Comparison of sevoflurane and propofol for ambulatory anaesthesia in gynaecological surgery.

PURPOSE: To analyse the cost-efficiency ratio of sevoflurane compared with propofol for gynaecological ambulatory anaesthesia.

METHODS: In a prospective randomised study 52 ASA I patients scheduled for ambulatory pregnancy termination were premedicated with lorazepam and received alfentanil prior to anaesthesia induction with propofol (group P, n = 26) or with sevoflurane 8% (group S, n = 26) using the single breath vital capacity technique. Anaesthesia was maintained with N2O in both groups supplemented with sevoflurane (group S) or propofol boluses (group P).

RESULTS: The quality of induction and maintenance of anaesthesia was similar between groups except for the incidence of movement during anaesthesia (14/26 patients in group P and 4/26 in group S, P < 0.05). The incidence of post-operative emesis was increased in the sevoflurane group (P < 0.05) but the patients felt able to perform normal activity after a similar delay (18.4 +/- 2.9 hr vs 20.6 +/- 2.8 hr, P > 0.05). The direct cost of anaesthesia was lower in the sevoflurane group (679 FF, n = 24 vs 1153 FF, n = 2-5 in propofol group) but the weight of uterine aspiration products was higher (293 +/- 66 g, median = 230 g, Range 110-800 g, n = 13 vs 108 +/- 8 g, median = 110 g, Range 60-160 g, n = 12, group S vs group P respectively, P = 0.004). Four patients needed reoperation and ambulatory anaesthesia failed in six patients because of uterine haemorrhage.

CONCLUSION: Ambulatory anaesthesia with sevoflurane offers a good alternative to propofol but further investigation concerning blood loss with sevoflurane needs to be performed in gynaecological practice.