Propofol and Thiopental-Enflurane: A Comparison of Anesthesia for Laryngomicrosurgery / 대한마취과학회지

BACKGROUND: Laryngomicrosurgery has some special characteristics. It is stressful due to intubation and direct laryngoscopy during a short operation time. Therefore both adequate anesthesia and quick recovery for the slience therapy after the operation are needed. This study compared the cardiovascular responses and recovery pattern between propofol and Thiopental-Enflurane anesthesia. METHODS: Sixty outpatients of ASA class 1 or 2 for microlaryngoscopy were randomly assigned to receive either anesthesia with propofol (Group P, n = 30) and thiopental-enflurane (Group E, n = 30). Group P was induced with propofol 2 mg/kg and succinylcholine 1 mg/kg and maintained with vecuronium 0.04 mg/kg, propofol 10 - 6 mg/kg/h, and N2:O2/3 L/min:2 L/min. Group E was induced with thiopental 5 mg/kg and succinylcholine 1 mg/kg and maintained with vecuronium 0.04 mg/kg, enflurane 1 3 vol%, and N2O:O2/3 L/min:2 L/min. Ketorolac (30 mg) and hydrocortisone (100 mg) were added for postoperative pain in both groups. The changes in blood pressure and heart rate, pre and post induction, were compared in both groups. In addition, we compared energence time and the state of recovery (Steward's score) 5 minutes and 15 minutes after extubation and the frequencies of other complications. RESULTS: No significant differences in age, wt, sex and anesthesia time of the two groups were observed. Mean arterial pressures were significantly different after anesthesia and after intubation between the two groups. However the heart rates were not different among the groups. The extubation time was significantly shorter in Group P. The recovery score at 5 min and 15 min after extubation was significantly higher in Group P. CONCLUSIONS: We conclude that propofol with nitrous oxide may be useful in laryngeal microsurgery, especially, when silence therapy is needed.

The Cardiovascular Responses and Recovery Patterns According to the Anesthetic Methods during Suspension Laryngoscopic Procedures / 대한마취과학회지

BACKGROUND: Anesthetic techniques for laryngeal microsurgery aims on modulation of sympathetic stimulation, good relaxation and rapid recovery from deep anesthesia. This study was designed to compare the influence of the different anesthetic methods on the cardiovascular responses and the recovery patterns during suspension laryngoscopic surgery. METHOD: Sixty patients of ASA class 1 or 2 scheduled for suspension laryngoscopic surgery were divided into 4 groups randomly. Two groups were anesthetized with inhalational anesthetic, enflurane, and other two groups were anesthetized with intravenous anesthetic, propofol. In each groups, esmolol or fentanyl was used as an adjunctive during anesthesia. When blood pressures increased above 30% of baseline value each adjunctive was added. The changes of blood pressure and heart rate were compared with each others during operation. Postoperatively, the start of spontaneous respiration, consciousness, memory, and the frequencies of other complications were also compared with each others. RESULT: The results were as follows; 1) The blood pressures and heart rates during operations were not different among the groups. 2) The recovery of spontaneous respiration was early in propofol esmolol group. 3) 30 minutes after operation, the consciousness state was better and complications were less in propofol groups compared with enflurane groups. CONCLUSION: From this results, it seems that propofol with nitrous oxide and supplemental fentanyl or esmolol may be useful in laryngeal microsurgery. Especially, esmolol can be a good substitute for those who can't be treated with opioids.