Comparison of sevoflurane and propofol for ambulatory anaesthesia in gynaecological surgery

Purpose: To analyse the cost-efficiency ratio of sevoflurane compared with propofol for gynaecological ambulatory anaesthesia. Methods: In a prospective randomised study 52 ASA I patients scheduled for ambulatory pregnancy termination were premedicated with lorazepam and recei ved alfentanil prior to anaesthesia induction with propofol (group P, n 26) or with sevoflurane 8% (group S, n = 26) using the single breath vital cap acity technique. Anaesthesia was maintained with N2O in both groups supplem ented with sevoflurane (group S) or propofol boluses (group P). Results: The quality of induction and maintenance of anaesthesia was simila r between groups except for the incidence of movement during anaesthesia (1 4/26 patients in group P and 4/26 in group S, P < 0.05). The incidence of p ost-operative emesis was increased in the sevoflurane group (P < 0.05) but the patients felt able to perform nor mal activity after a similar delay (1 8.4 +/- 2.9 hr vs 20.6 +/- 2.8 hr, P > 0.05), The direct cost of anaesthesi a was lower in the sevoflurane group (679 FF, n = 24 vs 1153 FF, n = 2-5 in propofol group) but the weight of uterine aspiration products was higher ( 293 +/- 66 g, median = 230 g, Range 110-800 g, n = 13 vs 108 +/- 8 g, media n = 110 g, Range 60-160 g, n = 12, group S vs group P respectively, P = 0.0 04), Four patients needed reoperation and ambulatory anaesthesia failed in six patients because of uterine haemorrhage. Conclusion: Ambulatory anaesthesia with sevoflurane offers a good alternati ve to propofol but further investigation concerning blood loss with sevoflu rane needs to be performed in gynaecological practice.