Qualit�tsvergleich von modifizierter Neurolept-, balancierter und intraven�ser An�sthesie Teil 2. Ergebnisse der Krefelder Studie 1992*

Abstract

The safety and tolerance of neuroleptanaesthesia (NLA), balanced anaesthesia (BAL), and intravenous anaesthesia with propofol (IVA) were analysed for the first time in a prospective, randomised clinical trial. METHODS. In all, 1318 surgical patients received either NLA, BAL, or IVA. Patients who had regional anaesthesia, were aged under 18 years, or were non-cooperative or vitally threatened (ASA class i.v. to V) did not participate in the study. Premedication and anaesthetic course were set up at a standard of 30% oxygen and 70% nitrous oxide. Incidents, events, and complications due to anaesthesia were obtained (IEC key of the German Society of Anaesthesia and Critical Care Medicine, DGAI). Furthermore, postanaesthetic alertness based on specific recovery tests and the quality of anaesthesia from the patient's viewpoint, rated by patient questionnaires from the DGAI were evaluated. All parameters were calculated and checked for statistical significance using the chi-square test. RESULTS AND DISCUSSION. The groups were broadly comparable with respect to age (P = 0.91), ASA class (P = 0.42), preoperative blood pressure (P = 0.36), and length of anaesthesia (P = 0.82). The anaesthesia, which averaged 103 min, comprised the following regimens: (1) NLA: 7.1 mg droperidol and 0.008 mg/kg body weight fentanyl, (2) IVA: 493.4 mg propofol and 0.004 mg/kg body weight fentanyl, and (3) BAL: 2.6 mg droperidol and 0.004 mg/kg body weight fentanyl with 0.4 vol.% isoflurane. With respect to anaesthetic risk, the following reactions were observed: the use of NLA led to a high incidence of tachycardia (P = 0.001), arrhythmias (P = 0.05), and hypertensive reactions (P = 0.001), whereas in the IVA group only hypotension (P = 0.0001) occurred. However, after the use of BAL none of the aforementioned complications were detectable to any considerable degree. Similarly, patients who had cardiac disease showed greater IEC changes after the use of NLA than after BAL or IVA (P = 0.02) (Tables 1 and 2). The heart rates and blood pressures during BAL and IVA were extremely stable, and therefore, vasoactive therapy was required considerably less in comparison to NLA (P = 0.001) (Table 4). Recovery after the use of IVA was strikingly rapid: the patient's responsiveness, orientation, and ability to concentrate was significantly better than after the other anaesthetic regimen (P = 0.01) (Table 5). With regard to the typical discomforts after anaesthesia, IVA was highly superior to BAL and NLA: nausea (P = 0.0003) and retching (P = 0.03) hardly ever occurred (Table 6). Due to the tolerable manner of waking up and rapid return of orientation and the ability to concentrate, IVA was highly favoured by the patients (P = < 0.01) (Table 7). CONCLUSION. The present results show clear clinical advantages of BAL and IVA in contrast to neuroleptanaesthesia. Due to the very low incidence of side effects such as nausea and vomiting IVA was highly recommended by the patients, at least in part because of the rapid recovery time.

Propofol anaesthesia and postoperative nausea and vomiting: quantitative systematic review of randomized controlled studies.

“…We considered 122 reports for analysis; 19 were excluded because propofol was used for induction in the control group (11 studies) and/or because nitrous oxide was omitted in the propofol but not in the control group (eight studies) and no other comparisons were possible. Another 19 studies were excluded for various reasons; six were not randomized, [19][20][21][22][23][24] the randomization method was inadequate in four, [25][26][27][28] the technique of maintenance was not mentioned in two, 29 30 three were not adequately controlled (opioid or droperidol only in one group), [31][32][33] one had eltanolone as the only control arm 34 and data from three studies were published twice. [35][36][37][38][39][40] Data from 84 randomized controlled studies involving 6069 patients (3098 treated with propofol) were analysed.…”

Propofol und postoperative Übelkeit und/oder Erbrechen

“…Für das antidopaminerg, antiserotonerg und antihistaminerg wirksame Droperidol ist dies gut belegt [21,25,27,33,35]. Unsere Ergebnisse bestätigen im Hinblick auf das Propofol Daten aus der jüngeren Literatur, die seine antiemetische Wirkung über die Modulierung subkortikaler Strukturen erklären [6,9,11,14,15,22,23,28]. Als vagotone Substanz, die gerade in den Kernen des hö-heren Gleichgewichtszentrums nicht zu einer Reduzierung des Glukosestoffwechsels führt, muß sie bei Nausea aus vagotoner Ursache oder durch Vestibularisaktivierung versagen [9].…”