Propofol-remifentanil TIVA-TCI vs inhalation anesthesia for laparoscopic cholecystectomy – hemodinamic profile evaluation

Daniela Ionescu¹, Simona Mărgărit¹, Georgeta Tudorică³, L. Azamfirei², Alina Alexe³, Delia Deac³, Adina Răduţ³, J. Szederjesi², Teodora Pop⁴, H. Vasian¹, A. Necula⁵

¹ Catedra ATI III – Universitatea de Medicină şi Farmacie „Iuliu Haţieganu” Cluj-Napoca
² Catedra ATI I – Universitatea de Medicină şi Farmacie Târgu Mureş
³ Clinica ATI – Spitalul Clinic de Urgenţă „Octavian Fodor” Cluj-Napoca
⁴ Catedra de Informatică Medicală – Universitatea de Medicină şi Farmacie „Iuliu Haţieganu” Cluj-Napoca
⁵ Clinica Chirurgie III – Spitalul Clinic de Urgenţă „Octavian Fodor” Cluj-Napoca

Abstract

TIVA-TCI is a very useful anesthetic option for laparoscopic cholecystectomy due to numerous advantages, including a decreased incidence of postoperative nausea and vomiting, shivering and favorable hemodynamics. The aim of our study was to evaluate hemodynamic parameters during TCI-propofol-remifentanil versus isoflurane-remifentanil for laparoscopic cholecystectomy.

Patients and methods: After institutional approval and the patients’ informed consent, 50 patients ASA physical status I/II were randomized to: group 1-TIVA (n = 25) which included patients receiving TCI-propofol-remifentanil and group 2-ISO (n = 25) which included patients undergoing isoflurane-remifentanil anesthesia. Remifentanil was administered in both groups as a 2-step manually-controlled infusion: 0.5 μg/kg/min for the first minute and 0.25 μg/kg/min thereafter, adjusted according with patients’ analgesic requirements. TCI-propofol was administered as a Cp targeting Marsh model with an initial Cp = 4 μg/ml, “lock” function activation (BBraun fm controller), thereafter adjusted according to patients hemodynamics and BIS (maintained between 40-60). MAP, HR, BIS, EtIso, CO2 were monitored every 1 minute for the first 5 minutes, and at a 5 minutes interval thereafter. The number of therapeutic interventions for correction of BP and HR was monitored as well as the response to anesthetic and surgical stimuli during anesthesia.

Results: The study groups were comparable for demographic data and duration of anesthesia. During induction, blood pressure decreased significantly in both study groups, but was more pronounced in the ISO group (p = 0.04 and p = 0.0002 respectively). There were no significant differences in the number of patients with response to intubation (hypertension, HR, increase BIS, tears) in the two study groups. During introduction of trocars and cystic clipping MAP increased in TIVA group to values not exceeding the preinduction level while in the patients of ISO group MAP was significantly lower (p = 0.04 and p = 0.0006 respectively). The number of therapeutic interventions for correcting hypotension/bradicardia during anesthesia was significantly greater in ISO group. The BIS values were not affected and were similar during anaesthesia in the two groups (41.78 ± 4.06 in TIVA group vs 44.04 ± 4.94 in ISO group).
Conclusions: TIVA-TCI offered a better hemodynamics compared with inhalation anesthesia for laparoscopic cholecystectomy.

Keywords: TIVA-TCI, inhalation anesthesia, propofol, remifentanil, laparoscopic cholecystectomy

TIVA-TCI cu propofol-remifentanil vs anestezia inhalatorie cu isofluran pentru colecistectomia laparoscopică. Evaluarea profilului hemodinamic