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At least 127 records · Page 7Linked to original sources
PubMed2002

Total intravenous anesthesia for intraoperative monitoring of the motor pathways: an integral view combining clinical and experimental data.

OBJECT: Monitoring of descending corticospinal pathways by using motor evoked potentials (MEPs) has proven to be useful in preventing permanent neurological deficits during cranial and spinal procedures. Difficulties in interpretation of intraoperative changes in potentials may largely be attributed to the effects of anesthesia. Development of suitable intravenous anesthesia protocols specifically tailored for MEP monitoring, including plasma level target-controlled infusion (TCI), requires precise knowledge of the specific neurophysiological properties of the various agents. METHODS: The effects of alfentanil, sufentanil, fentanyl, remifentanil, thiopental, midazolam, etomidate, ketamine, and propofol on neurogenic and myogenic MEPs were evaluated in an integral study combining clinical data obtained in 40 patients and experimental investigations conducted in 140 animals. The dose-dependent modulation of MEPs after electrical and magnetoelectrical stimulation of the motor cortex was recorded from peripheral muscles and the spinal cord. The results were as follows: opioids, propofol, and thiopental suppressed myogenic, but not neurogenic MEPs in a dose-dependent fashion; remifentanil exerted the least suppressive effects. Etomidate and midazolam did not suppress myogenic MEP, even at plasma concentrations sufficient for anesthesia. Ketamine induced moderate reduction of compound muscle action potential amplitudes only at high doses. Remifentanil and propofol administered via TCI systems allowed recording of myogenic potentials within a defined target plasma concentration range. CONCLUSIONS: Development of standardized total intravenous anesthesia/TCI protocols by using anesthetic agents such as propofol, remifentanil, ketamine, and midazolam, which have favorable pharmacokinetic and neurophysiological properties, will enhance the quality of intraoperative MEPs and promote the use of MEP monitoring as a useful tool to reduce surgery-related morbidity.

Adult↗
PubMed2003

Intravenous anesthesia provides optimal surgical conditions during microscopic and endoscopic sinus surgery.

OBJECTIVES/HYPOTHESIS: Controlled hypotension is used to improve surgical conditions during microscopic and endoscopic sinus surgery. New short-acting anesthetics such as propofol and remifentanil allow exact control of intraoperative blood pressure and thus might be valuable tools to improve intraoperative conditions for the otorhinolaryngological surgeon. Intravenous anesthesia was compared with traditional balanced anesthesia by subjective assessment of surgical conditions made by two experienced otorhinolaryngological surgeons. STUDY DESIGN: Prospective, randomized, patient- and observer-blinded study. METHODS: Ninety consecutive patients were randomly assigned to receive intravenous anesthesia with propofol 5 to 8 mg.kg-1.h-1 and remifentanil 10 to 30 microg.kg-1.h-1 or with isoflurane (0.4-1.0 vol%) and repetitive doses of 0.5 to 1 mg alfentanil. An injectable vasodilator was used in both groups to keep mean arterial pressure between 60 and 70 mm Hg (8-9.3 hecto-pascal). The attending otorhinolaryngological surgeon was unaware of the type of anesthesia administered. Immediately after the operation the surgeons rated surgical conditions (bleeding from the surgical field) on a visual analogue scale (0-10 cm) and on a verbal rating scale. RESULTS: Blood pressure was not different between the two groups, but heart rate was lower in the intravenous anesthesia group (mean heart rate in the intravenous anesthesia group, 62 beats per min [95% confidence interval, 52-72]; mean heart rate in the balanced anesthesia group, 75 beats per min [95% confidence interval, 67-83]). Surgical conditions were rated to be significantly better (P <.0001) during anesthesia with propofol-remifentanil (median rating: 2.8; 25th/75th percentile: 2.0/3.4) compared with isoflurane-alfentanil (median rating: 4.9; 25th/75th percentile: 3.6/7.6). CONCLUSIONS: Intravenous anesthesia using propofol-remifentanil provides better surgical conditions compared with a traditional balanced anesthesia technique using isoflurane-alfentanil. It is hypothesized that lower cardiac output caused by decreased heart rate during deep general anesthesia is responsible for this result.

Adult↗
PubMed1990

[Clinical study on total intravenous anesthesia with droperidol, fentanyl and ketamine--1. Introduction].

We have developed a new method of total intravenous anesthesia with droperidol, fentanyl and ketamine and have administered it to more than 400 surgical patients, ranging in ages from 4 to 80 years. Cardiac and neurosurgical patients were excluded. After establishing a routine monitoring, droperidol 0.06-0.1 ml.kg-1 was slowly given. After 5 minutes, fentanyl 1-2 micrograms.kg-1 and ketamine 1.0-1.5 mg.kg-1 were slowly administered intravenously. Trachea was intubated following intravenous succinylcholine. A total dose of 5-15 micrograms.kg-1 of fentanyl was given intravenously with a continuous infusion of ketamine 2 mg.kg-1.hr-1 during surgical procedure. Air and O2 (FIO2 0.30-0.35) were given and muscle relaxation was achieved with necessary dose of intravenous pancuronium or vecuronium and no inhaled anesthetic was given. Total intravenous anesthesia has many advantages such as no air pollution in the operating theatre, empty bowels, no organ (hepato-renal) toxicity, good peripheral perfusion and low cost, while this method has several disadvantages to overcome such as hypertension. There are many anesthetic agents for total intravenous anesthesia. However, sufentanil, alfentanil and propofol are not available. Droperidol, fentanyl and ketamine are the best combination for this purpose in Japan so far.

Adolescent↗
PubMed2006

[Anesthetic management of a patient with mitochondrial encephalomyopathy under total intravenous anesthesia].

This report describes a patient with mitochondrial encephalomyopathy who underwent tracheostomy under total intravenous anesthesia. This 15-year-old girl had been suffering from aspiration pneumonia repeatedly. Anesthesia was induced with propofol (30 mg) and fentanyl (50 microg), and the trachea was intubated without a muscle relaxant. The patient was mechanically ventilated also without a relaxant, and anesthesia was maintained with a continuous infusion of propofol 4-10 mg x kg(-1) x hr(-1) and a bolus injection of fentanyl 25 microg. Bispectral index (BIS) was monitored and maintained at 15-65. The patient showed smooth recovery from anesthesia, and the BIS value returned to the pre-anesthetic level 15 minutes after completion of the anesthesia. Her postoperative course was uneventful. We conclude that total intravenous anesthesia by propofol and fentanyl is a preferable method for the management of the patient with mitochondrial encephalomyopathy.

Adolescent↗
PubMed1997

[Total intravenous anesthesia with propofol and fentanyl for laparoscopic cholecystectomy].

The postoperative antiemetic effect of total intravenous anesthesia with propofol and fentanyl was evaluated in 40 patients for laparoscopic cholecystectomy. Patients were divided into 2 groups. In group P, anesthesia was induced with intravenous fentanyl 0.1 mg and propofol 2 mg.kg-1 and maintained with continuous infusion of propofol. In group I, anesthesia was induced with intravenous thiopental 5 mg.kg-1 and maintained with nitrous oxide 60% in oxygen and isoflurane. Post-operative nausea and vomiting were recorded for 8 h after surgery. Nausea scores (range 1-4) were significantly lower in group P as compared with group I at 0 h after surgery, but no difference between the groups at 2 h, 4 h, 8 h after surgery. No significant differences were found in the incidence of vomiting between the groups. These results suggest that total intravenous anesthesia with propofol and fentanyl is superior to inhalational anesthesia with nitrous oxide and isoflurane in postoperative nausea. This antiemetic effect is, however, limited in the early period after anesthesia.

Aged↗
PubMed2001

Assessment of depth of anesthesia and postoperative respiratory recovery after remifentanil- versus alfentanil-based total intravenous anesthesia in patients undergoing ear-nose-throat surgery.

BACKGROUND: The authors investigated whether total intravenous anesthesia (TIVA) with precalculated equipotent infusion schemes for remifentanil and alfentanil would ensure appropriate analgesia and that remifentanil would result in better recovery characteristics. METHODS: Forty consenting patients (classified as American Society of Anesthesiologists physical status I-III) scheduled for microlaryngoscopy were randomized to receive, in a double-blind manner, either remifentanil (loading dose 1 microg/kg; maintenance infusion, 0.25 microg x kg(-1) x min-1) or alfentanil (loading dose, 50 microg/kg; maintenance infusion, 1 microg x kg(-1) x min-1) as the analgesic component of TIVA. They were combined with propofol (loading dose, 2 mg/kg; maintenance infusion, 100 microg x kg(-1) min(-1)). To insure an equal state of anesthesia, the opioids were titrated to maintain heart rate and mean arterial pressure within 20% of baseline, and propofol was titrated to keep the bispectral index (BIS) less than 60. Neuromuscular blockade was achieved with succinylcholine. Drug dosages and the times from cessation of anesthesia to extubation, verbal response, recovery of ventilation, and neuropsychological testing, orientation, and discharge readiness were recorded. RESULTS: Demographics, duration of surgery, and anesthesia were similar between the two groups. Both groups received similar propofol doses. There were no difference in BIS values preoperatively (mean, 96), intraoperatively (mean, 55), and postoperatively (mean, 96). Recovery of BIS and times for verbal response did not differ. At 20, 30, and 40 min after terminating the opioid infusion, the peripheral oxygen saturation and respiratory rate were significantly higher in the remifentanil group compared with the alfentanil group. CONCLUSIONS: When both the hypnotic and analgesic components of a TIVA-based anesthetic are administered in equipotent doses, remifentanil provides a more rapid respiratory recovery, even after brief surgical procedures, compared with alfentanil.

Adult↗
PubMed1999

[Continuous total intravenous anesthesia is recommended for wake-up test].

Total intravenous anesthesia (TIVA) has been recommended in view of avoiding air pollution. However, intermittent administration of anesthetic agents has a large disadvantage of delayed emergence time. We reported that continuous TIVA with propofol, ketamine, vecuronium and buprenorphine (PKBp) could bring rapid emergence time. An 8-year old female with spinal scoliosis underwent spinal instrumentation under continuous TIVA. Wake-up test was done twice during surgery smoothly after stopping infusion of anesthetic agents in the cocktail. We conclude that continuous TIVA is one of the most recommended anesthetic methods for wake-up test.

Anesthesia Recovery Period↗
PubMed1991

[Optimal dosage strategies in total intravenous anesthesia using propofol and ketamine].

The combination of propofol and ketamine for total intravenous anesthesia was investigated; the intention was to minimize the side effects of each drug by the concomitant application of the other drug. METHODS. Twenty patients scheduled for lower abdominal interventions were divided into two groups. In the first group anesthesia was induced and maintained by a simple administration regimen based upon pharmacokinetic principles. Ketamine and propofol were given as bolus injections (60 mg each) with a time interval of 60 s for induction followed by a two-step infusion regimen for propofol (15.5 mg/min) and later on by an additional ketamine infusion (1-2 mg/min). Bolus injections (20 mg) of ketamine were administered to increase the depth of anesthesia if necessary (Fig. 1). The second group received propofol and ketamine by microprocessor-controlled infusion pumps requiring the anesthetist to operate a single dial to preset the desired blood levels of both drugs according to the needs of the individual patient (Fig. 2). RESULTS. There were no difference (Table 1) between the two groups in the demographic data of the patients or duration of surgery (30-120 min). The total doses of propofol (750 +/- 262 vs 624 +/- 468 mg) and ketamine (158 +/- 41 vs 99 +/- 48 mg) were smaller in the computer-controlled infusion group, though this difference just failed to be significant. The hemodynamic changes during induction were minor, with a small nonsignificant increase in all parameters (Fig. 3) for 10 min. The controllability of the pharmacodynamic effects of both drugs during anesthesia was very satisfactory in the computer-assisted infusion group and quite satisfactory in the first group. There were no psychic disturbances during induction of or recovery from anesthesia. Respiration was adequate within a few minutes after the end of surgery. The patients were awake about 10 min later and fully oriented after 20 min. No major side effects were observed with this anesthetic technique. CONCLUSION. Total intravenous anesthesia with propofol and ketamine proved to be very satisfactory from a clinical point of view. The major known side effects of propofol (reduced hemodynamics during induction) and ketamine (psychic disturbances and cardiovascular stimulation) were absent and respiratory function was adequate after the end of surgery. This technique, therefore, can be used in risk patients and under disaster conditions when i.v. access is the only possible route of drug administration. The use of computer-assisted infusion pumps markedly enhances handling and controllability of total i.v. anesthesia.

Adult↗