Recovery characteristics, haemodynamic profile,
analgesic requirement and costs were evaluated and compared in patients undergoing elective lumbar
discectomy with
remifentanil-based anaesthesia using either
desflurane or
sevoflurane as the volatile anaesthetic agent. Sixty-two patients (ASA I/II status) were randomly assigned to receive either
desflurane and
remifentanil or
sevoflurane and
remifentanil (in
oxygen/air) for anaesthesia. After induction with 0.5 microgram/kg/min
remifentanil, 4 to 5 mg/kg
thiopentone and 0.5 mg/kg
atracurium, the patients received 0.25 microgram/kg/min
remifentanil and 0.5 +/- 0.05 MAC of one of the volatile anaesthetic agents for further maintenance of anaesthesia. At the end of surgery, early emergence from anaesthesia was recorded by assessing the time to sufficient spontaneous respiration, eye opening and tracheal extubation. The total demand of
piritramide in the postoperative period was determined using
patient-controlled analgesia (PCA device). Quality of
pain therapy was assessed via a verbal ranking scale (VRS). Side-effects such as
postoperative nausea,
vomiting or shivering were recorded in the postanaesthetic care unit. In both groups, the haemodynamic profile was nearly identical. Mean arterial pressure (-18%) and heart rate (-23%) were significantly reduced throughout anaesthesia in both groups. All recovery parameters were significantly shorter in the
desflurane group in comparison with the
sevoflurane group (e.g. time to tracheal extubation: 8.5 +/- 3.0 min vs. 11.9 +/- 4.6 min). No significant differences between the groups were observed concerning the amount of
piritramide required, side-effects such as
nausea and
vomiting or the total cost of anaesthesia. In conclusion, both anaesthetic techniques provide adequate haemodynamic stability and
postoperative pain control in a
surgical procedure with minimal
trauma. Incidence and severity of side-effects such as
nausea,
vomiting or shivering did not differ between the groups and were acceptable under clinical conditions. Costs for
desflurane were significantly higher than those for
sevoflurane, but total costs were not different between the groups. Concerning recovery profile,
desflurane/
remifentanil seems to have small advantages over
sevoflurane/
remifentanil in patients undergoing lumbar vertebral disc resection.