Prospective evaluation of remifentanil‑propofol mixture for total intravenous anesthesia: A randomized controlled study

Abstract

Application of total intravenous anesthesia (TIVA) may be considered as unpractical when compared with inhalational anesthesia. Although it is mostly not recommended, mixing intravenous agents is popular in clinical practice. The aim of the present study was to investigate the suitability of using remifentanil-propofol mixture (MIXTIVA) for TIVA. Adult patients with an American Society of Anesthesiologists grade of I-II scheduled for elective thyroidectomy were randomly allocated to 3 groups (n=32 for each) to receive TIVA with remifentanil and propofol infusions separately (control group, Group I) or with MIXTIVA infusion that contained remifentanil/propofol at a proportion of 2/1,000 or 3/1,000 (remifentanil concentration, 20 or 30 µg/ml in 1% propofol in Group II or Group III, respectively). The extubation time (the primary outcome of the study), the orientation time and number of patients in whom intraoperative hypotension, hypertension or bradycardia episodes were encountered during anesthesia were comparable among the groups. The mean remifentanil infusion rate in Group III was significantly higher than that in the other groups. The mean propofol infusion rates and mean bispectral index (BIS) scores during anesthesia were comparable among groups. Hypotension accompanied with a high BIS was encountered in one patient in Group III. In conclusion, compared to the standard TIVA technique using separate drug infusions, MIXTIVA infusion used for thyroidectomies did not result in any statistically significant difference in recovery and clinical outcomes. This technique may be considered as a practical implementation for busy ambulatory centers performing general anesthesia. The present study was retrospectively registered at clinicaltrials. gov (trial registration no. NCT04394897).

Comparison of Single Target-Controlled Infusion Pump-Delivered Mixed Propofol and Remifentanil with Two Target-Controlled Infusion Pumps-Delivered Propofol and Remifentanil in Patients Undergoing Breast Cancer Surgery—A Prospective Study

“…The major finding in this study was that remifentanil combined with propofol proved a safe and effective anesthetic approach in breast cancer surgery under BIS and ANI monitoring. Our result was consistent with previous studies showing that the RP combination is practical during not only procedure sedation, such as for fibreoptic bronchoscopy, MRI, colonoscopy, breast biopsy surgery, shock wave lithotripsy, day-case urological surgery, radiation (photon beam) therapy, cataract surgery, endoscopic retrograde cholangiopancreatography, and third molar surgery [4][5][6][7][8][9][10][11][12][13][14][15], but also for GA [16][17][18]. In addition, our study provides evidence that an RP mixture in breast cancer surgery under BIS and ANI monitoring is an alternative for double-pump TCI.…”

“…Their clinical experience has been similar to the research by Bagshaw et al [17]: the incidence of adverse events is very low [19]. Bakan et al reported that the infusion of remifentanil (20 or 30 mcg.mL -1 ) in 1% propofol for thyroidectomies did not result in any statistically significant difference in recovery or clinical outcomes compared with the standard TIVA technique using separate drug infusions [18]. Stewart et al, reported that remifentanil can be mixed with propofol at low concentrations (5 mcg.mL -1 ), giving a remaining remifentanil concentration of 91.9% after 1 h [20].…”

“…In addition to a doubling in the need for TCI supplies (such as pumps, syringes, and extension tubes), it is more time-consuming to set TCI models for propofol and remifentanil when these are being infused separately. A remifentanil-propofol (RP) mixture in the same syringe for total intravenous anesthesia (TIVA) delivery has been reported to be safe and effective in procedural sedation and general anesthesia (GA) [4][5][6][7][8][9][10][11][12][13][14][15][16][17][18]. Research on the use of an RP mixture for maintenance of GA is limited [16][17][18].…”

“…A remifentanil-propofol (RP) mixture in the same syringe for total intravenous anesthesia (TIVA) delivery has been reported to be safe and effective in procedural sedation and general anesthesia (GA) [4][5][6][7][8][9][10][11][12][13][14][15][16][17][18]. Research on the use of an RP mixture for maintenance of GA is limited [16][17][18]. Brady et al concluded that remifentanil (25 mcg.mL -1 ) in 0.5% propofol was more cost-effective than conventional balanced anesthetics, resulting in quicker patient discharge, and has important implications for ambulatory surgery centers and office-based practices [16].…”

Drug mixtures and infusion technology

“…As a comparator, it is worth stating that sugammadex was approved by MHRA after use in only 579 adults. While not formally studied in "thousands of patients," a recent randomised controlled trial on 96 patients [3] and a multicentre service review including 873 patients [4] concluded that mixing propofol and remifentanil in paediatrics is a safe technique. Furthermore, this is so routinely performed that to many individuals and departments this is considered standard practice.…”