Total intravenous anaesthesia with etomidate-fentanyl. Use in general and gynaecological surgery

A total intravenous anaesthetic technique using etomidate, fentanyl and neuromuscular blocking drugs with artificial ventilation of the lungs has been used in 90 patients undergoing elective general and gynaecological surgery. A two-step schedule was used, based on a pharmacokinetic model for rapidly eliminated, intravenously administered drugs. Etomidate 100 micrograms/kg/minute with fentanyl 1 microgram/kg/minute were given for 10 minutes, followed by a maintenance dose at a rate of one-tenth this amount. Concurrent evaluation of the technique led to variations in the adjuvant drugs used (atropine, droperidol and neuromuscular blocking agent). The basic dose schedule provided adequate surgical anaesthesia for 76% of patients (although dose adjustments were used in the remainder), with recovery times of 10 minutes or less in 57% of patients. No further opiate analgesia was needed in 40% of patients postoperatively. Those patients given atropine intravenously prior to induction had a significantly lower incidence of nausea and vomiting postoperatively.