Comparison of total intravenous anesthesia and sevoflurane-fentanyl anesthesia for outpatient otorhinolaryngeal surgery.
OBJECTIVE
To compare the recovery characteristics of two widely used anesthetic techniques: remifentanyl-propofol and sevoflurane-fentanyl in a standardized ambulatory population.


METHODS
Randomized, single-blinded study.


METHODS
University-affiliated medical center.


METHODS
50 ASA physical status I and II patients undergoing elective ambulatory otorhinolaryngeal surgery.


METHODS
Patients were randomized two groups to receive total intravenous anesthesia (TIVA group) with remifentanil and propofol or sevoflurane-fentanyl (SF group). TIVA patients received induction with propofol 1.5 mg/kg intravenously (IV) and remifentanil 0.5 microg/kg IV. The anesthesia was continued with a continuous infusion of propofol 100 microg/kg/min and remifentanil 0.0625-0.25 microg/kg/min. The SF group received, at induction, fentanyl 2 microg/kg followed by propofol 1.5 mg/kg IV. Maintenance was obtained with 1 to 1.5 minimum alveolar concentration of sevoflurane and bolus of fentanyl 1 microg/kg IV as needed.


RESULTS
Early recovery times (eye opening, response to commands, extubation, orientation, operating room stay after surgery, and Aldrete score > or =9) and patient satisfaction were similar between the two groups. Postanesthetic discharge scoring system (PADSS) > or = 9 was significantly shorter for the TIVA group (135.9 +/- 51 vs. 103 +/- 32 min) (p < 0.01) but this difference was not associated with a shorter postanesthesia care unit (PACU) length of stay.


CONCLUSIONS
Early recovery times are comparable between total intravenous anesthesia and sevoflurane-based anesthesia. Even though patients in the TIVA group achieved home readiness criteria in a significantly shorter time, this technique does not shorten PACU length of stay, which depends instead on multiple nonmedical and administrative issues.
Montes
Félix R
FR
Department of Anesthesiology, Fundación Cardio Infantil - Instituto de Cardiología, Universidad del Rosario, Bogotá, Colombia, South America. cfmont@col1.telecom.com.co
Trillos
Julio E
JE
Rincón
Ismael E
IE
Giraldo
Juan C
JC
Rincón
José D
JD
Vanegas
María V
MV
Charris
Hernán
H
D000293:Adolescent; D000328:Adult; D000556:Ambulatory Surgical Procedures; D000762:Anesthesia Recovery Period; D000771:Anesthesia, Intravenous; D018685:Anesthetics, Inhalation / Q000627:therapeutic use*; D018686:Anesthetics, Intravenous / Q000627:therapeutic use*; D005260:Female; D005283:Fentanyl / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008738:Methyl Ethers / Q000627:therapeutic use*; D008875:Middle Aged; D013517:Otorhinolaryngologic Surgical Procedures; D010880:Piperidines / Q000627:therapeutic use*; D015742:Propofol / Q000627:therapeutic use*; D011446:Prospective Studies; D000077208:Remifentanil; D000077149:Sevoflurane; D016037:Single-Blind Method; D013997:Time Factors
D018685:Anesthetics, Inhalation; D018686:Anesthetics, Intravenous; D008738:Methyl Ethers; D010880:Piperidines; D000077149:Sevoflurane; D000077208:Remifentanil; D005283:Fentanyl; D015742:Propofol