Vojnosanitetski Pregled (Jan 2009)
Implications of anesthetic techniques on patients' recovery in laparoscopic cholecystectomy
Abstract
Background/Aim. Different techniques of general anesthesia are used for laparoscopic cholecystectomy (LC). The aim of the study was to establish the best anesthetic technique for achieving better results during awakening affecting not only patient's recovery, but activities of anesthesiological team, as well. Methods. The study was conducted as a prospective comparative clinical trial. The patients (n=90) were classified according to the applied anesthetic technique into two groups: Volatile Induction and Maintenance Anesthesia (VIMA) with sevofluran and Target Controlled Infusion (TCI). The results relating to parameters of recovery after anesthesia and surgery were compared between these two groups. The following parameters were analyzed: demographic patients' characteristics, duration of anesthesia, the times to eye opening, to respond to a command, to extubation, and to orientation, from the last anesthetic dose receiving until post anesthesia discharge (PAD), frequency of postoperative nausea, vomiting and agitation (PONVA). Results. In the examined groups there were no statistically significant differences in the duration of anesthesia (68.29 ± 6.47 vs 66.29 ± 11.97 min, p = 0.327). The time to eye opening was significantly shorter in the group VIMA compared to the group TCI (4.49 ± 1.20 vs 7.42 ± 1.25 min, p = 0.000), as well as the time to respond to a command (5.93 ± 1.12 vs 8.47 ± 1.08 min, p = 0.000). The patients anesthetized with VIMA technique were statistically significantly extubated earlier (6.84 ± 1.19 vs 9.69 ± 1.31 min, p = 0.000). Considering orientation time, there was also statistically significant difference between the two groups (7.51 ± 0.97 vs 11.60 ± 1.75 min, p = 0.000). There was no statistically significant difference in PAD time duration (19.42 ± 5.99 vs 20.80 ± 1.59 min, p = 0.142). There were no statistically significant differences in PONVA events between the examined groups. Conclusion. This study showed that VIMA technique with sevofluran in LC provides faster and more qualitative recovery of patients. Thus this technique should be applied in everyday anesthesiological procedures in LC, as well as in other minimally invasive videoendoscopic surgical procedures.
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