Anesthesia for laparoscopic cholecystectomy: comparative evaluation--desflurane/sevoflurane vs. propofol

Laparoscopic techniques, have rapidly increased in popularity because of its various benefits. They are widely used in day-case surgical operations and are extensively published. However, postoperative nausea vomiting (PONV) is a commonly observed phenomenon after laparoscopic procedures. Its occurrence may increase depending on the anesthetic techniques used. Despite the fact that the use of propofol and the new low solubility inhalation anesthetics, lead to faster induction and recovery, their effects on PONV is not sufficiently known. Therefore, the aim of this study is to compare the effects of various anesthetic drugs on recovery characteristics and PONV. Following informed consent, 300 ASA I-III patients scheduled for laparoscopic cholecystectomy were investigated. Anesthesia was induced by 1.5 microgkg(-1) fentanyl, 0.03 mgkg(-1) midazolam, 1.5 mgkg(-1) propofol and 0.01 mgkg(-1) vecuronium for all patients. Anesthesia was maintained with desflurane in group D (n = 100), sevoflurane in group S (n = 100) and propofol infusion in group P (n = 100), beside 50% N20/O2 ventilation. All patients were given 4 mg ondansetron and 8 mg dexamethazone iv for preventing PONV, ten minutes before the end of surgery. At the end of the operation, times for extubation, eye opening, orientation, sitting and walking, and the need of ondansetrone in post anesthetic care unit, were recorded. Also, PONV was observed and recorded as early period (first 4 hours) and late period (4-24 hours). Extubation and eye opening times were meaningfully lower in group D. However, no significant differences were observed in orientation, sitting and walking times and PONV among the three groups. All patients who had PONV were women. A correlation was found between PONV and body weight. Even though there were no statistically significant differences among the groups regarding PONV, the number of patients who had PONV in group P was lower. Early recovery time was shortest in group D, while delayed recovery time had no differences. It may be said that these anesthetic drugs have no statistically significant difference for PONV and delayed recovery.