Desflurane reinforces the efficacy of propofol target-controlled infusion in patients undergoing laparoscopic cholecystectomy

Abstract

Whether low-concentration desflurane reinforces propofol-based intravenous anesthesia on maintenance of anesthesia for patients undergoing laparoscopic cholecystectomy is to be determined. The aim of this study was to investigate whether propofol-based anesthesia adding low-concentration desflurane is feasible for laparoscopic cholecystectomy. Fifty-two patients undergoing laparoscopic cholecystectomy were enrolled in the prospective, randomized, clinical trial. Induction of anesthesia was achieved in all patients with fentanyl 2 μg/kg, lidocaine 1 mg/kg, propofol 2 mg/kg, and rocuronium 0.8 mg/kg to facilitate tracheal intubation and to initiate propofol target-controlled infusion (TCI) to effect site concentration (Ce: 4 μg/mL with infusion rate 400 mL/h). The patients were then allocated into either propofol TCI based (group P) or propofol TCI adding low-concentration desflurane (group PD) for maintenance of anesthesia. The peri-anesthesia hemodynamic responses to stimuli were measured. The perioperative psychomotor test included p-deletion test, minus calculation, orientation, and alert/sedation scales. Group PD showed stable hemodynamic responses at CO2 inflation, initial 15 minutes of operation, and recovery from general anesthesia as compared with group P. There is no significant difference between the groups in operation time and anesthesia time, perioperative psychomotor functional tests, postoperative vomiting, and pain score. Based on our findings, the anesthetic technique combination propofol and desflurane for the maintenance of general anesthesia for laparoscopic cholecystectomy provided more stable hemodynamic responses than propofol alone. The combined regimen is recommended for patients undergoing laparoscopic cholecystectomy.

Keywords: Desflurane; Laparoscopic cholecystectomy; Propofol; Target-controlled infusion.

Figure 1

Flowcharts of patients undergoing laparoscopic cholecystectomy allocated either group PD or group P. TCI = target‐controlled infusion.

Figure 2

Hemodynamic responses to various stimuli during peri‐anesthesia period. Group PD presents mean arterial pressure and heart rate more stable than group P at time intervals of PoC, Op5, Op10, Op15, Ce2, and stop‐P, respectively. Ce2 = effect‐site concentrations of propofol back to 2; HR = heart rate (beats/min); MAP = mean arterial pressure (mmHg); Op5 to Op35 = operation time every 5 minutes to 35 minutes; PC = pre‐CO₂ insufflation; PI = pre‐intubation as baseline; PoC = post‐CO₂ insufflation; PoI = post‐intubation; Rendo = remove endotracheal tube; Rt = remove trocar; SB = spontaneous breathing; stop‐P = stop propofol target‐controlled infusion.