ISSN:
1432-055X
Keywords:
Schlüsselwörter: Erholung, postoperative – Epiduralanästhesie – Allgemeinanästhesie – Propofol
;
Key words: Anaesthesia recovery period – Anaesthesia, epidural – Anaesthesia, general – Propofol
Source:
Springer Online Journal Archives 1860-2000
Topics:
Medicine
Description / Table of Contents:
Abstract. Early mental and psychomotor recovery was studied in 67 patients undergoing colorectal surgery under continuous epidural anaesthesia and light general anaesthesia using propofol, halothane, and midazolam/fentanyl. The study was approved by the local ethics commitee. All patients received epidural anaesthesia with 0.25% bupivacaine and were then randomly allocated to one of three groups. In group I (halothane), light general anaesthesia was induced with thiopental 3 – 5 mg/kg and maintained with halothane. The propofol group (II) received 2 mg/kg for induction and a mean continuous infusion of 1.7 mg/kg⋅h. In group III (Mi/Fe), midazolam and fentanyl were used for induction and maintenance. All patients were intubated, received non-depolarising muscle relaxants, and were manually ventilated with nitrous oxide-oxygen (2 : 1.2). For postoperative analgesia, 0.05 mg/kg morphine was administrated epidurally 30 min before the end of the operation; 30, 60, 90, and 120 min after arriving in the recovery room, vigilance was assessed using a modified Steward score, the Trieger test, the ability to recall a column of numbers (KAI test), and symbol counting (CI test). Heart rate, blood pressure, arterial oxygen saturation, and blood gases were recorded. Results. The three groups were comparable with regard to age, sex, ASA classification, and duration of anaesthesia and operation (Table 3). There was no difference between the groups in performance of the recovery tests (Figs. 2 – 5), blood pressure, heart rate, arterial blood gas analysis (Fig. 6), or oxygen saturation. Comparing pre- and postoperative values, we found severe psychomotor and mental impairment in all groups. pCO2 was slightly elevated in all groups, but only 3 patients in the propofol group and 6 in the midazolam/fentanyl group developed hypercapnia above 50 mm Hg. Patients receiving propofol or midazolam/fentanyl had significantly less postoperative nausea and vomiting than those receiving halothane (Table 5). Conclusion. It is concluded that propofol offers no advantage over halothane or midazolam/fentanyl where early postoperative recovery is concerned. Intraoperatively, all three techniques provided good anaesthesia. Propofol and midazolam/fentanyl caused less postoperative nausea and vomiting than halothane anaesthesia.
Notes:
Zusammenfassung. Bei 67 Patienten, die sich einem Koloneingriff in kontinuierlicher Epiduralanästhesie und leichter Allgemeinanästhesie unterzogen hatten, wurde das postoperative Aufwachverhalten untersucht. In Gruppe I (Halothan) wurde die Allgemeinanästhesie mit Thiopental eingeleitet und mit Halothan aufrechterhalten. Propofol wurde in Gruppe II zur Einleitung und Aufrechterhaltung der Anästhesie verwendet. Gruppe III (Mi/Fe) erhielt eine Midazolam/Fentanyl-Anästhesie. Zur postoperativen Analgesie erhielten die Patienten etwa 30 min vor OP-Ende 0,05 mg/kg Morphin epidural. 30, 60, 90 und 120 min nach Ankunft der Patienten im Aufwachraum wurde die Vigilanz mit einem modifizierten Steward-Score, dem Punkteverbindungstest nach Trieger, dem KAI-Test und dem C.I.-Test erfaßt. Dabei zeigten sich zu keinem Zeitpunkt Unterschiede zwischen den Gruppen. Der Vergleich prä- und postoperativer Werte zeigte jeweils eine deutliche Beeinträchtigung der mentalen und psychomotorischen Leistungsfähigkeit. Nach Propofol und Midazolam/Fentanyl traten Übelkeit und Erbrechen seltener auf als nach Halothan.
Type of Medium:
Electronic Resource
URL:
http://dx.doi.org/10.1007/s001010050044
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