Anestesia venosa total com remifentanil-propofol e anestesia balanceada com remifentanil-desflurano guiadas pela monitorização do índice bispectral (bis): comparação da recuperação anestésica em pacientes submetidas à cirurgia de mama

Abstract

There is a strong demand for fast anesthesia recovery, which provides safe and predictable anesthesia emergence with few side effects. Anesthesia technique and the choice of a primary hypnotic could impact on that. However, little is known about the differences between the post-operative recovery from remifentanil-propofol and remifentanil-desflurane anesthesia guided by BIS bispectral index monitoring.Forty patients were randomly distributed into 2 groups whose anesthesia techniques were based on remifentanil-propofol (REM-PRO group) or remifentanil-desflurane (REM-DES group). After anesthetic discontinuation, emergency time, to extubate and to restore protective airway reflex were measured. Side effects, postoperative nausea and vomiting (PONV) incidents, Ramsay sedation scale score, Numeric Pain Scale (NPS) score, post-operative morphine dose and stay length at the post-anesthetic care unit (PACU) were recorded. Data from 38 patients were analyzed, 18 from REM-PRO and 20 from REM-DES group. REM-DES group had shorter times than REM-PRO group for mean emergency time (5.6 minutes; SD 2.5 vs 8.5 minutes; SD 3.0), median extubation time (6.2 minutes; minimum 4.9, maximum 14.4 vs 9.5 minutes.; minimum 3.1, maximum 18.5). Time to recover airway protective reflex were similar between the groups. Side effects, Ramsay sedation scale score, NPS, PONV incidents, doses of morphine and stay length at the PACU were similar between the groups.Remifentanil-desflurane-based anesthesia guided by BIS ® monitoring has a faster anesthesia recovery profile than remifentanil-propofol-based anesthesia guided by BIS ®.