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Inhalational techniques in ambulatory anesthesia.

Girish P Joshi1

  • 1Perioperative Medicine and Ambulatory Anesthesia, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75235-9068, USA. girish.joshi@utsouthwestern.edu

Anesthesiology Clinics of North America
|June 19, 2003
PubMed
Summary
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For outpatient anesthesia, intravenous propofol induction is preferred by patients. Newer inhaled anesthetics offer faster recovery compared to propofol infusions, potentially reducing hospital stays.

Area of Science:

  • Anesthesiology
  • Ambulatory Surgery

Background:

  • Anesthesia practitioners seek efficient and cost-effective practices.
  • Patient preference favors intravenous (IV) induction with propofol over inhalational induction with sevoflurane for outpatients.

Purpose of the Study:

  • To compare the efficacy and recovery profiles of different anesthetic techniques in ambulatory surgery.
  • To evaluate the impact of anesthetic choices on patient outcomes, including recovery time and hospital stay.

Main Methods:

  • Comparison of IV induction (propofol) versus inhalational induction (sevoflurane).
  • Maintenance of anesthesia using newer inhaled anesthetics (desflurane, sevoflurane) versus total IV anesthesia (TIVA) with propofol.
  • Utilizing Bispectral Index (BIS) monitoring for titration of sedatives.

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  • Assessment of early and late recovery parameters, including time to awakening, PACU stay, and home readiness.
  • Evaluation of postoperative nausea and vomiting (PONV) incidence.

    • Main Results:

    • Patients show a preference for IV induction with propofol.
    • Inhaled anesthetics (desflurane, sevoflurane) provide faster early recovery compared to TIVA.
    • BIS monitoring may reduce awakening time, facilitating fast-tracking and shorter hospital stays.
    • Inhalational anesthesia is linked to a higher incidence of PONV, but no significant differences in late recovery were observed.
    • Desflurane may offer faster emergence, especially in elderly and obese patients.
    • Balanced anesthesia (IV propofol induction, N2O maintenance, LMA) may be optimal for ambulatory surgery.
    • Inhalational anesthesia may be more economical than TIVA.

    Conclusions:

    • While both IV and inhalational induction are suitable, patient preference leans towards IV propofol.
    • Newer inhaled anesthetics facilitate quicker recovery post-ambulatory surgery compared to TIVA.
    • Optimizing anesthetic techniques, potentially with BIS monitoring, can enhance efficiency and reduce hospital length of stay.