Utilisation du Diprivan ® en gynécologie

Abstract

1. Propofol as an induction agent At a dose of 2 to 2.5 mg.kg-1, as a bolus injection over 30 to 60 seconds, for gynaecological procedures of short duration (abortion, D and C), propofol can be characterized as follows when compared with other induction agents: ADVANTAGES OVER METHOHEXITONE AND ETOMIDATE: decreased incidence of hiccups and abnormal movements, increased quality of induction, similar to that obtained with thiopentone, decreased postoperative nausea and vomiting. ADVANTAGES OVER THIOPENTONE: shorter recovery period, more rapid recovery of consciousness and orientation. DISADVANTAGES WHEN COMPARED WITH THIOPENTONE: more frequent pain at the injection site, however its prevention is possible, more frequent apnoea, but may be avoided by slowly injecting the drug, higher cost. The main advantage of propofol over thiopentone (shorter recovery period), makes day-case gynaecological procedures one of its major indications. This concerns young, healthy women, whose professional and family lives are important and who may benefit from minimal disruption in their way of life. 2. Propofol as a maintenance agent Propofol is given as a continuous infusion at a dose ranging from 6 to 12 mg.kg-1.h-1 for maintenance of prolonged procedures (abdominal surgery, hysterectomy) and can be characterized as follows with respect to halogenated anaesthetics: ADVANTAGES OVER ENFLURANE AND ISOFLURANE: decreased postoperative nausea and vomiting, increased recovery scores (1st hour). COMPARED WITH DESFLURANE: shorter induction time than desflurane, less respiratory problems at induction, similar recovery period, same incidence of nausea and vomiting. The administration of propofol for maintenance of anaesthesia has the main advantage of reducing the incidence of postoperative nausea and vomiting when compared to conventional halogenated anaesthetics. Respective costs of the various techniques, using propofol or the new halogenated anaesthetics, may be a criterion for choice in the future.(ABSTRACT TRUNCATED AT 250 WORDS)