Recovery from total intravenous anaesthesia. Propofol versus midazolam‐flumazenil

Abstract

The aim of this study was to compare recovery assessed with the Newman, deletion af a's and postbox tests after total intravenous anaesthsia for procedures lasting more than 90 min, with either propofol (PPF) or midazolam (MDZ), reversed or not by flumazenil (FMZ). Thirty patients scheduled for peripheral surgery were randomly allocated to 3 groups of 10, receiving by continuous infusion until the end of surgery either PPF (n = 10) or MDZ (n = 20) combined with alfentanil. FMZ was administered thereafter to 10 patients receiving MDZ until they opened their eyes on command or to a maximum dose of 1 mg. Recovery tests were performed 45, 90 and 180 min after the end of anaesthesia. Results were analysed with non-parametric tests. Recovery scores were significantly better in the PPF group at all times, reaching control values at 180 min for the three first tests. FMZ reversal did not improve the scores compared to those resulting from MDZ alone. This study provides further data in favour of PPF as far as rapid and complete recovery is concerned. The efficiency of FMZ is incomplete and only transient when administered in a single dose.

Midazolam‐flumazenil versus propofol anaesthesia for scoliosis surgery with wake‐up tests

“…Therefore, we used only 1 mg of flumazenil in 500 ml0.9% NaCl per patient, which is half of the recommended concentration, and adjusted infusion speed to keep the patient arousable but not fully awake. None of the patients given propofol became resedated, which is in accordance with other reports of a faster early recovery after flumazenil and a better complete recovery after propofol (6,18). Midazolam-flumazenil anaesthesia alone was cheaper than propofol, 461 versus 603 crowns (P= 0.004).…”

“…The estimated number of patients to detect a minimum relevant difference in the speed of arousal of 5 min (50%), using 10.1 min24.5 (1 SD) as an average time of awakening after propofol anaesthesia (6)(7)(8), and both type 1 and type 2 errors of 5% each was 19…”

Comparison of postoperative nausea and vomiting between remimazolam and propofol: a propensity score-matched, retrospective, observational, single-center cohort study

“…Specifically, total intravenous anesthesia (TIVA) has a lower incidence of PONV than inhalational anesthesia [ 1 – 3 ]. Propofol is typically used as an intravenous general anesthetic agent because its duration of action is shorter than that of conventional benzodiazepines, which are associated with delayed awakening and resedation [ 4 ].…”

Midazolam coinduction does not delay discharge after very brief propofol anaesthesia

“…Used as a single agent, recovery from propofol anaesthesia is more rapid than that after thiopentone, 1-3 which is much more rapid than that after midazolam, 4-7 even with flumazenil reversal. 8 Midazolam and propofol are synergistic when used in combination for the induction of anaesthesia. 9-1t This interaction may occur at a common site of action of these agents on the GABA receptor.…”