Effect Of Target-controlled Infusion Research Articles

Effect of Target-Controlled Infusion of Propofol-Fentanyl versus Desflurane in Cirrhotic Patients Undergoing Major Hepatic Resection with Transoesophageal Doppler Monitoring A Randomized Control Study

Background and aim: The choice of anaesthetic agents is important for cirrhotics undergoing liver resection. Aim is to compare Target Controlled Infusion (TCI) Propofol-Fentanyl versus Desflurane (Des) on recovery, hemodynamics monitored with Transoesophageal Doppler (TED), the effect on hepatocellular, kidney functions and economics. Patients and methods: Prospective randomized controlled study, 50 patients (Child A) divided equally. In (Des) group induction with fentanyl (1microgram/kg), propofol (2 mg/kg) and rocuronium (1 mg/kg) and maintenance with Desflurane. In (TCI) group the Propofol blood target concentration (Ct) for induction was set at 4 μg/min and Fentanyl infusion was set at 3 μg/kg for 30 seconds , 2 μg/kg/h for 30 min, 1.5 μg/kg/h from 31-150 min, and 1 μg/kg/h until 30 min before end. Both propofol and fentanyl maintained with Navigator pharmacokinetic software and Entropy guidance. TED, urinary micro albuminurea (microalb), blood Glutathione-S-transferase (GST) were monitored. Results: Extubation time prolonged with TCI vs. Des (15.2 ± 2.6 vs. 9.7 ± 1.5 min respectively, (P 0.05), (Microalb. 17.7 ± 2.5 vs. 18.64 ± 1.19, (μgm/ml) respectively, P>0.05). Des more economic than TCI (33.5 ± 8.2 vs. 69.1 ± 8.1 US Dollars), (P< 0.05) respectively during same surgical time and with comparable hemoglobin concentrations. Conclusion: Recovery was enhanced better with Desflurane. TED monitoring demonstrated a significant preservation of SVR and MABP post-resection with Des vs. TCI. Neither was superior to the other with respect to liver and kidney functions. Further studies on a larger scale are recommended.

Effects of target controlled infusion of remifentanil during emergence on the recovery profiles of tracheal extubation from anaesthesia

Objective The trial was designed to examine the effects of target controlled infusion of remifentanil on recovery profiles such as cardiovascular responses and coughing after anaesthesia for thyroidectomy.Methods Eighty ASA Ⅰ or Ⅱ patients undergoing thyroidectomy surgery were randomly assigned to RF0.0 group,RF1.5 group,RF2.0 group,RF2.5 group.Each group contained 20 subjects.General anesthesia was maintained by total intravenous anesthesia (propofol and remifentanil).The target plasma concentrations of remifentanil were 0(RF0.0 group),1.5(RF1.5 group),2.0 (RF2.0 group),and 2.5 μg/L (RF2.5 group) during emergence from anesthesia.At the end of surgery,propofol was ceased.The infusion of remifentanil was stopped in RF0.0 group while maintained in the other 3 groups at a target plasma concentration of 1.5,2.0 μg/L or 2.5 μg/L till extubation.Heart rate (HR),mean arterial pressure (MAP),incidence and severity of coughing were recorded.Results The incidence and severity of coughing were lower in RF2.5 group and RF2.0 group compared with RF0.0 group(P＜0.05).MAP[(95±4),(87±4) mm Hg and(82±4) mm Hg (1 mm Hg=0.133 kPa)] and HR [(96.1±3.4),(85.2±3.0) and (79.9±2.4) bpm] values were significantly lower in the 3 groups rather than in RF0.0 group [MAP,(100±5) mm Hg and HR,(105±4) bpm] at the moment of tracheal extubation(P＜0.05).MAP [(100±3),(90±4) mm Hg and (86±4) mm Hg] and HR [(103±3),(92±3) bpm and (84±3) bpm] values were significantly lower in the 3 groups compared with the RF0.0 group [(100±5) mm Hg and(105±4) mm Hg] at 1 min after tracheal extubation(P＜0.05).MAP [(82.4±4.3) mm Hg and (85.7±4.0) mm Hg] and HR [(79.9±2.4) bpm and (84.4±3.3) bpm] values were significantly lower in RF2.5 group compared with RF1.5 group[(95±4) mm Hg and (100±3) mm Hg][(96.1±3.4) bpm and (103±3) bpm] or RF2.0 group [(87±4) mm Hg and (90±4) mm Hg] [(85.2±3.0) bpm and (92±3) bpm] at the moment or 1 min after tracheal extubation (P＜0.05).But time to eye opening and extubation were prolonged in RF2.5 group [(8.3±0.5) min and (11.6±0.7) min] compared with the RF0.0 group[(8.0±0.6) min and (9.8±0.5) min](P＜0.05).Conclusions Maintaining a remifentanil plasma concentration by TCI may reduce haemodynamic changes and incidence of coughing which associated with tracheal extubation in patients undergoing thyroidectomy.However,awakening may be delayed due to the relative higher remifentanil dose. Key words: Remifentanil; Target-controlled infusion; Tracheal extubation; Total intravenous anesthesia

Effect of target controlled infusion of Remifentanil combined with cervical plexus block in patients for bilateral subtotal thyroidectomy

Objective To evaluate the effect of target controlled infusion (TCI) of Remifentanil com-bined with cervical plexus block in patients with bilateral subtotal thyroidectomy.Methods 30 cases of ASA Ⅰ～Ⅱ patients with selective bilateral subtotal thyroideetomy,the ages between 30 to 64 years old, received TCI of Remifentanil after satisfactory cervical plexus block 5 minutes before operations.Initial target plasma concentration was 1.6ng/ml.During operation, adjusted the target concentration according to the patients? situation and the stimu-lating intensity, increasing or decreasing of 0.2ng/ml by degrees every time, until reached the Ramsay sedation scale at 2～3 score.. Or, the sedation reached verbal pain scores (VPS) at 0～1 score. Then, the patients were stopped taking the medicine 5 minutes before the end of operation. Recorded the mean arterial pressure (MAP), heart rate (HR), pulse,oxygen saturation (SpO2), Ramsay sedation scale, and VPS at the time before cervical plexus block (T0), the time after cervical plexus block (T1), 5 minutes after operation(T2), 30 minutes after operation(T3), trachea were pulled in evidence(T4), and at the end of operation (T5).Recorded the appearance adverse reactions including: respiratory inhibition, muscles stiffness, nausea and vomitting, Itch of skin, etc.And, recorded the biggest plasma target con-centration and calculated the average plasma target cnncentration.Results Comparing with T0,the MAP, SpO2 at every time was short of statistic significance (P>0.05), Ramsay sedation scale and VPS began to hoist at T2, reached pinnacle at T3, T4, and descended at T5(P<0.05), all Ramsay sedation scale at 2～3 score and VPS at 0～1 score. The effect of sedation and analgesia were excellent. There was no adverse event occurred. The final plasma target concentration of Remifentanil was 1.6～5ng/ml.The maintained average concentration was (3.4±1.0)ng/ml.Con-clusions The effect of target controlled infusion (TCI) of Remifentanil combined with cervical plexus block in patients for bilateral subtotal thyroidectomy is safe. It can reach the purpose of analgesia with waking state, and there is no apparently adverse event occurred. Key words: Cervical plexus; Nerves block; Remifentanil; Thyroid gland