Effect of Nalbuphine on Hemdynamic Values and Bispectral Indices during Total Intravenous Anesthesia (TIVA) with Propofol and Remifentanil / 대한마취과학회지

BACKGROUND: Remifentanil requires a long acting agent for postoperative pain control, and Nalbuphine, a long acting agonist-antagonist, causes less respiratory depression than pure mu-agonists. However, Nalbuphine can also cause additional distress when used with a pure mu-agonist. Therefore, we evaluated the effects of nalbuphine during TIVA with remifentanil and propofol. METHODS: 56 ASA class I, II adult patients undergoing minor surgery were included in this study. After maintaining BIS values between 40-60 as well as a relatively similar blood pressure (BP) and heart rate (HR) for 20 minutes without changing the target concentrations of anesthesia during surgical procedures, the subjects received either 0.1 ml/kg of normal saline or nalbuphine intravenously. Hemodynamic and BIS variables were then recorded for 20 minutes, during which time the target concentrations were not modified. The BIS values, heart rate, and mean arterial pressure were then compared between groups using t-tests, with a P < 0.05 being considered statistically significant. RESULTS: The mean BIS and HR measured at each interval in the nalbuphine group were not significantly different from those of the control group. However, 10, 15 and 20 minutes after the administration of nalbuphine, the mean systolic BP and the mean arterial BP of the treatment and control groups were significantly different (P < 0.05). In addition, the mean diastolic BP was also significantly different 10 and 20 minutes after the treatment was administered (P < 0.05). Postoperative pain was well controlled and none of the patients reported intraoperative awareness. CONCLUSIONS: Although nalbuphine seems to cause distress, which appeared as an increase in BP, it may still be used in combination with propofol and remifentanil because it did not cause a significant increase in the HR and BIS values.

The Experience of the Total Intravenous Anesthesia of Patient with Noonan Syndrome: A case report / 대한마취과학회지

Noonan syndrome is a condition involving facial, cardiovascular and skeletal abnormalities that may pose problems to anesthesiologists during surgery. Propofol, which is used as an induction agent for noncardiac surgery, produces little or no change in the heart rate. Remifentanil decreases the sympathetic and somatic responses to noxious stimuli and can be given in high doses without negative inotropic effects. We report successful management of a patient with Noonan syndrome, hypertrophic cardiomyopathy, and atrial fibrillation, undergoing laparoscopic cholecystectomy using the the total intravenous anesthesia with propofol and remifentanil.