Fast-track anaesthesia for laparoscopic cholecystectomy: a prospective, randomized, multicentre, blind comparison of desflurane-remifentanil or sevoflurane-remifentanil.
OBJECTIVE
To evaluate the effects of sevoflurane and desflurane in combination with intravenous remifentanil on time for discharge from the postanaesthesia care unit and need for postanaesthesia care unit management after elective laparoscopic cholecystectomy.


METHODS
231 ASA Grade I-II patients, undergoing elective laparoscopic cholecystectomy in seven University teaching hospital, were randomly allocated to receive a desflurane-remifentanil (n = 105) or sevoflurane-remifentanil (n = 126) anaesthetic. A blinded observer recorded times for emergence and postanaesthesia care unit discharge (achievement of an Aldrete score > or =9), number of patients eligible for postanaesthesia care unit discharge when exiting the operating room and occurrence of adverse events.


RESULTS
Intraoperative cardiovascular stability was similar in the two groups. Emergence, response and extubation occurred earlier after desflurane (5.4 +/- 3 min, 5.5 +/- 3 min and 7.5 +/- 4 min) than sevoflurane (6.6 +/- 3.5 min, 7.2 +/- 4 min and 9.1 +/- 4.2 min) (P = 0.0005, 0.05 and 0.003, respectively). Postanaesthesia care unit bypass was possible in 44 desflurane-remifentanil patients (41%) and 55 sevoflurane- remifenatnil patients (43%) (P = 0.69), while postanaesthesia care unit discharge occurred after 46 min (25th-75th percentiles: 18-40 min) with desflurane and 64 min (25th-75th percentiles: 20-50 min) with sevoflurane (P = 0.04). Postoperative nausea and vomiting was observed in 40 desflurane-remifentanil patients (36%) and 53 sevoflurane-remifentanil patients (42%) (P = 0.42).


CONCLUSIONS
Both the desflurane-remifentanil and sevoflurane-remifentanil combinations provide a similarly adequate intraoperative cardiovascular stability. Emergence and postanaesthesia care unit discharge were faster with desflurane-remifentanil than sevoflurane-remifentanil, but this was not associated with a larger proportion of postanaesthesia care unit bypass, confirming that no clinically relevant differences are present between the two agents.
Fanelli
G
G
University of Parma, Department of Anaesthesia and Pain Therapy, Parma, Italy.
Berti
M
M
Casati
A
A
D000762:Anesthesia Recovery Period; D019162:Anesthetics, Combined / Q000009:adverse effects / Q000627:therapeutic use*; D018685:Anesthetics, Inhalation / Q000009:adverse effects / Q000627:therapeutic use; D018686:Anesthetics, Intravenous / Q000009:adverse effects / Q000627:therapeutic use; D001794:Blood Pressure / Q000187:drug effects; D017081:Cholecystectomy, Laparoscopic / Q000379:methods*; D000077335:Desflurane; D005260:Female; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D007530:Isoflurane / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D008297:Male; D008738:Methyl Ethers / Q000009:adverse effects / Q000627:therapeutic use*; D008875:Middle Aged; D010880:Piperidines / Q000009:adverse effects / Q000627:therapeutic use*; D020250:Postoperative Nausea and Vomiting; D011446:Prospective Studies; D000077208:Remifentanil; D000077149:Sevoflurane; D013997:Time Factors; D016896:Treatment Outcome
D019162:Anesthetics, Combined; D018685:Anesthetics, Inhalation; D018686:Anesthetics, Intravenous; D008738:Methyl Ethers; D010880:Piperidines; D000077149:Sevoflurane; D000077335:Desflurane; D007530:Isoflurane; D000077208:Remifentanil