Total intravenous anesthesia(TIVA) is a anesthetic technique where hypnosis, analgesia and muscle relaxation are provided solely by intravenously administered drug without the use of anesthetic vapors of gases including nitrous oxide. For TIVA,
midazolam and propofol have been used as hypnotics because of their relatively short elimination half life.
Hemodynamic function during induction of anesthesia, the fentanyl and naloxone requirements, and speed of recovery from TIVA with midazolam/fentanyl(group M, n=20) or propofol/fentanyl(group P, n=20) were compaired in patients undergoing surgery.
Forty
patients were randomly assigned to receive either 0.2 mg/kg midazolam in 5 min followed by 0.4 mg/kg/hr for next 20 min, 0.05∼0.2 mg/kg/hr until 10∼15 min before skin closure, or 2 mg/kg propofol in 5 min followed by 9 mg/kg/hr for 30 min and
4.5
mg/kg/hr until 10∼15 min before skin closure. Simultaneously, a variable rate infusion of fentanyl was given. Patients were intubated with an aid of vecuronium and ventilated with 40% oxygen in air.
In both groups, mean arterial pressure decreased significantly(P<0.05) during induction period, but, in group P decreased more significantly compared to group M from 3 min after intubation to 8 min after skin incision(P<0.05). The heart rate was
decreased significantly in both groups(P<0.05), but not clinically, and the decrease had no difference between groups(P>0.05). The total dose, duration and rate of infusion of fentanyl was similar in both groups. 16 patients in group M and 9
patients in
group P needed naloxone for recovery of respiration and 10 patients in group M needed flumazenil for recovery of consciousness. Recovery of consciousness. Recovery as judged by scoring system(sedation score, comprehension score, orientation
score)
was
shorter in group P than group M. Among side effects, resedation was more frequent in group M(9 pts) than P group(0 pt).
In conclusion, both midazolam and propofol were useful hypnotics for TIVA. But, group M showed more stable hemodynamics than group P during induction period and P group showed earlier recovery than group M. We concluded that the selection of
hypnotics
between midazolam and propofol for TIVA depends on situation such as better hemodynamics during induction period or earlier recovery. (Korean J Anesthesiol 1995; 29: 671∼679)
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