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Total intravenous anesthesia with propofol and remifentanil for elective non-cardiac surgery
G Pelosi1, A Gratarola, C Pissaia
1Department of Anesthesiology and Intensive Care, University of Eastern Piedmont School of Medicine, Novara.
Background:
Remifentanil is a highly effective mu opioid agonist with predictable pharmacokinetics and a close concentration-effect relationship. Moreover, studies on anesthetic drugs interactions show that optimal propofol concentrations decrease more significantly with remifentanil as compared with other opioids and recovery appears to be much faster than when propofol is combined with other opioids combinations. This intervention study was designed to evaluate the efficacy of propofol combined with remifentanil in elective non cardiac inpatient surgery.
Methods:
N. 405 patients undergoing intraperitoneal, head-neck, intrathoracic, major orthopaedics, breast and major vascular surgery received: remifentanil (1 microgram.kg-1 at induction; 0.50 microgram.kg-1.min-1 at laryngoscopy; 0.25 microgram.kg-1.min-1 at skin incision; 0.25-0.30 microgram.kg-1.min1 from skin incision to end of skin suture) and propofol (0.5-1 mg.kg-1 at induction; 5 mg.kg-1.h-1 at laryngoscopy; 5 mg.kg-1.h-1 at skin incision and 5 mg.kg1.h1 thereafter). Intraoperative end-points included somatic responses, tachycardia and hypertension to laryngoscopy and surgery. Incidence of intraoperative bradycardia, hypotension and muscle rigidity were also recorded. Postoperative end-points included Aldrete score > or = 9, pain immediately following emergence and PONV.
Results:
Propofol-remifentanil combination effectively controlled responses to laryngoscopy and surgical stress. Drug related adverse events were transient bradycardia (< 50 bpm) and hypotension (SBP < or = 80 mmHg) respectively: at prelaryngoscopy 11.60-1.48% and at pre-skin incision 10.61-0.98%. N. 365 patients were discharged from PACU and the median time to first Aldrete score > or = 9 was 22.3 min. The most frequent postoperative event was shivering recorded in n. 46 patients (12%). Postoperative analgesic medication was requested by n. 16 patients (4.4%) and PONV was noted in n. 6 patients (1.6%).
Conclusions:
When combined with propofol, remifentanil effectively provided for profound analgesia during surgery, stable anesthetic conditions, simplicity of use and predictable recovery.
Insights
The combination of propofol and remifentanil offers effective analgesia and stable anesthesia for non-cardiac surgery. This anesthetic approach ensures predictable recovery with a low incidence of postoperative nausea and vomiting (PONV).
Area of Science:
- Anesthesiology
- Pharmacology
- Surgical Care
Background:
- Remifentanil, a potent mu opioid agonist, exhibits predictable pharmacokinetics and a close concentration-effect relationship.
- Optimal propofol concentrations are reduced when co-administered with remifentanil compared to other opioids, facilitating faster recovery.
- The study aimed to assess the efficacy of propofol-remifentanil in elective non-cardiac inpatient surgeries.
Purpose of the Study:
- To evaluate the efficacy of combining propofol with remifentanil for anesthesia in elective non-cardiac surgery.
- To assess intraoperative hemodynamic stability and patient responses to surgical stimuli.
- To determine the safety and recovery profile of this anesthetic combination.
Main Methods:
- A total of 405 patients undergoing various non-cardiac surgeries received a standardized regimen of remifentanil and propofol.
- Dosages were carefully controlled, with remifentanil administered at induction, laryngoscopy, skin incision, and throughout surgery.
- Intraoperative monitoring included somatic responses, heart rate, blood pressure, and incidence of bradycardia, hypotension, and rigidity; postoperative assessments focused on Aldrete score, pain, and PONV.
Main Results:
- The propofol-remifentanil combination effectively managed responses to laryngoscopy and surgical stress.
- Adverse events included transient bradycardia (11.60-10.61%) and hypotension (1.48-0.98%).
- 365 patients were discharged from the post-anesthesia care unit (PACU), with a median time to an Aldrete score ≥ 9 of 22.3 minutes. Shivering occurred in 12% of patients, while postoperative analgesic requests (4.4%) and PONV (1.6%) were infrequent.
Conclusions:
- Remifentanil combined with propofol provides profound intraoperative analgesia and stable anesthetic conditions.
- This combination offers simplicity in administration and predictable patient recovery.
- The propofol-remifentanil anesthetic strategy is effective and safe for elective non-cardiac surgery.