TOTAL IV ANESTHESIA WITH PROPOFOL AND ALFENTANIL - DOSE REQUIREMENTS FOR PROPOFOL AND THE EFFECT OF PREMEDICATION WITH CLONIDINE

We determined in 51 healthy patients undergoing body surface surgery the dose requirements for propofol, as part of a total i.v. anaesthesia technique with an alfentanil infusion. After premedication with temazepam, patients received alfentanil 50 μg kg-1 followed by an infusion of 50 μg kg-1 h-1. Patients were anaesthetized with a loading dose of propofol followed by a three-stage infusion designed to reach one of five preselected blood concentrations of propofol. The motor response to the initial surgical incision was noted and probit analysis was used to derive the ED50 (2.94 mg kg-1 h-1; 95% confidence limits: 2.35-3.37 mg kg-1 h-1). and ED95 (4.98 mg kg-1 h-1; 95% limits: 4.13-8.8 mg kg-1 h-1) for the final propolol infusion rate under these conditions. Whole blood concentration of propofol at the time of the incision was related linearly to the infusion rate and the EC50 and EC95 (probit analysis) were derived as 1.44 (95% confidence limits 0.62-1.87) and 4.05 (95% confidence limits 2.78-30.5) μg ml-1, respectively. Postoperative recovery was rapid, uncomplicated and uneventful. In a subgroup of eight patients, the addition of clonidine 0.6mg to the premedication significantly decreased the requirement for propofol (P <0.05) during surgery, but resulted in prolonged recovery times. © 1990 Copyright: 1990 British Journal of Anaesthesia.