The use of esmolol as an alternative to remifentanil during desflurane anesthesia for fast-track outpatient gynecologic laparoscopic surgery

We compared esmolol and remifentanil infusions with respect to their effect on intraoperative hemodynamic stability and early recovery after outpatien t laparoscopic surgery when administered as IV adjuvants during desflurane anesthesia. After premedication with midazolam 2 mg IV, anesthesia was indu ced with propofol 2 mg . kg(-1) IV in combination with either esmolol 1 mg . kg(-1) IV (n = 27) or remifentanil 1 mug . kg(-1) IV (n = 26) and succiny lcholine 1 mg . kg(-1) IV according to a randomized, double-blinded protoco l. Anesthesia was initially maintained with desflurane 2.5% (subsequently t itrated to maintain an electroencephalogram-bispectral index value of 60) a nd nitrous oxide 65% in oxygen. Before skin incision, an infusion of either esmolol (5 mug . kg(-1) . min(-1)) or remifentanil (0.05 mug . kg(-1) . mi n(-1)) was started and titrated to maintain the heart rate within 25% of th e baseline value. Mivacurium, 0.04 mg/kg IV,bolus doses were administered t o maintain a stable peak inspiratory pressure. Esmolol (12.8 +/- 13.1 mug . kg(-1) . min(-1)) and remifentanil (0.04 +/- 0.02 mug . kg(-1) . min(-1)) infusions were equally effective in maintaining a stable heart rate during these laparoscopic procedures. Although the mivacurium requirement was larg er in the Esmolol group (7 +/- 5 vs 3 +/- 4 mg), the Esmolol group reported a smaller incidence of postoperative nausea and vomiting (4% vs 35%). Both drugs were associated with freq quent "postanesthesia care unit bypass" ra tes (78-81%), short times to "home readiness" (119-120min), excellent patie nt satisfaction (81-85%), and rapid resumption of normal activities (2.6-3. 2 d). Fast-tracked patients were ready for discharge home significantly ear lier (112 +/- 46 vs 151 +/- 50 min). We concluded that esmolol infusion is an acceptable alternative to remifentanil infusion for maintaining hemodyna mic stability during desflurane-based fast-hack anesthesia for outpatient g ynecologic laparoscopic surgery.