RESUMEN
This study looks at the anesthetic and surgical safety of fast-track day case laparoscopic cholecystectomy [LC] when bispectral index [BIS] guided desflurane, sevoflurane or propofol are combined with remifentanil. Times of recovery, return of early and late cognitive functions as well as complications for the first 7 postoperative days are compared. The study involved 75 patients who underwent elective laparoscopic cholecystectomy scheduled on day-case basis. The patients were divided into three groups [25 cases each]: desflurane/remifentanil [group D], sevoflurane/remifentanil [group S] and propofol/remifentanil [group P]. All patients received midazolam, dexamethazone and ondansetrone premedication. Anesthesia was induced with remifentanil, propofol and cis-atracurium. Infusions of cisatracurium and remifentanil were continued in all patients. Bispectral index [BIS] was kept between 40-50 to guide desflurane, sevoflurane or propofol. IV paracetamol [Perfalgan] register and pethidine and local bupivacaine were used for analgesia. The selection criteria were an American Society of Anesthesiologists [ASA] grade I, low risk of common bile duct stones, adult company at home, and residence within 10km of the hospital with easy transfer. Cases with history of allergy to the used anesthetic agents or psychiatric history, also cases with history of jaundice or history of biliary pancreatitis were excluded. The LC procedure was performed using a standard four-canula technique. Early and late recovery times, the incidence of postoperative nausea and vomiting, pain, shivering and additional use of antiemetic and anti-shivering were documented. Follow up of patients were done to record hospital admission, readmission, visit to accident and emergency department and surgical problems. The patients were between 35 and 50 years of age and the male to female ratio was 12:63. The mean length of the operation was 45 +/- 16 min. Early and late recovery times were faster in [group D] than [group P] and [group S]. Postoperative nausea, vomiting, shivering and pain did not differ significantly between the three groups. There was no hospital mortality and only one patient needed open cholecystectomy. 63 [84%] of the 75 patients went home on the same operative day, while 12 [16%] were admitted overnight. Causes of admission included social reasons [4 cases], surgeon preference [3 cases], pain and nausea [4 cases] with no significant differences between the three groups. One case was converted to open cholecystectomy in [group S] and was also admitted. For selected patients, fast track day-case LC using remifentanil with BIS guided desflurane, sevoflurane or propofol ensures safe operative and postoperative course. Recovery was earlier in desflurane in comparison to the other two groups