Fast-track anaesthesia for laparoscopic cholecistectomy: a prospective, randomized,multicentre,blind comparison of desflurane-remifentanil or sevoflurane.remifentanil

Background and objective: To evaluate the effects of sevoflurane and desflurane in combination with intravenous
remifentanil on time for discharge from the postanaesthesia care uni t and ne ed for postanaesthesia care uni t
management after elective laparoscopic cholecystectomy. Methods: 231 ASA Grade I-Il patients, undergoing
elective laparoscopic cholecystectomy in seven University teaching hospital, were randomly allocated to receive
a desflurane-remifentanil (n = 105) or sevoflurane-remifentanil (n = 126) anaesthetic. A blinded observer
recorded times for emergence and postanaesthesia care unit discharge (achievement of an Aldrete score ~9),
number of patients eligible for postanaesthesia care unit discharge when exiting the operating room and occur­
rence of adverse events. Results: Intraoperative cardiovascular stability was similar in the two groups. Emergence,
response and extubation occurred earlier after desflurane (5.4 ± 3 min, 5.5 ± 3 min and 7.5 ± 4 min) than
sevoflurane (6.6 ± 3.5 min, 7.2 ± 4min and 9.1 ± 4.2 min) (P = 0.0005, 0.05 and 0.003, respecrively).
Postanaesthesia care unit bypass was possible in 44 desflurane-remifentanil patients (41 %) and 55 sevoflurane­
remifenatnil patients (43%) (P = 0.69), while postanaesthesia care unit discharge occurred after 46min
(25th-75th percentiles: 18-40min) with desflurane and 64min (25th-75th percentiles: 20-50min) with
sevoflurane (P = 0.04). Postoperative nausea and vomiting was observed in 40 desflurane-remifentanil patients
(36%) and 53 sevoflurane-remifentanil parients (42%) (P = 0.42). Conclusions: Both the desflurane-remifentanil
and sevoflurane-remifentanil combinations provide a similarly adequate intraoperative cardiovascular stability.
Emergence and postanaesthesia care unit discharge were faster with desflurane-remifentanil than sevoflurane­
remifentanil, but this was not associated with a larger proportion of postanaesthesia care uni t bypass, confirming
that no clinically relevant differences are present between the two agents.