2004 Annual Scientific Meeting - CLICK FOR PROGRAMME

TOTAL INTRAVENOUS ANAESTHESIA FOR COLORECTAL SURGERY  -  AN OBSERVATIONAL STUDY OF REDUCED REQUIREMENT OF MUSCLE RELAXANTS

SAMAAN, Amir A. Consultant Anaesthetist, SRINIVASAN, Venkat Specialist Registrar. Diana Princess of Wales Hospital, Grimsby, England

BACKGROUND

General anaesthesia with inhalational agents and muscle relaxants is a widely practised technique for colorectal procedures.  Total intravenous anaesthesia with Propofol and Remifentanil is an alternative technique that utilises minimal muscle relaxants. Remifentanil can cause profound relaxation of the muscles and has been used for intubation. We evaluated this technique in 95 consecutive patients.

METHODS

This was a prospective observational study of 95 consecutive patients who required general anaesthesia for major colorectal surgery e.g. anterior resection of rectum. Following insertion of the epidural, general anaesthesia was induced with Propofol (TCI at 4mg/ml) and Remifentanil (Loading dose of 1 mg/kg followed by 0.2-0.3mg/kg/mn). Endotracheal intubation was facilitated by Atracurium at a dose of 0.5-0.6mg/kg. The lungs were ventilated with oxygen and air. Additional doses of muscle relaxants were used depending on the operating conditions. Peripheral Nerve stimulation to the Ulnar Nerve was used to assess the muscle relaxation and the recovery.

RESULTS

 OBSERVATIONS AND DISCUSSION

85 patients had an epidural inserted while awake in the anaesthetic room. 10 patients did not have an epidural either because it was contraindicated or due to technical difficulty. All patients had an intubating dose of Atracurium. A supplemental dose of Atracurium (0.15-0.2 mg/kg.) was needed in 9 patients.(9.4%) due to muscle tightness after an average time of 112 minutes. It was noted that the supplemental dose was needed in 5 patients in the non-epidural group and 4 patients in the epidural group. This was not accompanied with any tachycardia denoting the wearing of the relaxant.

None of the 95 patients required reversal of the muscle relaxation as indicated by the nerve stimulation.

CONCLUSION

Total intravenous anaesthesia with Remifentanil and Propofol with epidural was evaluated in the above study. We conclude that the technique has distinct advantages in colorectal surgery, reducing the need for muscle relaxants and the haemodynamic changes that accompany the wearing off of the relaxation. It avoids the need for Neostigmine with its deleterious side effects on intestinal anastmoses.

REFERENCES