Target‐controlled propofol vs. sevoflurane: a double‐blind, randomised comparison in day‐case anaesthesia

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Abstract
We compared target‐controlled propofol with sevoflurane in a randomised, double‐blind study in 61 day‐case patients. Anaesthesia was induced with a propofol target of 8 μg.ml−1 or 8% sevoflurane, reduced to 4 μg.ml−1 and 3%, respectively, after laryngeal mask insertion and subsequently titrated to clinical signs. Mean (SD) times to unconsciousness and laryngeal mask insertion were significantly shorter with propofol [50 (9) s and 116 (33) s, respectively] than with sevoflurane [73 (14) s and 146 (29) s; p < 0.0001 and p = 0.0003, respectively]; however, these differences were not apparent to the blinded observer. Propofol was associated with a higher incidence of intra‐operative movement (55 vs. 10%; p = 0.0003), necessitating more adjustments to the delivered anaesthetic. Emergence was faster after sevoflurane [5.3 (2.2) min vs. 7.1 (3.7) min; p = 0.027], but the inhaled anaesthetic was associated with more nausea and vomiting (30 vs. 3%; p = 0.006), which delayed discharge [258 (102) min vs. 193 (68) min; p = 0.005]. Direct costs were lower with sevoflurane but nausea would have increased indirect costs. Patient satisfaction was high (≥ 90%) with both techniques. In conclusion, both techniques had advantages and disadvantages for day‐case anaesthesia.