Comparison of Fistulectomies Conducted under Intravenous General Anesthesia or Heavy Sedation with Midazolam and Meperidine

Abstract

Introduction. Anesthesia and postoperative pain are the main concerns of patients scheduled to undergo fistulectomies. Although several types of anesthesia are used for this procedure, opinions as to the simplest and most effective type are controversial. We compared the effects of heavy sedation and intravenous general anesthesia to clarify this issue.Methods. We retrospectively studied medical records of patients who were diagnosed with an anal fistula and underwent surgical treatment at our institute. Patients were given intravenous general anesthesia or heavy sedation during surgery. Outcomes were patient characteristics, medication dose, postoperative pain score, and complications.Results. Two hundred patients were enrolled in the study: 91 received intravenous general anesthesia (group 1) and 109 patients received heavy sedation (group 2). A further 10 patients were excluded because of incomplete admission data. There were no significant differences between groups 1 and 2 in age, ASA classification, body weight, or duration of hospital stay. However, the duration of surgery was longer in group 1 than in group 2 (51.03 ±18.745 minutes vs. 38.37 ±13.581 minutes, p ＜ 0.01). The postoperative meperidine dose was greater for group 1 than for group 2 (82.58 ±79.808 mg vs. 31.65 ±50.305 mg, p ＜ 0.01). Postoperative pain score was higher for group 1. None of the patients developed major surgical or anesthetic complications, including respiratory complications.Conclusion. Both anesthetic methods were safe and effective and did not differ in the incidence of postoperative complications. However, patients who received heavy sedation experienced less postoperative pain and required less medication, which simplifies hospital treatment and reduces occupancy of the post-anesthesia care unit with an associated reduction in costs.