A randomized, comparative study of propofol infusion and sevoflurane as the sole maintenance agent in laparoscopic surgery

Abstract

Background and objective: Laparoscopic techniques have rapidly increased in popularity because of associated benefits. Although the most commonly performed surgery still remains laparoscopic cholecystectomy, many other surgical procedures have been included in the list. Our aim of this study was to compare the hemodynamic changes and emergence characteristics during maintenance of anesthesia either with sevoflurane or propofol infusion in laparoscopic surgeries.

Methodology: Fifty patients of ASA physical status I or II, aged between 18-60 years, of either sex, scheduled for various elective laparoscopic surgeries of around 2 hours duration under general anesthesia were selected for this study. All the patients were given premedications; inj glycopyrrolate 0.004 mg/kg, inj ondansetron 0.08 mg/kg and inj fentanyl 1.0 mg/kg IV. Induction was done with inj thiopentone sodium 5 mg/kg and inj succinylcholine 2 mg/kg, followed by intubation. Muscle relaxation was achieved with inj vecuronium 0.1 mg/kg loading dose followed by 0.02 mg/kg IV 20-45min post initial PRN. Patients were then randomly divided into 2 groups: Group S (Sevoflurane group) was maintained on sevoflurane 1-1.5% + O₂:N₂O (50:50). Group P received inj propofol 1 mg/kg bolus followed by 100-300 µg/kg/min infusion + O₂:N₂O (50:50). Mean arterial pressure, mean heart rate, and emergence characteristics were recorded. All the quantitative data were analyzed using unpaired T test.

Results: Mean heart rate after pneumoperitonium was 93.32 ± 6.29 vs. 91.00 ± 4.46 per min for Group S and Group P respectively. Mean blood pressure after pneumoperitonium for Group S was 101.72 ± 6.32 and for Group P was 98.00 ± 7.69 mmHg. There was no significant difference in EtCO₂, and SpO₂ was maintained at 99-100% throughout the surgery in both groups. Time for spontaneous respiration, time to spontaneous eye opening, following verbal command and telling own name by the patient were significantly lower in Group S than Group P.

Conclusion: We conclude that maintenance of general anesthesia with sevoflurane is associated with faster emergence from anesthesia when compared with propofol, while propofol is associated with lower incidence of PONV in laparoscopic surgical procedures.