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At least 19 recordsLinked to original sources
PubMed1992

[Clinical study on total intravenous anesthesia with droperidol, fentanyl and ketamine--15. Application for cardiac anesthesia].

Total intravenous anesthesia with droperidol, fentanyl and ketamine (DFK) was administered to 36 cardiac patients who underwent mostly coronary artery bypass graft or heart valve replacement. The induction and maintenance of anesthesia using this technique were almost satisfactory with little decrease in systolic blood pressure (SBP), although six patients among the early 21 patients developed hypotension below 90 mmHg (SBP) during the induction, and required vasopressors. Half of the patients had hypertensive episode of above 180 mmHg (SBP), from the start of operation to onset of cardiopulmonary bypass, which was safely and effectively overcome by a small dose of antihypertensive agents. Total intravenous anesthesia with DFK was accompanied with much more hypertensive episodes compared to anesthesia with moderate dose fentanyl (30 micrograms.kg-1) combined with enflurane. However, the incidence of cardiovascular complications following anesthesia was not statistically different between the two anesthesia groups. In addition, most of the patients with DFK showed a rapid awaking time with relatively good postoperative cardiovascular stability. These findings suggest that total intravenous anesthesia with DFK is accompanied with minimal hemodynamic changes during and after open heart surgery.

Aged↗
PubMed1991

[Clinical study on total intravenous anesthesia with droperidol, fentanyl and ketamine--10. Effects of prostaglandin E1 on the hepatic and renal functions following prolonged surgery under total intravenous anesthesia].

Twenty one patients who underwent prolonged surgical procedures over 10 hours under total intravenous anesthesia with droperidol, fentanyl and ketamine were studied to evaluate post-operative hepatic and renal functions as judged by serum levels of GOT, GPT, BUN and creatinine. They were divided into two groups. Ten patients of the PGE1 group were given PGE1 at a rate of 0.035 micrograms.kg-1.min-1 during anesthesia, and the remaining eleven of the control group were not given PGE1. The two groups were comparable concerning, age, body weight, height, operation time and anesthesia time. In the PGE1 group, significantly more intraoperative fluid was given than in the control group. The blood loss was more but insignificantly in the PGE1 group than in the control group. There was no significant difference in urine output and the amount of blood transfused between the two groups. In both groups, post-operative s-GOT and s-GPT levels were increased significantly compared with pre-operative values, but there was no significant difference between the two groups. Serum BUN levels of the 7-10 the post-operative days were increased significantly in the PGE1 group, but those of the control group were not. These data suggest that our method of total intravenous anesthesia with droperidol, fentanyl and ketamine, when applied even for prolonged surgical procedure over 10 hours, would have beneficial effects on the post-operative hepatic and renal functions.

Alprostadil↗
PubMed1990

[Awareness in total intravenous anesthesia].

After total intravenous anesthesia with propofol for suspension laryngoscopy the patient recalled intraoperative events. There were no obvious clinical signs during the supposed anesthetic course to warn the anesthetist that the fully relaxed patient might not be unconscious.

Adult↗
PubMedDate not supplied

Anesthesia for craniotomy: total intravenous anesthesia with propofol and alfentanil compared to anesthesia with thiopental sodium, isoflurane, fentanyl, and nitrous oxide.

STUDY OBJECTIVE: To compare a total intravenous (IV) anesthetic technique based on propofol and alfentanil with a commonly used anesthetic technique for craniotomy. DESIGN: Open-label, randomized, clinical study. SETTING: Neurosurgical clinic at a university hospital. PATIENTS: Forty patients, aged 18 to 55 years, scheduled for brain tumor surgery. INTERVENTIONS: In 20 patients, anesthesia was induced with fentanyl and thiopental sodium and maintained with fentanyl, dehydrobenzperidol, isoflurane, nitrous oxide (N2O), and a thiopental sodium infusion. Twenty patients were anesthetized with a propofol loading infusion followed by a maintenance infusion at a fixed rate. In addition, alfentanil was administered as a loading bolus, followed by a variable-rate infusion, with additional doses as necessary to maintain hemodynamic stability. MEASUREMENTS AND MAIN RESULTS: A decrease in blood pressure (BP) after induction with thiopental sodium was followed by a significant increase in BP and heart rate (HR) during intubation. BP and HR did not change during the propofol loading infusion. However, the administration of alfentanil was followed by a similar decrease in BP with a return to baseline values during the intubation period. Return of normal orientation (7 +/- 5 minutes vs 27 +/- 23 minutes) and concentration (12 +/- 12 minutes vs 35 +/- 37 minutes) was shorter and more predictable for the propofol-alfentanil-treated patients than for the thiopental sodium patients. Maintenance propofol concentration (nine patients) was between 3 +/- 0.69 micrograms/ml and 3.36 +/- 1.17 micrograms/ml, while the concentration at awakening was 1.09 microgram/ml. Alfentanil concentration at extubation (nine patients) was 79 +/- 34 ng/ml. CONCLUSION: A total IV anesthetic technique with propofol and alfentanil is a valuable alternative to a more commonly used technique based on thiopental sodium, N2O, fentanyl, and isoflurane.

Adult↗
PubMed1991

[Cytotoxic activity of natural killer cells during balanced anesthesia with isoflurane versus total intravenous anesthesia].

Using two different anaesthetic techniques, the author have investigated the cytotoxicity in process during abdominal surgery. In these investigations, no significant differences have been demonstrated in the behaviour of the NK with the two techniques adopted. The increase noted in traceable to the mobilization of the N.K. of the extra vascular deposits. The increase of the cytotoxic activity is probably traceable to the action of the endogenous opiate substances.

Adult↗
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↗
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↗
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↗
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↗