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October 17-21, 2009 New Orleans, LA Home Abstract Archive Search Abstracts 2009 Session Grid 2009 Meeting Website Policy Statements ASA Website Feedback 
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A1075
October 20, 2009 9:00 AM - 11:00 AM Room Area E |
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| Clinical Outcomes with Single Syringe Remifentanil/Propofol TIVA Dosed to IBW | ||||||||||||||||||
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Mickel B. Sharp, M.D., Jeff D. Swenson, M.D., Ken B. Johnson, M.D., Noah D. Syroid, M.S., Chad Bunker, R.A. Anesthesiology, University of Utah, Salt Lake City, Utah |
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Background
: Total Intravenous Anesthesia (TIVA) using propofol and remifentanil is associated with high patient satisfaction and a decreased incidence of post-operative nausea and vomiting (PONV) when compared to inhalational anesthesia (1,2). Despite these benefits, TIVA is not commonly used by anesthesiologists. Possible reasons for this include: poor understanding of how to properly dose TIVA and the cumbersome nature of managing multiple infusion pumps. The aim of this study was to assess the effectiveness of a simplified (single syringe) TIVA technique dosed according to ideal body weight (IBW). We hypothesize that this technique will require minimal infusion rate changes and would facilitate extubation shortly following the end of surgery.
Methods : After IRB approval and written informed consent, 31 patients having elective orthopedic surgery were prospectively studied. Anesthesia was induced with propofol 2mg/kg and fentanyl 3mcg/kg based on IBW. Remifentanil was diluted into propofol at a concentration of 20 mcg/mL. An infusion pump was programmed to deliver propofol 10 mg/mL at 100 mcg/kg/min. This rate corresponded to a remifentanil infusion rate of 0.2 mcg/kg/min. Infusion rate adjustments were made using the following criteria: for an increase in systolic blood pressure (SBP) of more than 20% above preoperative values, fentanyl 3mcg/kg was administered. If high pressures persisted, the infusion rate was increased by 10%. Patient movement was treated with a bolus of the TIVA solution (0.1ml/kg) and a 10% increase in rate. Hypotension (SBP <90mmHg) was treated with 5-10 mg of ephedrine. For persistent hypotension the infusion rate was decreased by 10%. At skin closure, the infusion was stopped. Patients were questioned about recall in the recovery room and the following day. Metrics included movement in response to surgical stimulus, infusion rate adjustments, time from infusion termination to extubation, and time from the end of surgery to extubation. In the recovery room, medications for PONV and discharge time were recorded. Results : Thirty one ASA I-II patients (21 m, 10 f), ages 20-62 and body mass indexes (BMI) between 21-46 were studied. Anesthetic dose adjustments and extubation times are presented in Table 1. No patients moved, reported awareness, or required rescue medications for PONV.[table1] Conclusion : In this preliminary study, a simplified single syringe TIVA required minimal infusion rate adjustments and was hemodynamically stable. Despite a broad range in BMI and infusion duration, remifentanil mixed into propofol set to infuse at 100 mcg/kg/min dosed according to IBW when discontinued at skin closure resulted in favorable extubation times in an ambulatory surgery center setting. 1. Eur J Anaesthesiol 2001;18:20-8. 2. Anesth Analg 2000;91:1408-14. From Proceedings of the 2009 Annual Meeting of the American Society Anesthesiologists. |
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