Indian Journal of Anaesthesia (Jan 2008)
Comparison of the Effects of Sevoflurane, Desflurane and Totally Intravenous Anaesthesia with Propofol on Haemodynamic Variables Using Transesophageal Doppler
Abstract
Sevoflurane and desflurane inhalation anaesthetics are in routine use providing more rapid recovery than pre-existing inhalation anaesthetics. We wanted to compare the effect of different anaesthetic agents on haemodynamic parameters with using transesophageal echo-Doppler in ASA I-II patients. A total of 45 American Society of Anes-thesiologists (ASA) physical status I-II patients age between 18-65 scheduled for elective major abdominal surgery were admitted to this prospective randomized study and divided into three groups. Induction of anaesthesia was provided with 1µgkg -1 fentanyl, 6-8 mgkg -1 thiopenthal and 0.1 mgkg -1 vecuronium in sevoflurane (Group S, n=15), and desflurane (Group D, n=15), and 1µgkg -1 remifentanil, 2mgkg -1 propofol, and 0.1 mgkg -1 vecuronium in totally intrave-nous anaesthesia (TIVA) group (Group T; n=15). For maintenance of anaesthesia, patients received an infusion of 0.15 µgkg -1 min remifentanil, 4-6 mgkg -1 h -1 propofol, sevoflurane 2%, or desflurane 6% at 1.0 MAC. Bispectral index (BIS) values of 40-60 were targeted during operation. After endotracheal intubation, the haemodynamic and respira-tory parameters, and BIS were recorded 5 min after the intubation (T 0 ), 30 min after the intubation (T 1 ), 60 min after the intubation (T 2 ) and before the extubation (T 3 ) with using haemodynamic monitoring (Hemosonic 100). After induction of anaesthetic agents, heart rate (HR) increased significantly in desflurane group (Group D) compared with group sevoflurane (Group S) and TIVA (Group T) groups at 5 min after the intubations, 30 min after the intubations, 60 min after the intubations and compared with group sevoflurane before the extubation. The Stroke Volume (SV) values increased significantly at the 5th minute intubation in Group S as compared to the Group D and in Group D as compared to the Group T. Compared with Group D, maximum acceleration (Acc) increased significanly in Group T before extubation. The BIS values were significantly lower in the Groups S and D at all the time intervals as com-pared to the Group T. Although a significant increase in HR and no significant decrease in Acc were noted in the desflurane group, sevoflurane and desflurane provided similar cardiovascular effects in the present study. The BIS values were significantly lower in the sevoflurane and desflurane groups compared with the TIVA.
