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Comparison of Single Target-Controlled Infusion Pump-Delivered Mixed Propofol and Remifentanil with Two
Hou-Chuan Lai1, Meng-Fu Lai1, Yi-Hsuan Huang1
1Department of Anesthesiology, Tri-Service General Hospital and National Defense Medical Center, Taipei 11490, Taiwan.
Insights
Total intravenous anesthesia using a remifentanil and propofol (RP) mixture delivered via a single target-controlled infusion (TCI) pump provides adequate anesthesia for breast cancer surgery. This method simplifies delivery and reduces TCI pump adjustments compared to separate pumps.
Area of Science:
- Anesthesiology
- Pharmacology
- Oncology
Background:
- Total intravenous anesthesia (TIVA) with remifentanil and propofol (RP) is a preferred general anesthesia (GA) method.
- Delivery of RP mixture via target-controlled infusion (TCI) for GA has not been previously described.
- Investigating novel TCI delivery methods is crucial for optimizing anesthetic management.
Purpose of the Study:
- To evaluate the feasibility and efficacy of delivering a remifentanil and propofol (RP) mixture using a single target-controlled infusion (TCI) pump for general anesthesia (GA).
- To compare this single-pump RP mixture TCI method against separate TCI pumps for breast cancer surgery.
- To assess anesthetic adequacy, hemodynamic stability, and patient outcomes.
Main Methods:
- Eighty-four patients undergoing breast cancer surgery were randomized into two groups: separate TCI pumps (S group) or a single TCI pump for an RP mixture (M group).
- Anesthetic dosages were guided by bispectral index (BIS) and analgesia nociception index (ANI) monitoring.
- Primary outcomes included anesthetic adequacy (BIS 40-60, ANI 50-70), hemodynamic stability, TCI pump adjustment frequency, and anesthetic consumption.
Main Results:
- No significant differences were observed in patient characteristics, hemodynamic parameters, BIS/ANI scores, or duration of anesthesia and emergence between the groups.
- The single-pump RP mixture group (M group) showed significantly fewer TCI pump adjustments compared to the separate TCI pump group (S group) (p = 0.005).
- Total anesthetic dosage, postoperative pain, patient satisfaction, and adverse event incidence were comparable between the two groups.
Conclusions:
- Delivering a remifentanil and propofol (RP) mixture via a single target-controlled infusion (TCI) pump provides adequate hypnotic and analgesic effects for breast cancer surgery.
- This simplified TCI approach requires fewer adjustments, potentially streamlining anesthetic management.
- The RP mixture TCI method is a viable option for general anesthesia, demonstrating comparable efficacy and safety to separate TCI pumps.
Abstract:
Total intravenous anesthesia (TIVA) with remifentanil and propofol (RP) is considered to be an ideal type of general anesthesia (GA) for pediatric and adult patients undergoing medical procedures. However, delivery of an RP mixture by target-controlled infusion (TCI) for GA in surgical procedures has not been described. We investigated the merit of this approach for breast cancer surgery. Eighty-four patients (n = 42 per group) were randomly allocated to propofol and remifentanil either delivered by separate TCI pumps (S group) or in an RP mixture by a single TCI pump (M group). Dosages were adjusted based on the bispectral index (BIS) and the analgesia nociception index (ANI). The primary outcomes were adequate anesthesia (BIS 40-60 and ANI 50-70, respectively), acceptable hemodynamic fluctuations (<30% of baseline) with less frequent TCI pump adjustments, bolus injections of anesthetics, and total consumption of anesthetics during the procedure. The secondary endpoints included time of emergence from anesthesia, patient satisfaction, postoperative pain, rescue with opioids, and adverse events. The characteristics of patients, hemodynamic parameters, BIS and ANI scores, duration of surgery, anesthesia, and emergence were not significantly different between groups. The adjustment frequency of TCI was significantly higher in the S group (3 (range 0-6) vs. 2 (0-6) times; p = 0.005). The total dosage of anesthetics, pain rating, patient satisfaction, need for opioids postoperatively, and incidence of adverse events were not significantly different. We have demonstrated that this RP mixture provided adequate hypnotic and analgesic effects under BIS and ANI monitoring in patients undergoing breast cancer surgery within 1 h.
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