Anestesia total intravenosa con propofol vs anestesis balanceada con sevoflurano, para la cirugía abdominal, Hospital Vicente Corral Moscoso, Hospital José Carrasco Arteaga, 2009-2010

Abstract

With the last inovations in surgery, we required a better anaesthesic control and minimal side effects in the post operatives rooms. Right know we have the balanced general anaesthesia and lately with the new intravenous agents like propofol, we can do a maintenance during anaetshesia with endovenous drogs, avoid from this way the toxicity of the fluorathes componenets. Total intravenous anaesthesia (TIVA) is increasingly used in surgery. TIVA may provide fast recovery of psychomotor function, less nausea, thus being of benefit to both the patient's behaviour and postoperative management. The purpose of this prospective study was to compare postoperative recovery from TIVA using propofol as the hypnotic component and balanced anaesthesia with sevoflurane.

Objetive: This study was designed to investigate the differences between TIVA with propofol and remifentanil, and balanced anaesthesia with sevoflurane and remifentanil in abdominal surgery. Emphasis was put on hemodynamic reaction, recovery profile, and postoperative side effects.

Methods: One hundred eighty six patients were randomly assigned to receive either total intravenous anaesthesia with propofol and remifentanil (ninety three patients) or anaesthesia with sevoflurane and remifentanil (ninety three patients). After induction of anesthesia (propofol, rocuronium, remifentanil) in both groups, anaesthesia was maintained with 0.5 microgram/kg/min remifentanil (reduced to 50% after 5 min) and 4 mg/kg/h propofol or 1.8 vol % sevoflurane. Both groups were mechanically ventilated. The administration of sevoflurane and the infusion of the anaesthetics were adjusted to maintain a surgical depth of anaesthesia. At the end of surgery the anaesthetics were discontinued and hemodynamic, early emergence from anaesthesia, quality of awake, incidence of PONV, awareness, shivering and patient satisfaction were assessed. Parameters were recorded each 15 minutes postoperatively.

Results: Recovery time after propofol-remifentanil anaesthesia was significantly shorter than after administration of sevoflurane remifentanil (traqueal extubation 4.96 vs. 7.34 min, eye opening 5.3 vs. 8 min, orientation in time, space and person 15 min vs. 30 min. There were no significant differences between the groups in blood pression and hemodynamic stability. Side effects like PONV (RR 4 (IC95%: 1.4 - 11.5) P = 0,009)., headache (RR 3.25 (IC95%: 1.1 - 9.6) P = 0,041) were significantly less in the propofol Group. Awareness were presented in two patients in propofol group, but there were no significant differences between the two groups.

Conclusion: TIVA with propofol and remifentanil proved to be particularly suited for abdominal surgery. It´s major advantages are significantly shorter times of emergence, and the exceptional acceptance by the patients.

Key words: TIVA, balanced anaesthesia, propofol, sevoflurane, awareness, recovery profile.