Total Intravenous Anesthesia with Propofol and Fentanyl / 대한마취과학회지

ABSTRACT

Total intravenous anesthesia(TIVA) with ketamine and fentanyl has many advantages such as no air pollution, no hepatic or renal toxicity and good postoperative pain relief compared with inhalational anesthesia, but this anesthetic method also has several disadvantages such as hypertension, delayed recovery and emergence delirium. For improvement of this problems, the authors tried new TIVA method with propofol and fentanyl to the 20 patients in ASA class I or II and compared this method with 20 patients in ASA class I or II who had been anesthetized with enflurane-N2O from March to May 1992. The results were as follows; 1) Systolic blood pressure decreased after induction from 127+/-12mmHg to 105+/-17mmHg in propofol-fentanyl group(p<0.05) and mean arterial pressure decreased after induction from 93 9 mmHg to 799 mmHg in propofol-fentanyl group and from 98+/-10 mmHg to 83+/-11 mmHg in enflurane-N2O group(p<0.05), but they became preoperative values during operation in both groups. RPP(rate-pressure product) and heart rate decreased about 28-39% after induction and during operation in propofol-fentanyl group(p<0.05) but there was no change in enflurane- N2 group. 2) The data of arterial blood gas had no clinically significant changes in both groups. 3) The blood sugar level increased during operation(p<0.05) but it became preoperative value from postoperative 30 min in both groups. 4) There were no clinically significant changes in hepatic or renal function test of postoperative 3rd day compared with preoperative one. 5) There were no postoperative complications except 2 cases of nausea in propofol-fentanyl group. 6) Emergence time and recovery time had no difference in both groups but the duration from arrival on recovery room to postanesthetic recovery score of 10 was shorter in propofol- fentanyl group(7.5+/-7.3 min) than in enflurane-N2O group(16.7+/-l0.3 min)(p<0.05). Therefore TIVA with propofol and fentanyl is considered to have good controllability nearly equal to enflurane-N2O anesthesia and it can be applied as one of general anesthetic methods in the case of contraindication to N2O and volatile anesthetics, but futher study will be required to quantify the appropriate dosage of propofol or fentanyl to minimize perioperative hemodynamic changes and respiratory depression.