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ANESTHETIC PHARMACOLOGY

Propofol-Sufentanil Anesthesia for Thyroid Surgery: Optimal Concentrations for Hemodynamic and Electroencephalogram Stability, and Recovery Features

Elisabeth Hentgen, MD^*, Malik Houfani, MD^*, Valérie Billard, MD^*, Florent Capron, MD^*, Jean-Marc Ropars, RN^*, and Jean Paul Travagli, MD

Departments of *Anesthesia and Surgery, Institut Gustave Roussy, Villejuif, France

Address correspondence and reprint requests to Dr. V. Billard, Département d’Anesthésie, Institut Gustave Roussy, 39 rue Camille Desmoulins, 94805 Villejuif, France. Address e-mail to billard{at}igr.fr

Hypnotics and opioids interact synergistically to block responses to surgery and different dose combinations may be used to provide adequate anesthesia. In this study, we sought to determine the optimal concentrations of propofol and sufentanil, given by target-controlled infusions, to ensure hemodynamic stability, adequate hypnosis (assessed by electroencephalogram bispectral index^TM), and fast recovery for a moderately painful operation. Forty-five patients, ASA physical status I or II, undergoing thyroidectomy, were randomly assigned to a sufentanil target concentration (STC) that was maintained throughout surgery (0.1, 0.2, or 0.3 ng/mL). The propofol target concentration was adjusted to keep mean arterial blood pressure within 30% of a reference value, and bispectral index^TM between 40 and 60. Adequate anesthesia was obtained in all groups. Hypertension and clinically dangerous movements were more frequent with the small STC, and hypotension requiring treatment was more frequent with the large STC. Propofol target concentration during surgery decreased significantly with increasing STC (median at thyroid removal 5.0, 4.0, and 2.5 µg/mL, respectively) as well as the propofol consumption (740, 668, 474 mg/h). The 0.3 ng/mL STC significantly delayed the return of spontaneous breathing.

IMPLICATIONS: Given as a target-controlled infusion for thyroid surgery, sufentanil 0.3 ng/mL for intubation and 0.2 ng/mL during surgery, combined with propofol 4 µg/mL (corresponding to a maintenance infusion rate of approximately 7–10 mg · kg^-1 · h^-1), is recommended to ensure both optimal intraoperative stability and fast recovery.

This article has been cited by other articles:

				G. Godet, M. Reina, M. Raux, J. Amour, V. De Castro, and P. Coriat Anaesthesia for carotid endarterectomy: comparison of hypnotic- and opioid-based techniques{dagger} Br. J. Anaesth., March 1, 2004; 92(3): 329 - 334. [Abstract] [Full Text] [PDF]

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