Propofol-based Total Intravenous Anesthesia Research Articles

Lower incidence of prolonged extubation in propofol-based total intravenous anesthesia compared with desflurane anesthesia in laparoscopic cholecystectomy: A retrospective study

Background: Reducing anesthesia-controlled time (ACT) such as extubation time may improve operating room (OR) efficiency result from different anesthetic techniques. However, the information about the difference in ACT between desflurane (DES) anesthesia and propofol-based total intravenous anesthesia (TIVA) techniques for laparoscopic cholecystectomy (LC) under general anesthesia (GA) is not available in the literature. Methods: This retrospective study uses our hospital database to analyze the ACT of elective LC after either DES anesthesia or TIVA via target-controlled infusion (TCI) with propofol from January 2010 to December 2011. The various time intervals including waiting for anesthesia time, anesthesia time, surgical time, extubation time, exit from OR after extubation, total OR time, postanesthetic care unit (PACU) stay time, and percentage of prolonged extubation (≥15 min) were compared between the two anesthetic techniques. Results: We included data from 622 patients undergoing LC, with 286 patients receiving TIVA and 336 patients receiving DES anesthesia. The extubation time was faster (7.8 ± 0.4 vs. 10.9 ± 0.4 min; P

Propofol (TIVA) Versus Volatile-Based Anesthetics: Is There Any Oncological Benefit?

To summarize the most recent available clinical and pre-clinical research data concerning the effects of propofol-based total intravenous anesthesia (TIVA) and volatile anesthesia on oncological outcomes and to discuss the biological basis by which these drugs are purported to exert effects on the cancer cell and on the host. Recent retrospective analyses of clinical datasets have generated considerable interest in the hypothesis that the two major classes of general anesthetics in clinical use for oncological surgery—namely inhalational fluranes and intravenous propofol—disparately influence post-operative cancer outcomes. There is also growing pre-clinical data to indicate that these drugs exert distinct effects on cancer cell and immune cell phenotypes. The available evidence tends to support the superiority of propofol in terms of the effect on oncological outcomes, but there is a lack of prospective data and a need to be mindful of the complexity and heterogeneity of both the perioperative period and cancer as a disease when interpreting study results and deciding future directions.

Propofol-based Total Intravenous Anesthesia Is Associated with Better Survival Than Desflurane Anesthesia in Colon Cancer Surgery.

WHAT THIS ARTICLE TELLS US THAT IS NEW: BACKGROUND:: Previous research has shown different effects of anesthetics on cancer cell growth. Here, the authors investigated the association between type of anesthetic and patient survival after elective colon cancer surgery. A retrospective cohort study included patients who received elective colon cancer surgery between January 2005 and December 2014. Patients were grouped according to anesthesia received: propofol or desflurane. After exclusion of those who received combined propofol anesthesia with inhalation anesthesia or epidural anesthesia, survival curves were constructed from the date of surgery to death. After propensity matching, univariable and multivariable Cox regression models were used to compare hazard ratios for death. Subgroup analyses were performed for tumor-node-metastasis staging and postoperative metastasis. A total of 706 patients (307 deaths, 43.5%) with desflurane anesthesia and 657 (88 deaths, 13.4%) with propofol anesthesia were eligible for analysis. After propensity matching, 579 patients remained in each group (189 deaths, 32.6%, in the desflurane group vs. 87, 15.0%, in the propofol group). In the matched analyses, the propofol-treated group had a better survival, irrespective of lower tumor-node-metastasis stage (hazard ratio, 0.22; 95% CI, 0.11 to 0.42; P < 0.001) or higher tumor-node-metastasis stage (hazard ratio, 0.42; 95% CI, 0.32 to 0.55; P < 0.001) and presence of metastases (hazard ratio, 0.67; 95% CI, 0.51 to 0.86; P = 0.002) or absence of metastases (hazard ratio, 0.08; 95% CI, 0.01 to 0.62; P = 0.016). Simple propensity score adjustment produced similar findings. Propofol anesthesia for colon cancer surgery is associated with better survival irrespective of tumor-node-metastasis stage.

Sevoflurane is an effective adjuvant to propofol-based total intravenous anesthesia for attenuating cough reflex in nonintubated video-assisted thoracoscopic surgery.

Background:Nonintubated video-assisted thoracic surgery (VATS) has been widely developed during the recent years. Cough reflex is an inevitably encountered problem while approaching lung lesions, and it may induce major bleeding. Sevoflurane anesthesia may attenuate cough reflex by inhibiting the pulmonary irritant receptors. However, the incidence of postoperative nausea and vomiting (PONV) in inhalational anesthesia is higher than in the propofol-based total intravenous anesthesia (TIVA). We investigated the effect of sevoflurane combination with propofol-based TIVA on cough reflex and PONV in nonintubated VATS.Methods:Ninety patients undergoing nonintubated VATS with laryngeal mask airway (LMA) and spontaneous breathing were randomly assigned for TIVA or propofol/sevoflurane anesthesia. In the TIVA group (n = 45), anesthesia was induced and maintained with propofol and fentanyl; in the propofol/sevoflurane (P/S) group (n = 45), 1% sevoflurane anesthesia was added to propofol and fentanyl anesthesia. The primary outcome measurements were cough reflex. In addition, the incidence of PONV and extubation time were investigated.Results:Patients with cough reflex were significantly fewer in the P/S group than in the TIVA group (10/45 vs 34/45; P < .001). The cough severity (35/5/5/0 vs 11/17/17/0; P < .001) and limb movement (40/5/0/0 vs 28/17/0/0; P < .001) were lower in the P/S group than in the TIVA group. Besides, incremental fentanyl bolus for cough reflex was 5 (0 [0–1]) in the P/S group and 17 (0 [0–3]) in the TIVA group (P < .05). And there was no conversion to general anesthesia, postoperative hemorrhage, aspiration pneumonia, or PONV in the 2 groups. Besides, there was no significant difference in extubation time (TIVA: 5.04 ± 2.88 vs P/S: 4.44 ± 2.98 minutes; P = .33).Conclusion:Sevoflurane attenuated cough reflex under propofol-based TIVA and did not increase the incidence of PONV and extubation time in nonintubated VATS.

Intravenous versus inhalational maintenance of anaesthesia for postoperative cognitive outcomes in elderly people undergoing non-cardiac surgery.

Intravenous versus inhalational maintenance of anaesthesia for postoperative cognitive outcomes in elderly people undergoing non-cardiac surgery.

A randomised trial to compare the increase in intracranial pressure as correlated with the optic nerve sheath diameter during propofol versus sevoflurane-maintained anesthesia in robot-assisted laparoscopic pelvic surgery.

Robot-assisted surgery can cause raised intracranial pressures (ICP) due to steep trendelenburg position and pneumoperitoneum. The choice of anesthetic agents can influence the ICP, which can be measured indirectly by correlating it with the sonographically measured optic nerve sheath diameter (ONSD). In this study, our primary aim was to compare the change from baseline of the ONSD during propofol versus sevoflurane-maintained anesthesia in patients undergoing robotic pelvic surgery. In this prospective, interventional, double-blinded study, we randomised 50 patients into two groups P and S. Subjects in group P received intravenous propofol infusion while those in group S received inhalation sevoflurane for maintenance of anesthesia. The ONSD at fixed intervals was noted as the mean of four values measured using ultrasound in both eyes by two independent anesthesiologists who were blinded to the group allocation. The patient demographics and baseline parameters were similar. The mean maximum rise in ONSD from baseline was 0.01 ± 0.01cm in group P while it was 0.03 ± 0.01cm in group S (p = 0.001). Percentage change from baseline in group P was 3.41 ± 1.81% and 8.00 ± 2.95% in group S (p = 0.001). We found a positive correlation between the duration of surgery and the maximum rise in ONSD in group S (p = 0.003), but not in group P. Propofol-based total intravenous anesthesia is more effective than inhalation sevoflurane in attenuating the increase in ICP as correlated with the ONSD during robotic pelvic surgery.Clinical trial registration: Yes; Principal investigator: Nambiath Sujata; Trial number: REF/2016/11/012713 (registered); Trial registry: CTRI- http://ctri.nic.in .

Recovery characteristics of total intravenous anesthesia with propofol versus sevoflurane anesthesia: a prospective randomized clinical trial.

BackgroundPediatric dental procedures are performed under anesthesia because children may be uncooperative in the dental clinic due to their young age. Emergence delirium (ED), which involves a variety of behavioral disturbances that are frequently observed in children following emergence from general anesthesia, remains an unclear phenomenon. The aim of this randomized controlled trial is to compare the incidence of ED in children who underwent full mouth dental rehabilitation under either sevoflurane (SEVO) anesthesia or propofol-based total intravenous anesthesia (TIVA).Patients and methodsOne hundred and twenty children with American Society of Anesthesiologists status I–II, aged ≥3 and ≤6 years, undergoing dental rehabilitation were assigned to receive either TIVA or SEVO. ED and postoperative pain were evaluated by a blinded investigator using the Pediatric Anesthesia Emergence Delirium scale and the Face, Legs, Activity, Cry, Consolability scale every 5 min. The recovery time, satisfaction levels of parents or guardians, extubation time, duration of the operation, and type of dental procedure were also recorded.ResultsData of 116 subjects were analyzed. The incidence of ED was higher after SEVO than after TIVA (65.5 vs 3.4%, P=0.00). Greater postoperative pain was observed in the SEVO group (median 3 vs 1, P=0.000). A statistically significant, moderate correlation (rs=0.46, P<0.0001) was found between the Face, Legs, Activity, Cry, Consolability and Pediatric Anesthesia Emergence Delirium scores. A higher parental satisfaction level was observed in the TIVA group.ConclusionA lower incidence of ED and a higher parental satisfaction level were observed after TIVA. Moreover, TIVA resulted in a more comfortable postoperative period due to reduced postoperative pain, and the extubation time and recovery time were not increased.

An international survey evaluating factors influencing the use of total intravenous anaesthesia.

The purpose of this study was to evaluate factors influencing the use of propofol-based total intravenous anaesthesia (TIVA)since despite TIVA being a well-established technique, it is used far less frequently than volatile anaesthesia. Questions were formulated after reviewing the literature for perceived disadvantages of TIVA and meeting with a focus group consisting of both senior and junior anaesthestists from our department. Once the survey had been formulated, specialist anaesthetists from professional colleges and societies from several countries were invited to complete the survey on an electronic web-based platform to allow evaluation of the respondent's rating of the importance of a range of factors in their decision not to use TIVA for a particular case. Basic descriptive statistics were determined using SPSS statistical software, while graphical depictions of data were handled using R for statistical analysis. A total of 763 survey responses were included in the final analysis and stratified according to the frequency of TIVA use. Among the infrequent users, issues such as additional effort, institutional preference, lack of real-time monitoring of propofol concentration, risk of missing drug delivery failure and increased turnaround time were among the top reasons mentioned. Interestingly, these issues were considered far less important among the frequent users when not choosing TIVA. We concluded that frequent and infrequent users respond quite differently to similar technical TIVA-related factors. Non-technical factors may play an important role in the infrequent user's decision not to use TIVA for a particular case.

Effects of propofol-based total intravenous anesthesia on gastric cancer: a retrospective study.

BackgroundSeveral kinds of cancer surgeries with propofol-based total intravenous anesthesia (TIVA) have been shown to have better outcomes than those with sevoflurane-based inhalational anesthesia (INHA). However, the effects of this anesthetic technique have not been investigated in patients with gastric cancer. In this study, the authors retrospectively examined the link between the choice of anesthetic technique and overall survival in patients undergoing gastric cancer resection.MethodsWe conducted a retrospective analysis of the database of all patients undergoing gastric cancer resection for gastric cancer between 2007 and 2012. Patients who received TIVA or INHA were administered patient-controlled intravenous analgesia for 72–120 hours postoperatively. Survival was estimated using the Kaplan–Meier log-rank test, and associations between anesthetic technique and outcomes were analyzed using Cox proportional hazards regressions after propensity matching.ResultsA total of 2,856 anesthetics using INHA or TIVA were delivered in the study period. After propensity matching, 897 patients remained in each group. According to Kaplan–Meier analysis, the use of TIVA was associated with improved survival (P<0.001). TIVA was associated with a hazard ratio (HR) of 0.67 (95% confidence interval [CI]: 0.58–0.77) for death in univariate analysis and 0.65 (95% CI: 0.56–0.75) after a multivariate analysis of known confounders in the matched group. Cancer stage (HR =0.74, 95% CI: 0.64–0.86, P<0.001) and degree of differentiation (HR =1.28, 95% CI: 1.11–1.47, P<0.001) were also associated with survival in the univariate analysis in the matched group. In the multivariable Cox model, cancer stage (HR =0.72, 95% CI: 0.62–0.84, P<0.001) and degree of differentiation (HR =1.23, 95% CI: 1.07–1.42, P<0.001) were associated with survival in the matched group.ConclusionThese results indicate that TIVA may be associated with improved survival in gastric cancer patients who undergo resection.

Postoperative complications in total intravenous anesthesia with propofol compare with sevoflurane anesthesia: A retrospective study

The aim of us is to define the incidence of postoperative complications two anesthesia procedures. During the period between 01.01.2016 and 01.01.2017, totally 583 patients were included in the study, who had oral-maxillofacial surgeries. Anesthesia types were determined as propofol-based total intravenous anesthesia (TIVA) and sevoflurane-inhalation anesthesia (SA). Surgical types were divided into two groups, major and minor. Postoperative complications and recovery period were determined as tachycardia, bradycardia, hypertension, hypotension, recovery time, additional analgesia, nausea-vomiting. While TIVA was used 241 patients, SA was used 342 patients. Incidences of patients, having had major surgeries under TIVA, for additional analgesic, nausea-vomiting, and recovery period on average were found as 12.7%; 13.5%; 13min respectively. As for the patients having had minor surgeries under TIVA, the same values were 10.2%; 6.5%; 12min respectively. Incidences of patients, having had major surgeries under SA, for additional analgesic, nausea-vomiting, recovery period on average were found as 11.3%; 34.2%; 7min respectively. Patients having had minor surgeries under TIVA performed the same values as 9.8%; 19.5%; 5min respectively. It was observed that SA caused more nause-vomiting than TIVA; however, it had a shorter recovery period. We have been in the opinion of that SA absolutely must be done with nausea-vomiting premedication and that it could be preferred owing to the shorter recovery.

Intraocular pressure changes during laparoscopic surgery in Trendelenburg position in patients anesthetized with propofol-based total intravenous anesthesia compared to sevoflurane anesthesia: A comparative study

Background:Intraocular pressure (IOP) is increased during laparoscopic surgery with Trendelenburg position and may contribute to deleterious effects on optic nerve in susceptible patients.Aims:The primary objective of this study is to compare the effects of propofol-based total intravenous anesthesia (TIVA) with those of sevoflurane anesthesia on IOP in patients undergoing lower abdominal laparoscopic surgery in Trendelenburg position. Secondary objectives are to compare hemodynamic changes, mean arterial pressure (MAP), end-tidal CO2, and peak inspiratory pressure changes.Materials and Methods:Sixty patients with physical status American Society of Anesthesiologists classes I and II were randomly allocated in two groups: Group A (propofol) and Group B (sevoflurane). IOP along with other parameters was measured at seven points including baseline (T0), 5 min after induction (T1), 5 min after CO2 pneumoperitoneum in supine position (T2), 30 min after CO2 pneumoperitoneum with Trendelenburg position (T3), 5 min after returning to supine position (T4), 5 min after CO2 desufflation (T5), and 5 min after extubation (T6).Results:The change in IOP was different between the two groups. Maximum rise in IOP was seen at T3, and mean ± standard deviation IOP was 15.5 ± 0.9 mmHg and 19.8 ± 1.2 mmHg in Group A and Group B, respectively (P < 0.01). In Group A (propofol), IOP remained almost equal to the baseline value at T3 and the IOP difference was 0.3 ± 0.9 mmHg less than baseline (statistically insignificant, P > 0.05), while in Group B (sevoflurane), IOP increased significantly at T3 and the difference was 4.0 ± 1.2 mmHg (P < 0.001). The IOP was significantly greater (P < 0.01) from T2 to T6 in sevoflurane group than propofol group.Conclusion:Propofol-based TIVA is more effective than inhalational anesthesia with sevoflurane in attenuating the increase in IOP during laparoscopic surgery requiring CO2 pneumoperitoneum with Trendelenburg position.

Long-Term Oncologic Outcomes for Patients Undergoing Volatile Versus Intravenous Anesthesia for Non-Small Cell Lung Cancer Surgery: A Retrospective Propensity Matching Analysis.

Propofol-based total intravenous anesthesia (TIVA) has been reported to improve long-term outcome following cancer surgery, when compared with inhalation agents. However, such investigational reports are still controversial, and no studies have been conducted in relation to non-small cell lung cancer (NSCLC) surgery. The present study aimed to compare the favorable effects of TIVA versus inhalation agents on recurrence-free survival and overall survival after curative resection of NSCLC. This retrospective cohort study examined medical records of the patients who were diagnosed with NSCLC and underwent curative resection at Seoul National University Bundang Hospital from August 2003 to July 2012. The primary outcome included the comparison of postoperative overall survival and recurrence-free survival in both groups. To balance the 2 groups for analysis, a propensity matching method was used, and stratified Cox proportional hazard models were used for statistical analysis. This study included 943 cases of NSCLC for final analysis, and the cases were divided into the TIVA group (n = 749) and inhalation group (n = 194). Propensity matching produced 196 patients in each group. The final analysis revealed no significant difference in the hazard ratio (HR) for recurrence between the TIVA and inhalation groups (P = .233). The HR for death between the 2 groups was not significantly different either (P = .551). In this study, we found no benefit of propofol-based TIVA for long-term oncologic outcome after NSCLC surgery, relative to inhalation agents.

Efficacy of sevoflurane as an adjuvant to propofol-based total intravenous anesthesia for attenuating secretions in ocular surgery.

Background:The incidence of nasal secretions into the operative field is as high as 5% in ophthalmic surgery under general anesthesia. It may induce postoperative endophthalmitis. Secretions under propofol-based total intravanous anesthesia (TIVA) are greater than sevoflurane anesthesia during surgery. Postoperative nausea and vomiting (PONV) after inhalational anesthesia is higher than TIVA and may increase intraocluar pressure. We investigated the effect of sevoflurane combination with propofol-based TIVA on nasopharyngeal secretions and PONV in ocular surgery.Methods:Fifty patients undergoing ocular operations were randomly assigned for propofol-based TIVA or propofol/sevoflurane anesthesia. In the TIVA group (n = 25), anesthesia was induced and maintained with propofol and fentanyl; in the propofol/sevoflurane group (n = 25), 1% sevoflurane anesthesia was added.Results:Nasopharyngeal excretion volume was significantly higher in the propofol-based TIVA group than in the propofol/sevoflurane group (31.0 ± 18.1 vs 13.7 ± 12.6 ml; P < .001). No significant difference in extubation time was noted (propofol-based TIVA: 6.4 ± 3.6 vs propofol/sevoflurane: 7.4 ± 3.0 minutes; P = .34). No postoperative endophthalmitis or PONV in both groups was observed.Conclusion:Sevoflurane attenuated secretions under propofol-based TIVA and did not increase the incidence of PONV or prolonged extubation in ocular surgery.

Relationship between anesthesia and postoperative endophthalmitis

Previous study showed that patients under general anesthesia (GA) had nasopharyngeal secretions on the face at the end of ocular surgery, especially in propofol-based total intravenous anesthesia (TIVA), it might induce postoperative endophthalmitis. Therefore, we conducted a retrospective study to compare the incidence of endophthalmitis after ocular surgery under topical, inhalation anesthesia, and propofol-based TIVA in our medical center from 2011 to 2015.A total of 21,032 patients were included, and we evaluated epidemiologic factors, systemic diseases, other ocular pathologic characteristics, complications during the surgery, technique of ocular surgery, method of antibiotic prophylaxis, vitreous culture, and vision outcome in these patients.Fifteen endophthalmitis cases among 21,032 operations reported, equaling an incidence of 0.071%. The incidence rates under topical, inhalation anesthesia, and propofol-based TIVA were 0.083%, 0.039%, and 0%, respectively (P = 0.39). Moreover, the risk of endophthalmitis under GA (0.024%) was significantly lower than topical anesthesia (0.083%) (P < 0.001). We also found that elder was the risk factor for endophthalmitis following ocular surgery.In conclusion, propofol-based TIVA or inhalation anesthesia did not increase the risk of endophthalmitis after ocular surgery. Thus, GA was not a risk factor for postoperative endophthalmitis. By contrast, elder was the risk factor for postoperative endophthalmitis.

Planning for operating room efficiency and faster anesthesia wake-up time in open major upper abdominal surgery.

Reducing anesthesia-controlled time (ACT) may improve operation room (OR) efficiency result from different anesthetic techniques. However, the information about the difference in ACT between desflurane (DES) anesthesia and propofol-based total intravenous anesthesia (TIVA) techniques for open major upper abdominal surgery under general anesthesia (GA) is not available in the literature.This retrospective study uses our hospital database to analyze the ACT of open major upper abdominal surgery without liver resection after either desflurane/fentanyl-based anesthesia or TIVA via target-controlled infusion with fentanyl/propofol from January 2010 to December 2011. The various time intervals including waiting for anesthesia time, anesthesia time, surgical time, extubation time, exit from OR after extubation, total OR time, and postanesthetic care unit (PACU) stay time and percentage of prolonged extubation (≥15 minutes) were compared between these 2 anesthetic techniques.We included data from 343 patients, with 159 patients receiving TIVA and 184 patients receiving DES. The only significant difference is extubation time, TIVA was faster than the DES group (8.5 ± 3.8 vs 9.4 ± 3.7 minutes; P = 0.04). The factors contributed to prolonged extubation were age, gender, body mass index, DES anesthesia, and anesthesia time.In our hospital, propofol-based TIVA by target-controlled infusion provides faster emergence compared with DES anesthesia; however, it did not improve OR efficiency in open major abdominal surgery. Older, male gender, higher body mass index, DES anesthesia, and lengthy anesthesia time were factors that contribute to extubation time.

Correction: Comparison of Anesthesia-Controlled Operating Room Time between Propofol-Based Total Intravenous Anesthesia and Desflurane Anesthesia in Open Colorectal Surgery: A Retrospective Study

[This corrects the article DOI: 10.1371/journal.pone.0165407.].

Total Intravenous Anaesthesia (TIVA) for Ambulatory Surgery: An Update

Total intravenous anesthesia (TIVA) has several potential benefits in the context of ambulatory surgery. This review explores the use of propofol-based TIVA from a wide number of perspectives: we review relevant literature in relation to patient and institutional outcomes attributable to TIVA; we provide an overview of the pharmacology of propofol and how TIVA delivery systems have evolved; we explore the advent of closed loop anesthesia systems; and we briefly review some of the pharmacological adjuncts used in TIVA. Propofol-based TIVA is associated with less post-operative nausea and vomiting, better pain outcomes, higher quality of recovery scores and better measures of perioperative efficiency when compared to vapor-based anesthesia. The combination of propofol and low-dose remifentanil appears to confer some benefit to the use of propofol alone. Infusion algorithms based on drug pharmacokinetics can be used in combination with biometrics such as processed EEG, skin conductance and heart rate variability to deliver closed-loop anesthesia. Successful ambulatory surgery programmes require anaesthesia that permits rapid return of consciousness with minimal morbidity. Propofol-based TIVA appears to meet this challenge. The advent of new technology may further enhance this anesthesia modality.

Porównanie wartości BIS podczas całkowitego znieczulenia dożylnego z zastosowaniem propofolu i znieczulenia wziewnego sewofluranem u otyłych pacjentów

Intraoperative awareness is a rarely occurring phenomenon. Obesity is considered as one of the factors increasing the probability of intraoperative awareness due to problems with the dosing of anaesthetics. In a randomized prospective study we compared bispectral index (BIS) recordings during propofol-based total intravenous anaesthesia (TIVA) and sevoflurane-based inhalation anaesthesia in morbidly obese patients as a sign of possible intraoperative awareness. 120 morbidly obese patients were randomly allocated into two subgroups: TIVA or SEVO. Propofol TIVA was performed following the Servin formula, while sevoflurane was administered based on the age of the patients. The physician administering anaesthesia was blinded to the BIS recordings while the evaluation of the depth of anaesthesia was conducted based on the clinical symptoms of adequate anaesthesia. BIS recordings were evaluated for periods of BIS > 60. Blinded structured interviews were conducted 2 hours after anaesthesia was administrated. The incidence of BIS > 60 occurred in 90% vs. 91.67% of patients while the mean duration of periods of BIS > 60 was 13.74 ± 21.74% vs. 14.21 ± 18.78% of the duration of anaesthesia in TIVA and SEVO groups, respectively (P > 0.05). There was no correlation between the BMI value and the duration of elevated BIS values observed during anaesthesia in both studied methods of anaesthesia, nor between the total time of anaesthesia and the duration of elevated BIS values above 60 in this study. No patient complained of intraoperative awareness when asked in the post-operative period, probably due to the administration of midasolam. Although the incidence of BIS > 60 are very common in obese patients, true awareness during anaesthesia infrequent in this group of patients despite the type of anaesthesia, whether intravenous or inhalation.

Sevoflurane Versus Total Intravenous Anesthesia for Isolated Coronary Artery Bypass Surgery With Cardiopulmonary Bypass: A Randomized Trial.

Several studies have suggested that the cardioprotective effects of halogenated anesthetics in cardiac surgery result in reduced cardiac biomarker release compared with total intravenous anesthesia (TIVA). These findings came from relatively small randomized clinical trials and meta-analyses. The authors of this study hypothesized that the beneficial effects of volatile anesthetics translate into a reduced length of hospital stay after coronary artery bypass grafting surgery (CABG) with cardiopulmonary bypass. A randomized controlled trial. Two university hospitals. Adult patients undergoing elective CABG surgery with cardiopulmonary bypass. Patients were assigned randomly to 2 following groups: propofol-based TIVA group (n = 431) and sevoflurane group (n = 437). The primary endpoint was hospital length of stay, and the secondary endpoint included postoperative troponinT and N-terminal pro-brain natriuretic peptide release and mortality. In the sevoflurane group, a reduced length of hospital stay was observed compared with the propofol-based TIVA group (10 [9-11] days v 14 [10-16], p<0.001) as were reductions in cardiac troponinT release (0.18 ng/mL v 0.57 ng/mL at 24 hours, p<0.001), in N-terminal pro-brain natriuretic peptide release (633 pg/mL v 878 pg/mL at 24 hours, p<0.001; 482 pg/mL v 1,036 pg/mL at 48 hours, p<0.001), and in mortality at 1-year follow up (17.8% v 24.8%, p = 0.03). Anesthesia with sevoflurane reduced cardiac biomarker release and length of hospital stay after CABG with cardiopulmonary bypass surgery compared with propofol-based TIVA with a possible reduction in 1-year mortality.

Effects of propofol-based total intravenous anesthesia on recurrence and overall survival in patients after modified radical mastectomy: a retrospective study.

BackgroundThe optimal combination of anesthetic agent and technique may have an influence on long-term outcomes in cancer surgery. In vitro and in vivo studies suggest that propofol independently reduces migration of cancer cells and metastasis. Thus, the authors retrospectively examined the link between propofol-based total intravenous anesthesia (TIVA) and recurrence or overall survival in patients undergoing modified radical mastectomy (MRM).MethodsA retrospective analysis of the electronic database of all patients undergoing MRM for breast cancer between January 2007 and December 2008 was undertaken. Patients received either propofol-based TIVA (propofol group) or sevoflurane-based anesthesia (sevoflurane group). We analyzed prognostic factors of breast cancer and perioperative factors and compared recurrence-free survival and overall survival between propofol and sevoflurane groups.ResultsA total of 363 MRMs were carried out during the period of the trial; 325 cases were suitable for analysis (173 cases of propofol group, and 152 cases of sevoflurane group). There were insignificant differences between the groups in age, weight, height, histopathologic results, surgical time, or postoperative treatment (chemotherapy, hormonal therapy, and radiotherapy). The use of opioids during the perioperative period was greater in propofol group than in sevoflurane group. Overall survival was no difference between the two groups. Propofol group showed a lower rate of cancer recurrence (P = 0.037), with an estimated hazard ratio of 0.550 (95% CI 0.311–0.973).ConclusionsThis retrospective study provides the possibility that propofol-based TIVA for breast cancer surgery can reduce the risk of recurrence during the initial 5 years after MRM.