[TIVA-TCI (Total IntraVenous Anesthesia-Target Controlled Infusion) versus isoflurane anesthesia for laparoscopic cholecystectomy. Postoperative nausea and vomiting, and patient satisfaction].
Numerous studies have shown that TIVA is followed by a significant reduction in the incidence of PONV in day-case surgery, including laparoscopic cholecystectomy, where the incidence of PONV can reach 70% according to some studies. TCI is the TIVA technique that maintain a constant plasma concentration due to pharmacokynetic models incorporated in TCI device that inject the anesthetic agent. Besides implementing TIVA-TCI in clinical practice in Romania, our study was designed to evaluate the impact of TIVA-TCI on postoperative outcome and our patient satisfaction after laparoscopic cholecystectomy.


METHODS
After informed consent, 70 patients ASAI/II undergoing laparoscopic cholecystectomy were randomized in 2 equal study groups: group 1 (n = 35) included patients with TIVA-TCI with propofol (Cpi = 4 microg/ml) and remifentanil, and group 2 (n = 35) were patients undergoing Isoflurane anesthesia. In both groups propofol was administered during induction and remifentanil followed the same protocol: 0.5 microg/kg/min in the first minute during induction, followed by 0.25 microg/kg/min. This infusion was modified by 0.05 microg/kg/min steps according to analgesic needs. PONV (evaluated as both incidence and number of episodes), severity of pain and patient satisfaction score IOWA were compared between study groups.


RESULTS
Both the incidence of PONV (p = 0.03) and the number of episodes/24 h/patients (p = 0.01) were significantly lower in TIVA-TCI group, while there was no significant difference in opioid requirements in study groups (p = 0.21). Patients IOWA satisfaction score at 24 hours postoperatively was significantly higher in TIVA-TCI groups (p = 0.0001).


CONCLUSIONS
Compared with Isoflurane, TIVA-TCI was followed by significantly lower incidence of PONV and significantly greater patients satisfaction.
Ionescu
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Catedra ingrijiri calificate in ATI, Universitatea de Medicină si Farmacie "Iuliu Haţieganu", Cluj-Napoca, România. dionescuati@yahoo.com
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Vlad
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Iancu
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Alexe
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Deac
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Răduţ
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Tudorică
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D000368:Aged; D000556:Ambulatory Surgical Procedures / Q000379:methods; D000768:Anesthesia, General / Q000379:methods; D018685:Anesthetics, Inhalation / Q000008:administration & dosage / Q000009:adverse effects*; D018686:Anesthetics, Intravenous / Q000008:administration & dosage* / Q000009:adverse effects*; D017081:Cholecystectomy, Laparoscopic; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007530:Isoflurane / Q000008:administration & dosage / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D010880:Piperidines / Q000008:administration & dosage / Q000009:adverse effects; D020250:Postoperative Nausea and Vomiting / Q000139:chemically induced* / Q000517:prevention & control*; D015742:Propofol / Q000008:administration & dosage / Q000009:adverse effects; D000077208:Remifentanil; D016896:Treatment Outcome
D018685:Anesthetics, Inhalation; D018686:Anesthetics, Intravenous; D010880:Piperidines; D007530:Isoflurane; D000077208:Remifentanil; D015742:Propofol