Implications of anesthetic techniques on patients' recovery in laparoscopic cholecystectomy

Abstract

Background/Aim. Different techniques of general anesthesia are used for laparoscopic cholecystectomy (LC). The aim of the study was to establish the best anesthetic technique for achieving better results during awakening affecting not only patient's recovery, but activities of anesthesiological team, as well. Methods. The study was conducted as a prospective comparative clinical trial. The patients (n=90) were classified according to the applied anesthetic technique into two groups: Volatile Induction and Maintenance Anesthesia (VIMA) with sevofluran and Target Controlled Infusion (TCI). The results relating to parameters of recovery after anesthesia and surgery were compared between these two groups. The following parameters were analyzed: demographic patients' characteristics, duration of anesthesia, the times to eye opening, to respond to a command, to extubation, and to orientation, from the last anesthetic dose receiving until post anesthesia discharge (PAD), frequency of postoperative nausea, vomiting and agitation (PONVA). Results. In the examined groups there were no statistically significant differences in the duration of anesthesia (68.29 ? 6.47 vs 66.29 ? 11.97 min, p = 0.327). The time to eye opening was significantly shorter in the group VIMA compared to the group TCI (4.49 ? 1.20 vs 7.42 ? 1.25 min, p = 0.000), as well as the time to respond to a command (5.93 ? 1.12 vs 8.47 ? 1.08 min, p = 0.000). The patients anesthetized with VIMA technique were statistically significantly extubated earlier (6.84 ? 1.19 vs 9.69 ? 1.31 min, p = 0.000). Considering orientation time, there was also statistically significant difference between the two groups (7.51 ? 0.97 vs 11.60 ? 1.75 min, p = 0.000). There was no statistically significant difference in PAD time duration (19.42 ? 5.99 vs 20.80 ? 1.59 min, p = 0.142). There were no statistically significant differences in PONVA events between the examined groups. Conclusion. This study showed that VIMA technique with sevofluran in LC provides faster and more qualitative recovery of patients. Thus this technique should be applied in everyday anesthesiological procedures in LC, as well as in other minimally invasive videoendoscopic surgical procedures.Uvod/Cilj. Za izvodjenje laparoskopske holecistektomije (LH) koriste se razne tehnike opste anestezije. Cilj naseg rada bio je da se utvrdi kojom tehnikom anestezije se postizu bolji rezultati tokom budjenja, sto znacajno utice ne samo na oporavak bolesnika vec i na angazovanost celokupnog anestezioloskog tima. Metode. Ispitivanje je sprovedeno kao prospektivna komparativna klinicka studija. Devedeset ispitanika bilo je podeljeno u dve grupe u zavisnosti od primenjene tehnike anestezije: uvod i odrzavanje anestezije inhalacionim anestetikom (sevofluran) Volatile Induction and Maintenance Anaesthesia (VIMA) i tehnika ciljne kontrolisane infuzije - Target Controlled Infusion (TCI). Analizirani su sledeci parametri: demografske karakteristike bolesnika, trajanje anestezije, vreme do otvaranja ociju, vreme do izvrsavanja naredbi, vreme ekstubacije, vreme do postizanja orijentacije, vreme od poslednjeg davanja anestetika do odlaska na odeljenje - Post Anesthesia Discharge (PAD), ucestalost postoperativne nauzeje, vomitusa i agitacije (PONVA). Rezultati. Kod ispitivanih grupa nije zabelezena statisticki znacajna razlika u trajanju anestezije (68,29 ? 6,47 vs 66,29 ? 11,97 min, p = 0,327). Vreme do otvaranja ociju bilo je statisticki znacajno krace kod grupe VIMA u odnosu na grupu TCI (4,49 ? 1,20 vs 7,42 ? 1,25 min, p = 0,000), kao i vreme do izvrsavanja naredbi (5,93 ? 1,12 vs 8,47 ? 1,08 min, p = 0,000). Bolesnici anestezirani tehnikom VIMA bili su statisticki znacajno ranije ekstubirani (6,84 ? 1,19 vs 9,69 ? 1,31 min, p = 0,000). Kada je vreme do postizanja orijentacije u pitanju postojala je takodje statisticki znacajna razlika izmedju grupa VIMA i TCI (7,51 ? 0,97 vs 11,60 ? 1,75 min, p = 0,000). Nije bilo statisticke znacajne razlike u trajanju PAD (19,42 ? 5,99 vs 20,80 ? 1,59 min, p = 0,142), kao ni u pojavi PONVA izmedju ispitivanih grupa (p = 1,000). Zakljucak. Ovo ispitivanje pokazalo je da VIMA tehnika sevofluranom kod LH dovodi do brzeg i kvalitetnijeg oporavaka bolesnika. Zato se njena primena preporucuje u svakodnevnoj anestezioloskoj praksi kod LH, kao i kod drugih procedura koje spadaju u grupu minimalno invazivne videoendoskopske hirurgije.