Subject(s)
Anti-Inflammatory Agents, Non-Steroidal/administration & dosage , Arthroscopy/methods , Decompression, Surgical , Shoulder Joint/surgery , Administration, Oral , Analysis of Variance , Anesthesia, General , Cyclooxygenase Inhibitors/administration & dosage , Drug Administration Schedule , Elective Surgical Procedures/methods , Etoricoxib , Female , Humans , Male , Middle Aged , Pain Measurement/methods , Pain, Postoperative/prevention & control , Pyridines/administration & dosage , Sulfones/administration & dosage , Time FactorsABSTRACT
BACKGROUND: Sevoflurane has become widely used in day surgery; however, desflurane may be a valuable alternative even in this setting. This study compares emergence from anaesthesia for day surgery with spontaneous breathing using either desflurane or sevoflurane. METHODS: This prospective, randomized, single-blinded study examined 70 ASA III patients undergoing elective ambulatory varicose vein surgery. Primary endpoint was emergence time (cessation of anaesthetic gas to communicating). Secondary endpoints included post-operative pain, nausea, time to discharge, and patient satisfaction. Patients were anaesthetized according to a standardized protocol including multimodal analgesia and antiemetic therapy and were randomized to receive sevoflurane or desflurane as the main anaesthetic while breathing spontaneously through a laryngeal mask airway. Fresh gas flow was oxygen in air 1 : 2 l/min. RESULTS: Intra-operative anaesthesia was uneventful apart from airway irritation observed in 5/35 desflurane and 1/35 sevoflurane patients. Emergence was 25-40% faster in patients anaesthetized with desflurane. Pain and post-operative nausea and vomiting (PONV) were equally infrequent in both groups. Overall, patient satisfaction was high with no difference between the groups. CONCLUSION: Desflurane is associated with a faster emergence with no differences during the post-operative course except a somewhat higher incidence of airway irritation.
Subject(s)
Ambulatory Surgical Procedures , Anesthetics, Inhalation , Isoflurane/analogs & derivatives , Laryngeal Masks , Methyl Ethers , Varicose Veins/surgery , Vascular Surgical Procedures , Adult , Desflurane , Endpoint Determination , Female , Humans , Male , Middle Aged , Patient Satisfaction , Postoperative Nausea and Vomiting/epidemiology , Postoperative Period , Prospective Studies , Respiratory Mechanics , Sevoflurane , Single-Blind MethodABSTRACT
The potential for minimising anaesthetic gas consumption with a circle absorber system is related to fresh gas flow. This study measured the actual sevoflurane consumption during elective arthroscopy of the knee in 75 ASA I-II patients randomised to three fresh gas flow rates (6, 3, and 1.5 l/min) using sevoflurane and O(2):N(2)O (1:2) after intravenous induction with fentanyl and propofol. A circle absorber system was used with a laryngeal mask airway. Anaesthetic duration, discharge time and postoperative pain did not differ between groups. Sevoflurane consumption was more than doubled with each doubling of fresh gas flow (0.07+/-0.03; 0.16+/-0.05; 0.41+/-0.12 ml sevoflurane/min; for gas flow 1.5, 3, 6 l/min; P<0.01). The hourly sevoflurane related cost decreased from 15.5 to 2.8 US$ when reducing the fresh gas flow from 6 to 1.5 l/min. Decreasing the fresh gas flow from 6 to 1.5 l/min provides good anaesthetic depth with effective reduction in anaesthetic consumption, cost and environmental burden.
