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

Abstract

SummaryWe compared target-controlled propofol with sevoflurane in a randomised, double-blind study in 61 day-case patients. Anaesthesia was induced with a propofol target of 8 mg.ml ¹1 or 8% sevoflurane, reduced to 4 mg.ml ¹1 and 3%, respectively, after laryngeal mask insertion and subsequently titrated to clinical signs. Mean (SD) times to unconsciousness and laryngeal mask insertion were significantly shorter with propofol [50 (9) s and 116 (33) s, respectively] than with sevoflurane [73 (14) s and 146 (29) s; p < 0.0001 and p ¼ 0.0003, respectively]; however, these differences were not apparent to the blinded observer. Propofol was associated with a higher incidence of intra-operative movement (55 vs. 10%; p ¼ 0.0003), necessitating more adjustments to the delivered anaesthetic. Emergence was faster after sevoflurane [5.3 (2.2) min vs. 7.1 (3.7) min; p ¼ 0.027], but the inhaled anaesthetic was associated with more nausea and vomiting (30 vs. 3%; p ¼ 0.006), which delayed discharge [258 (102) min vs. 193 (68) min; p ¼ 0.005]. Direct costs were lower with sevoflurane but nausea would have increased indirect costs. Patient satisfaction was high (Ն 90%) with both techniques. In conclusion, both techniques had advantages and disadvantages for day-case anaesthesia.

Modulation of Presynaptic β3-Containing GABAAReceptors Limits the Immobilizing Actions of GABAergic Anesthetics

“…Compared with intravenous anesthetics, volatile anesthetics are known to affect, besides GABA A receptors, a multitude of molecular targets in the spinal cord (Cheng and Kendig, 2000Wong et al, 2001;Campagna et al, 2003). Although the experimental conditions in vitro are different from the in vivo measurement of immobility, our results reflect closely those obtained from studies in humans in whom intravenous GABAergic anesthetics were far less effective in depressing involuntary movements compared with volatile anesthetics (Ashworth and Smith, 1998;Smith and Thwaites, 1999;Watson and Shah, 2000). However, in clinical study settings, immobility can also be achieved with intravenous anesthetics at concentrations approximately 5-fold higher than those required for hypnosis (Smith et al, 1994).…”

“…General anesthetics like etomidate and propofol, which act almost exclusively via GABA A receptors, are potent hypnotics, but their efficacy in depressing spontaneous and evoked movements is clearly limited (Ashworth and Smith, 1998;Smith and Thwaites, 1999;Watson and Shah, 2000;Rudolph and Antkowiak, 2004;Grasshoff et al, 2006a). In clinical practice, these agents are routinely used for providing hypnosis and amnesia but rarely are administered to achieve immobility.…”

Hemodynamic response to Sevoflurane and Propofol induction: a comparative study

“…The use of Nitrous oxide (N 2 O) may have produced some of these minor differences in the timing and duration of hypotension, as compared to our study where N 2 O was not used. Smith and Thwaites 14 in another study in 1999, using methods similar to ours, observed a significant difference in MAP, 1 minute after induction but not at other times, closely resembling our findings. Comparable results to ours were also obtained by Priya V et al 7 but the MAP difference was significant at 3 minutes after induction, possibly due to the administration of Fentanyl 2 µg/kg IV, immediately after the induction end point.…”

“…Contrary to our study, HR was observed to increase slightly after induction possibly because analgesics were not administered prior to induction and airway was managed by holding a face mask after induction without muscle relaxation. However, Smith and Thwaites 14 in another study in 1999, demonstrated similar results to ours with a significant decrease in HR with sevoflurane at 3 and 5 minutes after induction. Priya V et al 7 and Jellish WS et al 8 et al observed a decrease in HR for both anesthetics up to several minutes after induction, but, in contrast to our study, the difference in HR between the two anesthetics was not statistically significant.…”

A comparison of propofol and sevoflurane anaesthesia: effects on aortic blood flow velocity and middle cerebral artery blood flow velocity*

“…Comparisons between inhalational and intravenous anaesthetic agents are difficult, owing to differences in pharmacokinetics, the difficulty in measuring intravenous drug concentrations in real time and the lack of equivalence for intravenous anaesthetics of minimum alveolar concentrations (MAC) of inhalational anaesthetics [35]. The BIS computes segments of EEG and produces an index value that monitors cortical suppression, tracking the changes of effects of anaesthetics on the brain [23].…”