Abstract
Total intravenous anesthesia (TIVA) with the target-controlled infusion (TCI) technique using propofol is increasingly common in Japan. Epidural anesthesia established with local anesthetic blocks transmission of perception from peripheral nerves to the spine, thereby reducing the level of consciousness. Reducing the level of consciousness leads to a decrease in the requirements for sedatives such as midazolam and thiopental. Hemodynamic status was depressed significantly by use of either propofol or sevoflurane in the patients receiving epidural anesthesia upon anesthetic induction, compared with the patients not receiving epidural anesthesia. Combination with epidural anesthesia significantly decreased in an effect-site concentration of propofol during anesthetic maintenance under a similar plasma fentanyl concentration (1.5μg/ml) . In the emergence from general anesthesia from similar sedation level, the epidural anesthesia shortened the time to awakening from propofol anesthesia (i.e., the patient opening his/her eyes in response to verbal command alone) . A strong analgesic effect elicited by an epidural local anesthetic is likely to be one of important factors in easing TIVA using the TCI technique.
