A novel mixture of propofol, alfentanil, and lidocaine for regional block with monitored anesthesia care in ophthalmic surgery.
OBJECTIVE
The purpose of this study is to determine the efficacy and safety of sedation/analgesia using a mixture of propofol, alfentanil, and lidocaine.


METHODS
A retrospective case review was undertaken.


METHODS
This study took place at a university medical center.


METHODS
Eighty-nine American Society of Anesthesiologists physical status 1, 2, and 3 adult patients undergoing ophthalmic surgery with regional block and monitored anesthesia care were studied.


METHODS
Six milliliters of propofol, 2 mL of alfentanil, and 2 mL of 2% lidocaine (6-2-2 mixture) were freshly mixed. The bolus dose was determined based on the patients' age: 5 microg/kg of alfentanil (and 0.3 mg/kg of propofol) for patients older than 75 years; the dose increased 1 mug/kg per 10-year decrease in age; and up to 9 microg/kg of alfentanil (0.54 mg/kg of propofol) for patients younger than 45 years. Regional block was performed at 1 minute after bolus completion. Blood pressure (BP), Sa(O2), electrocardiogram, capnography, clinical signs of sedation, responses to block, need for airway support, nausea and vomiting (N/V), pain due to propofol infusion, recall, and patient and surgeon satisfaction were recorded.


RESULTS
Seventy-eight percent of patients achieved analgesia and sedation without adverse response to the block. Twelve percent achieved good analgesia and sedation with only eyebrow movement upon needle insertion. Twenty-seven percent had respiratory depression but were able to follow commands and maintain adequate ventilation. Two percent had brief apnea alleviated by chin lift or jaw thrust. None had pain because of propofol infusion or N/V. Before sedation, average systolic BP was significantly increased (P < 0.0001) compared with baseline. After sedation and block, systolic BP decreased 6% from baseline (P < 0.005).


CONCLUSIONS
Adjusted for age and weight, the dose of the 6-2-2 mixture met the sedation requirements for most patients. With a low incidence of need for airway support, no pain during infusion, and no N/V, this novel mixture of propofol, alfentanil, and lidocaine provided adequate analgesia and sedation as well as hemodynamic stability for ophthalmic surgery under regional block.
Department of Anesthesiology, Center for Health Sciences, David Geffen School of Medicine at UCLA, Box 951778, Los Angeles, CA 90095-1778, USA. zfang@mednet.ucla.edu
Zhuang T
ZT
Fang
Mary A
MA
Keyes
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015760:Alfentanil / Q000009:adverse effects; D000765:Anesthesia, Conduction / Q000009:adverse effects; D018686:Anesthetics, Intravenous / Q000009:adverse effects; D000779:Anesthetics, Local / Q000009:adverse effects; D001794:Blood Pressure / Q000187:drug effects; D005260:Female; D006801:Humans; D007431:Intraoperative Complications / Q000453:epidemiology; D008012:Lidocaine / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D013508:Ophthalmologic Surgical Procedures; D015742:Propofol / Q000009:adverse effects; D012189:Retrospective Studies
D018686:Anesthetics, Intravenous; D000779:Anesthetics, Local; D015760:Alfentanil; D008012:Lidocaine; D015742:Propofol