Faster extubation time with more stable hemodynamics during extubation and shorter total surgical suite time after propofol-based total intravenous anesthesia compared with desflurane anesthesia in lengthy lumbar spine surgery

Abstract

<jats:sec> <jats:title>OBJECT</jats:title> <jats:p>Anesthesia techniques can contribute to the reduction of anesthesia-controlled time and may therefore improve operating room efficiency. However, little is known about the difference in anesthesia-controlled time between propofol-based total intravenous anesthesia (TIVA) and desflurane (DES) anesthesia techniques for prolonged lumbar spine surgery under general anesthesia.</jats:p></jats:sec> <jats:sec> <jats:title>METHODS</jats:title> <jats:p>A retrospective analysis was conducted using hospital databases to compare the anesthesia-controlled time of lengthy (surgical time &gt; 180 minutes) lumbar spine surgery in patients receiving either TIVA via target-controlled infusion (TCI) with propofol/fentanyl or DES/fentanyl-based anesthesia, between January 2009 and December 2011. A variety of time intervals (surgical time, anesthesia time, extubation time, time in the operating room, postanesthesia care unit [PACU] length of stay, and total surgical suite time) comprising perioperative hemodynamic variables were compared between the 2 anesthesia techniques.</jats:p></jats:sec> <jats:sec> <jats:title>RESULTS</jats:title> <jats:p>Data from 581 patients were included in the analysis; 307 patients received TIVA and 274 received DES anesthesia. The extubation time was faster (12.4 ± 5.3 vs 7.0 ± 4.5 minutes, p &lt; 0.001), and the time in operating room and total surgical suite time was shorter in the TIVA group than in the DES group (326.5 ± 57.2 vs 338.4 ± 69.4 minutes, p = 0.025; and 402.6 ± 60.2 vs 414.4 ± 71.7 minutes, p = 0.033, respectively). However, there was no statistically significant difference in PACU length of stay between the groups. Heart rate and mean arterial blood pressure were more stable during extubation in the TIVA group than in the DES group.</jats:p></jats:sec> <jats:sec> <jats:title>CONCLUSIONS</jats:title> <jats:p>Utilization of TIVA reduced the mean time to extubation and total surgical suite time by 5.4 minutes and 11.8 minutes, respectively, and produced more stable hemodynamics during extubation compared with the use of DES anesthesia in lengthy lumbar spine surgery.</jats:p></jats:sec>

Comparison of Anesthesia-Controlled Operating Room Time between Propofol-Based Total Intravenous Anesthesia and Desflurane Anesthesia in Open Colorectal Surgery: A Retrospective Study

“…Previous studies demonstrated that ACT, including exit from the OR after extubation, total OR time, and PACU time, may be affected by extubation time [7, 13, 14]. In other words, similar extubation time may contribute to equivalent PACU time, exit from OR after extubation, and total OR time in the same type of surgery.…”

“…In spine surgery, we discontinued DES or propofol at the end of the operation or at the last three stitches of surgery. After turning the patients to a supine position, the lungs were ventilated with 100% oxygen at a fresh gas flow of 6 L/min [11,14]. In addition, we used closed-circuit anesthesia in the DES patients, which would prolong neuromuscular blockade and contribute to delay emergence [47].…”

Comparison of Bispectral Index-Guided Administration of Desflurane and Propofol for Endoscopic Transnasal Transsphenoidal Resection of Pituitary Tumors

“…In an earlier study, the authors also found better hemodynamic control with propofol as compared with desflurane at extubation in lumbar surgery patients. 17 In our study, patients having tachycardia (26/30 versus 16/30) and bradycardia (9/30 versus 2/30) were more in the desflurane group compared with the propofol group. In an earlier study, HR was found significantly higher with desflurane as compared with sevoflurane and propofol.…”

Analysis of anesthesia-controlled operating room time after propofol-based total intravenous anesthesia compared with desflurane anesthesia in functional endoscopic sinus surgery

“…These findings were consistent with several of our previous studies showing that general anesthesia using TCI system with propofol could achieve faster extubation than using DES in different surgeries. [ 5 – 9 , 12 , 14 , 15 ]…”

“…As a retrospective study, the cases we collected were performed under routine clinical protocol, using 6 L/min of fresh gas flow during emergence. In our serial retrospective studies [ 5 – 8 , 13 – 15 ] TIVA delivered by TCI system has the advantage in predicting the propofol effect-site concentration at return of consciousness. [ 16 , 32 – 34 ] Moreover, TCI system could calculate the time required to reach such concentration, and therefore improve the OR efficiency.…”