Background: The objective of this study was to compare hemodynamic and recovery characteristics of total intravenous anesthesia using propofol target-controlled infusion (TCI) versus sevoflurane for extraction of four third molar teeth. Methods: One hundred patients undergoing extraction of four thi...
Background: The objective of this study was to compare hemodynamic and recovery characteristics of total intravenous anesthesia using propofol target-controlled infusion (TCI) versus sevoflurane for extraction of four third molar teeth. Methods: One hundred patients undergoing extraction of four third molar teeth under general anesthesia were randomized to one of two groups. Group 1 received propofol TCI-oxygen for induction and propofol TCI-oxygen-air for maintenance. Group II received a propofol bolus of 2 mg/kg for induction and sevoflurane-oxygen-air for maintenance. Heart rate, mean arterial pressure (MAP), operating time, time to emergence, nausea and vomiting, and sedation and pain scores were measured in each group. Results: Demographic data, including age, gender, weight, and height, were not significantly different between the two groups. The MAP was significantly higher after intubation (P = 0.007) and injection of anesthesia (P = 0.004) in the propofol group than in the sevoflurane group, with significant reflex bradycardia (P = 0.028). The mean time to emergence from anesthesia using propofol was 25 s shorter than that of sevoflurane (P = 0.02). Postoperatively, the propofol group was less sedated than the sevoflurane group at 30 min (0.02 versus 0.12), but this difference was not significant (P = 0.065). Conclusion: Both propofol TCI and sevoflurane are good alternatives for induction and maintenance of anesthesia for short day-case surgery. However, propofol TCI does not blunt the hemodynamic response to sudden, severe stimuli as strongly as sevoflurane, and this limitation may be a cause for concern in patients with cardiac comorbidities.
Background: The objective of this study was to compare hemodynamic and recovery characteristics of total intravenous anesthesia using propofol target-controlled infusion (TCI) versus sevoflurane for extraction of four third molar teeth. Methods: One hundred patients undergoing extraction of four third molar teeth under general anesthesia were randomized to one of two groups. Group 1 received propofol TCI-oxygen for induction and propofol TCI-oxygen-air for maintenance. Group II received a propofol bolus of 2 mg/kg for induction and sevoflurane-oxygen-air for maintenance. Heart rate, mean arterial pressure (MAP), operating time, time to emergence, nausea and vomiting, and sedation and pain scores were measured in each group. Results: Demographic data, including age, gender, weight, and height, were not significantly different between the two groups. The MAP was significantly higher after intubation (P = 0.007) and injection of anesthesia (P = 0.004) in the propofol group than in the sevoflurane group, with significant reflex bradycardia (P = 0.028). The mean time to emergence from anesthesia using propofol was 25 s shorter than that of sevoflurane (P = 0.02). Postoperatively, the propofol group was less sedated than the sevoflurane group at 30 min (0.02 versus 0.12), but this difference was not significant (P = 0.065). Conclusion: Both propofol TCI and sevoflurane are good alternatives for induction and maintenance of anesthesia for short day-case surgery. However, propofol TCI does not blunt the hemodynamic response to sudden, severe stimuli as strongly as sevoflurane, and this limitation may be a cause for concern in patients with cardiac comorbidities.
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문제 정의
Furthermore, none of the evaluated patients had vomiting. Therefore, a larger cohort of patients and the omission of other anti-emetics would be required to detect significant differences in postoperative nausea and vomiting between these two forms of anesthesia, which is beyond the scope of this study.
제안 방법
After enrolment, the patients were prospectively and randomly assigned to one of two study groups by drawing out sticks from a bag labeled as “sevoflurane” or “propofol.
However, new depth of anesthesia monitors such as bispectral index monitoring and entropy monitoring developed by Datex-Ohmeda [14,15] have allowed controlling the depth of anesthesia in the intraoperative period. In this study, hemodynamic stability and the postoperative levels of sedation, nausea and vomiting, and pain were compared between these two methods using a known depth of anesthesia.
The calculation of sample size was based on previous studies comparing propofol TCI and sevoflurane anesthesia [8,11,16]. Data on patient’s age, weight, height, operating time, time to emergence, sedation score, amount of administered fentanyl, VAS pain scores, heart rate, and MAP were analyzed using Student’s t-test.
The delivery of propofol TCI and sevoflurane was adjusted to keep state entropy between 40 and 55. The surgeon infiltrated 30 mL of bupivacaine 0.25% with adrenaline 1:400,000 in bilateral inferior alveolar nerve blocks plus local infiltration in teeth 18, 28, 38, and 48. At the end of surgery, neostigmine 2.
This study investigated the intraoperative hemodynamic responses and recovery profile of patients who underwent extraction of four third molar teeth and compared maintenance anesthesia using either propofol TCI or sevoflurane. All other aspects of anesthesia regarding the usual routine of the anesthetist and the operating surgeon remained unchanged between the two groups.
데이터처리
Data on patient’s age, weight, height, operating time, time to emergence, sedation score, amount of administered fentanyl, VAS pain scores, heart rate, and MAP were analyzed using Student’s t-test.
성능/효과
In conclusion, for short day-case anesthesia, propofol TCI is cheaper and has a recovery profile similar to that of sevoflurane. However, propofol TCI does not blunt the hemodynamic response to stimuli as strongly as sevoflurane.
Previous studies found that both propofol [12] and sevoflurane [1] significantly decreased recovery time in some cases; however, surgical time was longer and the depth of anesthesia was not standardized in these cases [12]. Our results indicated that there was no significant difference in the recovery time between the two groups, and most patients had a sedation score of zero at 30 min after arrival in the PACU (Table 2).
참고문헌 (16)
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