Total intravenous anesthesia with a continuous propofol-alfentanil infusion

A total intravenous anesthetic using propofol and alfentanil was evaluated to determine if it would provide a shorter recovery-room stay than a more traditional balanced anesthetic using isoflurane and alfentanil. Forty-three ASA I or II patients between 17 and 50 years of age undergoing major abdominal or orthopedic procedures were studied. The propofol group received alfentanil 50 mg/kg followed by propofol 1 mg/kg for anesthesia induction. Continuous propofol infusion was initiated at induction using 170 mg/kg/min for 10 minutes, followed by 130 mg/kg/min for 10 minutes, then maintained at 100 mg/kg/min until 10 minutes before the end of surgery. Ventilation was supported with an air-oxygen mixture. The group receiving balanced anesthesia received alfentanil 1 mg/kg, and anesthesia was induced with sodium thiopental 4 mg/kg. A 1% isoflurane inhalation with air-oxygen was initiated immediately upon induction. Both groups received a continuous infusion of alfentanil titrated to maintain heart rate within 10% of preinduction levels. Recovery from anesthesia was measured using a subjective pain assessment, a verbal fluency test, and a short-term memory test. No differences were detected in the rate of recovery at 30 minutes or 60 minutes postextubation. Hemodynamic stability during induction and intubation was slightly better in the propofol group than in the isoflurane group. One episode each of intraoperative awareness and delayed eye opening occurred in the propofol group. Total intravenous anesthesia using propofol and alfentanil is just as effective as a balanced inhalation anesthetic and provides equally rapid recovery. However, practitioners are cautioned to include an amnestic adjuvant when using propofol as the sole anesthetic agent.