Part I: propofol, thiopental, sevoflurane, and isoflurane-A randomized, controlled trial of effectiveness.
When compared with thiopental and isoflurane, propofol and sevoflurane are associated with a faster return to wakefulness after anesthesia. Yet their wider usage in inpatient surgery has been restrained by concerns regarding their acquisition costs and by lack of studies demonstrating improved patient outcome. We randomly allocated 453 adult surgical inpatients to one of four anesthetic regimens (thiopental-isoflurane, propofol-isoflurane, propofol induction and maintenance, or sevoflurane induction and maintenance) and measured their rate and quality of recovery. We found no significant differences in the rate and quality of recovery between groups. Propofol was associated with more pain on injection (P: < 0. 0005), but less cough during induction (P: = 0.003), and less early postoperative nausea and vomiting (P: = 0.003). We could not detect any significant advantages with propofol and sevoflurane, when compared with thiopental and isoflurane in adults undergoing elective inpatient surgery.


CONCLUSIONS
Propofol and sevoflurane do not offer any significant advantages over thiopental and isoflurane in adults undergoing elective inpatient surgery.
Myles
P S
PS
Department of Anaesthesia and Pain Management, Alfred Hospital, Prahran, Austalia. p.myles@alfred.org.au
Hunt
J O
JO
Fletcher
H
H
Smart
J
J
Jackson
T
T
D000328:Adult; D000762:Anesthesia Recovery Period; D019162:Anesthetics, Combined; D018685:Anesthetics, Inhalation / Q000008:administration & dosage / Q000009:adverse effects; D018686:Anesthetics, Intravenous / Q000008:administration & dosage / Q000009:adverse effects; D005260:Female; D006801:Humans; D007530:Isoflurane / Q000008:administration & dosage / Q000009:adverse effects; D008297:Male; D008738:Methyl Ethers / Q000008:administration & dosage / Q000009:adverse effects; D017060:Patient Satisfaction; D020250:Postoperative Nausea and Vomiting; D015742:Propofol / Q000008:administration & dosage / Q000009:adverse effects; D011446:Prospective Studies; D000077149:Sevoflurane; D016037:Single-Blind Method; D013874:Thiopental / Q000008:administration & dosage / Q000009:adverse effects
D019162:Anesthetics, Combined; D018685:Anesthetics, Inhalation; D018686:Anesthetics, Intravenous; D008738:Methyl Ethers; D000077149:Sevoflurane; D007530:Isoflurane; D013874:Thiopental; D015742:Propofol