CHOLECYSTECTOMY;

COMPARISON OF TOTAL INTRAVENOUS ANESTHESIA WITH VOLATILE INDUCTION MAINTENANCE ANESTHESIA AT A TERTIARY CARE HOSPITAL IN KARACHI PAKSITAN

Abstract

Objectives: The aim of our study which is to compare total intravenous
anesthesia with target controlled infusion using the drugs Propofol and remifenatnil with the
techniques of volatile induction maintenance anesthesia using sevoflurane and sufentanil in
patients undergoing laparoscopic cholecystectomy procedure, at a tertiary care hospital in
Karachi, Pakistan. Study Design: The type of study is a randomized control trial, conducted
for a period of 8 months Period: from June 2015 to January 2016 Setting: at a tertiary care
hospital in Karachi Pakistan. Method: The patient population consisted of n=100 patients
belonging to the ASA class I and II and undergoing laparoscopic cholecystectomy procedure at
our institute. The patients were divided into two groups group A consisted of all those patients
who underwent total intravenous anesthesia and group B consisted of patients who underwent
volatile induction maintenance anesthesia. Appropriate blinding measures were taken for those
who were involved in the post-operative care of the patients, and the patients themselves. During
the procedure routine monitoring was done, data was recorded in a pre-designed proforma.
Patients were analyzed in the post-operative period for side effects and pain levels. Statistical
analysis was done using SPSS version 23, a p value of less than 0.05 was considered to be
statistically significant. Results: The patient population consisted of n= 100 patients divided
into two groups. No statistically significant difference was found between the demographic
variables of the patients of both groups (age, weight, baseline values of blood pressure, heart
rate, time duration of surgery and anesthesia). The time for the loss of corneal reflex was longer
in the group A (109 +/- 90) as compared to group B (45 +/- 10) having a p value of less than
0.001. However the time for opening of the eyes and the duration of post anesthesia care unit
was shorter in group A (420 +/- 130 seconds for eye opening and 45 +/- 15 min for PACU) and
in group B (484 +/- 116 seconds for eye opening and 53 +/- 25 mins for PACU) having p values
of 0.006 (eye opening) and 0.017 (PACU) respectively. In group A n= 44 (88%) of the patients
required rescue analgesia, and in group B n= 36 (72%) of the patients required it, having a p
value of 0.013 respectively. The need for the use of ephedrine and atropine in the pre and port
operative period was similar in both the groups. Conclusion: According to the results of our
study we found that each method of anesthesia has its own advantages and disadvantages
and the anesthetist present should weigh the risks and benefits for each patient individually,
and use the most beneficial method of administration of anesthesia in the patient undergoing
laparoscopic cholecystectomy procedure, accordingly.