Comparison of sevoflurane/remifentanil and propofol/remifentanil anesthesia in patients undergoing gynecological laparoscopic surgery

Purpose To compare clinical properties of sevoflurane /remifentanil with propofol / remifentanil anesthesia in patients undergoing gynecological laparoscopic surgery, which included maintenance of anesthesia, postoperative recovery, and cognitive functions. Methods Fifty-two patients were randomized to either total intravenous anesthesia (group P) or sevoflurane anesthesia (group S). All patients received a target-controlled effect-compartment concentration of 5 ng/mL remifentanil from induction of anesthesia to the endpoint of surgery. Anesthesia was maintained with sevoflurane after tracheal intubation with propofol and scoline in group S, and maintained with propofol target-controlled infusion in group P. AAI values were kept between 15-25 intraoperatively. Hemodynamic parameters were observed continuously. Blood glucose were measured before induction, before the end of surgery and 10 min after extubation. Recovery time, extubation time, sedation scores(OAAS) , cognitive functions (MMSE), incidence of hypotensive or hypertensive episodes, PONV and pain scores (VAS) were also analyzed. Results The changes of AAI and hemodynamic parameters were comparable between the two groups. Blood glucose increased significantly before the end of surgery and 10 min after extubation, compared with the baseline levels in both groups(P 0. 05), but all values were within normal range and comparable in the two groups. Recovery time was significantly shorter in group S than in group P (7. 0 versus 11.2 min) (P 0. 05). There was no difference not only in sedation scores but also in MMSE scores between the two groups before and after surgery. The MMSE scores decreased significantly only 1 h after surgery, compared with those before surgery in both groups,and returned to preoperative levels within 2 h after surgery. Incidence of PONV or other side effects and VAS scores within 24 h postoperatively were also not different between groups. Conclusions Sevoflurane /remifentanil and Propofol /remifentanil both provide satisfactory anesthesia for gynecological laparoscopic surgery, and the side effects are similar between these two techniques except that sevoflurane is associated with more rapid early recovery than propofol.