Comparison of Propofol-Remifentanil and Desflurane-Remifentanil in Target-Controlled Infusion

Abstract

Objective: Our objective was to examine the clinical properties of two anesthetic regimens, propofol-remifentanil target-controlled infusion (TCI) or desflurane-remifentanil TCI under bispectral index (BIS) guidance during lower abdominal surgery procedures.Methods: Sixty consenting patients who scheduled for lower abdominal surgery were prospectively studied and were included in one of the two groups: propofol-remifentanil group (Group P) or desflurane-remifentanil group (Group D). General anaesthesia was induced with 2 mg kg -1 propofol, 1 µ kg -1 remifentanil and 0.6 mg kg -1 rocuronium injection. After intubation, remifentanil was administered using the TCI device in both groups. The pharmacokinetic model of Minto was used. Group D patients received a 50%-50% oxygenair mixture and 6% desflurane. The Schnider model was selected for the administration of propofol 1% (10 mg/mL) in Group P, and the TCI dose was adjusted to 4/mL -1 . The propofol infusion and inspired fraction of desflurane were adjusted to keep BIS value between 40-60. Hemodynamic parameters, time until recovery of spontaneous respiration, eye-opening and tracheal extubation, compliance with verbal commands, duration of anesthesia and surgery and postoperative modified Aldrete scores were recorded for all patients.Results: The heart rate (p=0.006), diastolic arterial pressure (p=0.003) and mean arterial pressure (p<0.0001) for the Group P was significantly higher than Group D. The extubation time was shorter in Group P (p=0.02), but there was no significant difference between the groups concerning other recovery findings. Conclusion:BIS-guided combinations of propofol-remifentanil and desflurane-remifentanil delivered using TCI are both suitable for patients undergoing lower abdominal surgery. The low blood pressure achieved with target-controlled infusions of remifentanil and desflurane may confer important advantages.