Target-controlled infusion (Propofol) versus inhaled anaesthetic (Sevoflurane) in patients undergoing shoulder arthroscopic surgery

Abstract

Background:One of the challenges of anaesthesia for shoulder arthroscopic procedures is the need for controlled hypotension to lessen intra-articular haemorrhage and thereby provide adequate visualisation to the surgeon. Achievement of optimal conditions necessitates several interventions and manipulations by the anaesthesiologist and the surgeon, most of which directly or indirectly involve maintaining intra-operative blood pressure (BP) control.Aim:This study aimed to compare the efficacy and convenience of target controlled infusion (TCI) of propofol and inhalational agent sevoflurane in patients undergoing shoulder arthroscopic surgery after preliminary inter-scalene blockade.Methods:Of thirty four patients studied, seventeen received TCI propofol (target plasma concentration of 3 μg/ml) and an equal number, sevoflurane (1.2-1.5 Minimum Alveolar Concentration). N2O was used in both groups. Systolic, diastolic, mean blood pressures and heart rate were recorded regularly throughout the procedure. All interventions to control BP by the anaesthesiologist and pump manipulation requested by the surgeon were recorded. The volume of saline irrigant used and the haemoglobin (Hb) content of the return fluid were measured.Results:TCI propofol could achieve lower systolic, mean BP levels and the number of interventions required was also lower as compared to the sevoflurane group. The number of patients with measurable Hb was lower in the TCI propofol group and this translated into better visualisation of the joint space. A higher volume of saline irrigant was required in the sevoflurane group. No immediate peri-operative anaesthetic complications were noted in either category.Conclusion:TCI propofol appears to be superior to and more convenient than sevoflurane anaesthesia in inter-scalene blocked patients undergoing shoulder arthroscopy.

Sevoflurane versus isoflurane in shoulder arthroscopy in beach chair position in patients with prior interscalene brachial plexus block: A prospective randomised equivalency-based haemodynamic evaluation trial

“…A few previous studies did focus on comparing haemodynamic effects of different anaesthetic agents, but in the LDP. [ 11 12 ] In contrast to previous findings, we observed equivalent SBPs, MBPs, and HR mean s with both agents in BCP arthroscopy. While rejecting the null hypothesis, we also checked whether sevoflurane could achieve haemodynamic status equivalent with isoflurane.…”

“…Our previous study on shoulder arthroscopy in lateral decubitus position (LDP) demonstrated approximately 10 mmHg mean difference of SBP between group subjects when different techniques and inhalational agents were compared. [ 11 12 ] Based on this, we calculated the sample size for this study. A minimum of 16 patients were required in each group to detect a mean BP difference of 10 mmHg [power 80%, α = 0.05, with standard deviation (SD) of 10 in each group] assuming that differences of <10 mmHg would not be clinically significant.…”

Isoflurane versus sevoflurane with interscalene block for shoulder arthroscopic procedures: Value of process capability indices as an additional tool for data analysis

“…While comparison of the efficacy of isoflurane vis-a-vis sevoflurane in hypotensive anaesthesia for shoulder arthroscopy formed the primary objective of our study, a new analytical approach, process capability indices (PCIs), different from conventional statistical methodologies deriving significance from P values[78910] was additionally deployed to derive more practical and meaningful conclusions. For various reasons (refer Flow chart), we felt that comparisons using conventional P values could highlight some but not all significant variations, and this could ultimately result in a divergence between ‘statistical’ significance and ‘clinical’ significance.…”

A Comparison of Three Methods for Postoperative Pain Control in Patients Undergoing Arthroscopic Shoulder Surgery

“…Third, evaluations of experimental factors such as pain scores were not performed blindly after the assignment of patients into the three groups. Since it is known that factors associated with incisions such as fibrosis and joint inflammation influence the operation time and types of anesthetics [ 29 ], future research will be required to study those factors.…”