title: Fast-track anesthesia in patients undergoing outpatient laparoscopic cholecystectomy: comparison of sevoflurane with total intravenous anesthesia.
abstract: BACKGROUND
  The use of short-acting anesthetics has introduced a "fast-track anesthesia" concept in outpatient surgery which provides discharge of the patients from operation room directly to the phase II recovery area without entering into postanesthesia care unit. The aim of this prospective and randomized study was to compare general anesthesia using sevoflurane with propofol-remifentanil-based total intravenous anesthesia (TIVA) for fast-track eligibility in patients undergoing outpatient laparoscopic cholecystectomy. The secondary aim was to compare 2 discharge scoring systems: White's Fast-Tracking Scoring System (WFTSS) and Modified Aldrete Scoring Systems (MASS) with regard to postanesthesia care unit bypass rate and postoperative problems.
  
  
  METHODS
  After obtaining ethical approval and written informed patient consent, 80 patients were randomly assigned into 2 groups: group sevoflurane (n=40) and group TIVA (n=40). Anesthesia was induced with propofol, fentanyl, and rocuronium in both groups and maintained with sevoflurane in group sevoflurane and with remifentanil-propofol in group TIVA. Fast-track eligibility was evaluated using both WFTSS and MASS while patients were discharged from operation room according to WFTSS. Recovery times, number of fast-track eligible patients, factors related to fast-track ineligibility, and perioperative complications were evaluated.
  
  
  RESULTS
  The ratio of fast-track eligible patients was higher and times to fast-track eligibility were shorter in group TIVA compared with group sevoflurane (82.1% vs 57.5% and 8 minutes vs 12 minutes; P<.05). The primary factors that have inhibited fast-tracking were desaturation, hemodynamic instability, pain, and postoperative nausea and vomiting, respectively. Postoperative nausea and vomiting presented a major difference in the rate of fast-track ineligibility between groups (4 patients in group sevoflurane, whereas none in group TIVA; P<.05). The fast-track ratio was lower with the WFTSS compared with MASS in group sevoflurane (57.5% vs 77.5%, P<.05), but similar in group TIVA.
authors.affiliation: Ministry of Health, Yıldırım Beyazıt Training Hospital, Ankara, Turkey.
authors.forename: Ceyda Özhan
authors.initials: CÖ
authors.lastname: Çaparlar
authors.affiliation: TDV 29 Mayıs Hospital, Ankara, Turkey.
authors.forename: Mehmet Özgür
authors.initials: MÖ
authors.lastname: Özhan
authors.affiliation: Çankaya Hospital, Ankara, Turkey.
authors.forename: Mehmet Anıl
authors.initials: MA
authors.lastname: Süzer
authors.affiliation: Ministry of Health, Yıldırım Beyazıt Training Hospital, Ankara, Turkey.
authors.forename: Dilek
authors.initials: D
authors.lastname: Yazicioğlu
authors.affiliation: Gülhane Military Medical Academy, Ankara, Turkey. Electronic address: burakeskin@hotmail.com.
authors.forename: Mehmet Burak
authors.initials: MB
authors.lastname: Eşkin
authors.affiliation: Gülhane Military Medical Academy, Ankara, Turkey.
authors.forename: Serkan
authors.initials: S
authors.lastname: Şenkal
authors.affiliation: Yüksek İhtisas Hospital, Ankara, Turkey.
authors.forename: Mehmet Ali
authors.initials: MA
authors.lastname: Çaparlar
authors.affiliation: International Medicana Hospital, Ankara, Turkey.
authors.forename: Ersin Özkan
authors.initials: EÖ
authors.lastname: Imren
authors.affiliation: Haydarpaşa Military Training Hospital, İstanbul, Turkey.
authors.forename: Bülent
authors.initials: B
authors.lastname: Atik
authors.affiliation: Güven Hospital, Ankara, Turkey.
authors.forename: Nedim
authors.initials: N
authors.lastname: Çekmen
mesh_terms: D000328:Adult; D000556:Ambulatory Surgical Procedures / Q000009:adverse effects* / Q000379:methods; D000732:Androstanols / Q000008:administration & dosage / Q000009:adverse effects; D000762:Anesthesia Recovery Period; D000768:Anesthesia, General / Q000009:adverse effects / Q000379:methods*; D000771:Anesthesia, Intravenous / Q000009:adverse effects / Q000379:methods*; D018685:Anesthetics, Inhalation / Q000008:administration & dosage* / Q000009:adverse effects; D018686:Anesthetics, Intravenous / Q000008:administration & dosage* / Q000009:adverse effects; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects* / Q000379:methods; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage / Q000009:adverse effects; D006801:Humans; D008297:Male; D008738:Methyl Ethers / Q000008:administration & dosage / Q000009:adverse effects; D008875:Middle Aged; D003473:Neuromuscular Nondepolarizing Agents / Q000008:administration & dosage / Q000009:adverse effects; D010351:Patient Discharge; D010880:Piperidines / Q000008:administration & dosage / Q000009:adverse effects; D020250:Postoperative Nausea and Vomiting / Q000453:epidemiology; D015742:Propofol / Q000008:administration & dosage / Q000009:adverse effects; D011446:Prospective Studies; D011897:Random Allocation; D000077208:Remifentanil; D000077123:Rocuronium; D000077149:Sevoflurane; D013997:Time Factors
chemical_list: D000732:Androstanols; D018685:Anesthetics, Inhalation; D018686:Anesthetics, Intravenous; D008738:Methyl Ethers; D003473:Neuromuscular Nondepolarizing Agents; D010880:Piperidines; D000077149:Sevoflurane; D000077208:Remifentanil; D005283:Fentanyl; D000077123:Rocuronium; D015742:Propofol