Induction with sevoflurane-remifentanil is comparable to propofol-fentanyl-rocuronium in PONV after laparoscopic surgery

Abstract

P Pu ur rp po os se e: : To compare sevoflurane-remifentanil induction and propofol-fentanyl-rocuronium induction with regards to the frequency of moderate to severe postoperative nausea and vomiting (PONV) in the first 24 hr after laparoscopic day surgery.M Me et th ho od ds s: : After informed consent, 156 ASA physical status class I to III patients undergoing laparoscopic cholecystectomy or tubal ligation were randomized to either induction with sevoflurane 8%, N 2 O 67% and iv remifentanil 1 to 1.5 µg·kg -1 or induction with iv fentanyl 2 to 3 µg·kg -1 , propofol 2 mg·kg -1 , and rocuronium 0.3 to 0.5 mg·kg -1 . All patients received iv ketorolac 0.5 mg·kg -1 at induction and sevoflurane-N 2 O maintenance anesthesia with rocuronium as needed. PONV was treated with iv ondansetron, droperidol, or dimenhydrinate; postoperative pain was treated with opioid analgesics. Patients were followed for 24 hr with regards to PONV and pain. Intubating conditions, induction and emergence times, time to achieve fast-track discharge criteria, and drug costs were measured. R Re es su ul lt ts s: : No differences were seen between the two groups in their frequencies of 24-hr moderate to severe PONV and postoperative pain, or in their intubating conditions, induction and emergence times, and time to achieve fast-track discharge criteria. Patients undergoing sevoflurane-remifentanil induction received more morphine (11 mg vs 8 mg; P < 0.001) in the postanesthetic care unit. Sevoflurane-remifentanil induction resulted in similar anesthetic and total drug costs for both procedures.C Co on nc cl lu us si io on n: : We did not demonstrate any difference in PONV, pain, or anesthetic/recovery times or costs between the sevoflurane and propofol groups. Sevoflurane-remifentanil induction is a feasible technique for anesthetic induction. Objectif : Comparer l'induction avec sévoflurane-rémifentanil ou propofol-fentanyl-rocuronium quant à la fréquence de nausées et vomissements postopératoires (NVPO) de modérés à sévères pendant les 24 premières heures après une opération en chirurgie d'un jour sous laparoscopie. Méthode : Après avoir accordé leur consentement, 156 patients d'état

A meta-analysis of ambulatory versus inpatient laparoscopic cholecystectomy

“…Along with other factors, postoperative nausea and vomiting has been suggested as a cause of unplanned admissions and common bile duct stones as a cause of readmissions [23]. Postoperative nausea and vomiting, a major concern in day case surgery, has been studied in different randomized controlled trials [24][25][26][27][28]. There has been no consensus on the premedications and anesthetic drug regimens, particularly for day case laparoscopic surgery.…”

Anesthesia for laparoscopy: a review

“…Song and White [38] demonstrated that the adjunctive use of a remifentanil infusion during desflurane-nitrous oxide anesthesia facilitates early recovery without increasing PONV, pain, or the need for rescue medication after laparoscopic surgery. Yang et al [39] did not find any difference in PONV, pain, or anesthetic/ recovery times or costs between sevoflurane-remifentanil induction and propofol-fentanyl-rocuronium induction in the first 24 hours after laparoscopic surgery.…”

Current Concepts in the Management of Postoperative Nausea and Vomiting

“…However, opioid given to a patient already in pain is not associated with significant increase in PONV episodes. Ultra short-acting opioid-like remifentanil has been found to have similar incidences of PONV as fentanyl over the first 24 hour postoperative period [14, 22]. …”