Outcomes of anesthesia with TCI of propofol and remifentanel in the elderly undergoing gestroendoscopy
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Abstract:
Objective To observe the outcomes of anesthesia with target-controlled infusion(TCI) of propofol and remifentanel in the elderly undergoing gestroendoscopy.Methods A total of 200 patients aged more than 70 years old was equally assigned into two groups.Group T was given TCI with target concentrtions of propofol 0.5-1.8 μg/ml and remifentanel 0.5-1.0 ng/ml.Group P was conventionally injected propofol 1.5-2.0 mg/kg,which was followed by 4 mg/s and supplemental injection of propofol if necessary.SBP,DBP,HR,RR and SpO2 were monitored.Propofol consumption and awakening time were compared.Results Anesthesia was more stable in group T than that in group P.Propofol consumption was less in group T than that in group P [(61.5±21.3) mg vs.(98.4±31.2) mg] and awakening time was earlier in group T than that in group P[(62±38) s vs.(426±57) s](P0.05).There was no case with severe respiratory depression in both groups.ConclusionCompared to propofol alone,anesthesia with TCI of propofol and remifentanel is better with less requirement of propofol and earlier awakening after surgery in the elderly undergoing gestroendoscopy.Keywords:
Target controlled infusion
Group B
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Mean arterial pressure
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Background: Clinically optimized focusing of drug administration to specific need of patient with bispectral index (BIS) monitoring results in reduced dose and faster recovery of consciousness. This study was planned with an aim to study and compare the conventional clinical end point or BIS on the requirement of dosage of propofol, hemodynamic effects, and BIS alterations following propofol induction. Methods: 70 patients, ASA I and II, 20-60 years undergoing elective surgical procedure under general anesthesia with endotracheal intubation were selected and divided into two groups. Group A received (inj.) fentanyl (2 μg/kg), followed 3 min later by inj. propofol at the rate of 30 mg/kg/hr infusion till the loss of response to verbal command while group B received inj. fentanyl (2 μg/kg), followed 3 min later by inj. propofol at the rate of 30 mg/kg/hr infusion. The end point of hypnosis was when the BIS value was sustained for 1 min at 48±2. The patients were intubated. Total induction dose of propofol was noted in each group. The value of BIS and hemodynamic parameters (heart rate, systolic/diastolic blood pressure) were noted at the time of loss of consciousness, at the time of intubation, and 1 min after intubation, thereafter every minute for first 10 min and thereafter every 10 min till end of surgery. Any involuntary muscle activity such as jerky movements, dystonic posturing, and opisthotonos were also recorded. Results: The mean dose of propofol used in groups A and B were 1.85±0.48 mg/kg and 1.79±0.41 mg/kg, respectively. The dosage used in group B were less but not clinically significant (P=0.575). On comparing the dosage of propofol in males among the groups there was a significantly lower dosage of propofol required in group B (2.06±0.45 mg/kg and 1.83±0.32 mg/kg, respectively, P=0.016). This decrease however was not seen in female patients dosage being 1.65±0.44 mg/kg and 1.75±0.49 mg/kg, respectively (P=0.372). The hemodynamic variables including heart rate, systolic/diastolic blood pressure and BIS were comparable within the group at induction, post-induction, and intubation. However, there was a significant increase in all the parameters at postintubation readings (P<0.001). Conclusion: No significant difference in the induction dose of propofol was observed when assessed clinically (loss of verbal response) or by BIS monitoring. Traditional teaching to titrate the dose of propofol and depth of anesthesia during intubation by loss of verbal response is as good as BIS value monitoring.
Bispectral index
Mean arterial pressure
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A retrospective study was performed to evaluate recovery from total intravenous anesthesia (TIVA) with propofol and buprenorphine for various types of surgery. The patients of the study were divided into two groups; Group A: n = 85, age 66 +/- 12 Y, duration 282 +/- 102 min, with epidural block and Group B: n = 56, 52 +/- 20 Y, 172 +/- 90 min, without the block. All patients were premedicated with intramuscular midazolam (1-5 mg). Anesthesia was maintained with propofol infusion with 40% oxygen in air, and an intravenous bolus dose of buprenorphine (0.11 +/- 0.03 mg). Muscle relaxation was obtained by intravenous vecuronium. The patients of Group A were supplemented with continuous epidural anesthesia using 2% mepivacaine. The maintenance dose of propofol (Group A: 4.5 +/- 1.2 mg.kg-1.h-1, Group B: 7.0 +/- 1.8 mg.kg-1.h-1) and temperature at the end of surgery decreased significantly with age. Awakening time in all patients was 12.3 +/- 7.4 min and it was correlated significantly with age and hypothermia, but not correlated with the maintenance dose or duration of propofol infusion. In short-duration surgery (within 2 hours, n = 36) awakening time was correlated with neither age nor temperature. There was no difference in awakening time between genders. Requirement for analgesics within 20 hours was 18.8% in Group A and 14.3% in Group B. Four patients (2.8%) reported dreaming, but none of the patients recalled the intraoperative events. We suggest that in elderly patients the reduction of intravenous anesthetics, maintenance of normothermia and short-duration surgery would result in rapid recovery in TIVA.
Midazolam
Bolus (digestion)
Mepivacaine
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Objective
To evaluate the effectiveness and safety of the combination of dexmedetomidine and propofol for sedation in pediatrics undergoing regional anesthesia.
Methods
Forty-eight children aged 2-6 years old, scheduled for elective surgery under regional anesthesia, were randomly divided into the two groups. The dexmedetomidine plus propofol group(group DP,n=24)received an infusion over 10 minutes of dexmedetomidine 0.7μg/kg and propofol 1.0 to 2.5 mg/kg bolus for induction,then an infusion of dexmedetomidine 0.5μg·kg-1·h-1 and propofol 100-300μg·kg-1·min-1 for maintenance.The propofol group(group P,n=24)received a propofol 1.0 to 2.5mg/kg bolus for induction,then an infusion of propofol 150-300μg·kg-1·min-1 for maintenance.If body movement was detected during surgery,a bolus of propofol 1.0mg/kg was administered in both groups,and if there was another body movement within three minutes of the propofol bolus,a bolus of ketamine 1.0mg/kg was administered. Hemodynamic data, respiratory rate,and oxygen saturation were recorded by researchers blinded to the study drugs. Recovery time and the primary outcome were evaluated by a modified Aldrete score. The occurrence of adverse events and the amount of supplemental ketamine used were also recorded.
Results
The consumption of propofol in the group DP was(149.00±24.93)μg·kg-1·min-1,and in the group P was(217.00±17.90)μg·kg-1·min-1.The propofol consumption was significant lower that in group DP(t=117.94,P=0.00).The needs for supplemental ketamine bolus in the group DP was 0.50(1.00)/case,and it was 2.00(1.00)/case in group P.The need for supplemental ketamine was less in group DP(Z=-4.48,P=0.00).Hypopnea occurred in 5 cases in group P,and 0 in group DP.The incidence of hypopnea was more in group P(χ2=5.58,P=0.03). In group DP,the mean arterial pressure and heart rate at discharge were respectively(74.96±5.69)mm Hg and(101.17±9.65) bpm,and their baseline values were(81.13±7.23)mm Hg and(112.00±13.65)bpm.Both mean arterial pressure and heart rate in the group DP remained decreased at discharge(t=10.78,P=0.00;t=10.08,P=0.00;respectively). The discharge time of the group DP was(40.91±10.90)min and it was(39.67±14.95)min in group P.There was no significant difference in the discharge time(t=0.11,P=0.74).
Conclusion
The combination of dexmedetomidine and propofol can provide appropriate depth of sedation in pediatric patients undergoing regional anesthesia.
Key words:
Dexmedetomidine; Propofol; Anesthesia and sedation; Anesthesia,combined with; Children
Dexmedetomidine
Bolus (digestion)
Loading dose
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Objective:To compare the clinical effects of propofol auto-co-induction and midazolam propofol co-induction. Methods:90 elective operation patients of ASAⅠ-Ⅱ grade aged 18～55 years were divided randomly into three groups, M-P group(midazolam propofol co-induction group),P-P group (propofol auto-co-induction group) and P group (propofol induction group). Patients in M-P group were received midazolam 3mg, patients in P-P group were received pre-administering propofol 30 mg given as a bolus before anesthesia was induced with intravenous propofol and patients in P group were received intravenous propofol directly. Mean arterial pressure (MAP) and heart rate of all patients were monitored before induction and intubation. Results:The induction dose of propofol required in M-P group or P-P group was smaller than that of P group. The decrease in MAP and HR was significantly smaller in M-P group when compared to P group. There was no statistical difference in MAP and HR reduction between P-P group and P group. There was a significantly greater in MAP and HR decreases when P-P group was compared to M-P group. Conclusions:Either midazolam propofol co-induction or pre-administering propofol auto-co-induction can decrease the dose of propofol required to induce anesthesia, but when compared to midazolam propofol co-induction, pre-administering propofol auto-co-induction had no benefit to maintain hemodynamics stability.
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Objective
By comparing the sedative effects of three anesthetisa methods of propofol on painless gastroscopy in morbidly obese patients to explore the optimal administration method of propofol.
Methods
90 patients with painless gastroscopy in the People's Hospital of Xinjiang Uygur Autonomous Region, aged 18 to 50 years, with BMI over 35 kg/m2, and ASA class I to II. They were randomly divided into three groups according the digital table method, with 30 patients in each group. At first, all the three groups of patients were given 0.1 μg/kg Sufentanil; in group A, 2 mg/kg propofol was injected after 2 minutes. In the group B, 1mg/kg propofol was given during at the same time as sufentanil, and the addition of 1 mg/kg propofol after 2min. In the group C, propofol was injected to maintain the plasma concentration at Cpt 2.5 μg/mL by TCI during giving sufentanil. All three groups were inserted nasopharyngeal airway after the patient fell asleep and the reflexes of the eyelashes disappeared. The anesthesiologist lifted the patient's lower jaw and operation began after patients breathed smoothly. If there is obvious body movement during operation, additional 0.5 mg/kg propofol would be added to enhance and maintain anesthesia. The heart rate (HR) of the three groups before the induction of anesthesia (T0), after the induction of anesthesia (T1), and at the time of the blink (T2) were recorded. We observed the numbers of coughing, significant respiratory depression and stopping operations; the Ramsay sedation score, time to start operation; time of opening their eyes, recovering orientation and recovering cognition, and propofol dosage (mg/kg).
Results
There was a statistically significant difference in HR between T1 and T0 in group A and group C (P 0.05). The incidence of respiratory depression was significantly lower in group B than in group A and C (P<0.05). Compared with group B and C, the incidence of cough and cessation during operation was significantly higher in group A (P<0.05). Compared with group B and C, the Ramsay sedation score was significantly lower in group A (P<0.05). The time of starting operation, opening eyes, recovering orientation and cognition in group B were significantly shorter than those of group A and group C (P<0.05). Compared with group A and C, the dosage of group B was significantly reduced (P<0.05).
Conclusions
The best mode of anesthesia for painless gastroscopy in obese patients is drug administration in divided doses.
Key words:
propofol; ureteral stent removal surgery; methods of anesthetisa
Sufentanil
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Alfentanil
Acepromazine
Respiratory Rate
Mean arterial pressure
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To explore the effects of propofol target controlled infusion (TCI) plus a low concentration of sevoflurane inhalation induction for the removal of tracheobronchial foreign body in children.After the approval of the hospital ethics committee, a total of 90 patients, aged 9 - 36 months old and weighted 8 - 17 kg, were randomly divided into 3 groups: group A, group B and group C. Propofol TCI plus a low concentration of sevoflurane inhalation induction was administered in group A while ketamine or fentanyl plus propofol TCI in group B or C respectively. Effects of anesthesia, complications and recovery durations were observed.The incidence of severe breathholding and bucking during inserting bronchoscope was 1 case in group A, 7 in group B and 5 in group C. There were significant differences between groups A and B (P < 0.05). The minimal intra-operative SpO2 in group B or group C was lower than that in group A (P < 0.01). The cases for intra-operative SpO2 < 95% in group B or group C were more than that in group A (P < 0.01). And the maximal target concentration of propofol was significantly higher than that in group A (P < 0.01). Ten cases in group B had laryngeal stridor and dyspnea during inspirations post-operatively and occurred more frequently than those in group A or C (P < 0.01). As compared with group A and C, post-operative staying lengths and recovery durations were significantly longer in those in group B (P < 0.01).Propofol TCI plus a low concentration of sevoflurane inhalation induction is both safe and practical for the controlled removal of tracheobronchial foreign body in children.
Group B
Group A
Target controlled infusion
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Objective To evaluate the efficacy and safety of dexmedetomidine combined with propofol for gastroscopy in elderly patients.Methods Ninety ASA physical status Ⅰ-Ⅲ patients,aged 65-80 yr,weighing 45-80 kg,scheduled for elective gastroscopy,were randomized to receive either dexmedetomidine combined with propofol (group DP,n =45) or propofol (group P,n =45).In group DP,dexmedetomidine 0.4 μg/kg was infused over 5 min and propofol 1.0 mg/kg was injected intravenously 25 min later.Propofol 2.0 mg/kg was injected intravenously in group P.When body movement occurred during operation,additional propofol 0.2 mg/kg was given intermittently.Mean arterial pressure (MAP),heart rate (HR),pulse oxygen saturation (SpO2) and Narcotrend index were monitored during the whole procedures.The consumption of propofol and vasoactive agents,adverse cardiovascular events,and respiratory depression were recorded.Results Compared with group P,the consumption of propofol,incidences of respiratory depression and tachycardia,and degree of body movement were significantly decreased (P ＜ 0.05),Narcotrend index was increased during operation (P ＜ 0.01),and no significant change in the incidence of circulatory depression was found in group DP (P ＞ 0.05).Conclusion Small dose of dexmedetomidine 0.4 μg/kg combined with small dose of propofol 1.0 mg/kg provides good efficacy and safety for gastroscopy in elderly patients.
Key words:
Aged; Gastroscopy ; Anesthesia ; Dexmedetomidine ; Propofol
Dexmedetomidine
Mean arterial pressure
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Objective To investigate the effect of different target plasma concentrations (Cp) of remifentanil on sedative effect of propofol. Methods Eighty adult ASA Ⅰ or Ⅱ patients aged 18-60 yr undergoing elective laparoscopic cholecystectomy were randomly assigned into 4 groups (n = 20 each). Anesthesia was induced with TCI of remifentanil (Cp = 2, 4 and 8 ng/ml in group Ⅱ-Ⅳ respectively) and propofol TCI (the initial Cp of propofol was 2 μg/ml in the 4 groups). Then the Cp of propofol increased by 0.5 μg/ml every 1 min until BIS value decreased to 50. BIS value and the Cp of propofol were recorded as the patient lost consciousness.The Cp and consumption of propofol were recorded when BIS value decreased to 50. Results BIS value was significantly increased, while the Cp of propofol was significantly decreased as the patient lost consciousness, and the Cp and consumption of propofol were significantly decreased when BIS value decreased to 50 in group Ⅲ - Ⅳ compared with group Ⅰ (P ＜ 0.05). Conclusion Remifentanil 4 ng/ml is the suitable Cp for anesthesia when combined with propofol.
Key words:
Piperidines; Propofol; Conscious sedation; Drug delivery systems
Target controlled infusion
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