Summary

Background and objective: Cervical spine movement may be limited for morphological reasons or through injury. The major goal of the present study was to evaluate the three-dimensional cervical spine movement during intubation with a Macintosh or Bullard laryngoscope, a Bonfils fibrescope or an intubating laryngeal mask using an ultrasound-based motion system.

Methods: Forty-eight patients without any history of cervical spine problems who had to undergo elective surgery in general anaesthesia were intubated using a Macintosh or Bullard laryngoscope, a Bonfils fibrescope or an intubating laryngeal mask airway. During intubation, cervical motion as well as overall time to intubation, number of attempts, and postoperative complaints were noted.

Results: The range of cervical spine motion during intubation, especially concerning extension, using the Macintosh laryngoscope was much greater (22.5° ± 9.9°) than using Bullard (3.4° ± 1.4°), Bonfils (5.5° ± 5.0°) or intubating laryngeal mask (4.9° ± 2.1°). Time to intubate the trachea using Bonfils (52.1 ± 22.0 s) and intubating laryngeal mask (49.8 ± 18.7 s) were much longer than with Macintosh (18.9 ± 7.1 s) and Bullard laryngoscope (16.1 ± 6.2 s) (significance level: 0.05).

Conclusions: Our findings suggest that the Bullard laryngoscope may be a useful adjunct to intubate patients with cervical spine injuries. In elective situations when time to intubation is not critical Bonfils as well as intubating laryngeal mask airway should also be considered as serious alternatives to direct laryngoscopy.

The value of pulmonary artery catheterization is a matter for discussion. Previous studies suggest that direct measurements of intravascular volume distribution and cardiac volume indices may be of greater relevance than central venous and pulmonary capillary wedge pressure. We therefore used a thermo-dye dilution technique for the quantification of central blood volume, right ventricular end-diastolic volume and left heart volume in patients undergoing coronary artery bypass surgery. Measurements were performed after the induction of anaesthesia as well as 1, 6 and 24 h after surgery. Central venous pressure was significantly increased at 1 and 6 h, whereas right ventricular end-diastolic volume was increased only at 6 h post-operatively. Pulmonary capillary wedge pressure showed a tendency to increase whereas left heart and central blood volume decreased significantly after surgery. The results of the present study suggest that changes in cardiac filling pressure do not indicate changes in indices of cardiac volume in patients after coronary bypass surgery.

Summary

Background and objective: The aim of this prospective, randomized, double-blind investigation was to assess the dose–effect characteristics of postoperative nausea and vomiting after intrathecal administration of small doses of morphine (from 0.015 to 0.25 mg) in opioid-naïve, non-surgical patients. Methods: With Ethic Committee approval and written informed consent 144 opioid-naïve patients suffering from non-cancerous chronic back-pain, and receiving intrathecal morphine as diagnostic test for their chronic pain, were randomly allocated to receive intrathecal injection of 0.015 mg (Group I, n = 25), 0.03 mg (Group II, n = 30), 0.06 mg (Group III, n = 31) or 0.25 mg (Group IV, n = 33) morphine. The control group consisted in 25 further patients not included in the dose–effect study and receiving a placebo injection of normal saline in the interspinous ligament. A blinded observer recorded the occurrence of pruritus, nausea, vomiting, urinary retention and respiratory depression (respiratory rate < 6 bpm) at 2, 4 and 24 h after injection. Results: Clinically significant pain relief was observed in all patients receiving intrathecal morphine but only six patients (25%) of the control group (P = 0.0005). The incidence of pruritus was lower in patients of Groups III (6%) and IV (3%) than in Groups I (12%) and II (20%) (P = 0.002). The incidence of nausea and vomiting was higher at 2- and 4-h observation times, and decreased 24 h after intrathecal injection. Surprisingly, nausea was more frequent in Groups I (56%) and II (50%) than in Groups III (33%) and IV (24%) (P = 0.0005). Vomiting was higher in patients receiving morphine than in control group, but without differences among the four doses. No urinary retention was observed in the control group, while 2 h after intrathecal injection urinary retention was observed in 20–40% of cases, and decreased to less than 10% 24 h after spinal injection without differences among the four doses. Conclusions: The onset and incidence of minor opioid-related side-effects after intrathecal morphine administration do not depend on its dose, occurring with even very small doses of morphine. Accordingly, they can be considered as a patient-dependent effect of the drug, suggesting the presence of a primary dose-independent excitatory component that might be related to the theory of the bimodal activation of opioid receptors. The very low incidence major respiratory depression prevents us from drawing any conclusion about the dose–effect relationship for this side-effect, and further properly powered studies should be advocated to evaluate major respiratory depression after spinal morphine.

Summary

Background and objectives: Ischaemic preconditioning is commonly regarded as one of the most powerful protective mechanisms against a subsequent lethal ischaemic injury during coronary artery bypass graft surgery but is not practiced routinely. Experimentally, isoflurane, a commonly used volatile anaesthetic agent, provides myocardial protection through a signal transduction cascade that is remarkably similar to the pathways identified in ischaemic preconditioning. The aim of our study was to investigate whether pre-ischaemic administration of isoflurane exerted protection against prolonged ischaemia with functional recovery and reduced necrosis among patients undergoing coronary artery bypass graft surgery. Methods: Forty patients scheduled for elective coronary artery bypass graft operations were prospectively randomized into the control or isoflurane groups. In the isoflurane group, isoflurane 2.5 minimum alveolar concentration was administered for 15 min followed by a 5-min washout period before aortic cross-clamping. The control group received a time-matched period of isoflurane-free cardiopulmonary bypass. The conduction of anaesthesia and surgery were standardized in all patients. Haemodynamic data, troponin I release and inotropic support were measured and recorded perioperatively. Results: There were no adverse effects related to isoflurane administration. In the isoflurane group, the mean cardiac index after cardiopulmonary bypass was significantly higher than the pre-bypass value (P < 0.05), whereas no difference was found in the control group. At 15 min after cardiopulmonary bypass and 6 h after surgery, the changes in cardiac index and stroke volume index were significantly higher in the isoflurane group than in the control group (P < 0.05). There was a consistently lower release of troponin I in the isoflurane group compared to the control group. Compared to the controls, the mean troponin I level was significantly reduced in the isoflurane group at 24 h after surgery (P = 0.042). Conclusions: The present results support the preconditioning effect of isoflurane in patients undergoing coronary artery bypass graft surgery as clinically feasible and providing optimal cardiac protection.

The wide use of anticlotting drugs by patients scheduled for surgery is a challenge for the anaesthesiologist when considering a regional anaesthesia technique. This practice seems safe if there is an appropriate management based on safety intervals established according to the pharmacology of the drug and the regional technique. Some anaesthesiology societies have published recommendations for the safe practice of regional anaesthesia with the simultaneous use of anticoagulants (heparin, low molecular weight heparins, oral anticoagulants (OA), fondaparinux and others) and antiplatelet agents (aspirin, clopidogrel, ticlopidine, argatroban and others). One of the most recent guidelines has been published by the Spanish Society of Anaesthesia and Critical Care. This article reviews these recommendations and compares them with others published in the last years. The recommendations are similar, but some interesting differences can be observed and need to be considered. A European consensus in this setting would probably be necessary.

Summary

Background and objective: In children, emergence agitation frequently complicates sevoflurane and desflurane anaesthesia. The effect of intravenous fentanyl 2.5 μg kg−1 was examined on the incidence of emergence agitation in children who received desflurane or sevoflurane after midazolam premedication and intravenous thiopental induction.

Methods: One hundred and twenty children (2–7 yr) undergoing adenoidectomy or tonsillectomy, or both, were studied. All children were premedicated orally with midazolam 0.5 mg kg−1. After intravenous induction with thiopental and atracurium to facilitate endotracheal intubation, patients were randomly assigned to one of four groups: Patients in Groups 1 and 3 received physiological saline solution, whereas patients in Groups 2 and 4 received intravenous fentanyl 2.5 μg kg−1 during induction. Anaesthesia was maintained with sevoflurane in Groups 1 and 2 and with desflurane in Groups 3 and 4. After discontinuation of the volatile anaesthetic, the times to tracheal extubation and response to verbal stimuli (emergence time), and emergence behaviours were recorded.

Results: The time to tracheal extubation was significantly shorter in Groups 3 (5.2 ± 1.7 min) and 4 (6.4 ± 2.1 min) than in Groups 1 (8.1 ± 2.1 min) (P = 0.0001 and 0.006, respectively) and 2 (8.8 ± 1.9 min) (P = 0.0001). The emergence time was significantly shorter in Group 3 (10.0 ± 3.9 min) than in Groups 1 (13.8 ± 4.9 min) (P = 0.017) and 2 (14.9 ± 4.1 min) (P = 0.003). The incidence rate of severe agitation was 13% in Groups 1 and 3, and 7 and 10% in Groups 2 and 4, respectively (P > 0.05).

Conclusions: After midazolam premedication and intravenous induction of anaesthesia with thiopental, administration of intravenous fentanyl 2.5 μg kg−1 did not provide any clinically significant benefit on emergence agitation in children who receive sevoflurane or desflurane anaesthesia.

Summary

Background and objective: Out-of-hospital intravenous line placement is used daily. All available studies take place using paramedics, e.g. US-American emergency medical system. The aim of this study was to assess the intravenous line placement feasibility (time and success rate) in the French emergency medical system. Methods: A prospective observational study was performed by a French out-of-hospital team during 3-month assessing the timing and success rates for intravenous line placement. All patients were enrolled at the emergency medical service of a university hospital in France. Six hundred and sixty-nine consecutive patients were included, 388 (58%) had at least one intravenous line placement in the out-of-hospital setting. Results: Success rate was 76% at the first attempt and 98% at the second attempt. The overall success rate for intravenous line placement was 99.7% (only one failure), and the average successful intravenous line time was 4.4 ± 2.8 min. Attempts ranged from 1 to 8. The time for intravenous line placement with blood sampling (58% of patients) is statistically longer than without (4.6 ± 2.5 vs. 4.3 ± 3 min, P < 0.05). Seventeen of the enrolled patients were trauma patients, and 83% were non-trauma patients. Four hundred and twenty-seven intravenous lines were placed, intravenous 10% had more than one intravenous line. Seventy-one percent of the intravenous lines were used to infuse drugs, the others were security intravenous. No significant difference was noticed between trauma and non-trauma patients in regard to the success rate and the time to place the intravenous line. Conclusion: The out-of-hospital team was skilled at intravenous line placement (success rate = 99.7%), and the time required to performed intravenous line access was short.

A postal survey was carried out on every 71st person aged between 18 and 80 in the population registers in County Regierungsbezirk Karlsruhe in the State of Baden-Würtemberg. It asked 2127 persons whether they had, in the previous 6 months, experienced any form of unduly prolonged pain (as distinct from brief intercurrent self-limiting episodes related to injury inflammation etc.) and, if so, to specify its location, duration, severity and persistence. It also sought information on the resulting calls on healthcare professionals and the degree of satisfaction with treat-ments received. The age and gender distributions of the sample selected for survey matched those in the population from which it was drawn. Of the 1420 respondents, only 1304 declared their age and gender – a condition for inclusion in the analysis. Of these, 610 reported some form of unduly prolonged pain, which had lasted more than a year in 530. For all pain lasting longer than a year, the estimated prevalence of mild pain was 11%, severe 25% and intolerable 3.5%: the corresponding estimates for persistent as opposed to episodic pain were 2% for mild, 10% for severe and 1% for intolerable. Pain was present in more than one anatomical location in most of those who reported it. Musculoskeletal pain was overwhelmingly the most common.Increasing age, obesityandbeing femalepre-disposed to the reporting of pain, with women being more liable to report headache and pain in the neck and shoulder.One hundred and thirty-six pain reporters either gave no information on consultation or sought no help from healthcare professionals: a third of the remainder consulted more than one professional, with general practitioners and specialists in physical medicine (niedergelassener Orthopäde) being the most common. A wide variety of treatments were used, with oral medications, massage, exercises, mud pack and heat treatment being the most popular; two-thirds of sufferers used more than one type of treatment. The most popular types of treatment tended also to be the most successful, except for oral medication (which was also the most heterogeneous). Multiple logistic regression analyses identified consistent associations between duration and severity of pain, the number of sites where it was reported, the numbers of healthcare professionals consulted and the number of treatments tried, and the same groupings of features were associated with decreased likelihood of overall satisfaction with treatment received.

Summary

Background and objective: Venous air embolism is a constant threat during neurosurgery performed in the sitting position. No large prospective study has compared the incidence of venous air embolism and associated hypotension between adults and children.

Methods: Four hundred and thirty patients (334 adults, 96 children) scheduled to undergo planned posterior fossa surgery in the sitting position (between January 1989 to December 1994) were studied with end-tidal carbon dioxide monitoring. Intraoperatively, a sudden and sustained decrease in end-tidal carbon dioxide tension of >0.7 kPa was presumed to be due to venous air embolism. Management during the episode was on the established guidelines. Hypotension (decrease in systolic arterial pressure of 20% or more from the previous level) was treated with crystalloids and/or a vasopressor.

Results: Capnometry detected a 28% incidence rate of air embolism in adults (93/334) and a 22% incidence rate in children (21/96) (P = 0.29). In both groups, the highest incidence rate of embolism took place during muscle handling (44% of adults versus 38% of children, P = 0.8). Embolic episodes were accompanied by hypotension in 37% of adults (34/93) and in 33% of children (7/21) (P = 0.98). To restore arterial pressure to pre-embolic levels, 53% of adults (18/34) and 43% of children (3/7) were administered vasopressors (P = 0.94). There was no intraoperative mortality. The surgical procedure on one adult was abandoned because of persistent hypotension following the embolic episode.

Conclusion: The incidence of venous air embolism and consequent hypotension is similar in adults and children.

Summary

Background and objective: We have investigated the accuracy of the Colin tonometry module, a non-invasive alternative to intra-arterial blood pressure (BP) measurement. The claims of previous publications range between good agreement to significant discrepancies between the Colin tonometry and intra-arterial methods. The Colin method relies on calibration of the tonometry module using an oscillometric method. Our aim was to look at the effect of this calibration on the accuracy. Methods: Ten conscious patients who already had an indwelling arterial catheter were studied. The Colin monitor was set to perform ten calibration cycles first with the oscillometric cuff on the same arm as the tonometry module and secondly on the opposite arm. Simultaneous recording of BP wave forms from the intra-arterial BP transducer and the Colin monitor allowed comparison of beat-by-beat systolic, diastolic and mean BP. Results: There was considerable inter- and intra-patient variation. In the worst case, the error range was 41 mmHg over ten calibrations. Analysis of variance showed that contra- and ipsilateral calibrations gave a significantly different bias while the multiple calibrations accounted for a significant proportion of the variability in systolic BP error. Conclusions: The Colin Tonometry method is not accurate enough to be used with confidence in clinical practice. The main reason for this is its reliance on an oscillometric method for calibration of the tonometry module. Single BP measurements, using either manual or semiautomatic instruments may vary considerably from the ‘true’ BP due to short-term perturbations of BP.

Background and objective: This study was performed to identify risk factors for complications and in-hospital mortality associated with pneumonectomy.

Methods: The influence of fluid balance during anaesthesia was evaluated, taking into account the patient's age, gender and body mass index, smoking habits, history of pulmonary or cardiac disorders, the site of pneumonectomy and duration of anaesthesia. One-hundred-and-seven patients undergoing elective pneumonectomy were included in the study.

Results: A total of 31 patients (29%) suffered from one or more postoperative complications, seven (22.4%) of these had severe dysrhythmias, six (19.6%) had pulmonary complications and three (9.3%) had cardiovascular complications. The overall mortality rate was 10.3%.

Conclusions: Based on logistic regression analysis, our data indicate the following risk factors for postoperative complications: positive fluid balance exceeding 4000 mL during anaesthesia (pulmonary complications and mortality), body mass index < 17 or > 25 kg m−2 (severe dysrhythmias), or history of chronic heart disease (pulmonary complications). Thirteen patients (12.4%) suffered from a fluid balance 4000 ml during anaesthesia. Regression analysis indicated that fluid balance exceeding 4000 mL was associated with a higher risk of postoperative complications than blood loss exceeding 1000 mL and to be the strongest risk factor for postoperative pulmonary complications and in-hospital mortality. Further trials estimating the effect of restrictive fluid regimens and the use of vasopressors for blood pressure control during anaesthesia must be carried out.

Summary

Background and objectives: The primary objective of sedation in the critically ill patient is to achieve security and comfort. The routine use of standardized and validated sedation scales and monitors are needed. The Richmond agitation sedation scale has been used but some patients cannot be evaluated with subjective assessment tools such as the Richmond agitation sedation scale because they lack motor responsiveness due to therapeutic paralysis or because they are receiving deep sedation. We aimed to assess the correlation of bispectral index with Richmond agitation sedation scale during dexmedetomidine sedation and evaluate the use of the bispectral index in monitoring the levels of sedation in intensive care patients. Methods: This was a single centre, prospective, clinical study. Eleven mechanically-ventilated critically ill patients, aged 17–82 (50.09 ± 17.76; mean ± SD) yr, 3 males and 8 females, APACHE II score 12.63 ± 3.90, SOFA score 3.27 ± 1.73 were enrolled in the study. Patients received a dexmedetomidine infusion of 1 μg kg−1 over 10 min followed by a maintenance infusion of 0.5 μg kg−1 h−1 for 8 h. Sedation was assessed using the Richmond agitation sedation scale and bispectral index monitoring. Heart rate, blood pressure, respiratory rate and SPO2 were monitored. Wilcoxon signed rank sum test and Spearman's rank correlation analysis were used for statistical analysis. Results: The variation of Richmond agitation sedation scale score was between 0.9 and −1.7 bispectral index varied from 65 to 75. Significant correlations between Richmond agitation sedation scale and bispectral index values were found in this study. (r = 0.900; P = 0.0001) Conclusions: Richmond agitation sedation scale levels significantly correlated with bispectral index values during dexmedetomidine sedation in critically ill patients requiring mechanical ventilation in the intensive care unit.

Background and objective: Clinical sedation assessment becomes insufficient in deeply sedated patients. Bispectral index as a processed electroencephalogram parameter provides a continuous and observer-independent value reported to change with sedation. The aim of this prospective observational study was to determine the reliability and possible confounding factors of the bispectral index to assess sedation in surgical intensive care patients.

Methods: Following major surgery, bispectral index, body temperature and electromyographic activity of 44 ventilated patients were recorded. Sedation levels were assessed with Ramsay sedation score.

Results: Although bispectral index correlated with Ramsay sedation score (-0.64; P < 0.01) we found that in deeply sedated patients temperature instability and electromyographic activity increased bispectral index. Bispectral index correlated significantly with electromyographic activity (0.80; P < 0.01) and with an increase of body temperature (0.55; P < 0.01) not only in all patients but also in clinically deeply sedated patients (0.57; P < 0.01 and 0.46; P < 0.05).

Conclusions: Only under certain conditions, such as low muscular activity and body temperature stability, may the bispectral index be a useful addition to clinical scoring in the sedation assessment of critically ill patients.

Summary

Background and objective: The quality of spinal anaesthesia, often used for Caesarean section, can be improved by adding an opioid to the local anaesthetic. This study compared the quality of anaesthesia, postoperative analgesia, and adverse effects on mother and neonate when either sufentanil 5 μg or morphine 0.2 mg was added to intrathecal hyperbaric bupivacaine for Caesarean section. Methods: This prospective, randomized and double-blind study encompassed 54 females undergoing Caesarean section. Spinal anaesthesia was obtained with 2 mL of 0.5% bupivacaine supplemented with either 0.2 mg morphine or 5 μg sufentanil. Characteristics of spinal block, intraoperative analgesia, maternal and neonatal side-effects and the time to first request for analgesics were assessed. Results: There were no differences in the onset time of sensory block, time to sensory block to T10, time to highest sensory block, highest sensory block level, time to regression of sensory block to T10 level and time to resolution of motor blockade. Perioperative haemodynamic parameters, neonatal Apgar scores, neurological and adaptive capacity scores, umbilical blood gas values, sedation scores, nausea–vomiting and pruritus incidences were similar in both groups. The time to the first request for an analgesic was significantly longer (19.5 ± 4.7 h vs. 6.3 ± 5.2 h) in patients given morphine (P < 0.05). Conclusions: The addition of 5 μg sufentanil or 0.2 mg morphine to hyperbaric bupivacaine for Caesarean section both provided safe and effective anaesthesia. Morphine increased the duration of postoperative analgesia compared with sufentanil without increasing maternal or neonatal side-effects.

Summary

Background and objective: The addition of clonidine to local anaesthetics enhances pain relief after peripheral nerve block, but the site of action is unproven.

Methods: Seven healthy volunteers underwent three brachial block procedures using bupivacaine 0.25% 1 mg kg−1 + epinephrine 1 : 200 000 (=local analgesic) in a randomized, double-blind cross-over fashion: (a) control treatment: local analgesic with 0.9% sodium chloride solution for the block and an intramuscular injection of saline; (b) intramuscular treatment: local analgesic with 0.9% NaCl for block and an intramuscular injection of clonidine 2 μg kg−1 and (c) block treatment: local analgesic with clonidine 2 μg kg−1 for block and an intramuscular injection of saline.

Results: The onset and duration of complete blockade (sensory/motor/temperature) was evaluated in the four nerve regions of the hand and forearm. Additionally, sedation score, blood pressure, heart rate and plasma clonidine concentrations were determined. The median duration of complete sensory blockade was 270 min (range 0–600) for block treatment compared to 0 min (range 0–480) for intramuscular treatment (P < 0.05) and 0 min (range 0–180) for control treatment (P < 0.05). Motor and temperature blockade exhibited similar results. Administration of clonidine was associated with sedation and a decrease in heart rate and blood pressure independent of the route of administration. Plasma clonidine concentrations were lower for block compared to the intramuscular treatment.

Conclusions: The admixture of clonidine to bupivacaine plus epinephrine prolongs and enhances brachial plexus blockade. Lower clonidine plasma concentrations for block treatment strongly suggest a local effect.

Background and objective Factors which lead to prolonged stay in the day–care unit and unplanned admission after day-case surgery are poorly understood.

Methods Data sets of 3152 day-case patients were collected with a computerized online record keeping system (NarkoData). Predictors of prolonged postoperative stay including unanticipated admission were identified using univariate analysis. Charts of patients, who needed admission, were reviewed.

Results 13.2% of day–case patients had a postoperative stay ≤3 h, 55.3% 3–6 h and 26.2%≥6h. The rate of unanticipated admission was 5.4%. Intraoperative haemoglobin concentration and blood loss were the best predictors of a prolonged postoperative stay. Other significant predictors were female gender, advanced age, longer duration of surgery, larger volume of infusions, intubation, spinal anaesthesia, intraoperative use of opioids and non–depolarizing muscle relaxants, high pain score, nausea and vomiting and prolonged preoperative waiting time. Chart review of patients admitted to hospital confirmed the validity of the statistically significant predictors.

Conclusions In day-case surgery, the predictors of prolonged stay in the day-care unit and unplanned Hospital admission are mainly related to the surgical procedure.

A telephone survey of 20 English intensive care units (ICUs) confirmed that visual estimation of patient weight is often performed. Four experienced intensive care staff (three doctors and one nurse) estimated the weight and measured the height of 30 volunteers and the estimates were compared with accurate reference measurements. The estimates were shown to be significantly inaccurate for individual observers. We consider the degree of inaccuracy to be of clinical importance. However, pooling the individual estimates of weight as mean values improved accuracy. Recommendations are made concerning the performance of height and weight determination.

Summary

Background and objective: MDA-MB-468 breast carcinoma cells respond to non-volatile anaesthetics such as propofol with an increased migration. Here we investigated the relationship between GABA-A receptor modulators, the mode of calcium oscillation and actin reorganization with regard to breast carcinoma cell migration. Methods: Expression of the GABA-A receptor was determined by Western blot analysis. Calcium-imaging experiments of individual MDA-MB-468 cells as well as visualization of the F-actin distribution were performed by confocal laser scanning microscopy. Cell migration was investigated in a three-dimensional collagen matrix by time-lapse video microscopy. The GABA agonist propofol was used in a final concentration of 6 μg mL−1. GABA-A receptor antagonist bicuculline (50 μmol) and selective L-type calcium channel blocker verapamil (5 μmol) were used to modulate the propofol effects. Results: A functional GABA-A receptor is expressed by MDA-MB-468 cells. Activation with propofol resulted in sustained increased intracellular calcium concentrations concomitant with actin reorganization and induction of migration in MDA-MB-468 cells. These propofol effects were completely blocked by verapamil. Spontaneous migration of MDA-MB-468 cells (64.4 ± 7.0%) was significantly increased by propofol to 85.0 ± 5.0%. MDA-MB-468 cells co-treated with propofol and verapamil showed a migratory activity of 63.0 ± 2.0% indicating that verapamil blocked the propofol effect. Similar results were achieved with the GABA-A receptor inhibitor bicuculline (control: 56.3 ± 8.5%; propofol: 80.5 ± 7.1%; propofol + bicuculline: 52.5 ± 8.6%). Conclusion: Activation of GABA-A receptor by propofol correlated with an increased migration of MDA-MB-468 breast carcinoma cells, mediated by calcium influx via L-type calcium channels and reorganization of the actin cytoskeleton.