[Remifentanil associated to propofol or sevoflurane for videolaparoscopic cholecystectomy: a comparative study.].
OBJECTIVE
Different intravenous, inhalational or combined anesthetic techniques have been used for videolaparoscopic cholecystectomy. This study aimed at comparing hemodynamic parameters, anesthetic recovery and side-effects of remifentanil associated to propofol or sevoflurane.


METHODS
Participated in this study 40 patients, who were divided in two groups: Group 1 (G1) - induced with 3 microg.ml-1 propofol and a 0.3 microg.kg-1.min-1 remifentanil infusion. Atracurium (0.5 mg.kg-1) was administered for tracheal intubation. Anesthesia was maintained with 2.5 to 3 microg.ml-1 propofol in target controlled infusion and 100% oxygen, and remifentanil by continuous infusion (0.3 microg.kg-1.min-1); Group 2 (G2) - induced with 6% sevoflurane and 100% oxygen at a 4 L.min-1 flow and a 0.3 microg.kg-1.min-1 remifentanil infusion. After loss of consciousness, sevoflurane concentration was decreased to 2% with a 2 L.min-1 oxygen flow. Similarly to G1, 0.5 mg.kg-1 atracurium was administered. A 0.3 microg.kg-1.min-1 remifentanil infusion was maintained throughout the surgery. Mean heart rate (HR) and systolic (SBP) and diastolic (DBP) blood pressure were measured in the following moments: M1, before anesthetic induction; M2, 1 minute before TI; M3, 1 minute after TI; M4, 5 minutes after TI; M5, 5 minutes after incision; M6 and M7, 10 and 30 minutes after pneumoperitoneum, respectively. After surgery, the time for eye opening, spontaneous ventilation, extubation, saying the complete name and anesthesiologists hand shaking under verbal command were measured in minutes: Atropine and ephedrine requirements, incidence of nausea, vomiting and pain were also evaluated.


RESULTS
Hemodynamic changes (SBP, DBP, MBP and HR) and patients emergence time were not significantly different between groups. There were similar ephedrine and atropine requirements. Among complications only vomiting was higher incidence in group 2.


CONCLUSIONS
Both techniques decrease blood pressure and heart rate. Anesthetic recovery was similar for both techniques. A higher incidence of vomiting was observed when remifentanil was associated to sevoflurane.
Estivalet
Fernanda Fischer
FF
CET, SANE.
Bagatini
Airton
A
Gomes
Cláudio Roberto
CR