A comparison of target- and manually controlled infusion propofol and etomidate/desflurane anesthesia in elderly patients undergoing hip fracture surgery.
Elderly patients have a higher risk of developing adverse drug reactions during anesthesia, especially anesthesia affecting cardiovascular performance. In this prospective randomized study we compared quality of induction, hemodynamics, and recovery in elderly patients scheduled for hip fracture surgery and receiving either etomidate/desflurane (ETO/DES) or target-controlled (TCI) or manually controlled (MAN) propofol infusion for anesthesia. Sixteen patients were anesthetized with ETO (0.4 mg/kg) followed by DES titrated from an initial end-tidal concentration of 2.5%. Eighteen patients received propofol TCI at an initial plasma concentration of 1 microg/mL and titrated upwards by 0.5-microg/mL steps. Fifteen patients received a bolus induction of propofol 1 mg/kg over 60 s followed by an infusion initially set at 5 mg . kg(-1) . h(-1). All received a bolus (20 microg/kg) followed by an infusion of 0.4 microg . kg(-1) . min(-1) alfentanil. According to hemodynamics, concentrations of DES or propofol (TCI group) and propofol infusion rate (MAN group) were respectively adjusted by a step of 20% and 50%. In the TCI and ETO/DES groups, the time spent at a mean arterial blood pressure within 15% and 30% of baseline values was more than 60% and 80% of anesthesia time, whereas in the MAN group it was <30% and 60%, respectively. In the MAN group more anesthetic drug adjustments were recorded (6.4 +/- 2.8 versus 2.5 +/- 1.2 [ETO/DES] and 2.6 +/- 1 [TCI]). TCI improves the time course of propofol's hemodynamic effects in elderly patients.
Passot
Sylvie
S
Département d'Anesthésie-Réanimation, Hôpital Bellevue, Saint-Etienne, France; *Service d'Anesthésie-Réanimation Chirurgicale, Hôpital Bichat, Paris, France.
Servin
Frédérique
F
Pascal
Jean
J
Charret
Françoise
F
Auboyer
Christian
C
Molliex
Serge
S
D000368:Aged; D000369:Aged, 80 and over; D000758:Anesthesia; D001794:Blood Pressure / Q000187:drug effects; D000077335:Desflurane; D005045:Etomidate / Q000008:administration & dosage*; D005260:Female; D006620:Hip Fractures / Q000601:surgery*; D006801:Humans; D007262:Infusions, Intravenous; D007530:Isoflurane / Q000008:administration & dosage* / Q000031:analogs & derivatives*; D008297:Male; D015742:Propofol / Q000008:administration & dosage*; D011446:Prospective Studies
D000077335:Desflurane; D007530:Isoflurane; D015742:Propofol; D005045:Etomidate