| Objective: The clinical efficacy, recovery characteristics, and costs of total intravenous anesthesia(TIVA) and sevoflurane anesthesia have been measured, but have not been evaluated between Target controlled infusion(TCI) of propofol-remifentanil and sevoflurane.In this prospective randomized study, we compared the quality of anesthesia induction, recovery, hemodynamics, patients' acceptability and cost in patients scheduled for laparoscopic cholecystectomy surgery receiving either TCI of propofol-remifentanil or induction/maintenance with sevoflurane (VIMA) anesthesia.Methods: After regional ethical committee approval. One hundred and twenty unpremedicated patients (ASA status I - II ,age of 18-65 years) undergoing elective laparoscopic cholecystectomy were randomly divided into two groups: Group T(n=60) and Group S(n=60). In Group T, anesthesia was induced with propofol-remifentanil TCI. The effect-site target concentration of propofol and remifentanil were set at 3ug/ml and 6ng/ml during induction and maintained with 2～3ug/ml and 2～6ng/ml, respectively. In Group S, anesthesia was induced with 8% sevoflurane in fresh gas flow(FGF) with 10 L.min-1 (50% nitrous oxide) by vital capacity breath and maintained with 1.3～2.2% sevoflure in FGF 2L.min-1 ( 50% nitrous oxide). The following variables were recorded and compared between the two groups: (1) The changings in MAP and HR during induction .(2) The times of Lossing the lid-lash reflex, openning eyes, tracheal extubation and the duration of stay in postanesthesia care unit (PACU). (3) OAAS socres and cognitive outcome after operation. (4) The number of patients needs pain control in the PACU. (5) Perioperative complications. (6) Costs in two groups. (7)Patients' acceptability.Results: (1) The haemodynamics changes were similar during induction in two groups, but more patients need the antihypertension drug in Group S during the operation(10 vs 1,p=0.004). (2) The time of Lossing the lid-lash reflex was significantly longer in Group T (109±82″VS 44±11″, p=0.000). However,The time of openning the eyes was shorter in Group T (419±134″VS 483±117″, p=0.006) .The extubation time was comparable in two groups(462±129″VS 439±121″, p=0.317), However, the time stay in PACU was shorter in Group T (44±15′VS 53±24′, p=0.017). (3) The OAAS scores at extubation and 30min after extubation were significantly higher in group T than in Group S( p=0.000 and p=0.005). (4)The number of patients that need fentanyl for analgesia in PACU was more in T group (53 in Group T VS 42 in Group S, p=0.013).(5) Perioperative complications , the pain associated with propofol injection was found in 77% in group T, while the postoperative nausea and vomiting (PONV) was present in 20%(Group T) and 38%(Group S) of patients in PACU(p= 0.027).Other sides effects such as coughing ,laryngospasm, shivering, restlessness etc, were compareble (p>0.05). (6) The direct expense (459.7±125.3 RMB VS 240.2±53.9RMB, p=0.000) and total expense(570.3±159.7RMB VS 359.1±75.2RMB, p=0.000) were more expensive in Group T, while the indirect expense was no statistically significant(112.9±51RMB VS 122.4±38.9 RMB, p=0.252).(7) Each technique was acceptable by the majority of patients(97%) and they would choose the same anaesthetic again ,Otherwise, two patients dissatisfied with sevoflurane induction in Group S because of the phobia of suffocation when the oxygen mask was placed on the face.Conclusion: The induction of anesthesia with TCI of propofol-reminfentanil is more hemodynamically stable between two groups. The speed of induction is faster in sevoflurane inhalation group, while the recovery from the anesthesia with both group are comparable. However, the ecnomical expense is much expensive in TCI propofol-remifentanil group. But both method of anesthesia was acceptable, we will unable to demonstrate a clear patient benefit of using either of one.
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