Hostname: page-component-78c5997874-s2hrs Total loading time: 0 Render date: 2024-11-16T03:24:56.264Z Has data issue: false hasContentIssue false
  • English
  • Français

Total intravenous anaesthesia with ketamine–midazolam versus halothane–nitrous oxide–oxygen anaesthesia for prolonged abdominal surgery

Published online by Cambridge University Press:  11 July 2005

A. A. Shorrab  and
M. M. Atallah
A. A. Shorrab
Affiliation:
Department of Anaesthesia, University of Mansoura, Mansoura, Egypt
M. M. Atallah
Affiliation:
Department of Anaesthesia, University of Mansoura, Mansoura, Egypt
Get access

Abstract

Summary

Background and objective: Total intravenous anaesthesia (TIVA) with ketamine–midazolam (KM) can be used for prolonged abdominal surgery. We compared this technique with halothane–nitrous oxide–oxygen anaesthesia using haemodynamic and endocrine stress responses as primary outcomes and adequacy of operating conditions and recovery profile as secondary outcomes.

Methods: Fifty adult patients undergoing radical cystectomy and bladder substitution were randomly assigned to receive either TIVA with KM (n = 25) or halothane, nitrous oxide and oxygen anaesthesia (n = 25). Invasive haemodynamic and oxygenation variables were monitored along with plasma cortisol and growth hormone concentrations. Operative conditions and recovery profiles were registered.

Results: Cardiac index and vascular resistance remained stable during and after surgery. Cortisol concentrations doubled during surgery and remained elevated in the recovery period. Growth hormone increased after induction, peaked during surgery and decreased during recovery. Neither the haemodynamic variables nor the plasma hormone concentrations differed significantly between the two groups. Intestinal loops were collapsed in the KM groups providing better operative conditions and a reduced need for postoperative analgesics.

Conclusions: The stress responses during KM anaesthesia for prolonged abdominal surgery were comparable to those during halothane–nitrous oxide–oxygen anaesthesia. However, KM anaesthesia provided better surgical conditions and better recovery.

Keywords

ANAESTHETIC TECHNIQUES, infusion, inhalationANAESTHETICS, ketamine, midazolam, fentanyl, halothane, nitrous oxideSURGERY, abdominal
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 20 , Issue 11 , November 2003 , pp. 925 - 931
Copyright
2003 European Society of Anaesthesiology

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Atallah MM, el-Mohayman HA, el-Metwally RE. Ketamine-midazolam total intravenous anaesthesia for prolonged abdominal surgery. Eur J Anaesthesiol 2001; 18: 29–35.Google Scholar
White PF. Clinical uses of intravenous anesthetic and analgesic infusions. Anesth Analg 1989; 68: 161–171.Google Scholar
Meleika LK, Ismail ME, Wechsler-Bellevue Intelligence Scale for Adults and Adolescents, Arabic version.Cairo, Egypt: Al-Nahda, 1991: 19–21.
Minto C, Schnider T. PKPD tools for Excel with XLMEM. Version: 1.02; Palo Alto, June 1995.
Domino EF, Domino SE, Smith RE, et al. Ketamine kinetics in unmedicated and diazepam-premedicated subjects. Clin Pharmacol Ther 1984; 36: 645–653.Google Scholar
Avram MJ, Fragen RJ, Caldwell NJ. Midazolam kinetics in women of two age groups. Clin Pharmacol Ther 1983; 34: 505–508.Google Scholar
Buchner A, Erdfelder E, Paul F. How to use GPower [www document] URL.http://www.psycho.uni-duesseldorf.de/aap/projects/gpower/index.html (last accessed December 3, 2002).
Brockmeyer DM, Kendig JJ. Selective effects of ketamine on amino acid-mediated pathways in neonatal rat spinal cord. Br J Anaesth 1995; 74: 79–84.Google Scholar
Kohrs R, Durieux ME. Ketamine: teaching an old drug new tricks. Anesth Analg 1998; 87: 1186–1193.Google Scholar
Gonzales JM, Loeb AL, Reichard PS, Irvine S. Ketamine inhibits glutamate-N-methyl-D-aspartate- and quisqualate-stimulated cGMP production in cultured cerebral neurons. Anesthesiology 1995; 82: 205–213.Google Scholar
Sarton E, Teppema LJ, Olievier C, et al. The involvement of the mu-opioid receptor in ketamine-induced respiratory depression and antinociception. Anesth Analg 2001; 93: 1495–1500.Google Scholar
Durieux ME. Inhibition by ketamine of muscarinic acetylcholine receptor function. Anesth Analg 1995; 81: 57–62.Google Scholar
Gage PW, Robertson B. Prolongation of inhibitory postsynaptic currents by pentobarbitone, halothane and ketamine in CAI pyramidal cells in rat hippocampus. Br J Pharmacol 1985; 85: 675–681.Google Scholar
Lin LH, Chen LL, Zirrolli JA, Harris RA. General anesthetics potentiate γ-aminobutyric acid actions on γ-aminobutyric acidA receptors expressed by Xenopus oocytes: lack of involvement of intracellular calcium. J Pharmacol Exp Ther 1992; 263: 569–578.Google Scholar
Irifune M, Sato T, Kamata Y, Nishikawa T, Dohi T, Kawahara M. Evidence for GABAA receptor agonistic properties of ketamine: convulsive and anesthetic behavioral models in mice. Anesth Analg 2000; 91: 230–236.Google Scholar
Guidotti A, Toffano G, Costa E. An endogenous protein modulates the affinity of GABA and benzodiazepine receptors in rat brain. Nature 1978; 275: 553–555.Google Scholar
Tallman JF, Thomas JW, Gallager DW. GABAergic modulation of benzodiazepine binding site sensitivity. Nature 1978; 274: 383–385.Google Scholar
Tanelian DL, Kosek P, Mody I, MacIver MB. The role of GABAA receptor/chloride channel complex in anesthesia. Anesthesiology 1993; 78: 757–776.Google Scholar
Hodges JR. The hypothalamo-pituitary-adrenocortical system. Br J Anaesth 1984; 56: 701–710.Google Scholar
Noel GI, Suh HK, Stone JG, Frantz AG. Human prolactin and growth hormone release during surgery and other conditions of stress. J Clin Endocrinol Metab 1972; 35: 840–851.Google Scholar
Nilsson A, Person MP, Hartvig P, Wide L. Effect of total intravenous anaesthesia with midazolam/alfentanil on the adrenocortical and hyperglycaemic response to abdominal surgery. Acta Anaesthesiol Scand 1988; 32: 379–382.Google Scholar
Atallah MM, Abdelbaky SM, Saied MM. Does timing of hemodilution influence the stress response and overall outcome? Anesth Analg 1993; 76: 113–117.Google Scholar
Tverskoy M, Oz Y, Isakson A, Finger J, Bradley EL Jr, Kissin I. Effect of fentanyl and ketamine on postoperative pain and wound hyperalgesia. Anesth Analg 1994; 78: 205–209.Google Scholar
Crossley AW. Peri-operative shivering. Anaesthesia 1992; 47: 193–195.Google Scholar
Kurz A, Sessler DI, Annadata R, Dechert M, Christensen R, Bjorksten AR. Midazolam minimally impairs thermoregulatory control. Anesth Analg 1995; 81: 393–398.Google Scholar
Freye E, Knufermann V. No inhibition of intestinal motility following ketamine-midazolam anaesthesia. A comparison of anaesthesia with enflurane and fentanyl/midazolam. Anaesthesist 1994; 43: 87–91.Google Scholar
Idvall J, Ahlgren I, Aronsen KR, Stenberg P. Ketamine infusions: pharmacokinetics and clinical effects. Br J Anaesth 1979; 51: 1167–1173.Google Scholar
White PF, Dworsky WA, Horai Y, Trevor AJ. Comparison of continuous infusion of fentanyl or ketamine versus thiopental – determining the mean effective serum concentrations for outpatient surgery. Anesthesiology 1983; 59: 564–569.Google Scholar
Grant IS, Nimmo WS, Clements JA. Pharmacokinetics and analgesic effects of i.m. and oral ketamine. Br J Anaesth 1981; 53: 805–810.Google Scholar
Nilsson A, Tamsen A, Persson P. Midazolam-fentanyl anaesthesia for major surgery. Plasma levels of midazolam during prolonged total intravenous anaesthesia. Acta Anaesthesiol Scand 1986; 30: 66–69.Google Scholar
Persson P, Nilsson A, Hartvig P, Tamsen A. Pharmacokinetics of midazolam in total intravenous anaesthesia. Br J Anaesth 1987; 59: 548–556.Google Scholar
Persson P, Nilsson A, Hartvig P. Relation of sedation and amnesia to plasma concentrations of midazolam in surgical patients. Clin Pharmacol Ther 1988; 43: 324–331.Google Scholar