Department of Anesthesiology and Pain Management, University of Texas
Southwestern Medical Center at Dallas.
Title
Recovery following outpatient anesthesia: use of enflurane versus propofol.
Source
Journal of Clinical Anesthesia. 5(6):447-50, 1993 Nov-Dec.
Abstract
STUDY OBJECTIVE: To compare the intraoperative conditions and
postoperative recovery of patients following the use of either propofol-nitrous
oxide (N2O) or enflurane-N2O for maintenance of outpatient anesthesia.
DESIGN: Randomized, single-blind study. SETTING: University
hospital outpatient surgery center. PATIENTS: 61 ASA physical status
I and II, healthy female outpatients undergoing laparoscopic surgery.
INTERVENTIONS: Patients were randomly assigned to one of three
anesthetic regimens. Group 1 (control) received thiopental sodium 4 mg/kg
intravenously (i.v.), followed by 0.5% to 1.5% enflurane and 67% N2O in
oxygen (O2). Group 2 received propofol 2 mg/kg i.v., followed by 0.5% to
1.5% enflurane and 67% N2O in O2. Group 3 received propofol 2 mg/kg i.v.,
followed by propofol 50 to 160 micrograms/kg/min i.v. and 67% N2O in O2. All
patients received succinylcholine 1 mg/kg i.v. to facilitate tracheal
intubation and atracurium 10 to 20 mg i.v. to provide adequate relaxation
during the maintenance period. MEASUREMENTS AND MAIN RESULTS:
Recovery from anesthesia was assessed by a research nurse who was unaware of
the anesthetic technique used. The mean +/- SD time to eye opening was
significantly longer in the thiopental-enflurane-N2O group (Group 1) than in
the propofol-propofol-N2O group (Group 3) (6.1 +/- 2.5 minutes vs. 3.5 +/-
2.8 minutes, respectively). In addition, the mean time to respond to verbal
commands was significantly shorter in the propofol induction groups compared
with the thiopental induction group. However, the use of enflurane versus
propofol for maintenance of anesthesia did not significantly prolong the
time from arrival in the recovery room to sitting, tolerating oral fluids,
walking, or being judged "fit for discharge." There were no
differences among the three groups with respect to postoperative pain or
analgesic requirements. Finally, patients who received enflurane for
maintenance of anesthesia had a significantly higher frequency of nausea and
vomiting than the propofol maintenance group. CONCLUSION: Induction
of anesthesia with propofol is associated with a more rapid emergence from
anesthesia than induction with thiopental. Maintenance of anesthesia with
enflurane did not prolong recovery compared with maintenance with propofol,
but enflurane was associated with increased frequency of postoperative
nausea and vomiting.