Abstract

Optimised target controlled infusion (OTCI) is a new TIVA-TCI technique that gives the possibility of effect-site concentration estimation for propofol and of adjusting Cp depending ofn the clinically effective Ce of the patient.

The aim of our study was to evaluate the effect of two opioids – fentanyl and remifentanil on propofol concentration in a TIVA-OTCI technique for laparoscopic cholecystectomy.

Patients and methods. 47 patients (ASA I/II) undergoing laparoscopic cholecystectomy, were randomised in two groups: group 1 (n=22) was patients with TIVA-OTCI with propofol-fentanyl and group 2 (n=25) was patients undergoing TIVA-OTCI with propofol-remifentanil. During anaesthesia BIS was maintained between 40-60. The following parameters were monitored on propofol: Ce during induction and the values of propofol Cp during anaesthesia (Cp minimal and Cp mean), the reaction to intubation, recovery time and total propofol consumption.

Results. The estimated Ce for propofol for hipnosis did not differ significantly between study groups, but was significantly lower than the value of CP initially set (4 µg/ml). The minimal values of Cp (2,47 vs. 2,17 µg/ml), the mean Cp (3,15 vs. 2,74 µg/ml) and the propofol consumption (562,8 vs. 472 mg) were significantly lower in the remifentanil group.

Conclusions. The use of remifentanil significantly reduced Cpmin, Cpmean and propofol consumption during laparoscopic cholecistectomy.

Key words: TIVA-OTCI, propofol, remifentanil, laparoscopic cholecystectomy