A Comparision Of The Anesthesia Maintenance And Recovery With Difference Anesthetic Regiment For Minor Surgeries

Objective: For the minor surgeries or day surgeries, it is important to have a fast recovery from general anesthesia. A number of regiments which combines sedatives with narcotics might be useful for this purpose. To explore the best combinations, this study observed the anesthesia maintenance and recovery of different regiments based with fentanyl, remifentanil or both of them···Methods: About 102 patients with ASA I and II undergoing knee arthroscopy were included in this study and they were randomly assigned into 6 groups. All patiens were induced with midazolam and propofol followed by LMA placement. Anesthesia was maintained by various regiments in different groups. In remifentanil-based group, remifentanil (1μg/kg) was administered followed by remifentanil 0.2μg/kg/min infusion when it combined with isoflurance or propofol. In fentanyl-based group, fentanyl (1μg/kg) was administered after induction and prior skin incision respectively when it combined with isoflurance. Fentanyl (1μg/kg) was administer after induction and 2μg/kg prior skin incision when it combined with propofol. In remifentanil-fentanyl-based group, fentanyl (1μg/kg) was administered afterinduction and followed by remifentanil (lug/kg) prior skin incision and then remifenatnil (0.1 ug/kg/min) i nfusion w hen i t c ombined w ith i soflurance o r with a infusion rate of remifenail of O.lug/kg/min infusion when it combined with propofol. No muscle relaxants were used in any groups. Patents' behavior responses to skin incision n Heart rate n mean arterial pressure(MAP) and respiratory depressions were observed as well as the speed of anesthesia recovery. Patients' awareness during anesthesia was investigated following the surgery.Results: Behavioral responses were seen in 11.8% of patients in fentanyl-isoflurance group and 5.9% in fentanyl-propofol group during skin incision but there were no patients showed behavioral responses in remifentanil-based group and remifentanil-fentanyl based group. The absolutely MAP or heart rate deviation from the base-line values were much higher in remifentanil-isoflurance group than that in remifentanil-propofol group (/><0.05). The time from the termination of anesthesia to LAM withdraw and full awakeness in remifentanil-isoflurance group was significantly longer than that of in remifentanil-propofol group (8.4min vs 5.8min, 10.6min vs 6.9min, PO.05). There was no difference in the recovery speed between the fentanyl-isoflurance combined group and fentanyl-propofol combined group, and between the remifentanil-fentanyl-isoflurance combined group andremifentanil-fentanyl-propofol combined group. There was a significant respiratory depression in all groups and it was 91.2% in remifentanil-based, 38.2% in fentanyl-based and 70.6% in remifentanil-fentanyl group (PO.05). There was no awareness in all patients. No significant differences were foundin postoperative nausea and vomiting among the groups. Conclusion: Although 6 anesthesia regiments that we have made for the minor surgeries shows a fast recovery, the anesthesia effects in remifentanil group and remifenanil-fentanyl are stronger than fentanyl-based regments. The hemodynamics with remifentanil combined with propofol is more stable than those with remifentanil and isoflurance, and the recovery speed of the former is faster than the later.