Comparison of Hemodynamic Responses and Postoperative Courses between Sevoflurane-Remifentanil Anesthesia and Sevoflurane-Nitrous Oxide Anesthesia for Gynecologic Surgery

ABSTRACT

BACKGROUND: This study was designed to compare hemodynamic responses and postoperative courses between sevoflurane-remifentanil and sevoflurane-nitrous oxide anesthesia. METHODS: Forty ASA I or II patients undergoing gynecologic surgery were randomly assigned to receive sevoflurane-remifentanil (group R) or sevoflurane-nitrous oxide group (group N). In group R, remifentanil was continuously infused by using target-controlled infusion pump from anesthetic induction (effect-site target concentration 4 ng/ml) to the end of surgery (1-5 ng/ml). In group N, fentanyl (2microg/kg) was administered before tracheal intubation and 50% N2O was used during anesthesia. In both groups, 2 vol% sevoflurane was used during anesthetic induction and then end-tidal sevoflurane concentrations were controlled between 1 to 3 vol% according to systolic blood pressure. We compared blood pressure (BP) and heart rate (HR) before and after tracheal intubation and frequencies of hemodynamic aberrations between the two groups. Postoperative nausea/vomiting, sedation, pain scores at 2 and 24 hours after operation were also compared. RESULTS: Changes of BP and HR after tracheal intubation were similar in group R and group N, but MAP at 1 and 2 min after intubation was significantly decreased versus baseline MAP in group N. Intraoperative hypertensive episodes (systolic BP > 140 mmHg) were more frequent in group N compared to group R, and hypotensive episodes (SBP < 90 mm Hg) were similar in both groups. There were no differences in postoperative nausea/vomiting, sedation and pain scores. CONCLUSIONS: Sevoflurane/remifentanil anesthesia provided more stable intraoperative hemodynamic status than sevoflurane/N2O and postoperative adverse effects were similar in both groups.