Hostname: page-component-cd9895bd7-7cvxr Total loading time: 0 Render date: 2024-12-27T11:01:34.942Z Has data issue: false hasContentIssue false
  • English
  • Français

Anaesthesia for day case excisional breast biopsy: propofol–remifentanil compared with sevoflurane–nitrous oxide

Published online by Cambridge University Press:  01 June 2008

J.-Y. Hong ,
Y. S. Kang  and
H. K. Kil
J.-Y. Hong*
Affiliation:
Yonsei University College of Medicine, Severance Hospital, Anesthesia and Pain Research Institute, Department of Anesthesiology and Pain Medicine, Seoul, South Korea
Y. S. Kang
Affiliation:
Yonsei University College of Medicine, Severance Hospital, Anesthesia and Pain Research Institute, Department of Anesthesiology and Pain Medicine, Seoul, South Korea
H. K. Kil
Affiliation:
Yonsei University College of Medicine, Severance Hospital, Anesthesia and Pain Research Institute, Department of Anesthesiology and Pain Medicine, Seoul, South Korea
*
Correspondence to: Jeong-Yeon Hong, Department of Anesthesiology, Severance Hospital, 134 Sinchon-dong, Seodaemun-gu, Seoul 120-752, South Korea. E-mails: [email protected], [email protected]>; Tel: +82 2 2228 2427; Fax: +82 2 312 7185
Get access

Summary

Background and objective

A randomized and prospective study was performed to compare anaesthetic characteristics and stress hormone responses of two anaesthetic techniques.

Methods

Forty-two patients undergoing day case excisional biopsy of breast mass were randomly assigned to receive propofol–remifentanil or sevoflurane–N2O. Anaesthesia was induced and maintained either with sevoflurane and 50% N2O in oxygen or with target-controlled remifentanil and propofol in 50% oxygen and air. Anaesthetic depth was monitored by the bispectral index.

Results

The times for induction (2.9 vs. 1.7 min) and for laryngeal mask insertion (5.7 vs. 3.3 min) were longer in the sevoflurane–N2O group than in the propofol–remifentanil group. However, apnoea (57.1% vs. 9.5%) and bradycardia (23.8% vs. 0%) were more prevalent with propofol–remifentanil. In the sevoflurane–N2O group, the emergence times to a verbal response (10.6 vs. 3.7 min), to extubation (11.8 vs. 4.0 min) and to orientation (14.7 vs. 4.8 min) were longer than in the propofol–remifentanil group. There were significantly more nausea (38.1% vs. 4.8%) and vomiting (19.2% vs. 0%) in the sevoflurane–N2O group than in the propofol–remifentanil group. The time to discharge was similar although there was less postoperative pain in the sevoflurane–N2O group. There were no differences in the perioperative cortisol responses in the two groups.

Conclusions

Smoother induction of anaesthesia was seen with sevoflurane–N2O. Propofol–remifentanil showed a quicker emergence with less nausea/vomiting. There were similar perioperative cortisol responses in the two anaesthetic techniques.

Keywords

ANAESTHETIC GENERALANAESTHESIA INTRAVENOUSPROPOFOLREMIFENTANILSEVOFLURANENITROUS OXIDE
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 25 , Issue 6 , June 2008 , pp. 460 - 467
Copyright
Copyright © European Society of Anaesthesiology 2008

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.2ndEger, EI. New inhaled anesthetics. Anesthesiology 1994; 80: 906–922.CrossRefGoogle ScholarPubMed
2.JrHogue, CW, Bowdle, TA, O’Leary, C et al. A multicenter evaluation of total intravenous anesthesia with remifentanil and propofol for elective inpatient surgery. Anesth Analg 1996; 83: 279–285.CrossRefGoogle ScholarPubMed
3.Larsen, B, Seitz, A, Larsen, R. Recovery of cognitive function after remifentanil-propofol anesthesia: a comparison with desflurane and sevoflurane anesthesia. Anesth Analg 2000; 90: 168–174.CrossRefGoogle ScholarPubMed
4.Theodorou, T, Hales, P, Gillespie, P, Robertson, B. Total intravenous versus inhalational anaesthesia for colonoscopy: a prospective study of clinical recovery and psychomotor function. Anaesth Intensive Care 2001; 29: 124–136.CrossRefGoogle ScholarPubMed
5.Montes, FR, Trillos, JE, Rincon, IE et al. Comparison of total intravenous anesthesia and sevoflurane-fentanyl anesthesia for outpatient otorhinolaryngeal surgery. J Clin Anesth 2002; 14: 324–328.CrossRefGoogle ScholarPubMed
6.Jellish, WS, Lien, CA, Fontenot, HJ, Hall, R. The comparative effects of sevoflurane versus propofol in the induction and maintenance of anesthesia in adult patients. Anesth Analg 1996; 82: 479–485.Google ScholarPubMed
7.Grundmann, U, Uth, M, Eichner, A, Wilhelm, W, Larsen, R. Total intravenous anaesthesia with propofol and remifentanil in paediatric patients: a comparison with a desflurane-nitrous oxide inhalation anaesthesia. Acta Anaesthesiol Scand 1998; 42: 845–850.CrossRefGoogle ScholarPubMed
8.Minto, CF, Schnider, TW, Egan, TD et al. Influence of age and gender on the pharmacokinetics and pharmacodynamics of remifentanil. I. Model development. Anesthesiology 1997; 86: 10–23.CrossRefGoogle ScholarPubMed
9.Schnider, TW, Minto, CF, Gambus, PL et al. The influence of method of administration and covariates on the pharmacokinetics of propofol in adult volunteers. Anesthesiology 1998; 88: 1170–1182.CrossRefGoogle ScholarPubMed
10.Yurino, M, Kimura, H. A comparison of vital capacity breath and tidal breathing techniques for induction of anaesthesia with high sevoflurane concentrations in nitrous oxide and oxygen. Anaesthesia 1995; 50: 308–311.CrossRefGoogle ScholarPubMed
11.Aldrete, JA. The post-anesthesia recovery score revisited. J Clin Anesth 1995; 7: 89–91.CrossRefGoogle ScholarPubMed
12.Chung, F, Chan, VW, Ong, D. A post-anesthetic discharge scoring system for home readiness after ambulatory surgery. J Clin Anesth 1995; 7: 500–506.CrossRefGoogle ScholarPubMed
13.Crozier, TA, Muller, JE, Quittkat, D, Sydow, M, Wuttke, W, Kettler, D. Total intravenous anesthesia with methohexital-alfentanil or propofol-alfentanil in hypogastric laparotomy. Clinical aspects and the effects of stress reaction. Anaesthesist 1994; 43: 594–604.CrossRefGoogle ScholarPubMed
14.Wormald, PJ, van Renen, G, Perks, J, Jones, JA, Langton-Hewer, CD. The effect of the total intravenous anesthesia compared with inhalational anesthesia on the surgical field during endoscopic sinus surgery. Am J Rhinol 2005; 19: 514–520.CrossRefGoogle ScholarPubMed
15.Ledowski, T, Bein, B, Hanss, R et al. Neuroendocrine stress response and heart rate variability: a comparison of total intravenous versus balanced anesthesia. Anesth Analg 2005; 101: 1700–1705.CrossRefGoogle ScholarPubMed
16.Molloy, ME, Buggy, DJ, Scanlon, P. Propofol or sevoflurane for laryngeal mask airway insertion. Can J Anesth 1999; 46: 322–326.CrossRefGoogle ScholarPubMed
17.Thwaites, A, Edmends, S, Smith, I. Inhalation induction with sevoflurane: a double-blind comparison with propofol. Br J Anaesth 1997; 78: 356–361.CrossRefGoogle ScholarPubMed
18.Grounds, RM, Morgan, M, Lumley, J. Some studies on the properties of the intravenous anaesthetic, propofol (“Diprivan”) – a review. Postgrad Med J 1985; 61: 90–95.Google ScholarPubMed
19.Gupta, A, Stierer, T, Zuckerman, R, Sakima, N, Parker, SD, Fleisher, LA. Comparison of recovery profile after ambulatory anesthesia with propofol, isoflurane, sevoflurane and desflurane: a systematic review. Anesth Analg 2004; 98: 632–641.CrossRefGoogle ScholarPubMed
20.Korttila, K, Ostman, P, Faure, E et al. Randomized comparison of recovery after propofol-nitrous oxide versus thiopentone-isoflurane-nitrous oxide anaesthesia in patients undergoing ambulatory surgery. Acta Anaesthesiol Scand 1990; 34: 400–403.CrossRefGoogle ScholarPubMed
21.Marshall, CA, Jones, RM, Bajorek, PK, Cashman, JN. Recovery characteristics using isoflurane or propofol for maintenance of anaesthesia: a double-blind controlled trial. Anaesthesia 1992; 47: 461–466.CrossRefGoogle ScholarPubMed
22.Kalman, SH, Jensen, AG, Ekberg, K, Eintrei, C. Early and late recovery after major abdominal surgery. Comparison between propofol anaesthesia with and without nitrous oxide and isoflurane anaesthesia. Acta Anaesthesiol Scand 1993; 37: 730–736.CrossRefGoogle ScholarPubMed
23.Rowbotham, DJ, Peacock, JE, Jones, RM et al. Comparison of remifentanil in combination with isoflurane or propofol for short-stay surgical procedures. Br J Anaesth 1998; 80: 752–755.CrossRefGoogle ScholarPubMed
24.Chung, F, Mulier, JP, Scholz, J et al. A comparison of anaesthesia using remifentanil combined with either isoflurane, enflurane or propofol in patients undergoing gynaecological laparoscopy, varicose vein or arthroscopic surgery. Acta Anaesthesiol Scand 2000; 44: 790–798.CrossRefGoogle ScholarPubMed
25.Glaisyer, HR, Sury, MR. Recovery after anesthesia for short pediatric oncology procedures: propofol and remifentanil compared with propofol, nitrous oxide, and sevoflurane. Anesth Analg 2005; 100: 959–963.CrossRefGoogle ScholarPubMed
26.Gupta, A, Vegfors, M, Odensten, M, Lennmarken, C. Alfentanil or fentanyl during isoflurane-based anaesthesia for day-care knee arthroscopy? Acta Anaesthesiol Scand 1994; 38: 156–160.CrossRefGoogle ScholarPubMed
27.Song, D, van Vlymen, J, White, PF. Is the bispectral index useful in predicting fast-track eligibility after ambulatory anesthesia with propofol and desflurane? Anesth Analg 1998; 87: 1245–1248.CrossRefGoogle ScholarPubMed
28.McCollum, JS, Milligan, KR, Dundee, JW. The antiemetic action of propofol. Anaesthesia 1988; 43: 239–240.CrossRefGoogle ScholarPubMed
29.Watcha, MF, White, PF. Postoperative nausea and vomiting. Its etiology, treatment, and prevention. Anesthesiology 1992; 77: 162–184.CrossRefGoogle ScholarPubMed
30.King, MJ, Milazkiewicz, R, Carli, F, Deacock, AR. Influence of neostigmin on postoperative vomiting. Br J Anaesth 1988; 61: 403–406.CrossRefGoogle ScholarPubMed
31.Doze, VA, Shafer, A, White, PF. Propofol-nitrous oxide versus thiopenthal-isoflurane-nitrous oxide for general anesthesia. Anesthesiology 1988; 69: 63–71.CrossRefGoogle ScholarPubMed
32.Parker, SD, Breslow, MJ, Frank, SM et al. Catecholamine and cortisol responses to lower extremity revascularization: correlation with outcome variables. Perioperative Ischemia Randomized Anesthesia Trial Study Group. Crit Care Med 1995; 23: 1954–1961.CrossRefGoogle ScholarPubMed
33.Eroglu, A, Solak, M, Ozen, I, Aynaci, O. Stress hormones during the wake-up test in scoliosis surgery. J Clin Anesth 2003; 15: 15–18.CrossRefGoogle ScholarPubMed
34.Juckenhofel, S, Feisel, C, Schmitt, HJ, Biedler, A. TIVA with propofol-remifentanil or balanced anesthesia with sevoflurane-fentanyl in laparoscopic operations. Hemodynamics, awakening and adverse effects. Anaesthesist 1999; 48: 807–812.Google ScholarPubMed
35.Castillo, V, Navas, E, Naranjo, R, Jimenez-Jimenez, L. Changes in the concentrations of catecholamines and cortisol in balanced anesthesia and total intravenous anesthesia. Rev Esp Anestesiol Reanim 1997; 44: 52–55.Google ScholarPubMed
36.Aono, H, Takeda, A, Tarver, SD, Goto, H. Stress responses in three different anesthetic techniques for carbon dioxide laparoscopic cholecystectomy. J Clin Anesth 1998; 10: 546–550.CrossRefGoogle ScholarPubMed