Recovery profile, costs, and patient satisfaction with propofol and sevoflurane for fast-track office-based anesthesia

Background: Office-based surgery is becoming increasingly popular because o f its cost-saving potential. Both propofol and sevoflurane are commonly use d in the ambulatory setting because of their favorable recovery profiles. T his clinical investigation was designed to compare the clinical effects, re covery characteristics, and cost-effectiveness of propofol and sevoflurane when used alone or in combination for office-based anesthesia. Methods: One hundred four outpatients undergoing superficial surgical proce dures at an office-based surgical center were randomly assigned to one of t hree general anesthetic groups. In groups I and II, propofol 2 mg/kg was ad ministered for induction followed by propofol 75-150 mu g.kg(-1).min(-1) (g roup I) or sevoflurane 1-2% (group II) with N2O 67% in oxygen for maintenan ce of anesthesia. In group III, anesthesia was induced and maintained with sevoflurane in combination with N2O 67% in oxygen. Local anesthetics were i njected at the incision site before skin incision and during the surgical p rocedure. The recovery profiles, costs of drugs, and resources used, as wel l as patient satisfaction, were compared among the three treatment groups. Results: Although early recovery variables (e.g., eye opening, response to commands, and sitting up) were similar in all three groups, the times to st anding up and to be "home ready" were significantly prolonged when sevoflur ane-N2O was used for both induction and maintenance of anesthesia. The time to tolerating fluids, recovery room stay, and discharge times were signifi cantly decreased when propofol was used for both induction and maintenance of anesthesia. Similarly, the incidence of postoperative nausea and vomitin g and the need for rescue antiemetics were also significantly reduced after propofol anesthesia. Finally, the total costs and patient satisfaction wer e more favorable when propofol was used for induction and maintenance of of fice-based anesthesia. Conclusion: Compared with sevoflurane-N2O, use of propofol-N2O for office-b ased anesthesia was associated with an improved recovery profile, greater p atient satisfaction, and lower costs. There were significantly more patient s who were dissatisfied with the sevoflurane anesthetic technique.