Journal of Anesthesia

, Volume 11, Issue 4, pp 250–254 | Cite as

Titration of propofol infusion using processed electroencephalogram during combined general and spinal anesthesia

  • Shuya Kiyama
  • Koichi Tsuzaki
Original Articles
  • 60 Downloads

Abstract

Purpose

To determine the necessary mean infusion rate of propofol during combined nitrous oxide (N2O) and propofol spinal anesthesia by using the processed electroencephalogram (pEEG).

Methods

Twelve elective gynecological patients were monitored by a Dräger pEEG monitor under N2O and propofol spinal anesthesia. To make it easier to detect an inadequate depth of anesthesia, muscle relaxants were not given and the patients breathed spontaneously through a laryngeal mask airway. Manual step-down infusion of propofol was employed to provide intraoperative hypnosis. Propofol infusion was titrated to maintain cardiorespiratory parameters within 20% of baseline and the 90th percentile of the spectral edge frequency (SEF 90) of the pEEG between 10 and 13.5 Hz.

Results

The mean (SD) induction dose of propofol was 2.9 (0.4) mg·kg−1. The mean (SD) maintenance infusion rate was 4.2 (0.5) mg·kg−1·h−1. The mean (SD) time from the end of propofol infusion to the opening of the patient's eyes was 5.4 (2.0) min. No gross movements or intraoperative awareness was recognized. The mean (SD) SEF 90 during the maintenance of anesthesia was 12.2 (1.5) Hz, which increased significantly to 16.2 (1.9) Hz at 1 min before the patients opened their eyes in reponse to verbal commands.

Conclusion

Titration of propofol infusion using SEF during combined general and spinal anesthesia provided a rapid recovery without any clinical signs of inadequate anesthesia.

Key words

Intravenous anesthetics Propofol Anesthetic technique Regional anesthetic Spinal anesthetic Monitoring Electroencephalogram 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Sandin R, Nordström O (1993) Awareness during total i.v. anaesthesia. Br J Anaesth 71:782–787PubMedGoogle Scholar
  2. 2.
    Kelly JS, Roy RC (1992) Intraoperative awareness with propofoloxygen total intravenous anesthesia for microlaryngeal surgery. Anesthesiology 77:207–209PubMedGoogle Scholar
  3. 3.
    Van Hemelrijck J, Tempelhoff R, White PF, Jellish WS (1992) EEG-assisted titration of propofol infusion during neuroanesthesia: effect of nitrous oxide. J Neurosurg Anesthesiol 4:11–20PubMedCrossRefGoogle Scholar
  4. 4.
    Leslie K, Sessler DI, Smith WD, Larson MD, Ozaki M, Blanchard D, Crankshaw DP (1996) Prediction of movement during propofol/nitrous oxide anesthesia. Performance of concentration, electroencephalographic, pupillary, and hemodynamic indicators. Anesthesiology 84:52–63PubMedCrossRefGoogle Scholar
  5. 5.
    Gurman GM, Fajer S, Porat A, Schily M, Pearlman A (1994) Use of EEG spectral edge as index of equipotency in a comparison of propofol and isoflurane for maintenance of general anaesthesia. Eur J Anaesthesiol 11:443–448PubMedGoogle Scholar
  6. 6.
    Sareen J, Hudson RJ, Rosenbloom M, Thomson IR (1997) Dose-response to anaesthetic induction with sufentanil: haemodynamic and electroencephalographic effects. Can J Anaesth 44:19–25PubMedCrossRefGoogle Scholar
  7. 7.
    Doi M, Gajraj RJ, Mantzaridis H, Kenny GNC (1997) Relationship between calculated blood concentration of propofol and electrophysiological variables during emergence from anaesthesia: comparison of bispectral index, spectral edge frequency, median frequency and auditory evoked potential index. Br J Anaesth 78:180–184PubMedGoogle Scholar
  8. 8.
    Traast HS, Kalkman CJ (1995) Electroencephalographic characteristics of emergence from propofol/sufentanil total intravenous anesthesia. Anesth Analg 81:366–371PubMedCrossRefGoogle Scholar
  9. 9.
    Arndt VM, Hofmockel R, Benad G (1995) EEG Veränderungen unter Propofol-Alfentanil-Lachgas-Narkose. [Changing in EEG during propofol-alfentanil-nitrous oxide anesthesia]. Anaesth Reanim 20:126–133Google Scholar
  10. 10.
    Schwender D, Daunderer M, Mulzer S, Klasing S, Finsterer U, Peter K (1996) Spectral edge frequency of the electroencephalogram to monitor “depth” of anaesthesia with isoflurane or propofol. Br J Anaesth 77:179–184PubMedGoogle Scholar

Copyright information

© JSA 1997

Authors and Affiliations

  • Shuya Kiyama
    • 1
  • Koichi Tsuzaki
    • 2
  1. 1.Department of AnesthesiaShizuoka Red Cross HospitalShizuokaJapan
  2. 2.Department of AnesthesiologyKeio University, School of MedicineTokyoJapan

Personalised recommendations