Target Controlled Infusion versus Sevoflurane/Desflurane Anesthesia for Laparoscopic Cholecystectomy: Comparison Postoperative Nausea/Vomiting and Extubation Time

Sumidtra Prathep MD*, Sasithorn Mahattanaporn BSN*, Wirat Wasinwong MD*

Affiliation : * Department of Anesthesiology, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand

Background : Target-controlled infusion (TCI) systems have been developed from manually controlled infusion systems and have rapidly increased in popularity, especially in laparoscopic surgery. Propofol is claimed to decrease nausea and vomiting.
Objective : To compare anesthetic techniques, propofol-TCI, desflurane, and sevoflurane, for better results in terms of postoperative nausea and vomiting (PONV) and extubation times. Material and Method: The present study was prospective with informed consent from 75 patients, ASA 1-3 scheduled for laparoscopic cholecystectomy, and classified by anesthetic technique into three groups. The patients were induced by propofol target plasma concentration 6 μg/ml in Group P, or 1-2 mg/kg in Group S and Group D, fentanyl 2 μg/kg and vecuronium 0.1 mg/kg followed by propofol 2 to 5 μg/ml in group P, sevoflurane 0.5 to 3% in Group S, and desflurane 2 to 6% in Group D.
Results : The incidence of postoperative nausea and vomiting was least in Group P, both at the PACU (p<0.001) and ward (p = 0.01). Extubation time excluding outlier were Group P 11.171.19 minutes, Group D 13.961.17 minutes, Group S 11.751.34 minutes (p = 0.25). There were no statistical differences in the amount of fentanyl (p = 0.38) and fluid replacements (p = 0.05).
Conclusion : Laparoscopic cholecystectomy under propofol with TCI is one option of anesthetic technique with a significantly lower incidence of PONV compared with both sevoflurane and desflurane otherwise there is no statistical difference in the extubation time. Propofol-TCI technique is suggested for laparoscopic and ambulatory surgery.

Keywords : Laparoscopic cholecystectomy, Propofol, Target-controlled infusion, Postoperative nausea/vomiting, Extubation time

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