title: A comparison of sevoflurane-fentanyl and neuroleptic anaesthesia for laparoscopic cholecystectomy of mildly obese patients.
abstract: The current study was formulated to evaluate the advantages and disadvantages of sevoflurane-fentanyl and neuroleptic anaesthesia for laparoscopic cholecystectomy surgery of mildly obese patients. Laparoscopic cholecystectomy was performed using either sevoflurane-fentanyl or neuroleptic anaesthesia. Intra-operative haemodynamic stability, surgical duration, awakening time, severity of post-operative pain and hormonal stress parameters (serum and urinary cortisol, serum insulinlike growth factor and serum insulin) were determined. The duration of both surgery and patient hospitalisation were similar in both study groups. Patients that received sevoflurane-fentanyl exhibited a significantly shorter awakening time compared to neuroleptic anaesthesia. In addition, the same group of patients had less post-operative complications (nausea, vomiting, urinary retention and respiratory insufficiency) despite more abdominal pain. The severity of postoperative pain and the requirement of additional analgesia (up to 12 hours post-surgery) were greater in patients that received sevoflurane-fentanyl. The serum and urinary cortisol concentrations were significantly increased in post-operative patients that received neuroleptic anaesthesia whereas the insulin-like growth factor-I concentration in both study groups significantly decreased post-operatively. Our results clearly show that neuroleptic anaesthesia attenuates the stress response to laparoscopic cholecystectomy to a lesser extent than sevoflurane-fentanyl. The latter anaesthesia is recommended for laparoscopic cholecystectomy of mildly obese patients.
authors.affiliation: Department of Anaesthesia, Bezanijska Kosa Clinical-Medical Centre, Belgrade, Serbia. vesnadrmalenkovic@yahoo.com
authors.forename: Vesna
authors.initials: V
authors.lastname: Malenković
authors.forename: Ivona
authors.initials: I
authors.lastname: Baricević
authors.forename: D R
authors.initials: DR
authors.lastname: Jones
authors.forename: Olgica
authors.initials: O
authors.lastname: Nedić
authors.forename: M
authors.initials: M
authors.lastname: Dordević
mesh_terms: D000328:Adult; D000758:Anesthesia / Q000379:methods; D018685:Anesthetics, Inhalation; D018686:Anesthetics, Intravenous; D014150:Antipsychotic Agents; D017081:Cholecystectomy, Laparoscopic; D041761:Cholecystolithiasis / Q000150:complications / Q000601:surgery; D004359:Drug Therapy, Combination; D005260:Female; D005283:Fentanyl; D006801:Humans; D008297:Male; D008738:Methyl Ethers; D008875:Middle Aged; D009765:Obesity / Q000150:complications*; D010149:Postoperative Pain / Q000517:prevention & control; D011446:Prospective Studies; D012383:Romania; D000077149:Sevoflurane
chemical_list: D018685:Anesthetics, Inhalation; D018686:Anesthetics, Intravenous; D014150:Antipsychotic Agents; D008738:Methyl Ethers; D000077149:Sevoflurane; D005283:Fentanyl