Propofol-sufentanil anesthesia for thyroid surgery: optimal concentrations for hemodynamic and electroencephalogram stability, and recovery features.
Hypnotics and opioids interact synergistically to block responses to surgery and different dose combinations may be used to provide adequate anesthesia. In this study, we sought to determine the optimal concentrations of propofol and sufentanil, given by target-controlled infusions, to ensure hemodynamic stability, adequate hypnosis (assessed by electroencephalogram bispectral index), and fast recovery for a moderately painful operation. Forty-five patients, ASA physical status I or II, undergoing thyroidectomy, were randomly assigned to a sufentanil target concentration (STC) that was maintained throughout surgery (0.1, 0.2, or 0.3 ng/mL). The propofol target concentration was adjusted to keep mean arterial blood pressure within 30% of a reference value, and bispectral index between 40 and 60. Adequate anesthesia was obtained in all groups. Hypertension and clinically dangerous movements were more frequent with the small STC, and hypotension requiring treatment was more frequent with the large STC. Propofol target concentration during surgery decreased significantly with increasing STC (median at thyroid removal 5.0, 4.0, and 2.5 microg/mL, respectively) as well as the propofol consumption (740, 668, 474 mg/h). The 0.3 ng/mL STC significantly delayed the return of spontaneous breathing.


CONCLUSIONS
Given as a target-controlled infusion for thyroid surgery, sufentanil 0.3 ng/mL for intubation and 0.2 ng/mL during surgery, combined with propofol 4 microg/mL (corresponding to a maintenance infusion rate of approximately 7-10 mg. kg(-1). h(-1)), is recommended to ensure both optimal intraoperative stability and fast recovery.
Department of Anesthesia, Institut Gustave Roussy, 39 rue Camille Desmoulins, 94805 Villejuif, France.
Elisabeth
E
Hentgen
Malik
M
Houfani
Valérie
V
Billard
Florent
F
Capron
Jean-Marc
JM
Ropars
Jean Paul
JP
Travagli
D000293:Adolescent; D000328:Adult; D000368:Aged; D000465:Algorithms; D000762:Anesthesia Recovery Period; D000771:Anesthesia, Intravenous; D018686:Anesthetics, Intravenous / Q000008:administration & dosage / Q000009:adverse effects; D001794:Blood Pressure / Q000187:drug effects; D004569:Electroencephalography / Q000187:drug effects*; D005260:Female; D006339:Heart Rate / Q000187:drug effects; D006439:Hemodynamics / Q000187:drug effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008954:Models, Biological; D011182:Postoperative Care; D020250:Postoperative Nausea and Vomiting / Q000453:epidemiology; D015742:Propofol / Q000008:administration & dosage / Q000009:adverse effects; D017409:Sufentanil / Q000008:administration & dosage / Q000009:adverse effects; D013961:Thyroid Gland / Q000601:surgery*
D018686:Anesthetics, Intravenous; D017409:Sufentanil; D015742:Propofol