Intubation in otorhinolaryngologic surgery: propofol versus propofol-suxamethonium

This study was carried out to assess the conditions of intubation in head and neck surgery when using propofol alone or associated with suxamethonium. Sixty patients were randomly allocated in two groups of 30. Group I was given 3 mg.kg-1 propofol and Group II 3 mg.kg-1 propofol immediately followed by 1.5 mg.kg-1 suxamethonium. All patients were premedicated orally with midazolam 0.1 mg.kg-1, 0.5 to 1 mg atropine and 7 to 10 micrograms.kg-1 alfentanil, while a colloidal solute (Plasmion) up to 250-500 ml was infused. One minute after injection of propofol, lidocaine 5% was pulverized on the glottis and intubation performed. The mean time required for intubation was similar in both groups: 128 +/- 10 sec in group I vs 132 +/- 9.7 sec in group II. Thirty-five % of patients had to be considered as difficult to intube but the mean times in these cases were not statistically different: 169 +/- 14 sec in group I vs 175 +/- 13 sec in group II. Opening of the glottis was found to be better in group II than in group I (p less than 0.01) and bucking was more frequent in group I (p less than 0.01). Successful intubation was obtained after one attempt at a similar rate in the two groups. The haemodynamic variations consisted in a significant decrease of systolic blood pressure compared to the initial value but these variations were similar in the two groups at each time (2.3 and 5 min) from induction.(ABSTRACT TRUNCATED AT 250 WORDS)     

Recovery after anesthesia with remifentanil combined with propofol, desflurane, or sevoflurane for otorhinolaryngeal surgery

Because no previous investigation has directly compared the combination of remifentanil (REM) and a hypnotic with that of REM and the newer volatile anesthetics, we studied recovery characteristics and patient satisfaction after the combination of REM with propofol (PRO), desflurane (DES), or sevoflurane (SEVO). One hundred twenty patients were randomly assigned to receive anesthesia with either REM/PRO, REM/DES, REM/SEVO, or thiopental/alfentanil/isoflurane/N(2)O (control group) for ear, nose, and throat surgery (n = 30 each). In the REM groups, the dosage of PRO (75 microg. kg(-1). min(-1)), and of DES or SEVO (0.5 minimum alveolar anesthetic concentration) was kept unchanged, and REM was titrated to hemodynamic response. The control group was managed according to standard practice. Early recovery (times to eye opening, extubation, and statement of name and date of birth) was predictably faster and more complete in the REM groups compared with the control group. However, late recovery (times to discharge from postanesthesia care unit and hospital) and overall patient satisfaction were not different among groups. No clinically relevant differences existed among the three REM groups. In conclusion, the combination of REM infusion with small-dose DES, SEVO, or PRO is characterized by predictably rapid, early recovery. However, late recovery and patient satisfaction are comparable to a conventional anesthetic technique. IMPLICATIONS: Remifentanil anesthesia, combined with small-dose propofol, desflurane, or sevoflurane, enables predictably fast and smooth early recovery after ear, nose, and throat surgery. Despite such faster, early recovery and less need for postoperative analgesic and antiemetic medication, late recovery was comparable among the remifentanil combination groups and the control group.     

Clinical recovery and psychomotor function after brief anesthesia with propofol or thiopental.

Propofol, the new intravenous anesthetic agent, is generally used in outpatient anesthesia with expectations of fast recovery. We assessed recovery from anesthesia in a double-blind, crossover, controlled manner in 12 healthy volunteers using clinical tests during the first hour and several psychomotor tests 0.5, 1, 3, 5, and 7 h after brief anesthesia with propofol (2.5 mg/kg and 1.0 mg/kg 3 min later) or thiopental (5.0 mg/kg and 2.0 mg/kg 3 min later). Subjects were able to respond to command, sit, and stand steadily significantly faster (P less than 0.05) after propofol (time until standing steadily 33 +/- 7 min; mean +/- SD) when compared to thiopental anesthesia (time until standing steadily 62 +/- 29 min; mean +/- SD). Psychomotor performance remained significantly worse (P less than 0.05 to P less than 0.001) compared to control for 1 h after propofol and for 5 h after thiopental anesthesia. We conclude that the rapid and complete recovery makes propofol a suitable anesthetic for patients undergoing brief ambulatory surgery.     

Intravenous anesthesia with propofol in intracranial surgery]

OBJECTIVES: To analyze the repercussions of intravenous anesthesia with propofol as the single hypnotic drug on intracranial pressure (ICP) and cerebral perfusion pressure (CPP), and also to study the time until recovery from anesthesia and to tracheal extubation as well as intraoperative hemodynamic changes in patients undergoing surgery to remove a supratentorial brain tumor. PATIENTS AND METHODS: Twenty-three ASA I/II patients scheduled for exeresis of a supratentorial brain tumor were studied. A fiberoptic sensor placed in direct contact with the dura mater was used to measure ICP. Anesthetic induction was achieved with propofol (2 mg/kg). Propofol (12 and 9 mg/kg/h for 10 min and 6 mg/kg/h throughout the rest of the operation) was used for maintenance. Mean arterial pressure (MAP), heart rate (HR), ICP and CPP were recorded at baseline and 1, 2, 3 and 4 min after induction, during laryngoscopy and tracheal intubation; 1, 3, 5, 10, 15 and 20 min after tracheal intubation (L + 1, L + 3, L + 5, L + 10, L + 15, L + 20), upon placement of a craniostat; upon skin incision; upon withdrawal of propofol perfusion; and during extubation. The following variables were recorded after awakening: time until eye opening after receiving a verbal command, time until extubation and time until orientation. Analysis of variance for repeated measures (ANOVA) was performed on the results. RESULTS: MAP decreased significantly from baseline at the following times: during the post-induction period, upon placement of the craniostat, upon skin incision and when the propofol infusion was switched off. HR increased significantly during laryngoscopy and at the following moments: intubation, post intubation (L + 1, L + 3, L + 5), craniostat placement, and extubation. ICP was lower throughout the surgical period except during laryngoscopy, when this variable increased significantly. CPP decreased significantly after induction and returned to baseline after intubation. CPP was significantly higher after surgery. Recovery times after weaning from propofol infusion until eye opening in response to an order and until orientation were 13 +/- 3 and 22 +/- 4 min, respectively. The mean interval between withdrawal of propofol until extubation was 18 min. CONCLUSIONS: Intravenous anesthesia with propofol in intracranial surgery (supratentorial tumors) affords hemodynamic stability and lowers ICP except during laryngoscopy. Early recovery from anesthesia allows for neurological assessment and vigilance during the immediate postoperative period.     

Recovery characteristics of propofol anesthesia in pediatric outpatients; comparison with sevoflurane anesthesia

We compared recovery characteristics of propofol anesthesia with those of sevoflurane anesthesia in pediatric outpatients. One hundred and four children, 3 months to 6 years of age, ASA physical status 1 or 2, were randomly assigned to following four groups; sevoflurane (group S), propofol (group P), sevoflurane with premedication (group MS), or propofol with premedication (group MP). Midazolam 0.5 mg.kg-1 and famotidine 1 mg.kg-1 were administered orally 30 min before the induction in the MS and MP group. Recovery from anesthesia, agitation, and postoperative pain were evaluated. The time intervals from the end of surgery to extubation and to discharge from the hospital were recorded. The incidence of vomiting and use of analgesic drugs were also checked. The emergence from anesthesia was slower with propofol anesthesia than with sevoflurane anesthesia, but the time to discharge from the hospital was not significantly different among the four groups. Incidence of agitation was higher in S group compared with P group, but there were no differences between MS and MP. Postoperative pain was similar among the four groups. There were no differences in the incidence of vomiting. Propofol anesthesia provided slower emergence and less agitation compared with sevoflurane anesthesia.     

Recovery from total intravenous anesthesia with propofol and buprenorphine

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.     

Comparative study between propofol and thiopental for anesthesia induction in surgery of short duration]

To compare anesthetic characteristics of thiopental and propofol in short duration surgical interventions, we have studied 40 patients undergoing gynecologic and proctologic surgery. Patients were randomly assigned to two groups receiving 2.5 mg/kg of propofol or 5 mg/kg of thiopental. In both groups, arterial hypotension of comparable intensity occurred. Heart rate was significantly higher in thiopental anesthesia. Postanesthesia recovery was significantly more rapid with propofol. Some of these results can be influenced by the different immediate premedication (atropine and diazepam in thiopental group) and duration of anesthesia.     

Induction of anesthesia with propofol in urological outpatient surgery

Propofol (Diprivan) in a new formulation, a short-acting intravenous anesthetic, was used as an induction agent for short urological procedures. Forty unpremedicated patients were treated with either propofol or thiopental in a randomized study. The onset of anesthesia and duration of apneic period were prolonged and the decrease in systolic blood pressure was more profound in the propofol group. Heart rate was less stable and recovery time was longer in the thiopental group. Other parameters, such as quality of anesthesia, acceptability of the drug or rate of side effects, were similar in both groups. These results suggest that propofol in a new formulation is a suitable agent for short urological procedures in outpatient surgery.     

Peridural anesthesia and narcosis with propofol in thoracic surgery

Twelve patients undergoing elective thoracic surgery because of lung cancer, have been studied. The anesthetic management included: continuous epidural anesthesia with bupivacaine (T6-T7), continuous infusion of propofol and vecuronium, mechanical ventilation with an oxygen/air mixture. We evaluated the perioperative analgesia and the cardiovascular side effects of two groups of patients differing for the position (supine or lateral) selected to administer the local anesthetic. We also analysed the most important characteristics of the recovery from anesthesia (degree of analgesia and consciousness, respiratory function and cooperation with physiotherapeutic manoeuvres). The authors conclude that, although the number of patients studied is limited, there are no significant differences between the two groups for intraoperative analgesia and hemodynamic imbalance; the anesthetic technique employed is a reliable alternative to classic balanced anesthesia, because seems to reply very well to the mayor purposes of thoracic surgery. Moreover it makes the operative room free from pollution caused by volatile anesthetics.     

Recovery and outcome after propofol and isoflurane anesthesia in patients undergoing laparoscopic hysterectomy

Background: Laparoscopic hysterectomy (LH) is expected to provide fast and comfortable recovery, plus an early return to normal daily activities. This study was carried out to compare the outcome after LH in patients anesthetized with isoflurane or propofol.
Methods: Sixty-two patients undergoing LH were randomized to receive either isoflurane-N₂O or propofol-N₂O anesthesia. The times when the patients could drink, void and walk were recorded. Recovery was also evaluated by the Digit Symbol Substitution Test in the postanesthesia care unit (PACU) 60 and 120 min after the operation. The patients were also given a questionnaire on their further recovery (return to daily activities, pain and nausea) to be filled out at home.
Results: Early recovery was significantly (P<.05) faster in the isoflurane group (eye opening within 3 min, orientation in 6 min) when compared to the propofol group (eye opening within 7 min, orientation in 14 min), but there was no significant difference in the other parameters of recovery. Most of the patients were discharged from the hospital on the first postoperative day in both groups. Twenty-five percent of the patients, however, stayed two nights in hospital, mainly for social reasons. No difference was found regarding the recovery at home: the patients resumed their normal daily activities on about the sixth postoperative day (median).
Conclusions: It is concluded that both isoflurane and propofol are suitable anesthetics for LH. In this study recovery was not fast enough to make the patients suitable for same-day surgery.     

Recovery of dynamic balance after general anesthesia with sevoflurane in short-duration oral surgery

Purpose  Recovery of dynamic balance, involving adjustment of the center of gravity, is essential for safe discharge on foot after ambulatory anesthesia. The purpose of this study was to assess the recovery of dynamic balance after general anesthesia with sevoflurane, using two computerized dynamic posturographies. Methods  Nine hospitalized patients undergoing oral surgery of less than 2 h duration under general anesthesia (air-oxygensevoflurane) were studied. A dynamic balance test, assessing the ability of postural control against unpredictable perturbation stimuli (Stability System; Biodex Medical), a walking analysis test using sheets with foot pressure sensors (Walk Way-MG1000; Anima), and two simple psychomotor function tests were performed before anesthesia (baseline), and 150 and 210 min after the emergence from anesthesia. Results  Only the double-stance phase in the walking analysis test showed a significant difference between baseline and results at 150 min. None of the other variables showed any differences among results at baseline and at 150 and 210 min. Conclusion  The recovery times for dynamic balance and psychomotor function seem to be within 150 min after emergence from general anesthesia with sevoflurane in patients undergoing oral surgery of less than 2-h duration.     

Recovery after oral surgery with halothane, enflurane, isoflurane or propofol anaesthesia

We have compared the recovery characteristics of four differenttechniques for maintenance of anaesthesia in 99 day-case patientsadmitted for oral surgery. All patients received propofol forinduction of anaesthesia followed by halothane, enflurane, isofluraneor propofol infusion for maintenance of anaesthesia. Each patientwas subjected to a battery of psychometric tests which includedSpielberger state, trait, mood stress and mood arousal questionnaires,Maddox-Wing test and five-choice serial reaction time. All testswere performed before operation and at 0.5, 1, 2, 4, 24 and48 h after operation. Performance in the reaction time testdecreased significantly in the immediate postoperative period,returning almost to preoperative values by 4 h. However, onlythose patients who received enflurane or propofol had returnedto their performance level before surgery by 4 h, although allfour groups had achieved this target by 24 h. There was a furtherimprovement in performance at 48 h. Anxiety and stress werehigh before surgery and decreased rapidly in the postoperativeperiod. The Maddox-Wing test demonstrated a significant impairmentin performance in the first 1 h after surgery, which returnedto normal by discharge at 4 h. There were no significant differencesbetween the four groups in these latter tests. (Br. J. Anaesth.1994; 72: 559–566)     

Recovery from sleep deprivation occurs during propofol anesthesia

BACKGROUND: Some neurophysiologic similarities between sleep and anesthesia suggest that an anesthetized state may reverse effects of sleep deprivation. The effect of anesthesia on sleep homeostasis, however, is unknown. To test the hypothesis that recovery from sleep deprivation occurs during anesthesia, the authors followed 24 h of sleep deprivation in the rat with a 6-h period of either ad libitum sleep or propofol anesthesia, and compared subsequent sleep characteristics. METHODS: With animal care committee approval, electroencephalographic/electromyographic electrodes and intrajugular cannulae were implanted in 32 rats. After a 7-day recovery and 24-h baseline electroencephalographic/electromyographic recording period, rats were sleep deprived for 24 h by the disk-over-water method. Rats then underwent 6 h of either propofol anesthesia (n = 16) or ad libitum sleep with intralipid administration (n = 16), followed by electroencephalographic/electromyographic monitoring for 72 h. RESULTS: In control rats, increases above baseline in non-rapid eye movement sleep, rapid eye movement sleep, and non-rapid eye movement delta power persisted for 12 h after 24 h of sleep deprivation. Recovery from sleep deprivation in anesthetized rats was similar in timing to that of controls. No delayed rebound effects were observed in either group for 72 h after deprivation. CONCLUSION: These data show that a recovery process similar to that occurring during naturally occurring sleep also takes place during anesthesia and suggest that sleep and anesthesia share common regulatory mechanisms. Such interactions between sleep and anesthesia may allow anesthesiologists to better understand a potentially important source of variability in anesthetic action and raise the possibility that anesthetics may facilitate sleep in environments where sleep deprivation is common.     

Recovery after anesthesia for short pediatric oncology procedures: propofol and remifentanil compared with propofol, nitrous oxide, and sevoflurane

Anesthesia techniques in children undergoing short painful oncology procedures should allow rapid recovery without side effects. We compared the recovery characteristics of two anesthetic techniques: propofol with sevoflurane and nitrous oxide and a total IV technique using propofol and remifentanil. Twenty-one children, undergoing two similar painful procedures within 2 wk were studied in a single-blind manner within patient comparison. The order of the techniques was randomized. Propofol and remifentanil involved bolus doses of both propofol 3-5 mg/kg and remifentanil 1-4 microg/kg. Propofol with sevoflurane and nitrous oxide involved propofol 3-5 mg/kg with 2%-8% sevoflurane and 70% nitrous oxide. The primary outcome variable was the time taken to achieve recovery discharge criteria; other recovery characteristics were also noted. The mean age of the children was 6.5 yr (range, 2.5-9.8 yr). Nineteen had lymphoblastic leukemia and two had lymphoma. All children had intrathecal chemotherapy and one had bone marrow aspiration. Most procedures lasted <4 min. The mean time to achieve recovery discharge criteria was appreciably shorter after propofol and remifentanil than propofol with sevoflurane and nitrous oxide by nearly 19 min (P = 0.001). All other time comparisons had similar trends and statistical differences. Seven parents expressed a preference for the propofol and remifentanil technique compared with one preferring propofol with sevoflurane and nitrous oxide. Children are apneic during the procedure and require respiratory support from an anesthesiologist. Discharge readiness from the recovery ward was achieved on average 19 min earlier after propofol with remifentanil compared with the combination of propofol, sevoflurane and nitrous oxide. Parents more often preferred propofol with remifentanil.