Optimization of Initial Anesthesia in a One-Day Surgical Hospital
Objective: to modify initial sevorane anesthesia so that the incidence of excitement and apnoea should be reduced. Subjects and methods. Seven hundred and sixty-three patients were examined and divided into 4 groups: total intravenous anesthesia (TIA) with propofol and fentanyl and 3 inhalational sevorane-based anesthesia modes; one of them was modified by the authors. Initial anesthesia modes were compared by the following criteria: the time of consciousness loss (sec); that of creating the favorable conditions for laryngeal mask airway instillation (sec); the incidence of apnoea (% of the number of patients in this group); the duration of assisted ventilation (sec); excitement (% of the number of patients in this group); cough (% of the number of patients in this group). Results. The use of sevorane excludes the need for successive induction or breathing circuit prefilling. However, initial sevorane anesthesia is somewhat longer than intravenous induction with propofol and fentanyl and is more frequently accompanied by episodes of excitement, although the latter is insignificant. TIA in turn results in the development of apnoe a more frequently, which is undesirable if anesthesia with preserved spontaneous breathing is to be further performed. The use of the subnarcotic doses of propofol (0.5 mg/kg) and fentanyl (50-μg bolus) during inhalation induction permits excitement to be prevented and a patient's spontaneous breathing to be maintained. TIA modes and the authors' modified inhalation induction procedure are comparable in the time of falling asleep and creating the optimal conditions for laryngeal mask airway instillation.