[Propofol-based protocol of general anesthesia for operations in patients with severe burns with ASA class III-IV]

Use of propofol in surgery on critical patients is limited because of the possibility of poorly corrected hypotonia. The effects of total anesthesia with propofol + fentanyl + nitric oxide under conditions of artificial ventilation of the lungs (tracrium) were evaluated during 63 operations on 42 patients with severe burns (ASA III-IV), divided into 2 groups depending on the protocol of anesthesia. The difference in the protocols consisted in the method of choice of anesthetic doses: in group A we proceeded from EEG data (bispectral index--BIS) and in group B relied only on general clinical and hemodynamic signs with a retrospective analysis of BIS. Prevention of hemodynamic disorders in both groups included infusion loading (7-8 ml/kg), dopamine (5-7 micrograms/kg/min) and decrease of the velocity of propofol infusion to 15 mg/kg/h during induction anesthesia. This method leveled the hypodynamic effects of propofol. Simultaneous monitoring of BIS showed that the propofol dose needed for adequate induction narcosis with subsequent intubation should be higher than the dose usually recommended for patients with ASA class III-IV. Use of BIS monitoring during the operation resulted in a decrease of the propofol and fentanyl doses. The authors do not recommend decreasing the velocity of propofol infusion below 3 mg/kg/h (at FiN2) = 0.6) because of the risk of awakening during narcosis.