Comparison of Propofol-Remifentanil and Sevoflurane-Remifentanil Anesthesia for Suspension Laryngoscopic Surgery

BACKGROUND: Suspension laryngoscopic surgery may cause acute hemodynamic changes such as hypertension and tachycardia and requires rapid recovery. The purpose of this study was to compare the hemodynamic responses, and emergence and recovery profiles between propofol-remifentanil and sevoflurane-remfentanil anesthesia. METHODS: Forty patients (ASA I, II) undergoing suspension laryngoscopic surgery were randomly allocated to either a propofol group (Group P) or sevoflurane group (Group S). Anesthesia was induced with target concentration of 5microg/ml using propofol target controlled infusion (TCI) in group P and thiopental sodium 5 mg/kg in group S, respectively. In both groups, after succinylcholine 1 mg/kg IV bolus injection, remifentanil was infused with a target concentration 5 ng/ml using remifentanil TCI for tracheal intubation. Anesthesia was maintained with N2O 2 L/min, O2 2 L/min, remifentanil (2.5-7.0 ng/ml), succinylcholine infusion (0.15 mg/kg/ min) in both groups, with propofol (2.0microg/ml) was used in group P and sevoflurane 3.0 vol% in group S. We compared hemodynamic status, and emergence and recovery profiles during and after operation. RESULTS: MAP and HR after tracheal intubation and suspension laryngoscopy insertion showed significantly smaller changes in group P and were more stable compared with group S. The suction time of the catheter response was shorter in group P compared with group S, and sedation was less deeper in group P than group S. Other recovery profiles were comparable between groups. CONCLUSIONS: During propofol-remifentanil anesthesia, hemodynamics were not increased by intubation or suspension laryngoscopy, and the early emergence and good recovery profiles of patients were appeared favorably compared with sevofluraneremifentanil anesthesia.

Effect of Positive End Expiratory Pressure on Intra-abdominal Pressure and Abdominal Perfusion Pressure at an Increased Intra-abdominal Pressure / 대한마취과학회지

BACKGROUND: Increased intra-abdominal pressure (IAP) leads to adverse effects on most organ systems and is associated with significant morbidity and mortality in surgical and trauma patients. The purpose of this study was to determine the effect of positive end expiratory pressure (PEEP) on IAP and abdominal perfusion pressure (APP, mean arterial pressure, MAP minus IAP) at normal and increased intra-abdominal pressures. METHODS: 15 patients requiring a laparoscopic cholecystectomy were included. IAP was measured indirectly using a transurethral catheter, and APP was calculated for each patient at 0, 5, 10, 15, and 20 cmH2O of PEEP, while the insufflator pressure was maintained at either 0 or 15 mmHg. RESULTS: At each insufflator pressure, IAP increased with higher PEEP levels (P < 0.05). At 0 mmHg insufflator pressure state, MAP substantially decreased according to increasing PEEP levels, however, at 15 mmHg insufflator pressure state, MAP substantially increased despite increasing PEEP levels. Meanwhile, APP decreased with increasing PEEP levels at an insufflator pressure of zero while remaining constant at a 15 mmHg insufflator pressure. CONCLUSIONS: We found that IAP increases in response to higher PEEP levels (10, 15, and 20 cmH2O) at insufflator pressures of both zero and 15 mmHg in patients anesthetized for laparoscopic cholecystectomy. However, APP did not decrease with increasing PEEP levels at a higher intraadominal pressure (15 mmHg).