Srovnání anestezie sevofluranem, propofolem a thiopentalem pro malégynekologické výkony

Comparison of Sevoflurane, Propofol and Thiopental for Minor Gynecologic Procedures

In a prospective randomized study we evaluated the advantages of sevoflurane anesthesia to propofol or thiopental anesthesia in 67 patientsscheduled for day-case minor gynecologic procedures. After premedication with alfentanil 0,25–0,5 mg plus atropine 0,5 mg plus droperidol 1,25 mg,anesthesia was induced with sevoflurane (group S, n = 21) using singlebreath technique; anesthesia was maintained with the mixture of sevofluranein nitrous oxide/oxygen mixture. In the group P (n = 23) anesthesia was induced with propofol 2–2,5 mg/kg and maintained with supplementary dosesof 20–30 mgs of propofol; group T (n = 23) was induced with thiopental and maintained with supplemetary doses of 50–100 mg of thiopental. Patientsin group P and T were ventilated with a mixture of nitrous oxide and oxygen. We assessed the onset of induction and time to recovery, smoothiness ofinduction, balance of anesthesia, side effects (circulatory, ventilatory, postoperative depression of consciousness, postoperative nausea and vomiting),time to spontaneous mobilization, time to fluid intake and micturition, time to hospital discharge, global final evaluation by the patient, anesthesiologists,gynecologists and the cost of anesthesia.Results: both groups of intravenous anesthesia had more rapid induction (p < 0,001: S 69,5 sec, P 26,3 sec, T 27,9 sec), the fastest recovery was ingroup P (p < 0,01: S 108,1 sec, P 44,6 sec, T 121 sec). We did not observe negative effects on hemodynamics. In all groups of patients there was a needto support the ventilation manually, most frequently in propofol group (p < 0,05). Only in group S there was observed a mild airway spasm. Patientsin group S were most prone for movements during anesthesia (p < 0,05). In the postoperative course, sleepiness was most pronounced in group T (p< 0,001). Spontaneous mobilization was fastest in P (p < 0,05); there was not a difference in other parameters. There were not differences betweengroups in time to hospital dicharge which is based upon organizational aspects of day case surgery in the Department of Gynecology. Decrease inuterine tonus and increased blood loss was observed in S (p < 0,001); this method of anesthesia was refused by gynecologists. According to subjectiveassessment by patients, S protocol was considered worse (p < 0,05). Thiopental was evaluated worse by anesthesiologists (p < 0,001) for somnolenceafter operation. Thiopental anesthesia is cheapest compared to other protocols (p < 0,001; S 333 Czech crowns (CZK), P 255 CZK, T 31 CZK). Inconclusion, sevoflurane appears to be absolutely unsuitable for minor gynecologic procedures due to increased blood losses. The advantage of propofolcould be seen in better recovery of psychomotoric functions, while the advantage of thiopental anesthesia lies in its low cost.

Key words:
minor gynecologic procedures – out-patient anesthesia – sevoflurane – propofol – thiopental