Inhalation induction with sevoflurane: a double-blind comparison with propofol

Abstract

We conducted a randomized, double-blind comparison of 8% sevoflurane and propofol as induction agents for day-case cystoscopy in 102 patients. All patients received an i.v. cannula and breathed oxygen 5 litre min-1. Anaesthesia was induced with propofol i.v. or inhalation of 8% sevoflurane and 10% Intralipid (as a placebo) i.v., delivered by a blinded observer. Anaesthesia was maintained in all patients with 2% sevoflurane via a face mask. Induction of anaesthesia with sevoflurane was significantly slower compared with propofol (mean 84 (SD 24) s vs 57 (11) s), but was associated with a lower incidence of apnoea (16% vs 65%) and a shorter time to establish spontaneous ventilation (94 (34) s vs 126 (79) s). Induction complications were uncommon in each group but the transition to maintenance was smoother with sevoflurane and was associated with less hypotension compared with propofol. Emergence from anaesthesia induced with sevoflurane occurred significantly earlier compared with propofol (5.2 (2.2) min vs 7.0 (3.2) min) and anaesthetic induction was also significantly cheaper with sevoflurane. According to a postoperative questionnaire, the majority of patients found both anaesthetic techniques acceptable. Nevertheless, significnatly more patients (14%) rated induction with sevoflurane as unpleasant compared with propofol (0) and significantly more patients (24%) would not choose sevoflurane induction compared with propofol (6%). This phenomenon may have been related to the particular patient population studied, however. Inhalation induction with 8% sevoflurane would appear to offer several objective advantages compared with induction with propofol in day-case patients, although a significant minority may dislike this technique.

Conditions for laryngeal mask insertionA comparison of propofol versus sevoflurane with or without alfentanil

“…The risk of anaphylaxis with intravenous agents, although small, is avoided and the hangover effect associated with intravenous agent is also avoided. It has already been proven that the cost of sevoflurane vital-capacity induction compares favourably with the cost of propofol induction [6,10]. To conclude, our results show that sevoflurane with alfentanil 5 mg.kg À1 is superior in providing optimal conditions compared with sevoflurane alone and propofol with alfentanil 5 mg/kg À1 for the insertion of LMA in ASA 1 or 2 patients.…”

“…However, propofol has its own side-effects such as pain on injection [8,9] and greater respiratory depression [10]. Sevoflurane is suitable for quick inhalational induction technique even in high concentrations because of its low blood gas solubility (0.69) [11] and minimal respiratory irritant effect [12].…”

Target‐controlled propofol vs. sevoflurane: a double‐blind, randomised comparison in day‐case anaesthesia

“…loss of consciousness, LMA insertion, resumption of spontaneous ventilation) were recorded by the blinded anaesthetist using a hand-held computer (Psion, London, UK) and custom software. The times of each change in delivered anaesthetic and/or fresh gas flow were also recorded to facilitate calculation [7] of the cost of sevoflurane anaesthesia. This was accomplished by dividing the anaesthetic into periods of constant vaporiser setting and fresh gas flow (and hence constant cost per minute), calculating the cost of each of these periods and adding them to derive total cost.…”

“…To facilitate this comparison, it would be necessary to administer the volatile agent for induction and maintenance of anaesthesia. Sevoflurane therefore appeared to be the most logical choice of volatile agent, as it has already been shown to be comparable with propofol during induction of anaesthesia [7,8], and it is increasingly used in day-case anaesthesia.…”

“…In addition, the study was not blinded and anaesthesia was induced with propofol in the inhalation group. We chose to use sevoflurane as our comparator anaesthetic because it can be used satisfactorily to induce anaesthesia in adults [7,8], allowing a comparison between 'pure' inhalation and intravenous anaesthesia, as well as greatly facilitating a blinded comparison. Although halothane could potentially have been used in place of sevoflurane, it is associated with a high incidence of adverse cardiac events during induction of anaesthesia in adults [10] and also has an unsuitable recovery profile for day-case anaesthesia.…”