Sevoflurane/propofol coadministration provides better recovery than sevoflurane in combined general/epidural anesthesia: a randomized clinical trial

A classic general anesthesia is performed by induction with an intravenous hypnotic (such as propofol) and maintenance with a volatile anesthetic (such as sevoflurane). The aim of the present study was to compare the effects of a propofol/sevoflurane maintenance regimen with that of a sevoflurane regimen on recovery profiles. One hundred and sixty patients, who were ASA 1 or 2, 45-65 years of age, and scheduled for elective gastrointestinal surgery under combined general/epidural anesthesia, were allocated randomly to receive the sevoflurane maintenance regimen (group S, n = 80) or sevoflurane/propofol regimen (group SP, n = 80). After induction, anesthesia was maintained with sevoflurane in group S and sevoflurane with propofol (1.2 mu g/ml target plasma concentration) in group SP. Bispectral index (BIS) values were maintained within 40-60 during the maintenance. Time to extubation, incidence of serious coughing and agitation, and other recovery characteristics were evaluated during emergence. The time to awakening and extubation in group SP were 7.2 +/- A 2 min and 8.0 +/- A 1.8 min, respectively, which were shorter than those results in group S (12.3 +/- A 1.5 and 12.8 +/- A 1.6 min, respectively) (P < 0.05). The incidence of serious coughing and agitation in SP (30 % and 25 %) was lower than that of group S (68 % and 53 %) (P < 0.05). BIS value, pain score, requirements of analgesics and antiemetics in the PACU, and length of stay in the PACU were similar in the two groups. Compared to sevoflurane maintenance, coadministration of propofol and sevoflurane provides faster awakening and extubation with a low incidence of emergence coughing and agitation.