Comparative study of diffferent combination of total intravenous anesthesia in different-surgical procedures

ABSTRACT

Total intravenous anesthesia [TIVA] is a natural extension of balanced anesthesia. Propofol is considered to be the most suitable anesthetic drug for use in TIVA because of its pharmacokinetic properties suitable for this technique. Remifentanyl is the best analgesic component, remifentanyl has an ester linkage in its molecular structure, it has a very short duration of action because of rapid breakdown of the ester linkage by nonspecific plasma and tissue esterases. 30 patients aged between 20-40 years old undergoing surgical-procedures were included in this study. All patients premedicated with oral diazepam [0.2 mg/kg], 90 minutes preoperative patients were divided into three groups propofol fentanyl [P/F], propofol/ remifentanyl [P/R], and ketamine midazolam[K/M] group. We used these drugs in each group for induction and maintenance of anesthesia and we compared the three groups regarding Hemodynamic changes, hormonal and metabolic changes, recovery pattern, side effect.-The result of this study showed that, remifentanyl in[P/R] group caused hemodynamic stability better than that of the other two groups. There is decrease in plasma cortisol level which was statistically significant during surgery and post operatively [P>0.05] in all patients in [P/R] group. While in [P/F] and [K/M] groups there was significant increase. All patients in the three group showed increase in blood sugar and B-endorphin levels during operation and in recovery room which was statistically significant only for B-endorphin in [K/M] group. There was no significant difference between [P/F] group and [P/R] group for the dose requirement of propofol. The small doses of fentanyl and ketarnin used in this study are not enough to suppress the hormonal and metabolic changes caused by stress response to surgary. Patients in [P/R] group showed shorter recovery period than in the other two group. We can concluded from this study that remifentanyl used with propofol was effective as the primary opioid in TiVA and provided better intra-operative hemodynamic stability during stressliall surgical events than that achieved with the recommended dose of fentanyl