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Induction with sevoflurane-remifentanil is comparable to propofol-fentanyl-rocuronium in PONV after laparoscopic surgery

  • Homer Yang
  • Peter T. -L. Choi
  • James McChesney
  • Norman Buckley
General Anesthesia

Abstract

Purpose

To compare sevoflurane-remifentanil induction and propofol-fentanyl-rocuronium induction with regards to the frequency of moderate to severe postoperative nausea and vomiting (PONV) in the first 24 hr after laparoscopic day surgery.

Methods

After informed consent, 156 ASA physical status class I to III patients undergoing laparoscopic cholecystectomy or tubal ligation were randomized to either induction with sevoflurane 8%, N2O 67% and iv remifentanil I to 1.5 βg · kg−1 or induction with iv fentanyl 2 to 3 μg · kg−1, propofol 2 mg · kg−1, and rocuronium 0.3 to 0.5 mg · kg−1. All patients received iv ketorolac 0.5 mg · kg−1 at induction and sevoflurane-N2O maintenance anesthesia with rocuronium as needed. PONV was treated with iv ondansetron, droperidol, or dimenhydrinate; postoperative pain was treated with opioid analgesics. Patients were followed for 24 hr with regards to PONV and pain. Intubating conditions, induction and emergence times, time to achieve fast-track discharge criteria, and drug costs were measured.

Results

No differences were seen between the two groups in their frequencies of 24-hr moderate to severe PONV and postoperative pain, or in their intubating conditions, induction and emergence times, and time to achieve fast-track discharge criteria. Patients undergoing sevoflurane-remifentanil induction received more morphine (11 mg vs 8 mg; P < 0.001) in the postanesthetic care unit. Sevoflurane-remifentanil induction resulted in similar anesthetic and total drug costs for both procedures.

Conclusion

We did not demonstrate any difference in PONV pain, or anesthetic/recovery times or costs between the sevoflurane and propofol groups. Sevoflurane-remifentanil induction is a feasible technique for anesthetic induction.

Keywords

Laparoscopic Cholecystectomy Sevoflurane Ondansetron Remifentanil Rocuronium 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

L’induction avec sévoflurane-rémifentanil ou propofol-fentanyl-rocuronium est similaire quant aux NVPO en chirurgie laparoscopique

Résumé

Objectif

Comparer l’induction avec sévoflurane-rémifentanil ou propofol-fentanyl-rocuronium quant à la fréquence de nausées et vomissements postopératoires (NVPO) de modérés à sévères pendant les 24 premières heures après une opération en chirurgie d’un jour sous laparoscopie.

Méthode

Après avoir accordé leur consentement, 156 patients d’état physique ASA I à III devant subir une cholécystectomie laparoscopique ou une ligature des trompes ont été randomisés pour une induction avec du sévoflurane à 8%, N2O à 67 % et l à 1,5 μg · kg−1 de rémifentanil iv ou une induction iv avec 2 à 3 μg · kg−1 de fentanyl, 2 mg · kg−1 de propofol et 0,3 à 0,5 mg · kg−1 de rocuronium. Tous les patients ont reçu 0,5 mg · kg−1 de kétorolac iv à l’induction et un mélange de sévoflurane-N2O pour le maintien de l’anesthésie, avec rocuronium au besoin. Un traitement iv avec ondansétron, dropéridol ou dimenhydrinate a été donné pour les NVPO et la douleur postopératoire a été soulagée avec des analgésiques opioïdes. Les patients ont été suivis pendant 24 h pour les NVPO et la douleur. Ont été notés: les conditions d’intubation, les temps nécessaires à l’induction et au réveil, le temps d’atteindre les critères de congé de la chirurgie ambulatoire et le coût des médicaments.

Résultats

Aucune différence intergroupe n’a été enregistrée concernant la fréquence de NVPO de modérés à sévères et la douleur postopératoire pendant 24 h, ou les conditions d’intubation, les temps d’induction et de réveil, de même que le temps nécessaire à l’atteinte des critères de congé. Les patients soumis à une induction avec un mélange de sévoflurane-rémifentanil ont demandé plus de morphine (11 mg vs 8 mg; P < 0,001) en salle de réveil. L’induction avec sévoflurane-rémifentanil a conduit à un usage d’anesthésiques et à un coût total de médicaments similaires pour les deux types d’interventions chirurgicales.

Conclusion

Nous n’avons trouvé aucune différence de NVPO, de douleur ou de temps liés à l’analgésie et à la récupération postopératoires entre les groupes sous sévoflurane ou propofol. Un mélange de sévoflurane-rémifentanil peut servir à l’induction de l’anesthésie.

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Copyright information

© Canadian Anesthesiologists 2004

Authors and Affiliations

  • Homer Yang
    • 1
  • Peter T. -L. Choi
    • 2
    • 3
  • James McChesney
    • 2
  • Norman Buckley
    • 1
  1. 1.Department of Anesthesia, Hamilton Health SciencesMcMaster UniversityHamiltonCanada
  2. 2.Department of Anesthesia, St. Joseph’s HealthcareMcMaster UniversityHamiltonCanada
  3. 3.Department of Clinical Epidemiology & BiostatisticsMcMaster UniversityHamiltonCanada

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