Comparison of anesthesia with target-controlled infusion of propofol-remifentanil/ fentanyl versus isoflurane

Objective To compare the induction of and emergence from anesthesia with target-controlled infusion (TCI) of propofol-remifentanil/fentanyl and isoflurane inhalation. Methods Sixty ASA Ⅰ -Ⅱ patients (26 male, 34 female) aged 65 yr undergoing elective laparoscopic cholecystectomy were randomly divided into three groups of 20 patients : group C, R and F. In group C anesthesia was induced with propofol 1.5-2.0 mg·kg-1 fentanyl 2 μg·kg-1 and vecuronium 0.1 mg·kg-1 and maintained with 1%-2% isoflurane - 66% N2O inhalation. In group R anesthesia was induced and maintained with TCI propofol-remifentanil which was stopped at the end of operation. The target plasma concentration of propofol was set at 3 μg·ml-1 and remifentanil at 7 ng·ml-1. In group F anesthesia was induced and maintained with TCI propofol-fentanyl. The TCI fentanyl was stopped at 30 min before the end of surgery. The target plasma concentration of propofol was set at 3 μg·ml-1 and fentanyl at 4 ng·ml-1 during induction and 2ng·ml-1 during maintenance. MAP, DBP, SBP, HR, ECG, SpO2, PETCO2 and end-tidal isoflurane and N2O concentration were monitored during anesthesia. The following were recorded and compared among the 3 groups : (1) the changes in MAP and HR during induction and tracheal intubation; (2) recovery of spontaneous breathing and orientation after tennination of anesthesia; (3) the duration of stay in PACU; (4) OAAS scores after operation;(5) postoperative cognitive outcome, pain and complications like nausea and vomiting;(6) awareness during operation. Results (1) During induction DBP was significantly lower in group C than that in group R and F, and more patients developed hypotension (SBP 90 mm Hg) in group C. The incidence of intubation response was higher in group F than that in group R. (2) The duration from tennination of anesthetics to full recovery of spontaneous breathing, eye opening at request and tracheal extubation were similar among the three groups. (3) The stay in PACU was significantly shorter in group F than that in group C. (4)The OAAS score (5 = fully conscious, 1 = deep sleep) at extubation and discharge from PACU was significantly higher in group F and R than in group C. (5) VRS score (0 = no pain, 4 = severe pain) after operation was significantly higher in group R than that in group C and F. (6) The incidence of postoperative nausea and vomiting was similar among the three groups. Conclusion Induction of anesthesia with TCI of propofol- remifentanil is hemodynamically stablest among the three groups. Recovery from anesthesia with TCI propofol-remifentanil is faster than that with inhalation anesthesia. Because of the shorter context-sensitive half time of remifentanil postoperative analgesia should be started earlier.