Nausea: the most important factor determining length of stay after ambulatory anaesthesia. A comparative study of isoflurane and/or propofol techniques

Speed of recovery and length of stay in hospital were studied in 95 ambulatory patients undergoing laparoscopy or arthroscopy. The patients were divided into three groups regarding maintenance of anaesthesia. Group A (n = 32) received isoflurane 0.7% end-tidally, group B (n = 31) propofol infusion for 25 min and thereafter isoflurane, and group C (n = 32) received an infusion of propofol throughout the procedure. Recovery was assessed by a combination of the Maddox-Wing, the Choice Reaction Time test and p-deletion. The awakening period was somewhat shorter in group A, but psychomotor recovery was somewhat slower compared to groups B and C. The length of stay in hospital depended on whether the patient was nauseated or not. In group A, 44% suffered from nausea requiring medical intervention compared to 13% and 19% in groups B and C, respectively. The stay in hospital was 235 ± 90 min (mean ± standard deviation) in group A compared to 184 ± 56 min and 197 ± 55 min in groups B and C, respectively. The non-nauseated patients in group A had a stay in hospital of 188 ± 55 min compared to 184 ± 52 and 184 ± 37 in the non-nauseated patients in groups B and C, respectively. In total, the nauseated patients (n = 24) stayed 267 ± 95 min compared to 185 ± 47 min for the non-nauseated patients (n = 71), P < 0.001. We found nausea to be the most important factor determining length of stay after ambulatory anaesthesia. Propofol in a dose higher than a normal induction dose decreases the incidence of nausea and thus the length of stay in hospital.     

A comparison of anaesthesia using remifentanil combined with either isoflurane, enflurane or propofol in patients undergoing gynaecological laparoscopy, varicose vein or arthroscopic surgery

BACKGROUND: Anaesthesia comprising remifentanil plus isoflurane, enflurane or propofol was randomly evaluated in 285, 285 and 284 patients, respectively, undergoing short-procedure surgery. METHODS: Anaesthesia was induced with propofol (0.5 mg x kg(-1) and 10 mg x 10 s(-1)), and a remifentanil bolus (1 microg x kg(-1)) and infusion at 0.5 microg x g(-1) x min(-1). Five minutes after intubation, remifentanil infusion was halved and 0.5 MAC of isoflurane or enflurane, or propofol at 100 microg x kg(-1) x min(-1) were started and titrated for maintenance. RESULTS: Patient demography and anaesthesia duration were similar between the groups. Surgery was performed as daycases (52%) or inpatients (48%). The median times (5-7 min) to extubation and postoperative recovery were similar between the groups. Responses to tracheal intubation (15% vs 8%) and skin incision (13% vs 7%) were significantly greater in the total intravenous anaesthesia (TIVA) group (P<0.05). Fewer patients given remifentanil and isoflurane (21%) or enflurane (19%) experienced > or =1 intraoperative stress response compared to the TIVA group (28%) (P<0.05). Median times to qualification for and actual recovery room discharge were 0.5-0.6 h and 1.1-1.2 h, respectively. The most common remifentanil-related symptoms were muscle rigidity (6-7%) at induction, hypotension (3-5%) and bradycardia (1-4%) intraoperatively and, shivering (6-7%), nausea and vomiting postoperatively. Nausea (7%) and vomiting (3%) were significantly lower with TIVA compared with inhaled anaesthetic groups (14-15% and 6-8%, respectively; P<0.05). CONCLUSION: Anaesthesia combining remifentanil with volatile hypnotics or TIVA with propofol was effective and well tolerated. Times of extubation, postanaesthesia recovery and recovery room discharge were rapid, consistent and similar for all three regimens.