Total intravenous anaesthesia

A continuous intravenous infusion of propofol can be used to maintain anaesthesia. This technique of total intravenous anaesthesia is becoming more popular because the quality of recovery may be better than after inhalational anaesthesia. 

Anaesthesia in MH-susceptible patients is achieved safely with total intravenous anaesthesia using propofol and opioids. Dantrolene for intravenous use must be available in every surgical theatre. The relation of malignant hyperthermia syndrome with neuroleptic malignant syndrome (for which dantrolene may be used as adjunctive treatment, see p. 388) is uncertain. 

Altermatt FR, Bugedo DA, Delfino AE, Solari S, Guerra I, Munoz HR, et al. Evaluation of the effect of intravenous Udocaine on propofol requirements during total intravenous anaesthesia as measured by bispectral index. Br J Anaesth 2012 108 979-83. 

Dose. For local anaesthesia, the total dose of lignocaine hydrochloride by injection should not exceed 300 mg (4.5 mg/kg), unless administered with adrenaline. For ventricular arrhythmias, initally 50 to 100 mg intravenously, followed by an infusion. 

Kampe S, Randebrock G, Kiencke P, Hunseler U, Cranfield K, Konig DP, Diefenbach C. Comparison of continuous epidural infusion of ropivacaine and sufentanil -with intravenous patient-controlled analgesia after total hip replacement. Anaesthesia 2001 56(12) 1189-93. 

A 71-year-old woman received a standard bowel preparation consisting of oral erythromycin and neomycin (a total of 3 g). Surgery was postponed for one day and she received a second similar bowel preparation pre-operatively. Anaesthesia was induced with sufentanil and etomidate and maintained with isoflurane and sufentanil. Rocuronium (total dose of 60 mg over 2 hours) was used to facilitate tracheal intubation and maintain muscle relaxation. Despite clinical appearance of a reversal of the neuromuscular blockade by neostigmine 3.5 mg and glycopyrrolate 400 micrograms, the patient complained of dyspnoea and required reintubation twice. The effects of additional doses of neostigmine were inconsistent and the use edrophonium 50 mg or calcium chloride 500 mg intravenously did not result in an improvement. ... 

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