Department of Anesthesiology, Tri-Service General Hospital and National Defense Medical Center, Taipei 11490, Taiwan.
Division of General Surgery, Department of Surgery, Tri-Service General Hospital and National Defense Medical Center, Taipei 11490, Taiwan.
Int J Environ Res Public Health. 2023 Jan 23;20(3):2094. doi: 10.3390/ijerph20032094.
Total intravenous anesthesia (TIVA) with remifentanil and propofol (RP) is considered to be an ideal type of general anesthesia (GA) for pediatric and adult patients undergoing medical procedures. However, delivery of an RP mixture by target-controlled infusion (TCI) for GA in surgical procedures has not been described. We investigated the merit of this approach for breast cancer surgery. Eighty-four patients (n = 42 per group) were randomly allocated to propofol and remifentanil either delivered by separate TCI pumps (S group) or in an RP mixture by a single TCI pump (M group). Dosages were adjusted based on the bispectral index (BIS) and the analgesia nociception index (ANI). The primary outcomes were adequate anesthesia (BIS 40-60 and ANI 50-70, respectively), acceptable hemodynamic fluctuations (<30% of baseline) with less frequent TCI pump adjustments, bolus injections of anesthetics, and total consumption of anesthetics during the procedure. The secondary endpoints included time of emergence from anesthesia, patient satisfaction, postoperative pain, rescue with opioids, and adverse events. The characteristics of patients, hemodynamic parameters, BIS and ANI scores, duration of surgery, anesthesia, and emergence were not significantly different between groups. The adjustment frequency of TCI was significantly higher in the S group (3 (range 0-6) vs. 2 (0-6) times; = 0.005). The total dosage of anesthetics, pain rating, patient satisfaction, need for opioids postoperatively, and incidence of adverse events were not significantly different. We have demonstrated that this RP mixture provided adequate hypnotic and analgesic effects under BIS and ANI monitoring in patients undergoing breast cancer surgery within 1 h.
全凭静脉麻醉（TIVA）联合瑞芬太尼和丙泊酚（RP）被认为是小儿和成人患者接受医疗程序的理想全身麻醉（GA）类型。然而，通过靶控输注（TCI）输送 RP 混合物用于手术中的 GA 尚未被描述。我们研究了这种方法在乳腺癌手术中的优点。84 名患者（每组 n = 42）随机分配到丙泊酚和瑞芬太尼分别通过单独的 TCI 泵（S 组）或通过单个 TCI 泵（M 组）输送。剂量根据脑电双频指数（BIS）和镇痛/伤害感受指数（ANI）进行调整。主要结局是足够的麻醉（BIS 分别为 40-60 和 ANI 分别为 50-70），可接受的血流动力学波动（<基线的 30%），较少的 TCI 泵调整，麻醉剂的推注和手术过程中麻醉剂的总消耗。次要终点包括麻醉苏醒时间、患者满意度、术后疼痛、阿片类药物解救和不良事件。患者特征、血流动力学参数、BIS 和 ANI 评分、手术、麻醉和苏醒时间在组间无显著差异。S 组 TCI 的调整频率明显更高（3（范围 0-6）次比 2（0-6）次；= 0.005）。麻醉剂的总剂量、疼痛评分、患者满意度、术后对阿片类药物的需求以及不良事件的发生率无显著差异。我们已经证明，在乳腺癌手术中，这种 RP 混合物在 1 小时内通过 BIS 和 ANI 监测提供了足够的催眠和镇痛效果。
