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Anesth Analg 2005;100:1338-1342
© 2005 International Anesthesia Research Society
doi: 10.1213/01.ANE.0000149542.04833.55

ANESTHETIC PHARMACOLOGY

A Comparison of Target- and Manually Controlled Infusion Propofol and Etomidate/Desflurane Anesthesia in Elderly Patients Undergoing Hip Fracture Surgery

Sylvie Passot, MD, Frédérique Servin, MD*, Jean Pascal, MD, Françoise Charret, MD, Christian Auboyer, MD, and Serge Molliex, MD, PhD

Département d'Anesthésie-Réanimation, Hôpital Bellevue, Saint-Etienne, France; *Service d'Anesthésie-Réanimation Chirurgicale, Hôpital Bichat, Paris, France

Address correspondence and reprint requests to Sylvie Passot, MD, Département d'Anesthésie-Réanimation, hôpital Bellevue, 42055 Saint-Etienne cedex 2, France. Address e-mail to sylvie.passot{at}chu-st-etienne.fr.

Elderly patients have a higher risk of developing adverse drug reactions during anesthesia, especially anesthesia affecting cardiovascular performance. In this prospective randomized study we compared quality of induction, hemodynamics, and recovery in elderly patients scheduled for hip fracture surgery and receiving either etomidate/desflurane (ETO/DES) or target-controlled (TCI) or manually controlled (MAN) propofol infusion for anesthesia. Sixteen patients were anesthetized with ETO (0.4 mg/kg) followed by DES titrated from an initial end-tidal concentration of 2.5%. Eighteen patients received propofol TCI at an initial plasma concentration of 1 µg/mL and titrated upwards by 0.5-µg/mL steps. Fifteen patients received a bolus induction of propofol 1 mg/kg over 60 s followed by an infusion initially set at 5 mg · kg–1 · h–1. All received a bolus (20 µg/kg) followed by an infusion of 0.4 µg · kg–1 · min–1 alfentanil. According to hemodynamics, concentrations of DES or propofol (TCI group) and propofol infusion rate (MAN group) were respectively adjusted by a step of 20% and 50%. In the TCI and ETO/DES groups, the time spent at a mean arterial blood pressure within 15% and 30% of baseline values was more than 60% and 80% of anesthesia time, whereas in the MAN group it was <30% and 60%, respectively. In the MAN group more anesthetic drug adjustments were recorded (6.4 ± 2.8 versus 2.5 ± 1.2 [ETO/DES] and 2.6 ± 1 [TCI]). TCI improves the time course of propofol's hemodynamic effects in elderly patients.






Lippincott, Williams & Wilkins Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999 HighWire Press
Copyright © 2005 by the International Anesthesia Research Society.