title: 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.
  
  
  OBJECTIVE
  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.
  
  
  CONCLUSIONS
  TCI propofol appears to be superior to and more convenient than sevoflurane anaesthesia in inter-scalene blocked patients undergoing shoulder arthroscopy.
authors.affiliation: Department of Anaesthesiology, A J Institute of Medical Sciences, Kuntikana, Mangalore, Karnataka, India.
authors.forename: Thrivikrama Padur
authors.initials: TP
authors.lastname: Tantry
authors.forename: Bg
authors.initials: B
authors.lastname: Muralishankar
authors.forename: Karunakara Kenjar
authors.initials: KK
authors.lastname: Adappa
authors.forename: Sudarshan
authors.initials: S
authors.lastname: Bhandary
authors.forename: Pramal
authors.initials: P
authors.lastname: Shetty
authors.forename: Sunil P
authors.initials: SP
authors.lastname: Shenoy
keywords: Intravenous anaesthetic; propofol; sevoflurane; shoulder arthroscopy; target control infusion; volatile anaesthetic