Comparison of sevoflurane and propofol for ambulatory anaesthesia in gynaecological surgery.
OBJECTIVE
To analyse the cost-efficiency ratio of sevoflurane compared with propofol for gynaecological ambulatory anaesthesia.


METHODS
In a prospective randomised study 52 ASA I patients scheduled for ambulatory pregnancy termination were premedicated with lorazepam and received alfentanil prior to anaesthesia induction with propofol (group P, n = 26) or with sevoflurane 8% (group S, n = 26) using the single breath vital capacity technique. Anaesthesia was maintained with N2O in both groups supplemented with sevoflurane (group S) or propofol boluses (group P).


RESULTS
The quality of induction and maintenance of anaesthesia was similar between groups except for the incidence of movement during anaesthesia (14/26 patients in group P and 4/26 in group S, P < 0.05). The incidence of post-operative emesis was increased in the sevoflurane group (P < 0.05) but the patients felt able to perform normal activity after a similar delay (18.4 +/- 2.9 hr vs 20.6 +/- 2.8 hr, P > 0.05). The direct cost of anaesthesia was lower in the sevoflurane group (679 FF, n = 24 vs 1153 FF, n = 2-5 in propofol group) but the weight of uterine aspiration products was higher (293 +/- 66 g, median = 230 g, Range 110-800 g, n = 13 vs 108 +/- 8 g, median = 110 g, Range 60-160 g, n = 12, group S vs group P respectively, P = 0.004). Four patients needed reoperation and ambulatory anaesthesia failed in six patients because of uterine haemorrhage.


CONCLUSIONS
Ambulatory anaesthesia with sevoflurane offers a good alternative to propofol but further investigation concerning blood loss with sevoflurane needs to be performed in gynaecological practice.
Nathan
N
N
Department of Anaesthesia, CHU Dupuytren, Limoges, France.
Peyclit
A
A
Lahrimi
A
A
Feiss
P
P
D000028:Abortion, Induced / Q000191:economics*; D000203:Activities of Daily Living; D000328:Adult; D000556:Ambulatory Surgical Procedures / Q000191:economics*; D000768:Anesthesia, General / Q000191:economics*; D018685:Anesthetics, Inhalation / Q000008:administration & dosage / Q000009:adverse effects / Q000191:economics*; D018686:Anesthetics, Intravenous / Q000008:administration & dosage / Q000009:adverse effects / Q000191:economics*; D016063:Blood Loss, Surgical; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D015994:Incidence; D008738:Methyl Ethers / Q000008:administration & dosage / Q000009:adverse effects / Q000191:economics*; D009068:Movement; D009609:Nitrous Oxide / Q000008:administration & dosage; D019106:Postoperative Hemorrhage / Q000209:etiology; D020250:Postoperative Nausea and Vomiting / Q000139:chemically induced; D011247:Pregnancy; D015742:Propofol / Q000008:administration & dosage / Q000009:adverse effects / Q000191:economics*; D011446:Prospective Studies; D012086:Reoperation; D012119:Respiration; D000077149:Sevoflurane; D013396:Suction; D014592:Uterine Hemorrhage / Q000209:etiology; D014797:Vital Capacity
D018685:Anesthetics, Inhalation; D018686:Anesthetics, Intravenous; D008738:Methyl Ethers; D000077149:Sevoflurane; D009609:Nitrous Oxide; D015742:Propofol