Total intravenous anaesthesia for major gynaecological surgery

A technique of total intravenous anaesthesia using etomidate by bolus intravenous (IV) injection for induction and by continuous intravenous infusion for maintenance of anaesthesia, with supplementary intravenous fentanyl analgesia, is described. Muscle relaxation was provided by competitive neuromuscular blockade, allowing controlled ventilation of the lungs with oxygen-enriched air. Arterial blood pressure, heart rate and rhythm remained stable throughout the procedure. Few complications were encountered of which the most significant was a 13% incidence of nausea and/or vomiting. Pain on injection, abnormal muscular movements on induction, and post operative venous sequelae were uncommon. Patients were easily rousable shortly after termination of drug infusion. The technique proved acceptable to the patient, surgeon and experienced anaesthetist and, thereby, would appear to offer a reasonable alternative to the more conventional inhalational anaesthetic technique.