Comparison of Total Intravenous Anesthesia with Volatile Induction Maintenance Anesthesia at a Tertiary Care Hospital in Karachi Paksitan

.. Objectives: The aim of our study which is to compare total intravenous anesthesia with target controlled infusion using the drugs Propofol and remifenatnil with the techniques of volatile induction maintenance anesthesia using sevoflurane and sufentanil in patients undergoing laparoscopic cholecystectomy procedure, at a tertiary care hospital in Karachi, Pakistan. Study Design: The type of study is a randomized control trial, conducted for a period of 8 months Period: from June 2015 to January 2016 Setting: at a tertiary care hospital in Karachi Pakistan. Method: The patient population consisted of n=100 patients belonging to the ASA class I and II and undergoing laparoscopic cholecystectomy procedure at our institute. The patients were divided into two groups group A consisted of all those patients who underwent total intravenous anesthesia and group B consisted of patients who underwent volatile induction maintenance anesthesia. Appropriate blinding measures were taken for those who were involved in the post-operative care of the patients, and the patients themselves. During the procedure routine monitoring was done, data was recorded in a pre-designed proforma. Patients were analyzed in the post-operative period for side effects and pain levels. Statistical analysis was done using SPSS version 23, a p value of less than 0.05 was considered to be statistically significant. Results: The patient population consisted of n= 100 patients divided into two groups. No statistically significant difference was found between the demographic variables of the patients of both groups (age, weight, baseline values of blood pressure, heart rate, time duration of surgery and anesthesia). The time for the loss of corneal reflex was longer in the group A (109 +/90) as compared to group B (45 +/10) having a p value of less than 0.001. However the time for opening of the eyes and the duration of post anesthesia care unit was shorter in group A (420 +/130 seconds for eye opening and 45 +/15 min for PACU) and in group B (484 +/116 seconds for eye opening and 53 +/25 mins for PACU) having p values of 0.006 (eye opening) and 0.017 (PACU) respectively. In group A n= 44 (88%) of the patients required rescue analgesia, and in group B n= 36 (72%) of the patients required it, having a p value of 0.013 respectively. The need for the use of ephedrine and atropine in the pre and port operative period was similar in both the groups. Conclusion: According to the results of our study we found that each method of anesthesia has its own advantages and disadvantages and the anesthetist present should weigh the risks and benefits for each patient individually, and use the most beneficial method of administration of anesthesia in the patient undergoing laparoscopic cholecystectomy procedure, accordingly.