[Anesthetic management by continuous total intravenous anesthesia]

Abstract

Total intravenous anesthesia (TIVA) is one of the most recommended methods of anesthesia for the prevention of air pollution. But the intermittent administration of anesthetic agents has a disadvantage of elongating emergence time. When inexperienced residents undertake TIVA with larger doses of drugs to stabilize vital signs, it takes long emergence time. Therefore, we suggested a continuous TIVA with propofol, ketamine and vecuronium in combination with butorphanol (PKBt) or buprenorphine (PKBp). In this study, we compared emergence times in the subjects, who underwent general anesthesia with PKBt and PKBp. After induction with propofol (2 mg.kg-1), ketamine (0.5 mg.kg-1), vecuronium (0.1 mg.kg-1) and agonist-antagonist opioids, subjects in each group were maintained with continuous intravenous injection of propofol (2-10 mg.kg-1.h-1), ketamine (240 micrograms.kg-1.h-1) and vecuronium (80 micrograms.kg-1.h-1) in combination with butorphanol (8 micrograms.kg-1.h-1) or buprenorphine (0.4 microgram.kg-1.h-1). The emergence times were designated as Op time (the end of operation to awareness), Pr time (the end of propofol to awareness), and B time (the end of butorphanol or buprenorphine to awareness). The emergence times of Op, Pr and B were not different between the groups. The elderly patients showed longer B time than the younger. The patients with long anesthetic time showed longer B time than the patients with short anesthesia. The patients with general anesthesia combined with epidural anesthesia showed longer B time than the patients with only general anesthesia. But there were no differences in Op time and Pr time. We conclude that the continuous TIVA is useful to reduce emergence time and prevent air pollution.