Recovery profile and side effects of remifentanil-based anaesthesia with desflurane or propofol for laparoscopic cholecystectomy

Background: Nitrous oxide (N2O) has been suggested to contribute to bowel d istension, resulting in worsened operating conditions for laparoscopic surg ery, and to increase incidence of postoperative nausea and vomiting. Theref ore, our objective was to assess the feasibility of two remifentanil-based anaesthetic regimens free from N2O with special regard to recovery profile, postoperative analgesic demand and side effects in patients undergoing lap aroscopic cholecystectomy. Methods: Fifty patients (ASA I-II, 23-65 yr) were randomly assigned to rece ive remifentanil-based anaesthesia in conjunction with propofol (group R/P) or desflurane (group R/D). After standardised induction of anaesthesia, an algesia was continued with remifentanil in all patients. For maintenance of hypnosis, propofol or desflurane were used in concentrations to ensure los s of consciousness, lack of awareness, and maintenance of heart rate and bl ood pressure within +/-25% of initial values. At the end of surgery all ana esthetics were discontinued without tapering and early emergence and recove ry were recorded, rain scores were assessed by using a visual analogue scal e. Patient controlled analgesia with i.v. piritramide was used for treatmen t of postoperative pain and recorded for 90 min in the postanaesthesia care unit (PACU). In addition, side effects were noted. Results: Early emergence from anaesthesia did not differ be-tween the group s. In group R/P, time to eye opening, spontaneous respiration and extubatio n was 4.4 +/- 2.9 min, 5.2 +/- 3.4 min and 5.5 +/- 3.3 min respectively, co mpared with 4.7 +/- 2.7 min, 5.3 +/- 2.4 min and 5.7 +/- 2.5 min in group R /D. While pain scores did not differ between both groups on admission to th e PACU, patients receiving desflurane required more i.v. piritramide as com pared to those receiving propofol, 22.0 +/- 6.5 mg and 17.9 +/- 7.0 mg, res pectively (P<0.05). Nausea was less frequent after propofol (16% vs. 48%, P <0.05). Conclusion: In patients undergoing laparoscopic cholecystectomy, remifentan il-based anaesthetic regimens in conjunction with propofol or desflurane ar e suitable and allow for rapid recovery from anaesthesia. However, the use of propofol results in less postoperative analgesic consumption and nausea as compared to desflurane.