2004 Annual Scientific Meeting - CLICK FOR PROGRAMME

TOTAL INTRAVENOUS ANAESTHESIA FOR TOTAL ABDOMINAL HYSTERECTOMY – AN OBSERVATIONAL STUDY OF MUSCLE RELAXANT REQUIREMENT

SAMAAN, Amir A. Consultant Anaesthetist,

Diana Princess of Wales Hospital, Grimsby, England

BACKGROUND

General anaesthesia with muscle relaxants is a widely practised technique for Total Abdominal hysterectomy.  TIVA with Remifentanil and Propofol is an alternative technique that either utilises minimal dose of muscle relaxants or none. Remifentanil can produce profound muscle relaxation without blocking the neuro-muscular junction. We undertook this study in order to evaluate the technique for lower abdominal surgery. There is very little literature available on the use of TIVA without muscle relaxants for TAH.

METHODS

This was a prospective observational study of 35 consecutive patients who required general anaesthesia for total abdominal hysterectomy.  Most of the patients were either ASA I or ASA II.  General anaesthesia was induced with Propofol (TCI at 4 mg/ml followed by 3-4 mg/ml for maintenance) and Remifentanil (Loading dose of 1 mg/kg followed by 0.2 – 0.4 mg/kg/min). The lungs were ventilated with oxygen and air through LMA.  Operative conditions, haemodynamic stability and the need for use of muscle relaxants were recorded. If the surgeon felt the need for muscle relaxation, Atracurium was used in the dose of 10 to 25 mgs.  Peripheral nerve stimulation to the Ulnar nerve was used to assess the muscle relaxation and the need for reversal.

RESULTS

OBSERVATIONS AND DISCUSSION

14 out of 35 patients (40%) required muscle relaxants.  An average dose of 15 mg of Atracurium was used. 12 out of these 14 patients weighed more than 70 Kgs. None of the patients required a second dose of muscle relaxant.  The surgical conditions were assessed as good or excellent.

There was a noticeable inter-individual variation in the dose of Remifentanil and Propofol needed as shown in the table. The decreased use of Muscle relaxants could be attributed to the use of Remifentanil. Only 1 patient needed reversal of residual muscle relaxation.

CONCLUSION

Our experience in the above study has shown that, with Remifentanil and Propofol TIVA, total abdominal hysterectomy can be done without muscle relaxants. This was achieved in 60% of the patients. 40% of patients required only a small dose of muscle relaxant. This reduces the side effects of the relaxants and the requirement for reversal and should lead to a reduction in the incidence of PONV.

REFERENCES

Hogue CW Jr. Bowdle TA. O'Leary C. Duncalf D. Miguel R. Pitts M. Streisand J. Kirvassilis G. Jamerson B. McNeal S. Batenhorst R. A multicenter evaluation of total intravenous anesthesia with remifentanil and propofol for elective inpatient surgery. Anesthesia & Analgesia 1996; 83:279-85.