BJA Advance Access originally published online on January 22, 2004
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
British Journal of Anaesthesia, 2004, Vol. 92, No. 3 329-334
© 2004 The Board of Management and Trustees of the British Journal of Anaesthesia
Clinical Investigations |
Anaesthesia for carotid endarterectomy: comparison of hypnotic- and opioid-based techniques
Department of Anesthesiology, Pitié-Salpêtrière Hospital, 47 bd de l’Hôpital, F-75651 Paris Cedex 13, France
*Corresponding author. E-mail: gilles.godet@psl.ap-hop-paris.fr 
This article is accompanied by Editorial I.
Background. Although the synergistic interaction between hypnotics and opioids for total i.v. anaesthesia has been repeatedly demonstrated, questions about different dose combinations of hypnotics and opioids remain. The optimal combination would be based on maximal synergy, using the lowest dose of both drugs and having the lowest incidence of side-effects.
Methods. The major goal of this prospective randomized study was to compare two different dose combinations of propofol and remifentanil (both administered by target controlled infusion (TCI)) in respect of haemodynamics during surgery and recovery, and the need for cardiovascular treatment in the recovery room. A secondary goal was to compare pain scores (VAS) and morphine consumption in the recovery room. Anaesthesia was induced in both groups using TCI propofol, adjusted to obtain a bispectral index score (BIS) value between 40 and 60. TCI for remifentanil commenced at an initial effect-site concentration of 0.5 ng ml–1, and was adjusted according to haemodynamics. Patients were divided into one of two groups during anaesthesia: (i) Group H, hypnotic anaesthesia (n=23), propofol effect-site concentration maintained at 2.4 µg ml–1; and (ii) Group O, opioid anaesthesia (n=23), propofol effect-site concentration maintained at 1.2 µg ml–1. In both groups, remifentanil effect-site concentration was adjusted according to haemodynamics and changes in BIS value.
Results. In Group O, more episodes of intraoperative hypotension (P<0.02) and hypertension (P<0.01), and fewer episodes of tachycardia were observed. More patients in Group O required nicardipine administration for postoperative hypertension (8 patients in Group H vs 15 patients in Group O, P<0.04). During recovery, morphine titration was necessary in 
50% of patients. No significant difference between groups was observed concerning pain scores or requirement for morphine titration.
Conclusions. Maintenance of anaesthesia predominantly with propofol and a low dose of remifentanil, both administered using TCI, is associated with greater stability in perioperative haemodynamics than anaesthesia predominantly with remifentanil alone. Postoperative pain was identical in both groups of patients who underwent relatively short duration, and relatively painless surgery.
Br J Anaesth 2004 92: 329–34
CiteULike 
Connotea 
Del.icio.us What's this?
This article has been cited by other articles:
|
|
 |
|
  S. J. Howell Carotid endarterectomy Br. J. Anaesth., July 1, 2007; 99(1): 119 - 131. [Abstract] [Full Text] [PDF]
|
|