PROPOFOL-BASED ANESTHESIA AS COMPARED WITH STANDARD ANESTHETIC TECHNIQUES FOR MIDDLE-EAR SURGERY

Study Objective: To determine if a total intravenous (IV) technique wi th propofol and fentanyl is superior to isoflurane anesthesia in patie nts undergoing middle ear surgery. Design: Prospective, randomized stu dy. Setting: Inpatient otolaryngology service at a university medical center. Patients: 102 ASA status I and II nonobese patients with no si gnificant history of diabetes, chronic cholecystitis, neuropathy, or n euromuscular disorders that could produce delayed gastric emptying. In terventions: Patients were admitted to the study and randomly divided into three equal groups. IV administration of thiopental sodium 5 mg/k g for induction of anesthesia followed by 60% air/oxygen (O-2) with is oflurane 1% to 2% end-tidal for maintenance anesthesia (group I). The same anesthetic was given as above, with the addition of droperidol 25 mcg/kg given after induction (group 2). IV administration of propofol 2 mg/kg for induction of anesthesia followed by propofol 50 to 250 mc g/kg/min for maintenance anesthesia. All groups received fentanyl 3 mc g/kg IV after induction. Measurements and Main Results: Surgical durat ion, induction, maintenance, and total anesthesia times were recorded in addition to eye opening and extubation. Intergroup comparisons of p ostoperative nausea, vomiting, and pain were done, as were recovery sc ores using the Steward system. Patients receiving propofol had signifi cantly less nausea than those receiving isoflurane only (4 of 34 Versu s 12 of 34, p < 0.05) as well as vomiting (2 of 34 versus 8 of 34, p < 0.05). Immediate recovery scores were significantly better for propof ol compared with the isoflurane/droperidol group. Recovery at 30 minut es was also faster with propofol compared with isoflurane or isofluran e/droperidol (5.7 +/- 0.1 min versus 5.1 +/- 0.2 min and 5.2 +/- 0.2 m in, p < 0.05). Conclusions: Propofol-fentanyl seems to be a better ane sthetic than isoflurane-fentanyl in reducing the incidence of nausea a nd vomiting after middle ear surgery. Though the addition of droperido l to the isoflurane anesthetic seemed as effective, emergence from ane sthesia was slower. For middle ear surgeries producing emesis, propofo l-based anesthetics produced a rapid emergence with less nausea and vo miting.