ISSN:
1432-055X
Keywords:
Schlüsselwörter: Balanced anaesthesia – Laparoskopische Cholezystektomie – Psychomotorische Erholung – Postoperative Übelkeit – Total(e) intravenöse Anästhesie-TIVA
;
Key words: Balanced anaesthesia – Laparoscopic cholecystectomy – Psychomotor recovery – Postoperative nausea – Total intravenous anaesthesia – Propofol – Isoflurane – Methohexitone – Nitrous oxide – Outpatient anaesthesia
Source:
Springer Online Journal Archives 1860-2000
Topics:
Medicine
Description / Table of Contents:
Abstract. Total intravenous anaesthesia (TIVA) is increasingly used in short-stay surgery such as laparoscopic cholecystectomy. TIVA may provide fast recovery of psychomotor function, thus being of benefit to both the patient's behaviour and postoperative management. The purpose of this prospective study was to compare postoperative recovery from TIVA using propofol or methohexitone as the hypnotic component and balanced anaesthesia with isoflurane. Patients and methods. After giving informed consent and approval by the ethical committee of our hospital, 51 patients (ASA I, II) were investigated in a prospective study. Patients were randomised to receive either isoflurane, methohexitone, or propofol. Perioperative management with regard to premedication, intraoperative analgesia, relaxation, ventilation, and postoperative analgesia was carried out identically for all groups. Postoperative vigilance, pain, and nausea scores were assessed 15, 30, 60, 120, and 360 min after extubation with a visual analogue scale (VAS). At the same points, psychomotor recovery was investigated with the following assays: sedation as shown in Table 1; orientation with ten questions as to person, time, and location; memory as expressed by the patient's ability to repeat five words; a calculation test with five subtractions of the number 7 beginning from 100; and word generation by the number of words with an initial "m" given within 1 min and with animal names. Data were analysed with Kruskal Wallis' test for multiple comparisons between the groups and with Friedman's test for repeated measurements. All values are given as medians (interquartile range) or ranges. Results. There was no difference between the groups' physical condition (Table 2). All intraoperative parameters compared well between groups; the management of anaesthesia was smoother with isoflurane than with the other anaesthetics. Psychomotor recovery was somewhat faster in the propofol group than the methohexitone group, as indicated by sedation score, orientation, memory and calculation tests (Table 4), word generation tests (Fig. 4), and subjective vigilance score (Fig. 3). The difference in recovery time between the propofol and isoflurane groups was minimal and without any significance or relevance. The incidence of postoperative nausea was significantly lower after balanced anaesthesia with isoflurane (24%, P〈0.05) as compared to TIVA with either propofol (53%) or methohexitone (41%). However, there were only minor differences between the groups; the ability to cooperate and be mobilised was not limited. Discussion. Each of the three techniques used in this study is suitable for anaesthesia in patients undergoing laparoscopic cholecystectomy. Since fast recovery of vigilance and psychomotor function is very important in outpatient surgery, opioid-supplemented propofol anaesthesia is well established. Inhalation anaesthesia with isoflurane in air/oxygen without adding nitrous oxide compares well to propofol TIVA for laparoscopic surgery.
Notes:
Zusammenfassung. Die totale intravenöse Anästhesie (TIVA) wird in der Tageschirurgie zunehmend eingesetzt, weil schnelleres Erwachen und eine raschere Wiederherstellung der psychomotorischen Funktionen erwartet werden. In einer randomisierten Doppelblindstudie an 51 Patienten zur laparoskopischen Cholezystektomie wurde das Aufwachverhalten nach einer TIVA mit Propofol, einer TIVA mit Methohexital und einer balanced anaesthesia mit Isofluran in den ersten 6 Stunden postoperativ anhand der Aufwachzeit, der Orientiertheit, der Merkfähigkeit, eines Rechentests und der Wortgenerierungsfähigkeit untersucht. Die Befindlichkeit wurde mit einer visuellen Analogskala für Schmerz, Übelkeit und Müdigkeit beurteilt. Nach der TIVA mit Propofol erwachten die Patienten schneller als nach Methohexital und auch geringfügig schneller als nach Isofluran. Mit dem Verzicht auf Lachgas ist die Quote der Patienten, die über Übelkeit klagten, auch nach Isofluran erstaunlich klein (24%). Die Unterschiede in den drei Gruppen sind insgesamt gering, insbesondere sind die Kooperationsfähigkeit und die Mobilisierbarkeit der Patienten in keiner Gruppe eingeschränkt. Für die laparoskopische Cholezystektomie können alle drei untersuchten Anästhesieverfahren als gut geeignet angesehen werden.
Type of Medium:
Electronic Resource
URL:
http://dx.doi.org/10.1007/s001010050095
Permalink
