Comparison of Sevoflurane-Nitrous Oxide and Target- Controlled Propofol with Fentanyl Anesthesia for Hysteroscopy

Hong, Jeong Yeon; Oh, Jong In; Kim, Soo Mie

Abstract

A randomized prospective study was performed on the anesthetic induction, maintenance, and recovery characteristics of sevoflurane-nitrous oxide, compaired to that of target- controlled propofol and fentanyl anesthesia, for forty day-case hysteroscopic surgery. The patients in the sevoflurane group (n = 20) received sevoflurane-nitrous oxide for both induction (8%) and maintenance (1 - 2%) of anesthesia, while the patients in the propofol group (n = 20) received target-controlled propofol (4 microgram/ml, 3-6 microgram/ml as occasion demanded) with fentanyl (1 microgram/kg). In both groups, the airway was maintained by a facemask with the patient breathing spontaneously during the surgery. The mean times to unconsciousness and readiness for surgery were similar in both groups, with those for the sevoflurane group, compared to the propofol group being 80.4 18.9 vs. 83.6 38.8 sec, and 220.1 76.9 vs. 231.0 95.4 sec, respectively. Propofol was associated with significantly higher incidences of involuntary movement (30% vs. 5%) and apnea (35% vs. 0%) during the induction period than with sevoflurane. Hemodynamic variables were similar with the exception of significantly lower blood pressures during the first 5 minutes of induction with propofol. Emergence times to eye opening, hand squeezing and orientation for sevoflurane compared to propofol were: 316.6 79.3 vs. 507.4 218.8 sec, 390.0 69.3 vs. 653.1 201.6 sec and 380.6 80.8 vs. 666.3 208.7 sec, respectively, all of these being significantly faster for sevoflurane than propofol. The postanesthetic Aldrete's recovery scores of the patients immediately after surgery were higher in the sevoflurane group. Propofol was associated with more drowsiness, with sevoflurane being associated with more nausea, in the recovery period; however, neither delayed the time to discharge (103.7 28.1 vs. 99.0 36.2 min). In conclusion, sevoflurane-nitrous oxide appears to be superior for day-case hysteroscopic surgery, than target-controlled propofol with fentanyl, with regards to the speed of recovery from anesthesia and the return to hemodynamic stability.