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PubMed1980

Practical and pharmacological implications of continuous intravenous anesthesia.

The concept of continuous intravenous anesthesia is reviewed and the need for an index comparable to MAC (minimum alveolar concentration) for volatile and gaseous anesthetics is stressed. The pharmacokinetic requirements for an intravenous anesthetic for continuous infusion are stated, and the place of existing intravenous anesthetics is discussed.

Anesthesia, Intravenous↗
PubMed1995

[Intravenous anesthesia--current aspects].

Intravenous anaesthesia as a defined technique has become popular in recent years, since new developed drugs and more sophisticated application systems were introduced into clinical practice. However, only a minority of anaesthesiologists really practise this new technique. The scientific basis of continuous intravenous anaesthesia has not been spread widely in the anaesthetic community yet. The following review therefore focusses on recent findings and developments in the field of pharmacology, pharmacokinetics, pharmacodynamics and modern application systems of intravenous anaesthetic drugs. The new opioid remifentanil is described, new aspects in the interpretation of pharmacokinetic data are presented and the concept of context-sensitive halftimes as a parameter to estimate the decrease in clinical effect of intravenous anaesthetics is introduced. Drug effect in clinical anaesthesia is a result of equilibration of the drug with the effect site (Biophase). By means of defining the effect site equilibration time (t1/2ke0 and the drugs concentration at which this effect is achieved (Cp50) the pharmacodynamic properties of each intravenous anaesthetic can be characterised. Computerised pharmacokinetic data can be used to generate stable drug concentrations (target plasma concentration) when connected to an infusion pump. These target controlled systems are able to reach a predefined level rapidly and to maintain it. Thus pharmacodynamic interactions of intravenous drugs can be evaluated. The newly found properties of propofol, such as antiemetic, anticonvulsive and antioxidant, and its present clinical use are described. Finally, modern continuous intravenous anaesthetica techniques have been feasible only by the development of efficient application systems. The text gives an overview of the properties of modern syringe pumps and future developments of "smart" pumps.

Analgesics, Opioid↗
PubMed1991

[Clinical study on total intravenous anesthesia with droperidol, fentanyl, and ketamine--6. Effects on postoperative liver function].

We have developed a new method of total intravenous anesthesia with droperidol, fentanyl, and ketamine, and have administered it to more than 700 surgical patients. We studied whether this method of anesthesia would influence postoperative liver function or not. A total of sixty elective surgical patients were the subjects of this study. Thirty patients underwent total hysterectomy under either the total intravenous anesthesia (15 patients) or modified neurolept-anesthesia with pentazocine (15 patients). The remaining 30 patients underwent gastrectomy under either this total intravenous anesthesia (15 patients) or enflurane-N2O anesthesia (15 patients). The hepatic function was evaluated as judged by s-GOT, s-GPT, ALP, gamma-GPT and total bilirubin levels, before anesthesia and during the first to third postoperative day. The patients for gastrectomy under enflurane-N2O anesthesia had significantly increased postoperative gamma-GPT levels compared with the patients of total intravenous anesthesia. Any other variables showed no significant difference among groups. We consider that this method of total intravenous anesthesia has no adverse effects on postoperative liver function as compared with other usual anesthetic methods.

Anesthesia, Inhalation↗
PubMed1991

[A review of recent advances in total intravenous anesthesia].

Recent articles on total intravenous anesthesia (TIVA) were reviewed. The definition of TIVA is a combination of hypnotic agent, analgesic drugs and muscle relaxants, excluding simultaneous administration of any inhaled drugs. Anesthesia with single and massive doses of narcotic drugs such as fentanyl for cardiac anesthesia is not described in this paper. About thirty articles on TIVA which appeared in the journals of our specialty for three years from 1988 through 1990 were reviewed. In these papers, midazolam, ketamine, propofol were employed as the hypnotic agents, and fentanyl, alfentanyl, or sufentanyl were administered for analgesia during surgery. Based on pharmacokinetic studies, continuous intravenous administration of these agents are strongly recommended and infusion pumps with or without computer may be used for this purpose. The reviewer has developed a new TIVA using droperidol, fentanyl and ketamine 2 micrograms.kg-1.hr-1 and has applied it for over 800 cases excluding cardiac surgery and craniotomy. This combination of the drugs is considered the best, because propofol, alfentanyl and sufentanyl are not available in Japan so far. TIVA has many advantages over inhaled anesthesia and it can be easily employed not only in the modern sophisticated situations but also in so-called field conditions. We anesthesiologists should be much more familiar with this method of anesthesia.

Analgesics↗
PubMed1985

A hemodynamic study of epidural versus intravenous anesthesia for aortofemoral bypass surgery.

The hemodynamic effects of two types of anesthesia on aortofemoral bypass surgery were studied in a randomised prospective trial. Epidural anesthesia supplemented with nitrous oxide (group I) and total intravenous anesthesia combining fentanyl and a continuous infusion of etomidate (group II) were compared. A high incidence of preoperative disease was found and all 18 patients were classified in ASA classes III-IV. It is concluded that epidural anesthesia provides excellent anesthetic and hemodynamic stability provided that an optimal filling pressure is maintained. Total intravenous anesthesia resulted in significant hypertensive reactions during surgery, which were not specifically related to crossclamping. Decreasing the high SVRI with vasodilatory treatment was necessary to treat hypertension in all those patients with preoperative hypertensive disease. No problems were seen in the intravenous group patients without preoperative hypertension. Cardiac work was higher in the intravenous group due to the high impedance of the cardiovascular system provoked by the absence of vasodilatory properties with this type of intravenous anesthesia. Monitoring of PWP and CI by Swan-Ganz catheter is shown to be very useful for optimalization of hemodynamics and fluid management especially during crossclamping, when normal Frank-Starling relationships might not be valid anymore. The effect of vasodilatory treatment, crossclamping and declamping could be carefully evaluated.

Aged↗
PubMedDate not supplied

[Intravenous anesthesia in surgical interventions in ambulatory practice].

Intravenous anesthesia with calipsol and diprivan was used in 297 gynecological patients subjected to various short-term interventions. The course of anesthesia was monitored (arterial pressure, respiration rate, SaO2, Fet CO2) and time course of recovery of attention, thinking, and motor activity in the postoperative period after different types of anesthesia was assessed. Diprivan and fentanyl (0.7-0.8 microgram/kg) anesthesia is preferable for surgical interventions in an outpatient setting due to a smooth and uneventful course of the postoperative period and its slight effect on the cardiovascular system.

Abortion, Induced↗
PubMed1999

[A case of total intravenous anesthesia with propofol, fentanyl and ketamine for lateral segmentectomy of the liver under pringle maneuver].

We successfully anesthetized an 80-year-old female for Pringle maneuver which was applied at the time of liver transection and consisted of cross-clamping the hepatoduodenal ligament for 25 minutes and releasing the clamp for 2 minutes until the completion of the liver transection. Anesthesia chosen was total intravenous anesthesia with propofol, fentanyl and ketamine (PFK) in combination with epidural anesthesia. The plasma concentrations of propofol at pre-, intra-, and post-Pringle maneuver under the intravenous infusion of propofol at 3 mg.kg-1.h-1 were 0.84, 1.49, and 1.29 micrograms.ml-1, respectively. All operative procedures were done uneventfully and recovery from anesthesia was prompt after the end of propofol infusion. Transient increases in liver enzymes were seen during early postoperative period, but no signs of hepatic failure were observed. In this patient, PFK anesthesia was useful and safe for the liver transection with Pringle maneuver.

Aged↗
PubMed1987

Atracurium infusion in total intravenous anesthesia.

The neuromuscular blocking effect of atracurium given as a bolus dose (0.5 mg X kg-1) followed by a maintenance infusion was studied during two different anesthetic techniques. It has been reported that benzodiazepines interact with non-depolarising neuromuscular blockers. In this study no difference was found in the effect of atracurium given with conventional fentanyl/nitrous oxide anesthesia when compared to total intravenous anesthesia using midazolam/alfentanil. More than 90% twitch depression was achieved after 123 and 137 s, respectively. Recovery time to 10% twitch height following the bolus dose was around 32 min. The dosage range for atracurium given by infusion (0.29-0.44 mg X kg-1 X h-1) was confirmed.

Adult↗
PubMed1999

[Total intravenous anesthesia for two patients complicated with myotonic dystrophy].

Total intravenous anesthesia with propofol, fentanyl and ketamine (PFK) was given to two patients complicated with myotonic dystrophy. Case-1: A 42-year-old female underwent a hemithyroidectomy. Anesthesia was induced slowly with intravenous ketamine 20 mg and propofol 60 mg. Her tracheal intubation was performed smoothly without any muscle relaxants. Anesthesia was maintained with propofol infusion of 5 mg.kg-1.h-1, ketamine infusion of 0.3 mg.kg-1.h-1 and fentanyl 200 micrograms in total. She regained consciousness 20 minutes after the end of propofol infusion, and 15 minutes later, her trachea was extubated without any troubles. Case-2: A 41-year-old female underwent a removal of left parotid tumor. Anesthesia was induced slowly with ketamine 40 mg and propofol 100 mg intravenously. Anesthesia was maintained with propofol infusion of 5-10 mg.kg-1.h-1, ketamine infusion of 0.5 mg.kg-1.h-1 and fentanyl 350 micrograms in total. No muscle relaxant was used through the surgical procedure. Emergence from anesthesia was observed 10 minutes after the end of propofol infusion and her trachea was extubated. When a nasogastric tube was pulled out, her respiration stopped suddenly and she was intubated again only for two hours without any troubles. In both cases their serum CPK levels and rectal temperatures were very stable. PFK method would be a choice for patients with myotonic dystrophy.

Adult↗