Total intravenous anaesthesia for laparoscopy

Abstract

Key wordsAnaesthetic techniques; total intravenous. Anaesthetics, intravenous; ketamine, propofol.In a previous study' we showed that a total intravenous anaesthetic technique with a mixture of ketamine, midazolam and vecuronium was a safe, simple and reliable alternative to inhalational anaesthesia for use in the field, and the method was proposed as a substitute for use in general civilian practice. We decided to compare this technique with another form of total intravenous anaesthesia for a relatively short surgical procedure, laparoscopy. Propofol has been used both alone2s3 and in combination with alfentani14 to provide anaesthesia for a variety of surgical procedures. The anaesthetic sequence described by Kay4 is suitable for laparoscopy and more major surgery and was used as a basis for comparison. We had noted previously the marked hypertensive response to tracheal intubation, so on this occasion we added alfentanil30 pg/kg a t induction 5 , 6 and excluded opioid prernedication. The aims were to compare the two techniques in terms of haemodynamic stability after induction, speed of recovery and incidence of complications after operation. MethodsPatient group. Eighty female patients scheduled for laparoscopy were included in the study. All were ASA grades 1-2 and aged between 1&45 years. None was taking any drugs likely to modify response to the agents used and all gave informed consent to the study.Procedure. All patients received temazepam 20 mg orally 2 hours before operation. An ECG monitor was connected and a cannula placed in a forearm vein on arrival in the anaesthetic room. Arterial pressure was observed using a Dinamap 846 noninvasive blood pressure monitor. Baseline values of blood pressure and pulse rate were recorded before induction and subsequently every 60 seconds for 10 minutes, and at I-3-minute intervals thereafter.The patients were allocated randomly to two groups at the pre-operative visit. Group 1 received alfentanil 10 pg/kg, propofol 2 mg/kg and vecuronium 0.1 mg/kg at induction. Anaesthesia was maintained with a mixture of propofol 200 mg and alfentanil 1 mg at six times the induction dose in ml/hour delivered by a syringe pump (Imed 800). Group 2 were given alfentanil 30 pg/kg, ketamine 1 mg/kg, midazolam 0.07 mg/kg and vecuronium 0.1 mg/kg a t induction. Maintenance was provided by a continuous infusion of ketamine 200 mg and midazolam 5 mg made up to 50 ml with NaCl and delivered by syringe pump at a rate, equal to half the patient's body weight in kg, in ml/hour.Correspondence should be addressed t o Brigadier J. Restall.

Patient evaluation of four different combinations of intravenous anaesthetics for short outpatient procedures

“…However, this finding of an uneventful postoperative course seems to be of importance, and accords with the results reported by Guit et al [4]. It has been shown that the use of a benzodiazepine, such as midazolam, lowers the incidence of psychological side effects [6]. It is possible that propofol could have the same effect.…”

H1- and H2-receptor antagonists prevent histamine release in allergic patients after the administration of midazolam-ketamine. A randomized controlled study

“…For these reasons, the combination of midazolam and ketamine has been previously recommended for total intravenous anesthesia [12][13][14], however, there are few reports on whether or not it is also useful for patients who have a history of allergy. Nevertheless, it is well known that combined H 1 -and H 2 -receptor antagonist reduces the number of histamine-related side effects [1][2][3].…”

“…Ketamine is useful for asthmatic patients [8], and its effectiveness and successful use in the anesthetic management of the asthmatic patients have both been reported [9][10][11]. The combination of midazolam with ketamine has also been previously recommended for total intravenous anesthesia in military surgery, general civilian practice and cardiac surgery [12][13][14].…”

Histamine release during the induction of anesthesia with propofol in allergic patients: A comparison with the induction of anesthesia using midazolam-ketamine

“…In general anesthesia, ketamine has been used safely against allergic reactions, especially for asthmatic patients because of its advantages for relaxing tracheal smooth muscle [34,35], and its ability to treat bronchospasm [11,12]. Since midazolam attenuated both the cardiostimulatory responses and unpleasant emergence associated with ketamine [36], the combination of midazolam and ketamine has been recommended for total intravenous anesthesia [13][14][15]. In our previous study, the induction of anesthesia with midazolam-ketamine was shown to be useful for allergic patients without any significant problems [16].…”

“…Moreover, the combination of midazolam and ketamine has been previously recommended for total intravenous anesthesia [13][14][15].…”