age are the fastest growing population with HIV. Common signs and symptoms have become more moderate or subclinical, and new clinical presentations have emerged. It is quite apparent that HIV-disease affects multiple organ systems. Advances have been made in elucidating the pathogenesis of HIV. In addition, the molecular technique of viral load determination and the CD + 4 T-lymphocyte count enable evaluation of the disease, its prognosis, and its response to therapy. There is limited specific information concerning the overall risk of anesthesia and surgery of HIV/AIDS patients. However, as far as can be determined, surgical interventions do not increase the postoperative risk for complications or death and should therefore not be withheld. There is also little evidence to suggest that HIV or antiretroviral drugs increase the rate of pregnancy complications or that pregnancy may alter the course of HIV infection. General anesthesia is considered safe, but drug interactions and their impact on various organ systems should be considered preoperatively. Regional anesthesia is often the technique of choice. Yet, one must take into consideration the presence of neuropathies, local infection, or blood clotting abnormalities. It should be emphasized that all practicing anesthesiologists should be familiar with the disease and should use prenatal anesthesia consultations and a team approach to assure optimal treatment for HIV patients.

Adult↗
PubMed2004

Identification of the epidural space: loss of resistance with air, lidocaine, or the combination of air and lidocaine.

The ideal technique for identifying the epidural space remains unclear. Five-hundred-forty-seven women in labor who requested epidural analgesia were randomly allocated to three groups according to the technique by which the epidural space was identified: 1) loss-of-resistance with air (air; n = 180), 2) loss-of-resistance with lidocaine (lidocaine; n = 185), and 3) loss-of-resistance with both air and lidocaine (air-plus-lidocaine; n = 182). We assessed ease of epidural catheter insertion, characteristics of the blockade, quality of analgesia, and complications. The inability to thread the epidural catheter occurred in 16% of the air, 4% of the lidocaine, and 3% of the air-plus-lidocaine patients (P < 0.001). More patients from the air group had unblocked segments (6.6% versus 3.2% and 2.2%, respectively; P < 0.02). The incidence of accidental dural puncture was greater in the air group (1.7% versus 0% in the other two groups; P < 0.02). Pain scores, time to onset of analgesia, upper sensory level, motor blockade, and the incidence of hypotension, transient neurological deficits, postpartum urinary retention, and postdural puncture headache were comparable. Identification of the epidural space with air was more difficult and caused more dural punctures than with lidocaine or air plus lidocaine. Additionally, sequential use of air and lidocaine had no advantage over lidocaine alone.

Adolescent↗
PubMed2004

Laparoscopic repair of "sportsman's hernia" in soccer players as treatment of chronic inguinal pain.

BACKGROUND: To evaluate the clinical course of soccer players affected by chronic groin pain, who were referred for laparoscopic inguinal exploration. MATERIAL/METHODS: Thirty-five professional soccer players affected by chronic groin pain and referred for laparoscopic inguinal exploration were included in this prospective, non-randomized study. Prior to surgery, patients were assessed by history, clinical examination, pelvic X-ray, bone scanning with Technetium and ultrasound of the inguinal region. The pre-peritoneal space was visualized with a laparoscope under general anesthesia. A bilateral polypropylene mesh was attached pre-peritoneally. Recorded data included demographics, history, symptoms, surgical findings and postoperative recovery. RESULTS: All patients were male. The mean age was 24.3 years. Six patients (17.1%) complained of pain affecting their normal life. A true indirect type I hernia was identified in 4 patients (11.4%). In 28 patients (80%), a wide internal ring and peritoneal dimple were found during the procedure. No clear pathology was found in three patients (8.6%). Thirty-four patients (97.1%) returned to their normal activities after surgery. CONCLUSIONS: Laparoscopic inguinal exploration and repair of "sportsman's hernias" in soccer players was associated with rapid recovery and fast return to full training and activity.

Adolescent↗
PubMed2003

Increased body mass index per se is not a predictor of difficult laryngoscopy.

PURPOSE: We investigated the association between morbid obesity and difficult laryngoscopy (DL). METHODS: In a prospective, controlled study we evaluated the impact of different variables on the prediction of DL in 200 morbidly obese (study group-SG), and 1272 non-obese (control group-CG) patients undergoing elective surgery. Variables assessed included age, sex, body mass index (BMI), protruding, loose, and missing upper teeth, thyro-mental distance, temporo-mandibular joint (TMJ) function, neck extension, and Mallampati class. A Cormack grade III or IV was considered DL. RESULTS: The SG patients were younger (P < 0.000), there were more females in the SG (P < 0.000) and more in the SG had teeth problems (P = 0.026). More patients in the SG (10% vs 1%), had obstructive sleep apnea (P < 0.001) with 90% of them in the SG having a grade III laryngoscopy. High BMI did not affect the laryngoscopy difficulty (P = 0.56). Multivariable regression analysis revealed that morbid obesity, increased age, male sex, pathology of TMJ, and higher Mallampati class, were independent predictors of DL. When interaction between the predictors and the group was added to the multivariable model, the SG was no longer a predictor by itself, rather its association with abnormal upper teeth turned to be significant for prediction of DL. CONCLUSIONS: Increased age, male sex, TMJ pathology, Mallampati 3 and 4, a history of obstructive sleep apnea and abnormal upper teeth were associated with a higher incidence of DL. The magnitude of BMI had no influence on difficulty with laryngoscopy.

Adult↗
PubMed2003

Topical nifedipine vs. topical glyceryl trinitrate for treatment of chronic anal fissure.

PURPOSE: Nifedipine (administered orally or applied topically) has been effective for nonsurgical treatment of anal fissure. We compared the efficacy of nifedipine vs. glyceryl trinitrate for chemical sphincterotomy of anal fissure. METHODS: In a prospective, double-blind trial, 52 patients suffering from chronic anal fissure were randomly and equally allocated to receive either glyceryl trinitrate or nifedipine, both applied topically to the perianal region. The end point of the study was healing within a predetermined period (6 months). Variables assessed included demographic data (age, gender), symptoms associated with the fissure, duration of treatment, percentage of healing, untoward effects of treatment, pain scores, duration of follow-up, recurrence, and need for complementary means of treatment. Descriptive data are presented as mean +/- standard deviation and quantal data as percentage. Inference analysis was performed using the Student's t-test for the descriptive data and the chi-squared or Fisher's exact test for nominal variables. RESULTS: No significant differences were recorded with regard to age, gender, symptoms associated with the fissure, or duration of treatment. Healing rate was higher (P < 0.04) with nifedipine (89 percent) as compared with glyceryl trinitrate (58 percent). Treatment side effects (headache, flushing) were more frequent (P < 0.01) with glyceryl trinitrate (40 percent) as compared with nifedipine (5 percent). Pain scores were significantly lower (P < 0.03) on completion of treatment in both groups (3.2 in glyceryl trinitrate and 3.4 in nifedipine vs. 6.2 and 6.1, respectively), but did not differ between the two groups. Recurrence occurred in 31 percent of patients treated with glyceryl trinitrate and 42 percent of those treated with nifedipine after a mean period of 18 +/- 3 weeks and 12 +/- 4 weeks, respectively. CONCLUSION: Topical application of nifedipine for management of chronic anal fissure was more effective and had fewer side effects than topical glyceryl trinitrate. Recurrence was frequent with both drugs.

Calcium Channel Blockers↗
PubMed2003

Efficiency of the operating room suite.

BACKGROUND: The need to control high costs of running operating rooms while providing for timely patient care led us to assess the time wasted in the operating room (OR). METHODS: OR use by two general surgery and two orthopedic departments in a metropolitan public hospital were analyzed, and the time elapsed when a scheduled OR remained unused or the patient was still awaiting surgery was measured. RESULTS: OR "time-waste" defined as the time in which the scheduled OR was not busy with the scheduled patient amounted to 79 hours over the 30-day study period (15% of total time). It was wasted owing to inappropriately prepared patients (12%), unavailability of surgeons (7%), insufficient nursing staff, anesthesiologists, or OR assignment to emergency surgery (59%), congestion of the postanesthesia care unit (10%), and delay in transport to the OR (2%) Another issue delineated was the frequent occurrence of surgical cases running longer than their scheduled time (termed "spill-over"), outrunning the staffing expectations after 3:00 PM and delaying admission of add-on and emergency procedures, adding 33% to the time wasted. A quality-assurance committee review resulted in implementation of new guidelines, and within 3 months several underlying causes were rectified, and time-waste and spill over time was reduced by 35%. Surgical time predictions were also improved. Shortage of nurses and anesthesiologists, and OR emergency reassignment remained the major causes of OR waste time. CONCLUSIONS: Continuous surveillance on OR suite-patients' prompt care, repeated evaluation, and wise staff deployment-could maximize OR efficiency.

Efficiency, Organizational↗
PubMed2003

Difficult airway management practice patterns among anesthesiologists practicing in the United States: have we made any progress?

STUDY OBJECTIVE: To determine the extent instruction and practice in the use of airway devices and techniques varies among anesthesiologists practicing in the United States. DESIGN: Survey questionnaire. SETTING: University medical center. MEASUREMENTS: Questionnaires were completed by American-trained anesthesiologists who attended the 1999 American Society of Anesthesiologists (ASA) Annual Meeting. Data collected included demographics, education, skills with airway devices/techniques, management of clinical difficult airway scenarios, and the use of the ASA Difficult Airway Algorithm. MAIN RESULTS: 1) DEMOGRAPHICS: 452 questionnaires were correctly completed; 62% attending anesthesiologists, 70% <50 years, 81% males, 44% from academic institutions, 63% >10 years of practice, 81% night duty, 77% board certified. 2) Education: 71% had at least one educational modality: difficult airway rotation, workshops, conferences, books, and simulators. 3) Skills: Miller blade 61%, Bullard laryngoscope 32%, LMA 86%, Combitube 43%, bougie 43%, exchangers 47%, cuffed oropharyngeal airway (COPA) 34%, retrograde 41%, transtracheal needle jet ventilation 34%, cricothyrotomy 21%, fiberoptics 59%, and blind nasal intubation 78%. The average reported use of special airway devices/techniques was 47.5%. 4) Management choices: failed intubation/ventilation: LMA (81%) and for all other situations: fiberoptic intubation. Use of ASA Difficult Airway Algorithm in clinical practice (86%). CONCLUSION: Fiberoptic intubation and the LMA are most popular in management of the difficult airway.

Anesthesia, Conduction↗
PubMed2003

Current understanding of the patient's attitude toward the anesthetist's role and practice in Israel: effect of the patient's experience.

STUDY OBJECTIVE: To assess the patient's understanding and knowledge of the anesthesiologist's role and responsibilities in the operating room and in other areas of hospital activity, and to delineate the effect of previous anesthetic experience on this knowledge. DESIGN: Prospective study consisting of standard preanesthetic interview and questionnaire survey. SETTING: Preoperative anesthetic clinic in a large central private hospital in Israel. PATIENTS: 295 adult patients who were seen in the preanesthetic clinic in a 4-week period in May, 2000. INTERVENTIONS: After patients were checked for exclusion criteria and given a standard preanesthetic interview, all adult patients presenting to this clinic were asked to participate in the study and complete a questionnaire, which was later evaluated statistically. RESULTS: A total of 295 patients (90% response rate) took part in the study. Two hundred (67.8%) patients had previous experience with anesthetics (Group A), and 95 (32.2%) patients presented for the first time for anesthesia (Group B). Ninety-five percent in Group A and 94.7% of Group B believed that the anesthesiologist is a doctor. Ninety-three percent of Group A and 90.5% of Group B answered that the anesthesiologist himself administered the anesthetic drugs. As to the responsibility for the patient's well-being during the operation and postoperatively, opinion was divided equally as to whether the surgeon or the anesthesiologist is responsible. The patients in both groups seemed to be well informed about the way anesthetic drugs act. Only 4% of patients of both groups knew about the anesthesiologist's other duties outside the operation room. CONCLUSION: If able to be extrapolated to all of Israel, our results show a high appreciation for the physician status of the anesthesia professional and role in safe recovery. Passive learning from a prior anesthetic experience did not appear to improve such appreciation.

Adult↗
PubMed2003

Difficult laryngoscopy: incidence and predictors in patients undergoing coronary artery bypass surgery versus general surgery patients.

OBJECTIVE: Cardiac surgery patients might have a higher incidence of difficult laryngoscopy than the general population because of older age, dental problems, and obesity. The authors estimated the incidence and predictors of difficult laryngoscopy in coronary artery bypass surgery patients. DESIGN: Prospective, controlled study. SETTING: University setting. PARTICIPANTS: Patients undergoing coronary artery bypass or general surgery. INTERVENTIONS: Two hundred consecutive patients undergoing coronary artery bypass graft and 444 general surgery patients, all aged >40 years, were compared for the incidence and predictors of difficult laryngoscopy, defined as a grade III or IV view. MEASUREMENTS AND MAIN RESULTS: Predictors of difficult laryngoscopy were considered mouth opening <4 cm, limited cervical mobility, thyromental distance <6 cm, protruding or partially missing upper teeth, and Mallampati classes 3 and 4. More cases of difficult laryngoscopy were recorded in cardiac patients (10% v 5.2%, p <0.023). The cardiac patients were older, mostly men, and belonged to ASA III-IV risk classes. Mallampati classes 3 and 4 were more frequent in the control group. With univariate analysis, difficult laryngoscopy correlated with 7 variables: older age, ASA-IV risk class, protruding or partially missing upper teeth, limited mouth opening, limited neck movement, thyromental distance <6 cm, and diabetes mellitus. Multivariate analysis adjusted for propensity score identified older age (odds ratio = 1.05/yr, 95% confidence interval = 1.005-1.09, p < 0.03) and limited neck movement (odds ratio = 9.5, 95% confidence interval = 2.2-41, p < 0.003), but not cardiac surgery per se, as independent predictors of difficult laryngoscopy. CONCLUSIONS: Difficult laryngoscopy was more frequent in cardiac surgery patients (10% v 5.2%). Older age and limited neck movement, but not cardiac surgery per se, were independent predictors of difficult laryngoscopy.

Adult↗
PubMed2003

Anesthetic management of juvenile nasopharyngeal angiofibroma resection.

OBJECTIVE: To evaluate the anesthetic implications of the surgical resection of juvenile nasopharyngeal angiofibroma (JNA). DESIGN: Retrospective study. SETTING: University-affiliated community hospital. PARTICIPANTS: Ten patients undergoing resection of JNA. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Data from the records of 10 patients undergoing resection of JNA were reviewed and analyzed with regard to demographics, history of the disease, characteristics of the tumor, surgical resection techniques, and anesthetic management. Patients were age 11 to 29 years. All had nasal obstruction as presenting symptom. There was no intracranial invasion. Eight tumors were resected via a lateral rhinotomy and 2 endoscopically (after embolization of the tumor's feeding vessels). Duration of surgery was 6 +/- 1 hours for rhinotomy and 6 and 6.5 hours for the 2 endoscopic resections. Anesthesia was induced in a rapid-sequence manner. Arterial and central venous catheters were placed in all patients. Mean arterial pressure was targeted to 55 to 65 mmHg by using increasing concentrations of isoflurane. The estimated blood loss was 4,800 +/- 1,600 mL and blood replacement was 3,200 +/- 1,400 mL in the first group. The 2 other patients lost 600 mL and 1,500 mL. Blood replacement in this group was 0 and 700 mL respectively. No mortality or major morbidity occurred. CONCLUSION: Resection of JNA should be considered a major procedure with many anesthetic challenges. Isoflurane may be employed to provide deliberate hypotension.

Adjuvants, Anesthesia↗
PubMed2003

Anaesthesia for magnetoencephalography in children with intractable seizures.

BACKGROUND: Magnetoencephalography (MEG), a noninvasive technique for evaluation of epileptic patients, records magnetic fields during neuronal electrical activity within the brain. Anaesthesia experience for MEG has not yet been reported. METHODS: We retrospectively reviewed records of 48 paediatric patients undergoing MEG under anaesthesia. Thirty-one patients (nonprotocol group) were managed according to the anaesthesiologist's discretion. Premedication included oral midazolam, chloral hydrate or fentanyl oralet, intravenous midazolam or inhalational anaesthesia with sevoflurane. Anaesthesia was maintained with propofol, midazolam, fentanyl, alone or in combination. A subsequent protocol group (17 patients) received chloral hydrate as premedication and propofol for maintenance of anaesthesia. RESULTS: There was an overall 25% failure of interictal activity and localization on the MEG scan. In the nonprotocol group, 11 scans failed (35.5%). Of these, eight (72.7%) received midazolam orally. Only one failure (5.8%) was recorded in the protocol group in a patient who received chloral hydrate as sedation supplemented by sevoflurane. CONCLUSIONS: In our experience, midazolam premedication resulted in a high MEG failure rate (73%). Chloral hydrate premedication and propofol maintenance resulted in a lower incidence of MEG failure (5.8%). General anaesthesia with a continuous infusion of propofol or sevoflurane appears acceptable, although, lighter levels of anaesthesia might be required to avoid interference with interictal activity of the brain.

Anesthesia, General↗