Abstract
Purpose
A classic general anesthesia is performed by induction with an intravenous hypnotic (such as propofol) and maintenance with a volatile anesthetic (such as sevoflurane). The aim of the present study was to compare the effects of a propofol/sevoflurane maintenance regimen with that of a sevoflurane regimen on recovery profiles.
Methods
One hundred and sixty patients, who were ASA 1 or 2, 45–65 years of age, and scheduled for elective gastrointestinal surgery under combined general/epidural anesthesia, were allocated randomly to receive the sevoflurane maintenance regimen (group S, n = 80) or sevoflurane/propofol regimen (group SP, n = 80). After induction, anesthesia was maintained with sevoflurane in group S and sevoflurane with propofol (1.2 μg/ml target plasma concentration) in group SP. Bispectral index (BIS) values were maintained within 40–60 during the maintenance. Time to extubation, incidence of serious coughing and agitation, and other recovery characteristics were evaluated during emergence.
Results
The time to awakening and extubation in group SP were 7.2 ± 2 min and 8.0 ± 1.8 min, respectively, which were shorter than those results in group S (12.3 ± 1.5 and 12.8 ± 1.6 min, respectively) (P < 0.05). The incidence of serious coughing and agitation in SP (30 % and 25 %) was lower than that of group S (68 % and 53 %) (P < 0.05). BIS value, pain score, requirements of analgesics and antiemetics in the PACU, and length of stay in the PACU were similar in the two groups.
Conclusions
Compared to sevoflurane maintenance, coadministration of propofol and sevoflurane provides faster awakening and extubation with a low incidence of emergence coughing and agitation.
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References
Schumacher PM, Dossche J, Mortier EP, Luginbuehl M, Bouillon TW, Struys MM. Response surface modeling of the interaction between propofol and sevoflurane. Anaesthesiology. 2009;111:790–804.
Diz JC, Del Rio R, Lamas A, Mendoza M, Duran M, Ferreira LM. Analysis of pharmacodynamic interaction of sevoflurane and propofol on bispectral index during general anaesthesia using a response surface model. Br J Anaesth. 2010;104:733–9.
Tramer M, Moore A, McQuay H. Meta-analytic comparison of prophylactic antiemetic efficacy for postoperative nausea and vomiting: propofol anaesthesia vs omitting nitrous oxide vs. total i.v. anaesthesia with propofol. Br J Anaesth. 1997;78:256–9.
Djalali AG, Sadovnikoff N. Cardioprotective properties of sevoflurane in patients undergoing coronary surgery with cardiopulmonary bypass are related to the modalities of its administration. Anaesthesiology. 2005;102:699–700 author reply.
Guarracino F, Landoni G, Tritapepe L, Pompei F, Leoni A, Aletti G, Scandroglio AM, Maselli D, De Luca M, Marchetti C, Crescenzi G, Zangrillo A. Myocardial damage prevented by volatile anesthetics: a multicenter randomized controlled study. J Cardiothorac Vasc Anesth. 2006;20:477–83.
Kim MS, Moon BE, Kim H, Lee JR. Comparison of propofol and fentanyl administered at the end of anaesthesia for prevention of emergence agitation after sevoflurane anaesthesia in children. Br J Anaesth. 2013;110:274–80.
Abu-Shahwan I. Effect of propofol on emergence behavior in children after sevoflurane general anaesthesia. Paediatr Anaesth. 2008;18:55–9.
Aouad MT, Yazbeck-Karam VG, Nasr VG, El-Khatib MF, Kanazi GE, Bleik JH. A single dose of propofol at the end of surgery for the prevention of emergence agitation in children undergoing strabismus surgery during sevoflurane anaesthesia. Anaesthesiology. 2007;107:733–8.
Sebel LE, Richardson JE, Singh SP, Bell SV, Jenkins A. Additive effects of sevoflurane and propofol on gamma-aminobutyric acid receptor function. Anaesthesiology. 2006;104:1176–83.
Schnider TW, Minto CF, Gambus PL, Andresen C, Goodale DB, Shafer SL, Youngs EJ. The influence of method of administration and covariates on the pharmacokinetics of propofol in adult volunteers. Anaesthesiology. 1998;88:1170–82.
Kim SY, Kim JM, Lee JH, Song BM, Koo BN. Efficacy of intraoperative dexmedetomidine infusion on emergence agitation and quality of recovery after nasal surgery. Br J Anaesth. 2013;111:222–8.
Minogue SC, Ralph J, Lampa MJ. Laryngotracheal topicalization with lidocaine before intubation decreases the incidence of coughing on emergence from general anaesthesia. Anesth Analg. 2004;99:1253–7 table of contents.
Hans P, Marechal H, Bonhomme V. Effect of propofol and sevoflurane on coughing in smokers and non-smokers awakening from general anaesthesia at the end of a cervical spine surgery. Br J Anaesth. 2008;101:731–7.
Agarwal A, Pandey R, Dhiraaj S, Singh PK, Raza M, Pandey CK, Gupta D, Choudhury A, Singh U. The effect of epidural bupivacaine on induction and maintenance doses of propofol (evaluated by bispectral index) and maintenance doses of fentanyl and vecuronium. Anesth Analg. 2004;99:1684–8 table of contents.
Hendrickx JF, Eger EI 2nd, Sonner JM, Shafer SL. Is synergy the rule? A review of anesthetic interactions producing hypnosis and immobility. Anesth Analg. 2008;107:494–506.
Gauthier A, Girard F, Boudreault D, Ruel M, Todorov A. Sevoflurane provides faster recovery and postoperative neurological assessment than isoflurane in long-duration neurosurgical cases. Anesth Analg. 2002;95:1384–8 table of contents.
Hughes MA, Glass PS, Jacobs JR. Context-sensitive half-time in multicompartment pharmacokinetic models for intravenous anesthetic drugs. Anaesthesiology. 1992;76:334–41.
Hocker J, Tonner PH, Bollert P, Paris A, Scholz J, Meier-Paika C, Bein B. Propofol/remifentanil vs. sevoflurane/remifentanil for long lasting surgical procedures: a randomised controlled trial. Anaesthesia. 2006;61:752–7.
Nathanson MH, Fredman B, Smith I, White PF. Sevoflurane versus desflurane for outpatient anaesthesia: a comparison of maintenance and recovery profiles. Anesth Analg. 1995;81:1186–90.
Sundman E, Witt H, Sandin R, Kuylenstierna R, Boden K, Ekberg O, Eriksson LI. Pharyngeal function and airway protection during subhypnotic concentrations of propofol, isoflurane, and sevoflurane: volunteers examined by pharyngeal videoradiography and simultaneous manometry. Anaesthesiology. 2001;95:1125–32.
Batra YK, Ivanova M, Ali SS, Shamsah M, Al Qattan AR, Belani KG. The efficacy of a subhypnotic dose of propofol in preventing laryngospasm following tonsillectomy and adenoidectomy in children. Paediatr Anaesth. 2005;15:1094–7.
Guglielminotti J, Rackelboom T, Tesniere A, Panhard X, Mentre F, Bonay M, Mantz J, Desmonts JM. Assessment of the cough reflex after propofol anaesthesia for colonoscopy. Br J Anaesth. 2005;95:406–9.
Shajar MA, Thompson JP, Hall AP, Leslie NA, Fox AJ. Effect of a remifentanil bolus dose on the cardiovascular response to emergence from anaesthesia and tracheal extubation. Br J Anaesth. 1999;83:654–6.
Saghaei M, Reisinejad A, Soltani H. Prophylactic versus therapeutic administration of intravenous lidocaine for suppression of post-extubation cough following cataract surgery: a randomized double blind placebo controlled clinical trial. Acta Anaesthesiol Taiwan. 2005;43:205–9.
Guler G, Akin A, Tosun Z, Eskitascoglu E, Mizrak A, Boyaci A. Single-dose dexmedetomidine attenuates airway and circulatory reflexes during extubation. Acta Anaesthesiol Scand. 2005;49:1088–91.
Bonhomme V, Deflandre E, Hans P. Correlation and agreement between bispectral index and state entropy of the electroencephalogram during propofol anaesthesia. Br J Anaesth. 2006;97:340–6.
Revuelta M, Paniagua P, Campos JM, Fernandez JA, Martinez A, Jospin M, Litvan H. Validation of the index of consciousness during sevoflurane and remifentanil anaesthesia: a comparison with the bispectral index and the cerebral state index. Br J Anaesth. 2008;101:653–8.
Kodaka M, Johansen JW, Sebel PS. The influence of gender on loss of consciousness with sevoflurane or propofol. Anesth Analg. 2005;101:377–81 table of contents.
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Liang, C., Ding, M., Du, F. et al. Sevoflurane/propofol coadministration provides better recovery than sevoflurane in combined general/epidural anesthesia: a randomized clinical trial. J Anesth 28, 721–726 (2014). https://doi.org/10.1007/s00540-014-1803-0
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DOI: https://doi.org/10.1007/s00540-014-1803-0