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Propofol, thiopental sodium and fentanyl effects on patient recovery from anesthesia
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P R O P O F O L , T H I O P E N T A L SODIUM AND FENTANYL EFFECTS ON PATIENT R E C O V E R Y F R O M ANESTHESIA Jaeobson P, Doss NW, Sidhom G, Abadir AR, Gintautas J, The Brookdale Hospital Medical Center, Brooklyn, NY 11212. ABSTRACT We evaluated retrospectively propofol and thiopental sodium combined with fentanyl effects on patient recovery from anesthesia after ambulatory surgery. Our results show that 92% of the patients in propofol group have no recollection of the procedures and have no nausea or vomiting. The patients under thiopental and fentanyl were less satisfied. Surgeon's rating of propofol effect on patient was also significantly higher than thiopental and fentanyl. The stay in recovery room was significantly shorter in the propofol group. We conclude that propofol is superior to thiopental sodium and fentanyl for the outpatient anesthetic-surgical procedures. INTRODUCTION The incidence of adverse effects is one of the most important factors that determine the suitability of an anesthetic agent. The ideal anesthetic agent should have at least the following properties: rapid onset, sort duration, controllable depth, high margin of safety no toxic metabolites and no major side effects. Diprivan (Propofol; 2,6 - diisopropylphenol) is a new short acting intravenous anesthetic agent. Propofol has an MW of 178 and is given as an isotonic oil-in-water emulsion, pH of 7.0-8.5. It is only slightly soluble in water, but is liposoluble and contains no antimicrobial preservatives. For clinical use, it is prepared in a vehicle of soybean oil (100 mg/ml), glycerol (22.5 mg/ml), and purified eggyolk lecithin (12 mg/ml). Propofol is a potent sedative hypnotic agent providing clinically useful anesthetic and sedative actions [1]. Propofol became very popular because of its fast induction and short recovery period and good anesthetic control. The drug is effective and versatile both as an induction agent and for continuous IV maintenance of anesthesia for inpatient and outpatient surgery [2]. Since its introduction into clinical practice in the United States, propofol has become important for the induction and maintenance of general anesthesia, particularly for ambulatory surgical procedures[3]. No new drug has had a greater impact on the clinical practice of outpatient anesthesia and surgery than propofol. The metabolic clearance of propofol is ten times faster than the metabolic clearance of thiopental sodium, an ultrashort-acting barbiturate [4]. This metabolic characteristic is one of the most important quality that makes propofol clinically and pharmacokinetically distinguishable from thiopental. Thiopental is metabolized slowly in the liver. However, there is evidence that propofol has extrahepatic routes of metabolism [5]. The distribution clearance of propofol and thiopental (3-4 liter/min/kg; i.e. 60-80% of the cardiac output) is determined by cardiac output and regional blood flow [3]. Both drugs have slow elimination and extensive storage in muscle and fat tissue. Thus the pharmacokinetics profile of propofol has some uniqueness as compared to other IV anesthetics.
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Opioid analgesics e.g. morphine, meperidine, fentanyl, sufentanyl, alfentanyl etc., are frequently used as supplements during inhalation or intravenous anesthesia. Delay in awakening, respiratory depression, mild hypotension, and incidence of postoperative nausea and vomiting are unpleasant side effects of the opioid analgesics. Fentanyl is a synthetic opioid primarily a agonist 80 times as potent as morphine, became very popular supplemental drug in general anesthesia. The purpose of this study was to evaluate retrospectively the effects of propofol and thiopental combined with fentanyl on patient recovery from anesthesia after ambulatory surgery. METHODS
We evaluated medical charts of 55 ambulatory patients, who received propofol (20-50 g/kg/min) and charts of 55 patients treated with thiopental sodium (4-6 mg/kg) and fentanyl (1-2 g/kg). These patients underwent endoscopic procedures. For each patient O z saturation, blood pressure, pulse, EKG, was monitored using a precordial stethoscope and nasal O z canula. We compared the onset of anesthesia and the recovery time in both groups of patients. Efficacy of analgesia was subjectively evaluated by all patients and surgeons. Inapsine (droperidol) as prophylactic antiemetic was not used. RESULTS AND CONCLUSIONS Our results indicate that 92% of the patients under propofol sedation have no recollection of the procedures, eight percent have some remembering. All of our patients recovered from propofol without nausea or vomiting. The patients under thiopental and fentanyl were less satisfied since 19% of them exhibited recall and 11% had nausea. Both the onset of anesthesia and the recovery time was significantly shorter in propofol group. Surgeons' ratings of the effect of propofol on patient were also significantly higher than the ratings for surital and fentanyl. The stay in recovery room was shorter and the return of physiological functions to normal was significantly shorter in the propofol group. We conclude that propofol is superior to sodium thiopental sodium and fentanyl for the outpatient anesthetic-surgical procedures. REFERENCES: 1. Sebel PS, Lowdon JD: Anesthesiology 71:260-77 (1990). 2. Wrigley SR, Fairfield JE, Jones RM, Black AE: Anesthesia 46:615-22 (1991). 3. Steven L. Shafer, MD : J. Clin. Anesth. 5(Suppl 1):14S-21S, (1993). 4. Stanski DR, Maitre PO: Anesthesiology 72:412-22 (1990). 5. Veroli P, O'Kelly B, Bertrand F, Trouvin JH, Farinotti R, Ecoffey C: Br. J. Anaesth 68:183-6 (1992).
P R O P O F O L , T H I O P E N T A L SODIUM AND FENTANYL EFFECTS ON PATIENT R E C O V E R Y F R O M ANESTHESIA Jaeobson P, Doss NW, Sidhom G, Abadir AR, Gintautas J, The Brookdale Hospital Medical Center, Brooklyn, NY 11212. ABSTRACT We evaluated retrospectively propofol and thiopental sodium combined with fentanyl effects on patient recovery from anesthesia after ambulatory surgery. Our results show that 92% of the patients in propofol group have no recollection of the procedures and have no nausea or vomiting. The patients under thiopental and fentanyl were less satisfied. Surgeon's rating of propofol effect on patient was also significantly higher than thiopental and fentanyl. The stay in recovery room was significantly shorter in the propofol group. We conclude that propofol is superior to thiopental sodium and fentanyl for the outpatient anesthetic-surgical procedures. INTRODUCTION The incidence of adverse effects is one of the most important factors that determine the suitability of an anesthetic agent. The ideal anesthetic agent should have at least the following properties: rapid onset, sort duration, controllable depth, high margin of safety no toxic metabolites and no major side effects. Diprivan (Propofol; 2,6 - diisopropylphenol) is a new short acting intravenous anesthetic agent. Propofol has an MW of 178 and is given as an isotonic oil-in-water emulsion, pH of 7.0-8.5. It is only slightly soluble in water, but is liposoluble and contains no antimicrobial preservatives. For clinical use, it is prepared in a vehicle of soybean oil (100 mg/ml), glycerol (22.5 mg/ml), and purified eggyolk lecithin (12 mg/ml). Propofol is a potent sedative hypnotic agent providing clinically useful anesthetic and sedative actions [1]. Propofol became very popular because of its fast induction and short recovery period and good anesthetic control. The drug is effective and versatile both as an induction agent and for continuous IV maintenance of anesthesia for inpatient and outpatient surgery [2]. Since its introduction into clinical practice in the United States, propofol has become important for the induction and maintenance of general anesthesia, particularly for ambulatory surgical procedures[3]. No new drug has had a greater impact on the clinical practice of outpatient anesthesia and surgery than propofol. The metabolic clearance of propofol is ten times faster than the metabolic clearance of thiopental sodium, an ultrashort-acting barbiturate [4]. This metabolic characteristic is one of the most important quality that makes propofol clinically and pharmacokinetically distinguishable from thiopental. Thiopental is metabolized slowly in the liver. However, there is evidence that propofol has extrahepatic routes of metabolism [5]. The distribution clearance of propofol and thiopental (3-4 liter/min/kg; i.e. 60-80% of the cardiac output) is determined by cardiac output and regional blood flow [3]. Both drugs have slow elimination and extensive storage in muscle and fat tissue. Thus the pharmacokinetics profile of propofol has some uniqueness as compared to other IV anesthetics.
134
Opioid analgesics e.g. morphine, meperidine, fentanyl, sufentanyl, alfentanyl etc., are frequently used as supplements during inhalation or intravenous anesthesia. Delay in awakening, respiratory depression, mild hypotension, and incidence of postoperative nausea and vomiting are unpleasant side effects of the opioid analgesics. Fentanyl is a synthetic opioid primarily a agonist 80 times as potent as morphine, became very popular supplemental drug in general anesthesia. The purpose of this study was to evaluate retrospectively the effects of propofol and thiopental combined with fentanyl on patient recovery from anesthesia after ambulatory surgery. METHODS
We evaluated medical charts of 55 ambulatory patients, who received propofol (20-50 g/kg/min) and charts of 55 patients treated with thiopental sodium (4-6 mg/kg) and fentanyl (1-2 g/kg). These patients underwent endoscopic procedures. For each patient O z saturation, blood pressure, pulse, EKG, was monitored using a precordial stethoscope and nasal O z canula. We compared the onset of anesthesia and the recovery time in both groups of patients. Efficacy of analgesia was subjectively evaluated by all patients and surgeons. Inapsine (droperidol) as prophylactic antiemetic was not used. RESULTS AND CONCLUSIONS Our results indicate that 92% of the patients under propofol sedation have no recollection of the procedures, eight percent have some remembering. All of our patients recovered from propofol without nausea or vomiting. The patients under thiopental and fentanyl were less satisfied since 19% of them exhibited recall and 11% had nausea. Both the onset of anesthesia and the recovery time was significantly shorter in propofol group. Surgeons' ratings of the effect of propofol on patient were also significantly higher than the ratings for surital and fentanyl. The stay in recovery room was shorter and the return of physiological functions to normal was significantly shorter in the propofol group. We conclude that propofol is superior to sodium thiopental sodium and fentanyl for the outpatient anesthetic-surgical procedures. REFERENCES: 1. Sebel PS, Lowdon JD: Anesthesiology 71:260-77 (1990). 2. Wrigley SR, Fairfield JE, Jones RM, Black AE: Anesthesia 46:615-22 (1991). 3. Steven L. Shafer, MD : J. Clin. Anesth. 5(Suppl 1):14S-21S, (1993). 4. Stanski DR, Maitre PO: Anesthesiology 72:412-22 (1990). 5. Veroli P, O'Kelly B, Bertrand F, Trouvin JH, Farinotti R, Ecoffey C: Br. J. Anaesth 68:183-6 (1992).