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Korean Journal of Anesthesiology 2004;47(1):42-47.
DOI: https://doi.org/10.4097/kjae.2004.47.1.42   
Effect-site Target-Controlled Infusion of Propofol and Alfentanil for Laryngeal Mask Airway (LMA) Insertion in Ambulatory Breast Surgery without Neuromuscular Blockade.
Jeong Ki Lee, Moo Song Lee, Sung Lyang Chung, Gyu Jeong Noh
1Departments of Anesthesiology and Pain Medicine, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea. nohgh@amc.seoul.kr
2Departments of Preventive Medicine, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea.
Abstract
BACKGROUND
We performed this study to evaluate the appropriate effect-site concentrations of propofol and alfentanil for LMA insertion in ambulatory breast surgery without neuromuscular blockade.
METHODS
Seventy-three ASA physical status 1 patients were enrolled. The administration of propofol and alfentanil was titrated versus bispectral index (BIS < 60), systolic blood pressure (SBP > or = 80 mmHg) and heart rate (HR > or = 50/min), respectively. The condition of LMA insertion was assessed as grade 1 (excellent), 2 (acceptable), and 3 (poor) according to gag, cough, movement, and laryngospasm. We recorded SBP, HR and BIS before and after LMA insertion, the effect-site concentrations of propofol and alfentanil at the time of LMA insertion, and the LMA removal time at recovery.
RESULTS
The condition of LMA insertion at first attempt was grade 1 in 71.6% of patients, grade 2 in 20.3%, and grade 3 in 8.1%. After the first attempt at LMA insertion, movement occurred in 25.7% and the BIS increased above 60 in 31.5%. The range of the effect-site concentrations of propofol and alfentanil at the first attempt were 2.0 6.0 (3.7 +/- 0.7)microgram/ml and 30.0 150.0 (71.6 +/- 24.4) ng/ml, which reflected a large inter-individual variability. The incidences of hypertension, tachycardia, hypotension, and bradycardia were 6.8%, 1.4%, 11.0% and 5.5%, respectively. The mean LMA removal time was 4.7 min.
CONCLUSIONS
LMA was inserted successfully in 91.7% at first attempt and removed promptly at recovery. Movement and increase of BIS above 60 occurred frequently after the first attempt of LMA insertion with the effect-site target-controlled infusion of propofol and alfentanil without neuromuscular blockade.
Key Words: alfentanil; effect-site; laryngeal mask airway; neuromuscular blockade; propofol


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