Resultados de la anestesia total intra venosa (TIVA) con perfusión controlada por objetivo (TCI) en pacientes sometidos a trasplante renal / Outcomes of Total Intravenous Anesthesia (TIVA) with Goal Controlled Perfusion (TCI) in Kidney Transplant Patients

Introducción: La anestesia total intravenosa (TIVA) con perfusión controlada por objetivo (TCI) es una técnica de anestesia general que usa una combinación de fármacos administrados exclusivamente por vía intravenosa sin usar fármacos por vía inhalatoria. Objetivos: Determinar los resultados del uso de TIVA TCI en los pacientes sometidos a trasplante renal, donantes y receptores, entre noviembre de 2014 y julio de 2018, en el Hospital de Clínicas. Pacientes y métodos: Estudio observacional, analítico transversal, con muestreo no probabilístico a criterio. La serie se agrupó en donantes y receptores. Los datos se expresan en medias y proporciones, se analizó el Odds Rattio y el R2. Se consideró una p< 0,05 como significativa. Resultados: se incluyeron a 198 intervenciones anestésicas, 131 (66,2%) fueron receptores. El rango de edad fue de entre 5 y 66 años (35,8±13 años) y 114 (57%) fueron masculinos. En el post operatorio inmediato, el tiempo en despertar, la PAS, PAD, PAM, frecuencia cardiaca y saturación de oxígeno no tuvieron diferencias significativas, en la comparación de los grupos (donante y receptor). Se observó cefalea en 3 (1,5%) del grupo de donantes y ninguna en los receptores. La diuresis fue tardía en 18 (9,1%) pacientes (p= 0,084 R2=29). Conclusión: La TIVA TCI demostró ser una técnica muy efectiva en el trasplante renal, con pronta recuperación y despertar inmediato tras la extubación, con lucidez absoluta en todos los pacientes.

Introduction: Total intravenous anesthesia (TIVA) with goal-controlled perfusion (TCI) is a general anesthesia technique that uses a combination of drugs administered exclusively intravenously without using inhalational drugs. Objectives: To determine the results of the use of TIVA TCI in kidney transplant patients, donors and recipients, between November 2014 and July 2018, at the Hospital de Clínicas. Patients and methods: Observational, cross-sectional analytical study, with non-probabilistic sampling at the discretion. The series was grouped into donors and recipients. The data is expressed in means and proportions, the Odds Rattio and the R2 were analyzed. A p<0.05 was considered significant. Results: 198 anesthetic interventions were included, 131 (66.2%) were recipients. The age range was between 5 and 66 years (35.8±13 years) and 114 (57%) were male. In the immediate postoperative period, time to awakening, SBP, DBP, MAP, heart rate and oxygen saturation did not show significant differences when comparing the groups (donor and recipient). Headache was observed in 3 (1.5%) of the donor group and none in the recipients. Diuresis was late in 18 (9.1%) patients (p= 0.084 R2=29). Conclusion: TIVA TCI proved to be a very effective technique in kidney transplantation, with prompt recovery and immediate awakening after extubation, with absolute clarity in all patients.

Anestesia total intravenosa en pacientes con síndrome oclusivo intestinal / Total Intravenous anesthesia in patients with intestinal occlusive syndrome

Introducción: La anestesia total intravenosa es una técnica de anestesia general en la que se administran los fármacos exclusivamente por vía endovenosa, en ausencia de agentes inhalatorios. Objetivo: Describir los resultados que se observaron en el empleo de la anestesia total intravenosa en los pacientes con diagnóstico de síndrome oclusivo para tratamiento quirúrgico. Métodos: Se desarrolló una investigación observacional descriptiva, longitudinal en el Hospital General Docente "Abel Santamaría Cuadrado", de enero de 2014 a enero de 2017. De un universo de 417 pacientes, se seleccionó una muestra de 205 casos que cumplieron con los criterios de inclusión y exclusión. Las variables fueron presión arterial media, frecuencia cardíaca, saturación de oxígeno, complicaciones, tiempo de recuperación, nivel de sedación y respuesta analgésica. Resultados: El 95,61 por ciento de los casos se mantuvieron normotensos y el 96,10 por ciento con frecuencia cardíaca normal. Se constataron signos clínicos de superficialidad anestésica en el 1,46 por ciento de los individuos. La mayoría de los casos se recuperaron entre 10 y 20 min para un 92,19 por ciento. Se observó un nivel de sedación insuficiente en 189 pacientes (92,19 por ciento). No se evidenciaron complicaciones posoperatorias en el 96,58 por ciento. La respuesta analgésica fue adecuada en el 95,12 por ciento de los casos. Conclusiones: La aplicación de la anestesia total intravenosa para cirugía por oclusión intestinal demostró resultados satisfactorios como método anestésico(AU)

Introduction: Total intravenous anesthesia is a general anesthesia technique in which drugs are administered exclusively intravenously, in the absence of inhalation agents. Objective: To describe the outcomes observed in the use of total intravenous anesthesia in patients diagnosed with occlusive syndrome for surgical treatment. Methods: A descriptive, longitudinal and observational research was carried out in Abel Santamaría Cuadrado General Teaching Hospital of Pinar del Río, Cuba, from January 2014 to January 2017. From a universe of 417 patients, a sample of 205 cases that met the inclusion and exclusion criteria was selected. The variables were mean arterial pressure, heart rate, oxygen saturation, complications, recovery time, level of sedation, and analgesic response. Results: 95.61 percent of the cases remained normotensive and 96.10 percent kept a normal heart rate. Clinical signs of sedation were found in 1.46 percent of the individuals. Most of the cases recovered between 10 and 20 minutes, accounting for 92.19 percent. Insufficient sedation was observed in 189 patients (92.19 percent). No postoperative complications were observed in 96.58 %. Analgesic response was adequate in 95.12 percent of cases. Conclusions: The application of total intravenous anesthesia for intestinal occlusion surgery showed satisfactory outcomes as an anesthetic method(AU)

Effects of PEEP on the thermoregulatory responses during TIVA in patients undergoing tympanoplasty / 대한마취과학회지

BACKGROUND: During general anesthesia, core temperature decreases, largely due to heat loss caused by peripheral vasodilation, resulting in heat redistribution to peripheral tissues. Multiple factors contribute to body temperature regulation during general anesthesia. It was reported that baroreceptor unloading by positive end-expiratory pressure (PEEP) attenuates anesthetically-induced hypothermia. So, we evaluated the effects of PEEP on thermoregulatory responses during total intravenous anesthesia (TIVA). METHODS: Forty healthy patients scheduled for tympanoplasty were allocated two groups, Group ZEEP (zero end-expiratory pressure, n = 20) and Group PEEP (PEEP application of 5 cmH2O, n = 20). Ambient temperature was maintained at 22-24degrees C, and anesthesia was induced and maintained with propofol-remifentanil. The core temperature and the temperature difference between forearm and fingertip skin were monitored before and after the induction of general anesthesia having a duration of 180 minutes. RESULTS: The core temperature gradient (Ti-Tf) was higher in patients with ZEEP than with PEEP. The core temperature was maintained at a higher level in patients with PEEP. Additionally, the vasoconstriction threshold was higher in patients with PEEP. CONCLUSIONS: It seems that PEEP attenuates anesthetically-induced hypothermia during TIVA.

Effect of Small-Dose Sufentanil: Target-Controlled Infusion Combined with General Anesthesia Using Propofol / 대한마취과학회지

BACKGROUND: Sufentanil has been shown to act synergistically when combined with propofol, or when combined with potent inhalation anesthetics. The aiml of this study was to determine the dosing rate and target plasma concentration of propofol in the presence of low concentrations and to determine the impact of sufentanil infusion. METHODS: Sixty patients undergoing a plastic surgery and urologic surgery were anesthetized with nitrous oxide, and given a target-controlled infusion (TCI) of sufentanil [target plasma concentrations of 0 (group 1) and 0.05 ng/ml (group 2)], and propofol at rates varying according to the bispectal index (BIS). The mean target concentration (Tc) and infusion rate of propofol according to the changes in the sufentanil concentrations were determined. The recovery time (from stopping the infusion to eye opening) and side effects were compared. RESULTS: The induction time and recovery time were shorter in group 2 than in group 1 (P < 0.05). The infusion rate and mean target concentration of propofol were significantly lower in group 2 (148.8 +/- 25.2 microgram/kg/min, 4.1 +/- 0.8 microgram/ml) than in group 1 (161.7 +/- 26.9 microgram/kg/min, 4.7 +/- 0.5 microgram/ml) (P < 0.01). There were a similar number of side effects in the two groups. CONCLUSIONS: The blood propofol and plasma sufentanil concentrations in the plastic surgery and urologic surgery patients, with respect to satisfactory intraoperative anesthetic conditions and speed of recovery, were 4.1 +/- 0.8 microgram/ml and 0.05 ng/ml.

A Comparison of Midazolam and Propofol on Hemodynamic Changes and Postanesthetic Recovery as Hypnotics for Total Intravenous Anesthesia(TIVA) / 대한마취과학회지

Total intravenous anesthesia(TIVA) is a anesthetic technique where hypnosis, analgesia and muscle relaxation are provided solely by intravenously administered drug without the use of anesthetic vapors or gases including nitrous oxide. For TIVA, midazolam and propofol have been used as hypnotics because of their relatively short elimination half life. Hemodynamic function during induction of anesthesia, the fentanyl and naloxone requirements, and speed of recovery from TIVA with midazolam/fentanyl(group M, n=20) or prapofol/fentanyl (group P, n=20) were compaired in patients undergoing surgery. Forty patients were randomly assigned to receive either 0.2 mg/kg midazolam in 5 min followed by 0.4 mg/kg/hr for 20 min, 0.3 mg/kg/hr for next 20 min, 0.05~0.2 mg/kg/hr until 10~15 min before skin closure, or 2 mg/kg propofol in 5 min followed by 9 mg/kg/hr for 30 min and 4.5 mg/kg/hr until 10~15 min before skin closure. Simultaneously, a variable rate infusion of fentanyl was given. Patients were intubated with an aid of vecuronium and ventilated with 40% oxygen in air. In both groups, mean arterial pressure decreased significantly(P0.05). The total dose, duration and rate of infusion of fentanyl was similar in both groups. 16 patients in group M and 9 patients in gmup P needed naloxone for recovery of respiration and 10 patients in group M needed flumazenil for recovery of consciousness. Recovery as judged by scoring system(sedation score, comprehension score, orientation score) was shorter in group P than group M. Among side effects, resedation was more frequent in group M(9 pts) than P group(0 pt). In conclusion, both midazolam and propofol were useful hypnotics for TIVA. But, group M showed more stable hemodynamics than group P during induction period and P group showed earlier recovery than group M. We concluded that the selection of hypnotics between midazolam and propofol for TIVA depends on situation such as better hemodynamics during induction period or earlier recovery.