The effect of different isoflurane-fentanyl dose combinations on early recovery from anesthesia and postoperative adverse effects.
We evaluated the effect of different combinations of fentanyl-isoflurane on early recovery from anesthesia in 80 adult patients undergoing laparoscopic cholecystectomy. Anesthesia was induced with fentanyl 2 microg/kg and thiopental 5 mg/kg. Nitrous oxide was not used and patients were randomly assigned to one of four groups: Group 1 (n = 20) received 0.6% end-tidal isoflurane plus fentanyl, Group 2 (n = 20) received 1.2% end-tidal isoflurane plus fentanyl, Group 3 (n = 20) received 1.8% end-tidal isoflurane plus fentanyl, and Group 4 (n = 20) received only isoflurane. In Groups 1, 2 and 3 isoflurane concentration was kept constant and fentanyl was given as necessary to maintain the mean arterial blood pressure within +/- 10% of the minimum mean arterial blood pressure measured in the ward. In Group 4, isoflurane concentration was adjusted to maintain mean arterial blood pressure as above. At the end of skin closure isoflurane was discontinued and the time to spontaneous breathing (TSB), time to extubation (TE) and time to eye opening (TEO) were recorded. In the postanesthesia care unit, the degree of sedation, respiratory rate, Spo(2), emesis, pain, and morphine consumption were evaluated every 15 min for 1 h, and thereafter every 30 min until discharge. Fentanyl requirements were 8.3 +/- 4.5 microg/kg (mean +/- sd) in Group 1, 3.8 +/- 1.3 microg/kg in Group 2, and 3.0 +/- 0.7 microg/kg in Group 3 (P < 0.001), whereas in Group 4 the mean end-tidal concentration of isoflurane was 2.0% +/- 0.4%. Although the mean TSB was <5.5 min in all groups, TE increased from 7.3 +/- 5.1 min in Group 1 to 20.6 +/- 10.7 min in Group 4 (P < 0.001), and TEO increased from 7.4 +/- 5.1 min in Group 1 to 25.8 +/- 9.4 min in Group 4 (P < 0.001). There were no differences among the groups in any of the variables measured in the postanesthesia care unit. This study shows that the combination of a small concentration of isoflurane and a relatively larger dose of fentanyl results in a faster recovery from anesthesia than the inverse combination of doses.


CONCLUSIONS
A fast recovery from anesthesia increases patient safety. This study shows that the combination of a small concentration of isoflurane and a relatively larger dose of fentanyl results in a faster recovery from anesthesia than the inverse combination of doses.
Muñoz
Hernán R
HR
Departamento de Anestesiología, Escuela de Medicina, Pontificia Universidad Católica de Chile. Santiago, Chile.
Altermatt
Fernando R
FR
González
Julio A
JA
León
Paula J
PJ
D000759:Adjuvants, Anesthesia / Q000008:administration & dosage* / Q000009:adverse effects; D000328:Adult; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000627:therapeutic use; D000762:Anesthesia Recovery Period; D018685:Anesthetics, Inhalation / Q000008:administration & dosage* / Q000009:adverse effects; D001794:Blood Pressure / Q000187:drug effects; D017081:Cholecystectomy, Laparoscopic; D004305:Dose-Response Relationship, Drug; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage* / Q000009:adverse effects; D006801:Humans; D007530:Isoflurane / Q000008:administration & dosage* / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D009020:Morphine / Q000008:administration & dosage / Q000627:therapeutic use; D010147:Pain Measurement / Q000187:drug effects; D011183:Postoperative Complications / Q000139:chemically induced / Q000453:epidemiology*
D000759:Adjuvants, Anesthesia; D000701:Analgesics, Opioid; D018685:Anesthetics, Inhalation; D009020:Morphine; D007530:Isoflurane; D005283:Fentanyl