title: [No better vigilance after general anesthesia with propofol in colonic surgery. A comparison of three procedures for general anesthesia (propofol, halothane and midazolam/fentanyl) in combination with catheter epidural anesthesia].
abstract: Early mental and psychomotor recovery was studied in 67 patients undergoing colorectal surgery under continuous epidural anaesthesia and light general anaesthesia using propofol, halothane, and midazolam/fentanyl. The study was approved by the local ethics committee. All patients received epidural anaesthesia with 0.25% bupivacaine and were then randomly allocated to one of three groups. In group I (halothane), light general anaesthesia was induced with thiopental 3-5 mg/kg and maintained with halothane. The propofol group (II) received 2 mg/kg for induction and a mean continuous infusion of 1.7 mg/kg.h. In group III (Mi/Fe), midazolam and fentanyl were used for induction and maintenance. All patients were intubated, received non-depolarising muscle relaxants, and were manually ventilated with nitrous oxide-oxygen (2:1.2). For postoperative analgesia, 0.05 mg/kg morphine was administrated epidurally 30 min before the end of the operation; 30, 60, 90, and 120 min after arriving in the recovery room, vigilance was assessed using a modified Steward score, the Trieger test, the ability to recall a column of numbers (KAI test), and symbol counting (CI test). Heart rate, blood pressure, arterial oxygen saturation, and blood gases were recorded. RESULTS. The three groups were comparable with regard to age, sex, ASA classification, and duration of anaesthesia and operation (Table 3). There was no difference between the groups in performance of the recovery tests (Figs. 2-5), blood pressure, heart rate, arterial blood gas analysis (Fig. 6), or oxygen saturation. Comparing pre- and postoperative values, we found severe psychomotor and mental impairment in all groups. pCO2 was slightly elevated in all groups, but only 3 patients in the propofol group and 6 in the midazolam/fentanyl group developed hypercapnia above 50 mm Hg. Patients receiving propofol or midazolam/fentanyl had significantly less postoperative nausea and vomiting than those receiving halothane (Table 5). CONCLUSION. It is concluded that propofol offers no advantage over halothane or midazolam/fentanyl where early postoperative recovery is concerned. Intraoperatively, all three techniques provided good anaesthesia. Propofol and midazolam/fentanyl caused less postoperative nausea and vomiting than halothane anaesthesia.
authors.affiliation: Universitätsklinikum für Anästhesiologie, Universität Ulm.
authors.forename: L H
authors.initials: LH
authors.lastname: Eberhart
authors.forename: M
authors.initials: M
authors.lastname: Kumm
authors.forename: W
authors.initials: W
authors.lastname: Seeling
mesh_terms: D000328:Adult; D000368:Aged; D000762:Anesthesia Recovery Period; D000767:Anesthesia, Epidural; D000768:Anesthesia, General; D003106:Colon / Q000601:surgery*; D005283:Fentanyl; D006221:Halothane; D006801:Humans; D008874:Midazolam; D008875:Middle Aged; D015742:Propofol
chemical_list: D008874:Midazolam; D005283:Fentanyl; D006221:Halothane; D015742:Propofol
vernacular_title: Keine bessere Vigilanz nach Allgemeinanästhesie mit Propofol bei Koloneingriffen. Vergleich von drei Verfahren der Allgemeinanästhesie (Propofol, Halothan und Midazolam/Fentanyl) in Kombination mit einer Katheterepiduralanästhesie.