Anesthesia with 1.5 minimum alveolar concentration sevoflurane is not altered by physostigmine as measured by bispectral and clinical indices.
OBJECTIVE
To evaluate the effect of physostigmine on 1.5% sevoflurane anesthesia and recovery.


METHODS
Prospective, randomized, double-blinded study.


METHODS
Operating room of a university-affiliated, metropolitan hospital (Aretaieion Hospital and St Savas Hospital).


METHODS
Forty female American Society of Anesthesiologists physical status I and II patients scheduled for breast biopsy.


METHODS
Patients were randomly assigned in physostigmine (PHYSO) and normal-saline (NS) group. Anesthesia was induced with sevoflurane 8% using a vital capacity breath technique, and rocuronium 0.6 mg/kg was given to facilitate Laryngeal Mask Airway (LMA) No. 4 insertion. Anesthesia was maintained with end-tidal sevoflurane 1.5 minimum alveolar concentration (MAC; 3% end-tidal concentration) throughout the procedure.


METHODS
After skin closure and under steady-state sevoflurane anesthesia 1.5 MAC, heart rate, blood pressure, and Bispectral Index (BIS) were recorded. Immediately after, the PHYSO group received intravenous 2 mg of physostigmine, whereas the NS group received equal volume of normal saline. Bispectral Index and hemodynamic measurements were recorded 5, 8, and 10 minutes after treatment. Anesthesia was then discontinued and the LMA was removed. Zero, 15, and 30 minutes after LMA removal, patients were evaluated for orientation, sedation, sitting ability, and the "picking up matches" test, as well as for nausea and vomiting.


RESULTS
No difference was found in BIS (29 +/- 4, 32 +/- 6, 31 +/- 6, 30 +/- 7, 84 +/- 11 in the PHYSO group vs 29 +/- 6, 30 +/- 6, 30 +/- 5, 31 +/- 5, 86 +/- 7 in the NS group), hemodynamic parameters, or recovery parameters between the 2 groups at any time. No nausea or vomiting was observed in either group.


CONCLUSIONS
Physostigmine did not influence BIS values or early recovery when administered to patients anesthetized with 1.5 MAC sevoflurane anesthesia.
Paraskeva
Anteia
A
Department of Anesthesiology, Aretaieion Hospital, Medical School University of Athens, 11528 Athens, Greece.
Staikou
Chryssoula
C
Diamadis
Morphis
M
Siafaka
Ioanna
I
Fassoulaki
Argyro
A
D000328:Adult; D000758:Anesthesia / Q000379:methods*; D000762:Anesthesia Recovery Period; D018685:Anesthetics, Inhalation / Q000008:administration & dosage*; D001794:Blood Pressure / Q000187:drug effects; D002800:Cholinesterase Inhibitors / Q000494:pharmacology*; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D004569:Electroencephalography / Q000187:drug effects / Q000379:methods*; D005260:Female; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D017214:Laryngeal Masks; D008738:Methyl Ethers / Q000008:administration & dosage*; D010830:Physostigmine / Q000494:pharmacology*; D011446:Prospective Studies; D000077149:Sevoflurane; D012965:Sodium Chloride / Q000008:administration & dosage; D013997:Time Factors
D018685:Anesthetics, Inhalation; D002800:Cholinesterase Inhibitors; D008738:Methyl Ethers; D000077149:Sevoflurane; D012965:Sodium Chloride; D010830:Physostigmine