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[The need for alfentanyl in total intravenous anesthesia. Comparison between laparoscopic cholecystectomy and subcostal laparotomy].

AbstractOBJECTIVE:
To quantify intraoperative consumption of alfentanil in cholecystectomy by laparoscopy or by the traditional approach; to evaluate its relation to time until extubation, presence and intensity of postoperative pain and vomiting.
PATIENTS AND METHODS:
Prospective, non randomized study. Forty female physical status ASA I-II patients between 18 and 60 years of age scheduled to undergo subcostal cholecystectomy by subcostal laparotomy (group CSL, n = 20) or by laparoscopy (group CL, n = 20). Total intravenous anesthesia with propofol, alfentanil and atracurium was provided. A continuous infusion of alfentamil 1 microgram/kg/min was used, with a supplement of 7 micrograms/kg when mean arterial pressure (MAP) rose more than 10% above baseline or with a supplement of 14 micrograms/kg when MAP rose 20% or more above baseline. Variables measured were intraoperative alfentanil requirements, time until extubation, presence and intensity of pain in the immediate postoperative period and incidence of vomiting.
RESULTS:
Alfentanil consumption was 1.81 and 1.63 micrograms/kg/min and time to extubation was 17.5 and 14.05 min in the CL and CSL groups (p < 0.05), respectively. There was less pain in the early postoperative period in the CL group (36.8% for the CL patients as opposed to 85% in the CSL group, p < 0.01) and pain was less intense (p < 0.01). The incidence of vomiting was 42.1% in group CL and 25% in group CSL (p = NS).
CONCLUSIONS:
Insufflating the pneumoperitoneum for laparoscopic surgery brings about hemodynamic changes that increase intraoperative consumption of alfentanil during surgery, and this can lead to delayed awakening.
AuthorsE Figueredo-Gaspari, L Canosa-Ruiz
JournalRevista española de anestesiología y reanimación (Rev Esp Anestesiol Reanim) Vol. 44 Issue 3 Pg. 103-7 (Mar 1997) ISSN: 0034-9356 [Print] SPAIN
Vernacular TitleNecesidades de alfentanilo durante la anestesia total intravenosa. Comparación entre la colecistectomía laparoscópica y por laparotomía subcostal.
PMID9229728 (Publication Type: Clinical Trial, Comparative Study, English Abstract, Journal Article)
Chemical References
  • Anesthetics, Intravenous
  • Alfentanil
Topics
  • Adolescent
  • Adult
  • Alfentanil
  • Anesthesia, General
  • Anesthesia, Intravenous
  • Anesthetics, Intravenous
  • Cholecystectomy, Laparoscopic
  • Female
  • Humans
  • Laparotomy (methods)
  • Middle Aged
  • Prospective Studies

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