Comparision of Total Intravenous Anesthesia and Sevoflurane-N2O-Alfentanil Anesthesia for Laryngeal Microscopic Surgery

Abstract

Background: The aim of this study was to compare the clinical properties of sevoflurane-N2O-alfentanil with propofol- remifentanil anesthesia for patients undergoing laryngeal microscopic surgery. Methods: Sixty patients scheduled for elective ambulatory surgery received either total intravenous anesthesia (TIVA group) with remifentanil and propofol or balanced anesthesia with sevoflurane-N2O-alfentanil (sevoflurane-N2O-alfentanil group). The TIVA group patients were induced with an effective-site concentration of 4μg/ml propofol and a bolus dose of 0.5μg/ml remifentanil. The anesthesia was maintained with a continuous infusions with an effective-site concentration of 2-5μg/kg propofol and 0.05-0.5μg/kg/min remifentanil, according to the hemodynamic response. The sevoflurane-N2O-alfentanil group patients were induced with 5 mg/kg thiopental and 20μg/kg IV alfentanil. Maintenance was obtained with 1.5-3.0 vol% sevoflurane and a bolus dose of 10μg/kg IV alfentanil if needed. The anesthetic depth was controlled under bispectral index (BIS) monitoring: propofol and sevoflurane concentrations were adjusted to achieve target BIS values, and were between levels of 40-60 during surgery. Results: Both anesthetic methods provided acceptable hemodynamic responses during surgery. The late recovery times (postanesthetic discharge scoring system), patient satisfaction and postoperative side effects were similar between patients in the two groups. Early recovery times (eye opening and the aldrete score) were shorter in the TIVA group patients, but this difference was not associated with a shorter hospital length of stay. Conclusions: Total intravenous anesthesia with remifentanil-propofol and balanced anesthesia with sevoflurane-N2O-alfentanil both provided satisfactory anesthesia for laryngeal microscopic surgery.