Efficacy of sevoflurane as an adjuvant to propofol-based total intravenous anesthesia for attenuating secretions in ocular surgery

Abstract

Background:The incidence of nasal secretions into the operative field is as high as 5% in ophthalmic surgery under general anesthesia. It may induce postoperative endophthalmitis. Secretions under propofol-based total intravanous anesthesia (TIVA) are greater than sevoflurane anesthesia during surgery. Postoperative nausea and vomiting (PONV) after inhalational anesthesia is higher than TIVA and may increase intraocluar pressure. We investigated the effect of sevoflurane combination with propofol-based TIVA on nasopharyngeal secretions and PONV in ocular surgery.Methods:Fifty patients undergoing ocular operations were randomly assigned for propofol-based TIVA or propofol/sevoflurane anesthesia. In the TIVA group (n = 25), anesthesia was induced and maintained with propofol and fentanyl; in the propofol/sevoflurane group (n = 25), 1% sevoflurane anesthesia was added.Results:Nasopharyngeal excretion volume was significantly higher in the propofol-based TIVA group than in the propofol/sevoflurane group (31.0 ± 18.1 vs 13.7 ± 12.6 ml; P < .001). No significant difference in extubation time was noted (propofol-based TIVA: 6.4 ± 3.6 vs propofol/sevoflurane: 7.4 ± 3.0 minutes; P = .34). No postoperative endophthalmitis or PONV in both groups was observed.Conclusion:Sevoflurane attenuated secretions under propofol-based TIVA and did not increase the incidence of PONV or prolonged extubation in ocular surgery.

Sevoflurane is an effective adjuvant to propofol-based total intravenous anesthesia for attenuating cough reflex in nonintubated video-assisted thoracoscopic surgery

“…Sevoflurane and propofol had similar efficacy for anesthesia, nevertheless, propofol based TIVA may still be the preferred anesthetic because of its favorable anesthesia characteristics, such as high patient satisfaction and less frequent incidence of PONV. [ 13 , 34 – 36 ] In this study, we found no patient with PONV in the 2 groups. This finding may be resulting from that the patients received propofol/sevoflurane anesthesia, the anesthetic technique was propofol predominant and adjuvant sevoflurane.…”

“…In the P/S group, the anesthesia induction were as the TIVA group patients, whereas anesthesia was maintained using propofol infusion and fixed 1% sevoflurane (inhaled concentration) with an oxygen flow of 1 L/min with 100% oxygen. [ 13 ]…”

“…Maintenance of the Ce for the TIVA and P/S was adjusted to keep BIS value between 40 and 60, mean arterial blood pressure (MABP) and HR at baseline levels ± 20%. [ 11 , 13 ] The SpO 2 was maintained ≧ 90%. [ 14 ] Incremental intravenous injections of fentanyl (25 μg) were administrated as: the presence of moderate to severe cough with limb movement affecting the surgical procedure, to keep a respiratory rate (RR) of 12 to 20 breaths/min.…”

Learning fiberoptic intubation for awake nasotracheal intubation

“…Intra-oral and nasal cavity discharge can be reduced using antisialagogues such as glycopyrrolate [ 22 ]. Nasal bleeding occurs commonly during nasotracheal intubation when endotracheal tubes with large diameters are used, when too much force is applied during tube insertion, or when multiple attempts at intubation are made [ 23 ].…”

Does a combined intravenous-volatile anesthesia offer advantages compared to an intravenous or volatile anesthesia alone: a systematic review and meta-analysis

“…1). Ten studies provided data on the occurrence of PONV in the PACU/RR, PONV within 24 h, time to extubation, movement during surgery, pain intensity in the PACU/RR and pain intensity within 24 h. All included studies provided data on PONV [4][5][6][7][8][9][10][11][12][13], five on time to extubation [5,6,8,9,13], two on movement during surgery [6,8] and four on postoperative pain [4,6,7,10]. Liang et al [9] and Chen et al [4] presented their data on pain only categorized, whereas Hensel et al provided data only as median with confidence interval [6].…”