Induction with sevoflurane-remifentanil is comparable to propofol-fentanyl-rocuronium in PONV after laparoscopic surgery.
OBJECTIVE
To compare sevoflurane-remifentanil induction and propofol-fentanyl-rocuronium induction with regards to the frequency of moderate to severe postoperative nausea and vomiting (PONV) in the first 24 hr after laparoscopic day surgery.


METHODS
After informed consent, 156 ASA physical status class I to III patients undergoing laparoscopic cholecystectomy or tubal ligation were randomized to either induction with sevoflurane 8%, N(2)O 67% and iv remifentanil 1 to 1.5 microg.kg(-1) or induction with iv fentanyl 2 to 3 microg.kg(-1), propofol 2 mg.kg(-1), and rocuronium 0.3 to 0.5 mg.kg(-1). All patients received iv ketorolac 0.5 mg.kg(-1) at induction and sevoflurane-N(2)O maintenance anesthesia with rocuronium as needed. PONV was treated with iv ondansetron, droperidol, or dimenhydrinate; postoperative pain was treated with opioid analgesics. Patients were followed for 24 hr with regards to PONV and pain. Intubating conditions, induction and emergence times, time to achieve fast-track discharge criteria, and drug costs were measured.


RESULTS
No differences were seen between the two groups in their frequencies of 24-hr moderate to severe PONV and postoperative pain, or in their intubating conditions, induction and emergence times, and time to achieve fast-track discharge criteria. Patients undergoing sevoflurane-remifentanil induction received more morphine (11 mg vs 8 mg; P < 0.001) in the postanesthetic care unit. Sevoflurane-remifentanil induction resulted in similar anesthetic and total drug costs for both procedures.


CONCLUSIONS
We did not demonstrate any difference in PONV, pain, or anesthetic/recovery times or costs between the sevoflurane and propofol groups. Sevoflurane-remifentanil induction is a feasible technique for anesthetic induction.
McMaster University, Department of Anesthesia, 1200 Main Street West, Room HSC-2U1, Hamilton, Ontario L8N 3Z5, Canada.
Homer
H
Yang
Peter T-L
PT
Choi
James
J
McChesney
Norman
N
Buckley
D000328:Adult; D000556:Ambulatory Surgical Procedures / Q000009:adverse effects / Q000379:methods; D000732:Androstanols / Q000009:adverse effects* / Q000191:economics / Q000627:therapeutic use; D019162:Anesthetics, Combined / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use; D018685:Anesthetics, Inhalation / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use; D018686:Anesthetics, Intravenous / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use; D005260:Female; D005283:Fentanyl / Q000009:adverse effects* / Q000191:economics / Q000627:therapeutic use; D006801:Humans; D007442:Intubation, Intratracheal / Q000379:methods; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods; D008297:Male; D008738:Methyl Ethers / Q000009:adverse effects* / Q000191:economics / Q000627:therapeutic use; D003473:Neuromuscular Nondepolarizing Agents / Q000009:adverse effects / Q000627:therapeutic use; D010880:Piperidines / Q000009:adverse effects* / Q000191:economics / Q000627:therapeutic use; D020250:Postoperative Nausea and Vomiting / Q000139:chemically induced / Q000517:prevention & control*; D015742:Propofol / Q000009:adverse effects* / Q000191:economics / Q000627:therapeutic use; D000077208:Remifentanil; D000077123:Rocuronium; D000077149:Sevoflurane; D013997:Time Factors
D000732:Androstanols; D019162:Anesthetics, Combined; D018685:Anesthetics, Inhalation; D018686:Anesthetics, Intravenous; D008738:Methyl Ethers; D003473:Neuromuscular Nondepolarizing Agents; D010880:Piperidines; D000077149:Sevoflurane; D000077208:Remifentanil; D005283:Fentanyl; D000077123:Rocuronium; D015742:Propofol