Clinical Evaluation of Total Intravenous Anesthesia Using a 3-in-1 Mixture of Propofol, Alfentanil and Atracurium

Cho, In Hea; Cho, Sung Kang

Abstract

BACKGROUND: The use of 3 syringe pumps for one patient has disadvantages. To avoid errors and confusion associated with 3 separate infusions, we conducted a feasibility study of total intravenous anesthesia (TIVA) using a 1 syringe pump to deliver a 3-in-1 mixture containing fixed proportions of propofol, alfentanil and atracurium.
METHODS
The 3-in-1 mixture was obtained by mixing 400 mg propofol, 2.5 mg alfentanil, 40 mg atracurium, and totally 80 ml with a 5% dextrose solution. Light microscopy was used to compare emulsion instability of the 3-in-1 with a control mixture. In 40 ASA physical status 1 patients, bolus infusions of 0.5 ml/kg of the 3-in-1 mixture were given for induction of anesthesia. All patients were subsequently intubated and ventilated with an oxygen. Immediately after induction, the maintenance infusion rate was initially set at 2 ml/kg/hr for the first 5 to 10 minutes followed by 1 ml/kg/hr. If inadequate anesthetic depth or muscle relaxation was suspected clinically, a 5 ml bolus of the 3-in-1 mixture (rescue solution) was administered followed by a 10% stepwise increase in the infusion rate. Ten to fifteen minutes before the expected time of completion of surgery, the infusion rate of the 3-in-1 mixture was reduced to 0.5 ml/kg/hr and was stopped at the end of surgery.
RESULTS
The 3-in-1 mixtures remained stable for up to 5 hours after preparation. Induction and maintenance of anesthesia were smooth, intubation conditions satisfactory, and intraoperative hemodynamic changes acceptable. Recovery from anesthesia and neuromuscular blockade was rapid. There were no major intra- or immediate postoperative complications.
CONCLUSIONS
It may be feasible to provide TIVA using the 3-in-1 mixture for induction and maintenance of anesthesia.