A comparison of propofol-remifentanil versus sevoflurane for laparoscopic cholecystectomy

Objective To compare the efficacy of anesthesia with TGI of propofol-remifentanil and sevoflurane for laparoscopic cholecystectomy.Methods One-hundred and twenty ASA Ⅰ or Ⅲ patients of both sexes aged 18-64 yr weighing 45-80 kg undergoing elective laparoscopic cholecystectomy were randomly divided into 2 groups(n=60 each):group Ⅰ propofol-remifentanil(PR)and group Ⅱ sevoflurane(S).In group PR anesthesia was induced and maintained with TCI of propofol-remifentanil.The target effect-site concentration of propofol and remifentanil were set at 3μg/ml and 6 ng/ml during induction and at 2-3 μg/ml and 2-6 ng/ml during maintenance of anesthesia respectively.In group S anesthesia was induced with 8%sevoflurane-50%N2O-O2(FGF=10 L/min)and fentanyl 2 μg/kg and maintained with 1.3%-2.2%sevoflurane-50%N2O-O2(FGF=2 L/min).All patients were intubated and mechanically ventilated.Tracheal intubation was facilitated with vecuronium 0.1 mg/kg.The following variables were recorded:duration of induction;eye-opening time;extubation time;duration of anesthesia and operation;length of stay in PACU;OAA/S scores(5=fully awake,1=asleep)immediately and at 30,60 min after extubation and while leaving PACU;MMSE before anesthesia and 1 h after operation;the number of the patients who needed fentanyl for analgesia and the amount of fentanyl given;the vasoactive drugs used during operation;complications during operation and stay in PACU and awareness.Results The duration of induction was significantly shorter,eye-opening time and the length of stay in PACU were longer,and the OAA/S scores immediately and at 30 min after extubation were lower in group S than in group PR.Less patients needed fentanyl for analgesia in PACU and the amount of fentanyl was less,the antihypertensive used during operation and the incidence of postoperative nausea and vomiting were higher in group S than in group PR.The majority of the patients in both groups(98%)were happy with the anesthesia they received and would choose the same anesthetics again if needed.Conclusion Each technique has its advantage and disadvantage for laparoscopic cholecystectomy. Key words: Propofol; Piperidines; Drug delivery systems; Cholecystectomy,laparoscopic; Sevoflurane