Continuous Versus Intermittent Propofol for Maintenance of General Anesthesia: Effects on Hemodynamic Stability and Recovery Profile

Abstract

Background: Propofol is commonly used for maintenance of General Anesthesia (GA) and it can be used as Continuous Infusion (CI) or Intermittent Bolus (IB). The optimal or best method is still debated. This study compared the effects of CI and IB propofol on hemodynamic stability, bispectral trends, propofol consumption, recovery times, and postoperative outcomes. Methods: A prospective comparative study was conducted on 80 patients undergoing laparoscopic gynecological surgeries at Paropakar Maternity and Women’s Hospital, Kathmandu, Nepal. Group A (n= 40) received continuous propofol infusion (CI) (9mg/kg/hr.) and group B (n= 40) received intermittent boluses (IB) of propofol. Hemodynamic stability (MAP), bispectral trend (BIS) values, total propofol consumption, time to obey commands, extubation time, and post-operative nausea/vomiting (PONV), hypotension and brady/tachycardia, were recorded. Statistical analysis was performed using independent sample t-tests, Repeated analysis of variance (ANOVA), and chi square tests, and p-values below 0.05 (p<0.05) were considered significant. Results: There were significant differences between Group A (CI) and Group B (IB) on hemodynamic stability, but not on bispectral trends. Group A (CI) demonstrated relative stability in overall blood pressure throughout the intraoperative period with lower fluctuations in MAP (F= 0.536, p>0.05, ηp²= .027), compared to Group B (IB), which had significant fluctuations (F= 2.88, p<0.05, ηp²= .138). Similarly, fluctuation in BIS was significant in Group B (F= 5.59, p<0.01, ηp²= .237), but not in Group A (F= 1.53, p>0.05, ηp²= .074). Total propofol consumption was lower in group B (IB) (mean 71.90 ml vs. 100.82 ml, p<0.01). Recovery times in terms of time to obey commands were shorter in group B (IB) (7.33 vs. 9.28 minutes, p<0.05). There were no significant differences between the two groups in recovery parameters (time to open eye, extubation & orientation) and post operative outcomes (nausea/vomiting, hypotension, bradycardia /tachycardia). Conclusion: The efficacy and limitations of both Continuous Infusion (CI) and Intermittent Bolus (IB) propofol infusion methods were noted. CI provided better intraoperative hemodynamic stability but IB led to lower propofol consumption and faster recovery time.