Propofol/Remifentanil Vs Desflurane/Fentanyl in Open Hemicolectomy Surgery

In a prospective, randomized, parallel-group study the aim was to compare TIVA (total intravenous anesthesia) with propofol / remifentanil and anesthesia with desflurane / fentanyl in open hemicolectomy surgery. 10 patients were randomly assigned each group. The primary endpoint hemodynamic stability was evaluated as number of dose-adjustments due to responses to surgery (hypertension, tachycardia, somatic or autonomic responses). Catecholamine levels, recovery times after anesthesia, postoperative variables and costs were also evaluated. There were no significant differences between the two groups in number of dose-adjustment due to responses to surgery (P = 0.88). One min after skin incision arterial noradrenaline levels were 59 ± 14 pg/ml in the TIVA-group and 262 ± 87 pg / ml in the desflurane-group (P < 0.01). Corresponding adrenaline levels were 16 ± 3 and 38 ± 12 pg/ml (P < 0.05), respectively. Recovery times after anesthesia were not significantly different between the two groups. In the TIVA-group we found significant increased use of opioids (P = 0.034), a trend towards increased use of epidural analgesia (P = 0.06) and about 30% higher costs (P = 0.03). We conclude that hemodynamic stability is not different between the two types of anesthesia in patients undergoing open hemicolectomy. TIVA reduces catecholamine levels and increases postoperative analgesic demands and costs.