Fast-track anesthesia in patients undergoing outpatient laparoscopic cholecystectomy: comparison of sevoflurane with total intravenous anesthesia

Abstract Background The use of short-acting anesthetics has introduced a “fast-track anesthesia” concept in outpatient surgery which provides discharge of the patients from operation room directly to the phase II recovery area without entering into postanesthesia care unit. The aim of this prospecti...

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Bibliographic Details
Published in:Journal of clinical anesthesia 2017-02, Vol.37, p.25-30
Main Authors: Çaparlar, Ceyda Özhan, MD, Özhan, Mehmet Özgür, MD, Süzer, Mehmet Anıl, MD, Yazicioğlu, Dilek, MD, Eşkin, Mehmet Burak, MD, Şenkal, Serkan, MD, Çaparlar, Mehmet Ali, MD, Imren, Ersin Özkan, MD, Atik, Bülent, MD, Çekmen, Nedim, MD
Format: Article
Language:English
Subjects:
Adult
Ambulatory Surgical Procedures - adverse effects
Ambulatory Surgical Procedures - methods
Androstanols - administration & dosage
Androstanols - adverse effects
Anesthesia
Anesthesia & Perioperative Care
Anesthesia Recovery Period
Anesthesia, General - adverse effects
Anesthesia, General - methods
Anesthesia, Intravenous - adverse effects
Anesthesia, Intravenous - methods
Anesthesiology
Anesthetics, Inhalation - administration & dosage
Anesthetics, Inhalation - adverse effects
Anesthetics, Intravenous - administration & dosage
Anesthetics, Intravenous - adverse effects
Cholecystectomy
Cholecystectomy, Laparoscopic - adverse effects
Cholecystectomy, Laparoscopic - methods
Consciousness
Costs
Female
Fentanyl - administration & dosage
Fentanyl - adverse effects
Humans
Intubation
Laparoscopy
Male
Methyl Ethers - administration & dosage
Methyl Ethers - adverse effects
Middle Aged
Neuromuscular Nondepolarizing Agents - administration & dosage
Neuromuscular Nondepolarizing Agents - adverse effects
Pain
Pain Medicine
Patient Discharge
Patients
Performance evaluation
Piperidines - administration & dosage
Piperidines - adverse effects
Postoperative Nausea and Vomiting - epidemiology
Propofol - administration & dosage
Propofol - adverse effects
Prospective Studies
Random Allocation
Surgery
Time Factors
Vomiting
Workloads
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Summary:Abstract Background The use of short-acting anesthetics has introduced a “fast-track anesthesia” concept in outpatient surgery which provides discharge of the patients from operation room directly to the phase II recovery area without entering into postanesthesia care unit. The aim of this prospective and randomized study was to compare general anesthesia using sevoflurane with propofol-remifentanil–based total intravenous anesthesia (TIVA) for fast-track eligibility in patients undergoing outpatient laparoscopic cholecystectomy. The secondary aim was to compare 2 discharge scoring systems: White's Fast-Tracking Scoring System (WFTSS) and Modified Aldrete Scoring Systems (MASS) with regard to postanesthesia care unit bypass rate and postoperative problems. Methods After obtaining ethical approval and written informed patient consent, 80 patients were randomly assigned into 2 groups: group sevoflurane (n = 40) and group TIVA (n = 40). Anesthesia was induced with propofol, fentanyl, and rocuronium in both groups and maintained with sevoflurane in group sevoflurane and with remifentanil-propofol in group TIVA. Fast-track eligibility was evaluated using both WFTSS and MASS while patients were discharged from operation room according to WFTSS. Recovery times, number of fast-track eligible patients, factors related to fast-track ineligibility, and perioperative complications were evaluated. Results The ratio of fast-track eligible patients was higher and times to fast-track eligibility were shorter in group TIVA compared with group sevoflurane (82.1% vs 57.5% and 8 minutes vs 12 minutes; P < .05). The primary factors that have inhibited fast-tracking were desaturation, hemodynamic instability, pain, and postoperative nausea and vomiting, respectively. Postoperative nausea and vomiting presented a major difference in the rate of fast-track ineligibility between groups (4 patients in group sevoflurane, whereas none in group TIVA; P < .05). The fast-track ratio was lower with the WFTSS compared with MASS in group sevoflurane (57.5% vs 77.5%, P < .05), but similar in group TIVA.
ISSN:0952-8180
1873-4529
DOI:10.1016/j.jclinane.2016.10.036