Total Intravenous Anaesthesia for Major Gynaecological Surgery

Abstract

A technique of total intravenous anaesthesia using etomidate by bolus intravenous (IV) injection for induction and by continuous intravenous infusion for maintenance of anaesthesia, with supplementary intravenous fentanyl analgesia, is described. Muscle relaxation was provided by competitive neuromuscular blockade, allowing controlled ventilation of the lungs with oxygen-enriched air. Arterial blood pressure, heart rate and rhythm remained stable throughout the procedure. Few complications were encountered of which the most significant was a 13% incidence of nausea and/or vomiting. Pain on injection, abnormal muscular movements on induction, and post operative venous sequelae were uncommon. Patients were easily rousable shortly after termination of drug infusion. The technique proved acceptable to the patient, surgeon and experienced anaesthetist and, thereby, would appear to offer a reasonable alternative to the more conventional inhalational anaesthetic technique.

Disoprofol (ICI 35868) for Total Intravenous Anaesthesia

“…Total intravenous anaesthesia (TIVA) has been advocated for reduction of operating theatre pollution and avoidance of the potential toxic effects of halogenated hydrocarbons (1, 2, 3, 4,5,6). TIVA may now be feasiblc because shorter acting, less toxic intravenous hypnotics and analgesics are available (7).…”

Prolonged Myoclonus after Etomidate Anesthesia

“…Rocke et al (14) reported a waking time of 16.6 min (range 1-125 min) and time to patient communication of 30.4 min in patients after a mean duration of anesthesia of 87 min with a mean dose of 90.2 mg of etomidate and 0.375 mg of fentanyl. All patients had uneventful stays in the recovery room.…”

“…This technique has been used successfully without incident in gynecological (14), general (15), and major vascular surgery (16). Constant infusion doses range from 0.018 mgkg -'.min-' (16) to 0.02 mgkg '.min-' Because etomidate has also been reported to lower cerebral blood flow and metabolism (18) it has been considered advantageous for neurosurgical procedures.…”