Comparación de dos protocolos para TIVA para cirugía de mama con propofol combinado con sufentanil o alfentanil
Comparison of Two Clinical Protocols for Total Intravenous Anesthesia (TIVA) for Breast Surgery Using Propofol Combined With Either Sufentanil or Alfentanil.Radke OC, Sippel D, Radke K, Hilgers R, Saur P. Anesth Pain Med. 2014 Sep 3;4(4):e19278. doi: 10.5812/aapm.19278. eCollection 2014. Abstract BACKGROUND: Sufentanil and alfentanil have pharmacokinetic and dynamic properties which make them favourable substances for totalintravenous anesthesia (TIVA) in combination with propofol. OBJECTIVES: We planned to compare two clinical protocols for TIVA with propofol, and either sufentanil or alfentanil in regards to postoperative pain, hemodynamic stability during the case and time for emergence from anesthesia. PATINETS AND METHODS: Treaty eight patients scheduled for general anesthesia for breast surgery were included in this Double-blind, randomized, controlled trial. All patients received a standardized TIVA with propofol and either 0.2 µg kg(-1) sufentanil or 20 µg kg(-1) alfentanil for induction and 0.3 µg kg(-1) h(-1) sufentanil or 30 µg kg(-1) h(-1) alfentanil for maintenance with additional propofol boluses as needed. Duringanesthesia, heart rate, non-invasive blood-pressure, peripheral oxygen saturation and depth of anesthesia, were recorded. In the post anesthesiacare unit, pain scores, nausea and vomiting as well as medications were recorded. RESULTS: Patients in the sufentanil group required less often additional opioid and propofol boluses to maintain adequate anesthesia. We did not observe a significant difference in time to extubation. Postoperatively, patients in the sufentanil group had less pain (P = 0.03) and required less i.v. opioids (0.4 vs. 1.9 mg piritramid, P = 0.04). CONCLUSIONS: Both protocols provide excellent anesthesia, but patients receiving sufentanil had more stable anesthesia and less postoperative pain. KEYWORDS: Alfentanil; Intravenous Anesthesia; Pharmacokinetics; Postoperative Pain; Sufentanil |
Infusión de propofol asociada con acidosis metabólica en pacientes de neuroanestesia. Estudio retrospectivo
Propofol infusion associated metabolic acidosis in patients undergoing neurosurgical anesthesia: a retrospective study.
Choi YJ, Kim MC, Lim YJ, Yoon SZ, Yoon SM, Yoon HR.
J Korean Neurosurg Soc. 2014 Aug;56(2):135-40..
Abstract
OBJECTIVE: Propofol and volatile anesthesia have been associated with metabolic acidosis induced by increased lactate. This study was designed to evaluate changes in pH, base excess (BE), and lactate in response to different anesthetic agents and to characterize propofol infusion-associated lactic acidosis. METHODS: The medical records of patients undergoing neurosurgical anesthesia between January 2005 and September 2012 were examined. Patients were divided into 2 groups : those who received propofol (total intravenous anesthesia, TIVA) and those who received sevoflurane (balanced inhalation anesthesia, BIA) anesthesia. Propensity analysis was performed (1 : 1 match, n=47), and the characteristics of the patients who developed severe acidosis were recorded. RESULTS: In the matched TIVA and BIA groups, the incidence of metabolic acidosis (11% vs. 13%, p=1) and base excess (p>0.05) were similar. All patients in the TIVA group who developed severe acidosis did so within 4 hours of the initiation of propofol infusion, and these patients improved when propofol was discontinued.
CONCLUSIONS: The incidence of metabolic acidosis was similar during neurosurgical anesthesia with propofol or sevoflurane. In addition, severe acidosis associated with propofol infusion appears to be reversible when propofol is discontinued.
KEYWORDS: Acidosis; Neurosurgery; Propofol
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