A comparison of anaesthesia using remifentanil combined with either isoflurane, enflurane or propofol in patients undergoing gynaecological laparoscopy, varicose vein or arthroscopic surgery

Background: Anaesthesia comprising remifentanil plus isoflurane, enflurane or propofol was randomly evaluated in 285, 285 and 284 patients, respective ly, undergoing short-procedure surgery. Methods: Anaesthesia was induced with propofol (0.5 mg . kg(-1) . and 10 mg . 10 s(-1)), and a remifentanil bolus (1 mu g . kg(-1)) and infusion at 05 mu g . g(-1) . min(-1). Five minutes after intubation, remifentanil infusi on was halved and 0.5 MAC of isoflurane or enflurane, or propofol at 100 mu g . kg(-1) . min(-1) were started and titrated for maintenance. Results: Patient demography and anaesthesia duration were similar between t he groups. Surgery was performed as daycases (52%) or inpatients (48%). The median times (5-7 min) to extubation and postoperative recovery were simil ar between the groups. Responses to tracheal intubation (15% vs 8%) and ski n incision (13% vs 7%) were significantly greater in the total intravenous anaesthesia (TIVA) group (P<0.05). Fewer patients given remifentanil and is oflurane (21%) or enfluane (19%) experienced greater than or equal to 1 int raoperative stress response compared to the TIVA group (28%) (P<0.05). Medi an times to qualification for and actual recovery room discharge were 0.5-0 .6 h and 1.1-1.2 h, respectively. The most common remifentanil-related symp toms were muscle rigidity (6-7%) at induction, hypotension (3-5%) and brady cardia (1-4%) intraoperatively and, shivering (6-7%), nausea and vomiting p ostoperatively. Nausea (7%) and vomiting (3%) were significantly lower with TIVA compared with inhaled anaesthetic groups (14-15% and 6-8%, respective ly; P<0.05). Conclusion anaesthesia combining remifentanil with volatile hypnotics or TI VA with propofol was effective and well tolerated. Times of extubation, pos tanaesthesia recovery and recovery room discharge were rapid, consistent an d similar for all three regimens.