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Query: UMLS:C0262471 (ENT)
 5,307 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The pharmacokinetics of a constant rate infusion of propofol were studied in 11 patients who received total intravenous anaesthesia for ENT surgery. Alfentanil was administered as an exponentially decreasing infusion using a computer-assisted infusion device with a constant target plasma alfentanil concentration of 300 ng/ml. Propofol was infused at a constant rate of 6 mg/kg/hours. Plasma alfentanil concentrations were determined by gas chromatography and whole blood propofol concentrations by high-performance liquid chromatography in arterial blood samples collected at selected times during and up to 8 hours after infusion. Pharmacokinetic modelling of the blood propofol concentration-time data indicated that a three-compartment open model with central elimination was most appropriate. Derived pharmacokinetic parameters were in agreement with previous studies on the pharmacokinetics of propofol. The plasma alfentanil concentrations in 10 patients significantly exceeded the expected values at any time during the infusion. The population mean bias amounted to 20.2% (SD 12.6). Only three data sets were significantly underestimated after the infusion was stopped (mean bias 11.9% (SD 25.5]. The elimination half-life of alfentanil was approximately 75 minutes (SD 21). We conclude that alfentanil does not interfere with the pharmacokinetic profile of propofol but that propofol induces higher plasma alfentanil concentrations than expected.
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PMID:Disposition kinetics of propofol during alfentanil anaesthesia. 312 56

Fourteen patients of ASA grades 1-3 were anaesthetised with continuous infusions of propofol and alfentanil for endoscopic carbon dioxide laser ENT microsurgery. Their lungs were ventilated with an oxygen-air mixture using a high frequency jet ventilator. Propofol was given at an initial rate of 120 micrograms/kg/minute for 10 minutes after a bolus dose of 2.6 mg/kg, and then at 80 micrograms/kg/minute. Alfentanil was given at a rate of 0.5 micrograms/kg/minute. Arterial pressure decreased significantly after the bolus dose. It increased significantly for a few minutes after laryngoscopy and returned to baseline values during maintenance of anaesthesia. Heart rate increased significantly during induction and until laryngoscopy was performed but it decreased below its initial value after 5 minutes of maintenance. Platelet count and the degree of aggregation did not change during infusion of propofol.
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PMID:Intravenous infusion of propofol for induction and maintenance of anaesthesia during endoscopic carbon dioxide laser ENT procedures with high frequency jet ventilation. 312 58

Since venous cannulation in children has become easier and extensive experience has been gained with total intravenous anaesthesia (TIVA) in adults, the interest in TIVA for children has recently increased. An intensified sensitivity of the operating room atmosphere to contamination with volatile anaesthetic agents is another important reason to choose intravenous techniques for paediatric anaesthesia. One of the most interesting agents for TIVA in paediatric anaesthesia is propofol. The pharmacokinetic and pharmacodynamic data for modern intravenous drugs is poor. Because the interpatient variability is relatively large, pharmacokinetic data can only provide guidelines for the dosage of propofol. Propofol has a rapid and smooth onset of action and is as easy to titrate in children as in adults. Propofol can be excellently controlled. Severe haemodynamic side-effects are missing in healthy children and plasma is cleared rapidly of propofol by redistribution and metabolism. There is no evidence of significant accumulation, not even after prolonged infusion times. Because propofol has no analgetic properties it must be combined with analgetics or a regional block for all painful procedures. The combination with the ultra-short acting remifentanil is a major advantage, but requires effective analgetic concepts for painful procedures. In comparison the combination of propofol with long acting opioids abolishes some of the favourable properties of propofol. Further studies of the kinetics and dynamics of propofol and other intravenous agents are needed in paediatrics which should focus on age, maturity and severity of illness. The whole importance of the propofol-infusion syndrome has to be cleared up urgently. TIVA has an important significance in paediatric anaesthesia for diagnostic and therapeutic procedures, especially where these have to be repeated. In day-case anaesthesia TIVA has advantages for all short procedures and for ENT and ophthalmic surgery: even after prolonged infusion children have an short recovery time. There is no evidence of agitation or other behavioural disorders after TIVA with propofol in paediatric anaesthesia. Propofol has anti-emetic properties. TIVA with propofol can be combined with regional anaesthesia advantageously to provide long-lasting analgesia after surgery. TIVA with propofol has been used successfully for sedation of spontaneously breathing children for MRI and CT and other procedures with open airways like bronchoscopy or endoscopy. Propofol facilitates endotracheal intubation without the use of muscle relaxants. Of course, in malignant hyperthermia TIVA will continue to be the technique of choice. Nothing is known about awareness under TIVA in paediatric patients. TIVA must be considered by comparison with the volatile agents. The use of ultra-short acting agents may cause problems such as awareness, vagal response, involuntary movements and in some cases slow recovery after prolonged infusion of propofol. But it is not known exactly how often this happens during paediatric anaesthesia. With TIVA an effective postoperative analgesia must be provided. Newer administration techniques such as the target-controlled infusions or closed-loop control systems are under development and will help to minimise the potential risk of overdosage with TIVA in paediatrics. At the present TIVA is an interesting and practicable alternative to volatile anaesthesia for pre-school and school children. TIVA with propofol in infants younger than 1 year old requires extensive experience with TIVA in older children and with the handling of this special age group and should be undertaken with maximum precautionary measures.
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PMID:[Total intravenous anesthesia. On the way to standard practice in pediatrics]. 1450 2

The present study aimed to compare the effects of sevoflurane (a commonly used inhalation anesthetic) and intravenous propofol on middle ear pressure (MEP) and determine the more appropriate option for middle ear operations. Fifty-seven American Society of Anesthesiologists risk class I-II patients aged 18-65 years who were not scheduled for ear or tympanic membrane operations were included in the study. The patients were randomly divided into two groups using the sealed envelope method. Propofol (0.2-0.5 mg/kg; Group P) and sevoflurane (1-2%; Group S) were used to maintain anesthesia. Baseline tympanometry was conducted on both ears and recorded before anesthesia was induced. Four additional measurements were performed and recorded at 5, 10, 15, and 30 minutes after induction. All post-induction MEP values were significantly higher than baseline measurements in Group S (P < 0.05 for all); there were no differences between post-induction and baseline measurements in Group P. At 10, 15, and 30 min post-induction, MEP values were significantly higher in Group S than in Group P (P < 0.05). Sevoflurane increased MEP values significantly compared with propofol anesthesia. We conclude that propofol can be used more reliably than sevoflurane in middle ear operations.
B-ENT 2015
PMID:Middle ear pressure changes with sevoflurane and propofol-remifentanil. 2660 55