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KMID : 0381219940260010001
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Journal of RIMSK
1994 Volume.26 No. 1 p.1 ~ p.11
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Total Intravenous Anesthesia with Midazolam and Fentanyl
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Abstract
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Total intravenous anesthesia(TIVA)with ketamine and fentanyl has many advantages such as no air pollution, no hepatic or renal toxicity and good postoperative pain relief compared with inhalational anesthesia, but this anesthetic method also has
several
disadvantages such as hypertension, delayed recovery and emergence delirium. For improvement of this problems, the author tried new TIVA method with propofol and fentanyl This time the author modified above TIVA method with midazolam and fentanyl
to the
30 patients in ASA class I or II during 6 months from July to December 1993.
@ES The results were as follows:
@EN 1) Systolic blood pressure, diastolic blood pressure and mean arterial pressure decreased during 10 minutes after anesthetic induction, and they increased during l hour after surgical incision(p<0.05). Heart rate increased during 6 minutes
after
anesthetic induction(p<0.05). RPP showed fluctuation during postinduction and preincision period, but there was no change in RPP from 30 minutes after surgical incision.
2) Among the data of arterial blood gas PaO2 increased during recovery period(p<0.05), but clinically both data were within normal limit.
3) The blood sugar level increased during operation and postoperative 60 minutes(p<0.05).
4) There were some complications such as movement, eye opening and grimace during anesthesia. Nausea or vomiting and headache were the chief complications postanesthetic 2 hours and 24 hours.
5) According to the results of hepatic or renal function test of postoperative 3rd day the levels of alkaline phosphatase and BUN decreased compared with preoperative value(p<0.05), but there were no significant changes in the levels of SGOT,
SGPT,
GGTP and creatinine.
6) Emergence time was 13.5±8.4 minutes, and recovery time was 45.9 ±16.7 minutes. The duration from arrival on recovery room to postanesthetic recovery score of 10 was 34.7±16.3 minutes.
Therefore TIVA with midazolam and fentanyl is considered to have good controllability and it can be applied as one of general anesthetic methods in the case of contraindication to N2O and volatile anesthetics, but further study will be required
to
quantify the appropriate dosage of midazolam or fentanyl to minimize perioperative hemodynamic changes and respiratory depression.
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