Propofol in urological endoscopy in elderly patients. Comparison with methohexital

Twenty patients undergoing cystoscopy (group A) and forty patients undergoing transurethral resection (group B), aged more than 65 years, were anaesthetized. Duration of anaesthesia was less than 15 min for cystoscopy, and more than 30 min for transurethral resection. No premedication was given. The patients were ASA I or ASA II. Group A patients were allocated randomly to receive either 1.5 mg . kg-1 propofol (n = 10) or 2 mg . kg-1 methohexitone (n = 10) for induction of anaesthesia. Anaesthesia was maintained using incremental doses of propofol or methohexitone and 60% N2O with a face-mask. Forty group B patients undergoing transurethral resection were randomly assigned to four equal groups (PB: propofol 1.5 mg . kg-1; MB: methohexitone 2 mg . kg-1; PF: propofol and 1.5 micrograms . kg-1 fentanyl; PFV: propofol, 2 micrograms . kg-1 fentanyl and 0.1 mg . kg-1 vecuronium). Suxamethonium (1 mg . kg-1; groups PB, MB and PF) and vecuronium (0.1 mg . kg-1; group PFV) were given to facilitate endotracheal intubation. Anaesthesia was maintained by infusion of propofol or methohexitone, using a calibrated pump started immediately after intubation. Ventilation was controlled only in group PFV. Induction with 1.5 mg . kg-1 propofol resulted in stopping counting after 62 s and loss of the eye-lash reflex after 84 s versus 47 and 67 s respectively with methohexitone. The anaesthesist's assessment was favourable for cystoscopy with propofol and methohexitone; recovery times were similar for the two drugs in cystoscopy lasting less than 30 min.(ABSTRACT TRUNCATED AT 250 WORDS)     

Comparison of propofol and propanidid administered at a constant rate

So as to compare the anaesthesia obtained using propofol with that obtained using propanidid, 40 ASA I patients, aged between 18 and 50 years, who were to undergo elective orthopaedic or plastic surgery lasting more than 60 min, were randomly divided into two equal groups, one receiving propofol (PF) and the other propanidid (PD). All the patients received 0.5 mg atropine, 100 mg pethidine and 7.5 mg droperidol (10 mg if weight greater than 60 kg) intramuscularly 45 min before induction. Patients in group PF were then given 2 mg.kg-1 propofol over 1 min and 0.9 microgram.kg-1 fentanyl over 3 min, followed by a constant rate infusion of 5 mg.kg-1.h-1 propofol and 3 micrograms.kg-1.h-1 fentanyl. For PD patients, the doses of fentanyl were identical; they were given 10.6 mg.kg-1 propanidid over 3 min for induction, and 37 mg.kg-1.h-1 for maintenance. All the patients were intubated and ventilated mechanically. The usual anaesthetic parameters were monitored at induction, during surgery, and during recovery. Consciousness was lost more quickly with propofol (p less than 0.05), but the corneal reflex returned more rapidly in group PD (p less than 0.02). The time required for a full return to normal consciousness was identical in both groups. The fall, during induction, and the increase, during recovery, of Pasys were greater in group PD (p less than 0.05 and less than 0.001 respectively). Padia and heart rate were lower in group PF after the 30th min (p less than 0.05 and less than 0.01 respectively).(ABSTRACT TRUNCATED AT 250 WORDS)     

Total intravenous anaesthesia with propofol or etomidate

In combination with fentanyl, propofol was compared with etomidate for total intravenous anaesthesia in 21 women (ASA Grades I-II) admitted for elective hysterectomy. They received either propofol (bolus 1.5 mg kg-1, infusion 9 mg kg-1 h-1 for 10 min thereafter 6 mg kg-1 h-1) or etomidate (bolus 0.10 mg kg-1, infusion 3 mg kg-1 h-1 reduced to 0.6 mg kg-1 h-1). Fentanyl 10 micrograms kg-1 was given for induction followed by an infusion of 30 micrograms kg-1 h-1 for 10 min reduced to 6 micrograms kg-1 h-1 for the first hour and successively reduced over time. Induction was smooth and maintenance easy to manage in both groups. There was no difference in time from end of infusion until extubation, but the time until the patients could report their date of birth was significantly shorter in the propofol group. Nausea and vomiting were more pronounced in the etomidate group, and mental side-effects were only seen after etomidate. After 3 months, more patients in the etomidate group complained of reduced power of concentration. We conclude that total intravenous anaesthesia with either propofol or etomidate is equally easy to manage, but in the recovery situation propofol was advantageous in time and quality.     

Recovery after anesthesia with propofol in otorhinolaryngologic surgery of brief duration

This study was designed to assess recovery from total intravenous anaesthesia with propofol for short ENT procedures. Twenty-six patients (ASA I and II) were assigned to two groups of thirteen: one breathed air (Laser laryngeal microsurgery), the second N2O-O2 (FIO2 : 0.5) (various ENT procedures). The induction sequence was exactly the same for both groups: oral premedication with 10 mg diazepam one hour before surgery, I mg pancuronium bromide, 2 micrograms X kg-1 fentanyl, denitrogenation within 3 min, after which propofol was delivered (2.5 mg X kg-1). When the eye-lash reflex had disappeared (time recorded), 1.5 mg X kg-1 suxamethonium was given and laryngotracheal intubation carried out. A continuous infusion of propofol (9 mg X kg-1 X h-1) was started. Surgery began 5 +/- 2 min after the start of propofol infusion. The durations of anaesthesia, surgery and propofol infusion were similar in both groups. To have good surgical conditions, it was necessary to give repeated doses of propofol for 15 patients. Thus, the total dose of propofol was significatively different between the two groups: 24.5 +/- 6.7 mg X kg-1 X h-1 in group "air" versus 16 +/- 3.6 mg X kg-1 X h-1 in group "N2O-O2" (p less than 0.001). Extubation occurred within 16 +/- 8 min in group "air", being more rapid in group "N2O-O2" (11 +/- 9 min; no significant difference). Recovery was assessed with two psychomotor tests: choice reaction time (CRT) and tracing test (TT).(ABSTRACT TRUNCATED AT 250 WORDS)     

Effects of propofol on intraocular pressure in surgery of strabismus in children

Propofol was assessed for eye surgery in 20 children. ASA group I or II, 2-14 year-old, randomly assigned to 2 equal groups. Premedication, analgesia and muscle paralysis were similar in both groups. Group P patients were given an induction dose of 4 mg.kg-1 propofol, followed by an infusion of 15 mg.kg-1.h-1 for the first half hour, and then 10 mg.kg-1.h-1 to maintain anaesthesia. Group C patients were given 10 mg.kg-1 thiopentone for induction and halothane for maintenance. The quality of anaesthesia was assessed by monitoring adverse effects, heart rate, blood pressure, the length of anaesthesia, the delay of the first spontaneous breath and eye opening, and extubation. Intraocular pressure was measured before and 3 min after intubation, and 5 min after extubation. The quality of anaesthetic induction and maintenance were very similar in both groups. Pain occurred more frequently at the injection site with propofol (p less than 0.01). Children in group P recovered more quickly, and extubation was possible much earlier in this group (p less than 0.05). However, restlessness was significantly more frequent in group P (n = 9) than in group C (n = 1) (p less than 0.01). Systolic, diastolic blood pressure and heart rate were significantly lower in group P (p less than 0.05; 0.001; 0.001 respectively). No significant decrease in intraocular pressure in both groups was observed. The use of propofol for eye surgery in children is acceptable, despite some restlessness during recovery.     

Use of a continuous infusion of propofol in maintaining anesthesia

This open, non comparative study was designed to establish a suitable dose regime for propofol when used as the main anaesthetic agent and given as a continuous infusion. Thirty patients (ASA I and II) were studied; five received muscle relaxants and were excluded from the analysis of maintenance and recovery. Immediately after an i.v. bolus dose of fentanyl (2 micrograms X kg-1), anaesthesia was induced in all patients with a mean dose of 2.03 mg X kg-1 propofol. Apnoea at induction was seen in 14 patients, with a mean duration of 151 s (range: 20 to 360 s). Mean, systolic and diastolic arterial pressures and heart rate decreased slightly but statistically significantly following induction. Fourteen patients, four of whom received propofol into a vein of the hand, noted pain on the injection site without venous sequelae immediately nor 24 h after anaesthesia. The mean duration of anaesthesia from induction to the patient ability to obey a simple command was approximately 40 min (range: 10 to 95 min). The mean infusion rate of propofol during maintenance was 0.86 +/- 0.04 mg X kg-1 X min-1. During maintenance, a satisfactory depth of anaesthesia was achieved in 23 patients without any further bolus injection of propofol. The mean time from stopping the infusion to eye opening on verbal command was 6.2 min, whilst that for orientation was 8.4 min. The anaesthesist assessed the quality of recovery as good or adequate in all the patients, who all were satisfied by the anaesthesia. No major adverse reactions occurred during or after anaesthesia and the incidence of minor side-effects was low.     

Effects of propofol and isoflurane on the neuromuscular block induced by atracurium]

Speed of onset, duration of action and recovery time for a bolus injection of atracurium were measured in two groups of patients. In group I anaesthesia considered of propofol, fentanyl, nitrous oxide and oxygen mixture. The induction dose of propofol was 2 mg/kg-1 followed by an infusion of 9.0 mg/kg-1/h-1 for first half hour and 4.5 mg/Kg-1/h-1 subsequently. In group II anaesthesia consisted of isoflurane, fentanyl, nitrous oxide and oxygen mixture. Isoflurane was given upon clinical needs. Speed of onset, duration of action, and recovery time for atracurium were measured in the two groups. No statistically significant differences between speed of onset and duration of action between the two groups were found. The recovery period from T1 = 10% to T1 = 70% twitch response was considerably longer with isoflurane (25 min +/- 6) than with propofol (18 min +/- 3) (p less than 0.01). Results obtained suggest that for adequate relaxation during tracheal intubation smaller doses of atracurium are not needed during isoflurane than propofol administration. Because of the longer recovery period of residual neuromuscular blockade during isoflurane anaesthesia decreasing doses of atracurium and careful monitoring of twitch depression tension are also suggested.     

Comparison of propanidid with propofol for dental surgery of short or medium duration

The properties of propofol in emulsion given by continuous intravenous infusion to spontaneously breathing patients have been well studied. Thirty randomized voluntary premedicated patients undergoing dental extraction were anaesthetized with propofol (2.5 mg X kg-1 IVD, and 9 mg X kg-1 X h-1) or with propanidid (9 mg X kg-1 IVD, and 60 mg X kg-1 X h-1), supplemented with nitrous oxide in oxygen and fentanyl. Induction, maintenance and recovery times had the same characteristics. Highly significant differences occurred between the two groups regarding the increase in heart rate, apnoea and recovery time. This study showed that propofol was an eminently suitable agent for continuous intravenous anaesthesia in spontaneously breathing patients for dental surgery.     

Propofol versus methohexital in the surgery of the spinal canal

The aim of this study was to compare the quality of postanaesthetic recovery after anaesthesia with methohexitone (M) or with propofol (P). Thirty patients undergoing spinal surgery were randomly assigned to either group. The induction dose was 2 mg . kg-1 for both M and P. Anaesthesia was maintained by continuous infusion. The rate was 0.15 mg . kg-1 . min-1 for P and 0.07 mg . kg-1 . min-1 for M. Analgesia was obtained with fentanyl with the same doses in both groups. The maintenance doses were subsequently decreased by 50 and 75% of the initial values. This work compared the quality induction and the criteria of recovery (Aldrete score, Newman test). In two patients in each group, sensory evoked potentials (SEP) were recorded to monitor neurological integrity. The quality of induction was similar in both groups. Awakening was significantly more rapid in group P. The SEP were much decreased in group P, whilst there were few changes in group M. Monitoring of medullar integrity is mandatory in spinal surgery, requiring a rapid recovery. This objective was obtained with shorter delays in patients anaesthetized with propofol than in those who had received methohexitone. However, the former, at the doses used, seemed to depress the SEP.     

Effects of dose and concentration of rectal methohexitone for induction of anaesthesia in children

To investigate the effect of dose and concentration of rectal methohexitone for induction of anaesthesia, 60 children (ASA physical status 1 or 2) undergoing outpatient surgery were studied. Each child was randomly assigned to receive one of three rectal solutions (each containing atropine 0.02 mg X kg-1): Group A - ten per cent methohexitone, 25 mg X kg-1 (n = 20); Group B - ten per cent methohexitone, 15 mg X kg-1 (n = 20); or Group C - one per cent methohexitone, 15 mg X kg-1 (n = 20). After induction of anaesthesia, or a maximum period of 20 minutes following rectal administration of methohexitone, halothane, nitrous oxide, and oxygen were administered by mask. The time to induction of anaesthesia, complications, postanaesthetic recovery scores, and recovery time did not differ significantly among the three groups. The incidence of failed inductions did not differ significantly between Group A (zero per cent) and Group C (ten per cent) but both were significantly less than Group B (45 per cent) (p less than 0.05). Heart rate increased significantly between 10 and 30 minutes after rectal administration of methohexitone and atropine. The authors conclude that ten per cent rectal methohexitone 25 mg X kg-1 and one per cent rectal methohexitone 15 mg X kg-1 are equally effective for induction of anaesthesia in children and both are significantly more effective than ten per cent methohexitone 15 mg X kg-1.     

Anesthesia for arthroscopy of the knee: propofol versus thiopental and halothane

Sixty ASA I or II patients, who underwent general anaesthesia for arthroscopy of the knee, were separated into two groups. Induction was performed either with thiopentone 7 mg . kg-1 (group I) or with propofol 2.5 mg . kg-1 (group II). All patients were intubated and ventilated. Dextromoramide was used as analgesic. Maintenance of anaesthesia was obtained with halothane inhalation (group I) or by continuous automatic injection of propofol at a dose of 9 mg . kg-1 . h-1 (group II). Induction and maintenance were satisfactory in both groups. Pulse rate was stable at induction and intubation for the propofol group, whereas it increased at both stages of anaesthesia with thiopentone; it fell moderately in both groups afterwards. Systolic and diastolic blood pressures dropped more in the propofol group after induction, with a maximum decrease of 20%. Recovery was significantly more rapid and comfortable with propofol than with thiopentone.     

Propofol versus propanidid for the conduction of suspension laryngoscopy

Forty patients who where to undergo suspension laryngoscopy were randomly assigned to two groups, the first receiving 1 microgram . kg-1 fentanyl and a bolus of 2.5 mg . kg-1 propofol followed by 5 to 10 mg . kg-1 . h-1 propofol infusion, and the second 1 microgram . kg-1 fentanyl and 0.2 mg . kg-1 flunitrazepam with 8 mg . kg-1 propanidid in a bolus followed by 40 to 50 mg . kg-1 propanidid infusion. The following parameters were studied: length of apnoea, quality of anaesthesia, the time between stopping giving the anaesthetic and the moment when the patient opens the eyes, gives his name and date of birth, the heart rate, the systolic, diastolic and mean blood pressures, blood gases, before induction, during suspension and at stopping the infusion. Anaesthetic quality was the same for both protocols, and the variations of the haemodynamic parameters were very similar for both groups. Apnoea lasted twice as long with propofol as with the flunitrazepam-propanidid association (p less than 0.001), whereas recovery was twice as quick (p less than 0.001). This seemed to confirm that propofol is better indicated for this type of surgery than the previously used flunitrazepam-propanidid association.     

Influence of bispectral index monitoring on fentanyl requirements during total intravenous anesthesia for major gynecological surgery]

OBJECTIVE: To determine the influence that bispectral index (BIS) monitoring of hypnosis might have on need for analgesia during surgery under total intravenous anesthesia provided by bolus administration of fentanyl. PATIENTS AND METHOD: Prospective, randomized and partially double-blind study of 40 patients undergoing major gynecological surgery under total intravenous anesthesia with propofol and fentanyl. In the BIS group (n = 20) propofol administration was adjusted to maintain BIS between 40 and 60. In the control group (n = 20) standard doses were given: 10 mg/kg-1/h-1 after anesthetic induction and for 5 minutes, 8 mg/kg-1/h-1 over the next 5 minutes and 6 mg/kg-1/h-1 throughout the rest of the operation. All patients received intravenous bolus administration of 150 or 75 microg of fentanyl to maintain analgesia whenever systolic blood pressure and heart rate increased 20% over baseline. We compared propofol and fentanyl requirements, intraoperative changes in BIS, and awakening from anesthesia. RESULTS: Patient and surgical characteristics were similar in both groups. BIS monitoring allowed propofol administration to be decreased a mean 24% during maintenance of anesthesia, and this in turn was associated with a significant increase in mean dose of fentanyl (415 microg versus 253 microg in the BIS and control groups, respectively; p = 0.01). Mean values of BIS were higher in the BIS group (46.4 versus 42.2; p = 0.04) and patients in the BIS group awoke sooner (in 7.7 min versus 11.1 min; p = 0.01) and tended to report less pain upon arrival at the postanesthetic recovery room, although the difference was not statistically significant. CONCLUSIONS: BIS monitoring of depth of hypnosis can influence requirements for fentanyl during total intravenous anesthesia by bolus dosing for maintenance of analgesia. This is probably due to changes in the administration of propofol made possible by BIS monitoring.     

Comparaison des effets cliniques du propofol et du méthohexital au cours des interruptions volontaires de grossesse

The clinical effects of propofol and methohexitone were compared in a group of 59 women undergoing abortion under general anaesthesia. At induction, the premedicated patients were given 2.5 mg · kg⁻¹ propofol or methohexitone, followed by 1 mg · kg⁻¹ fentanyl; if necessary, extra bolus doses of hypnotic were given. Hiccups and other movements were more frequent with methohexitone. There was no difference between the two groups as for injection pain and apnoea. The quicker recovery with propofol, with a mean of 2 min less, even when extra doses were given, could be explained by the pharmacokinetics of the drug. However, the quality of recovery in either group was satisfactory for short-length anaesthesia.     

Electroencephalographic impact of propofol anesthesia

Two groups of patients were studied. In group A, propofol was used alone, given by repeat injections of 2.5 mg X kg-1 in 30 s, in 5 patients undergoing percutaneous thermocoagulation of the Vth cranial nerve. In group B, a series of 12 patients undergoing lumbar disc hernia surgery, propofol was given as a bolus of 2.5 mg X kg-1 in 60 s followed by an infusion of 7 to 12 mg X kg-1 X h-1 together with vecuronium and fentanyl. The EEG recording was carried out during the whole length of anaesthesia and for 1 h after its end. The recordings were all stereotyped, within five successive phases: the awake physiological pattern (phase 0) was desynchronized a mean 52 s after the start of the propofol injection; it was followed by an increase in amplitude of the alpha rhythm (phase I); within a mean of 132 s were seen phases II to V. Phase V corresponded to surgical anaesthesia and could be kept up by a rate of infusion of 9 mg X kg-1 X h-1 propofol. An increase in this rate gave rise to burst suppressions which lasted as much as 15 s or more, and disappeared very quickly when the infusion rate was slowed. After stopping the anaesthesia, the EEG phases were quickly reversed, V to 0: in a mean of 11.1 min, the EEG pattern had returned to the awake state (extremes 4.3 to 19 min).(ABSTRACT TRUNCATED AT 250 WORDS)     

Comparative study of anesthesia and recovery with propofol and enflurane in cervical surgery

The recovery times and the state of postoperative awakening were studied after anaesthesia with propofol or enflurane. The forty patients who were to undergo surgery for cold thyroid nodules were divided into two homogeneous groups which were similar in age, sex, weight and length of surgery. In one group, induction was carried out with propofol, fentanyl, pancuronium bromide, and maintained with 9 mg X kg-1 X h-1 propofol. In the other group, this was done with thiopentone, fentanyl, pancuronium bromide, followed by 0.8% enflurane. Repeat injections of fentanyl were given as required. The time between stopping giving the anaesthetic drug and eye opening was measured, as well as the performance in memorizing and sorting numbers; these two tests were carried out before and 2 h after surgery. The overall results did not show any differences between the two groups in recovery time or quality of awakening. In the propofol group, recovery time and quality were better than in the enflurane group if the patient was less than 50 years old or surgery lasted less than 100 min. In the propofol group, there were significant correlations between recovery time and age (r = 0.83), and between recovery time and duration of surgery (r = 0.87). The doses of this new product should therefore be modified according to the age of the patient and the length of surgery.     

Desflurane maintains intraocular pressure at an equivalent level to isoflurane and propofol during unstressed non-ophthalmic surgery

We have investigated the effects of desflurane compared with isoflurane and propofol on intraocular pressure (IOP) in 48 ASA I-II patients undergoing elective non-ophthalmic surgery. Anaesthesia was induced with thiopental 3-5 mg kg-1, fentanyl 2-4 micrograms kg-1 and vecuronium 0.1 mg kg-1. Patients were allocated randomly to receive propofol (n = 16) 4-8 mg kg-1 h-1, isoflurane (n = 16) or desflurane (n = 16) for maintenance of anaesthesia. Fentanyl was added if necessary. The lungs were ventilated with 70% nitrous oxide in oxygen. Arterial pressure, electrocardiography, heart rate and end-tidal carbon dioxide were measured throughout anaesthesia. IOP was measured before surgery, during maintenance and after emergence from anaesthesia with applanation tonometry by an ophthalmologist blinded to the anaesthetic technique. There was a significant decrease in IOP after induction of anaesthesia which did not differ between groups. Desflurane maintained IOP at an equivalent level to isoflurane and propofol.      

The effect of pre-induction glycopyrronium on the haemodynamic response of elderly patients to anaesthesia with propofol

This study investigated whether pretreatment with glycopyrronium can attenuate the hypotension caused by anaesthesia of the elderly with propofol. Twenty elderly patients (77.1 +/- 2.44 years, mean +/- SEM) of ASA physical status 2 or 3 scheduled for elective urological procedures were given glycopyrronium 0 (n = 10) or 5 micrograms.kg-1 (n = 10) in a randomised, double-blind manner, 5 min before induction of anaesthesia with propofol infused at 600 ml.h-1 (average induction dose 1.7 +/- 0.06 mg.kg-1, mean +/- SEM) followed by maintenance with a propofol infusion at 10 mg.kg-1.h-1. Although glycopyrronium significantly increased heart rate (p less than 0.01, ANOVA), the decrease in blood pressure 2 and 5 min after induction was similar in both groups. The study had a power of 80% to detect a 20 mmHg difference in systolic arterial pressure between treatment groups with p less than 0.05.     

Propofol auto-co-induction as an alternative to midazolam co-induction for ambulatory surgery

We propose the use of an intravenous propofol/propofol auto-co-induction technique as an alternative to propofol/midazolam for induction of anaesthesia. We have studied 54 unpremedicated ASA 1 or 2 patients undergoing day-stay anaesthesia for minor orthopaedic surgery. All received 10 micrograms.kg-1 or alfentanil before induction, followed by either midazolam 0.05 mg.kg-1, propofol 0.4 mg.kg-1 or saline, and 2 min later, a propofol infusion at a rate of 50 mg.kg-1.h-1 until loss of eyelash reflex. We compared pre- and postinduction haemodynamic changes, complications at insertion of a laryngeal mask airway and recovery from anaesthesia in the three groups. Both co-induction techniques showed less postinduction hypotension and significant reduction of the total induction dose of propofol when compared to the control group. In the propofol/propofol group there was a decreased incidence of apnoea during induction of anaesthesia. These patients were discharged from hospital 2 h after the end of anaesthesia whereas patients in the midazolam/propofol group were discharged after 2 1/2 h (p < 0.001).     

A comparison of remifentanil and fentanyl in patients undergoing carotid endarterectomy

BACKGROUND AND AIM: We investigated the haemodynamic stability and emergence characteristics of isoflurane/nitrous oxide anaesthesia supplemented with remifentanil or fentanyl in patients undergoing carotid endarterectomy. METHODS: Anaesthesia was induced with propofol (1-2 mg kg-1) and either remifentanil (0.5 microgram kg-1) or fentanyl (1 microgram kg-1), followed by an infusion of remifentanil (0.2 microgram kg-1 min-1) or fentanyl (2 micrograms kg-1 h-1). RESULTS: There were no significant differences between the groups in haemodynamic variables, postoperative pain, nausea or vomiting. After induction there was a significant decrease in mean arterial pressure for both groups (P < 0.001) and a decrease in heart rate (P = 0.001) in the remifentanil group. In both groups these haemodynamic changes continued during maintenance of anaesthesia (P < 0.05). The time to eye opening after surgery was significantly shorter with remifentanil compared with fentanyl (6.62 +/- 3.89 vs. 18.0 +/- 15.18 min, P = 0.015). CONCLUSION: Remifentanil appears to be a comparable opioid to fentanyl when supplementing isoflurane/nitrous oxide anaesthesia for carotid endarterectomy.