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[Delayed emergence from propofol, nitrous oxide and oxygen anesthesia--a case report]
T Koitabashi1, N Satoh, Y Takino
1Department of Anesthesiology, Ichikawa General Hospital, Tokyo Dental College.
Masui. the Japanese Journal of Anesthesiology
|July 1, 1997
Summary
This study highlights delayed anesthesia recovery in a patient with hepatic dysfunction. Lowering propofol infusion rates is recommended for patients with impaired Indocyanine green clearance.
Area of Science:
- Anesthesiology
- Pharmacology
- Hepatology
Background:
- Propofol and nitrous oxide are common anesthetic agents.
- Hepatic dysfunction can affect drug metabolism and recovery times.
- Indocyanine green (ICG) retention rate is a measure of liver function.
Observation:
- A patient with preoperative hepatic dysfunction (ICG retention rate 22%) received anesthesia with epidural block, nitrous oxide, oxygen, and propofol.
- The average propofol infusion rate was 5-6 mg.kg-1.h-1.
- Anesthesia emergence was delayed by 59 minutes after simultaneous discontinuation of propofol and nitrous oxide.
Findings:
- Delayed emergence from anesthesia occurred in a patient with hepatic dysfunction.
- The patient's hepatic dysfunction, indicated by elevated ICG retention, may have contributed to the prolonged recovery.
- Simultaneous cessation of propofol and nitrous oxide did not ensure timely recovery.
Implications:
- Anesthesiologists should consider decelerating propofol infusion rates in patients with impaired hepatic function or prolonged ICG clearance times.
- Careful titration of anesthetic agents is crucial in patients with compromised liver function.
- Further research may be warranted to establish specific propofol dosing guidelines for patients with varying degrees of hepatic dysfunction.