Two common general anaesthetic methods are total i.v. anaesthesia (TIVA) and inhalation anaesthesia, but it is unclear whether this affects the patient's perception of their quality of recovery. The Quality of Recovery-40 questionnaire (QoR-40) is a valid and reliable method to evaluate the extent of functional recovery after surgery with general anaesthesia. This study therefore compared patient recovery using the QoR-40 in surgical patients who received TIVA with those who received desflurane anaesthesia. Eighty females (20–65 years old) undergoing thyroid surgery were prospectively recruited and randomized to either the TIVA (effect-site target controlled infusion using propofol and remifentanil) or DES (desflurane inhalation with manual infusion of remifentanil) groups. The QoR-40 was administered by an investigator blind to group allocation before surgery, and postoperative days 1 and 2 (POD1 and POD2). Additional data including the incidence of nausea or vomiting, the consumption of antiemetic and analgesic agents in the post-anaesthesia care unit, and the duration of the hospital stay, were collected in all cases. The QoR-40 score on POD1 was significantly higher in the TIVA group compared with the DES group (174 vs 161, respectively; P=0.004), indicating a better quality of recovery in the TIVA group. Among the five dimensions of the QoR-40, physical comfort and physical independence were significantly better on POD1 and POD2 in the TIVA group. This study demonstrates that the quality of recovery for female thyroid surgery patients is significantly better with TIVA compared with desflurane anaesthesia. www.clinicaltrials.org; ref.: NCT01760018.

Purpose: The purpose of this study was to assess the extent of the increased intracranial pressure (ICP) resulting from CO₂ pneumoperitoneum and steep Trendelenburg positioning using ultrasonographic measurement of optic nerve sheath diameter (ONSD) in patients undergoing robot-assisted laparoscopic radical prostatectomy (RALRP). Patients and Methods: Twenty patients who underwent elective RALRP were enrolled in this study. ONSD and regional cerebral oxygen saturation (rSO₂) were investigated noninvasively using ocular ultrasonography and near-infrared spectroscopy before anesthesia (T0), 10 minutes after anesthesia induction in the supine position (T1), 10 and 30 minutes after CO₂ pneumoperitoneum with 30-degree Trendelenburg positioning (T2 and T3), and after returning to supine position without CO₂ pneumoperitoneum at the conclusion of the RALRP (T4). Results: The mean values of ONSD at all time points (T1, T2, T3, and T4) after general anesthesia significantly increased compared with that before general anesthesia (T0). During CO₂ pneumoperitoneum with 30-degree Trendelenburg positioning (T2, T3), a significant increase of 12.5% in ONSD was observed in comparison with ONSD after anesthesia induction in the supine position without CO₂ pneumoperitoneum (T1). Three patients had an ONSD value equivalent to an ICP above 20 mm Hg, and these patients did not experience a decrease of rSO₂ or any neurologic complications. Conclusions: In patients undergoing RALRP, the increase of 12.5% in ONSD during CO₂ pneumoperitoneum with steep Trendelenburg positioning was observed and thus the increase of ICP corresponding to this change of ONSD could be predicted. In 15% of the enrolled patients, ONSD increased by values equivalent to an ICP above 20 mm Hg without a deterioration of rSO₂ or any neurologic complications.

Propofol and fentanyl can be administered at the end of sevoflurane anaesthesia to decrease the incidence and severity of emergence agitation (EA), although it has not been determined which agent has superior efficacy. The purpose of this study was to compare the effects of propofol and fentanyl on EA. In this prospective, randomized, double-blind study, 222 children, 18–72 months of age, undergoing sevoflurane anaesthesia were randomly assigned to one of the three groups receiving either propofol 1 mg kg⁻¹ (Group P), fentanyl 1 µg kg⁻¹ (Group F), or saline (Group S) at the end of anaesthesia. The incidence and severity of EA were evaluated with the paediatric anaesthesia emergence delirium (PAED) scale. Time to recovery and incidence of nausea/vomiting were assessed. The mean PAED score was 4.3 in Group P and 4.9 in Group F (P=0.682), which were lower than 9.0 in Group S (P<0.001). Nausea and vomiting were significantly more frequent in Group F than Groups P and S (adjusted P=0.003 and adjusted P<0.001). Group F had also longer stay in the post-anaesthesia care unit (PACU) than Group S (P<0.001), while Group P did not. However, the differences in PACU stays between the P and F groups were considered clinically insignificant. Small doses of propofol or fentanyl at the end of sevoflurane anaesthesia comparably reduced EA. Propofol was better than fentanyl due to a lower incidence of nausea and vomiting.

Lee JR. Korean J Anesthesiol. 2014 Jan;66(1):3-11. http://dx.doi.org/10.4097/kjae.2014.66.1.3

The administration of short-acting opioids can be a reliable and safe method to prevent coughing during emergence from anaesthesia but the proper dose or effect site concentration of remifentanil for this purpose has not been reported. We therefore investigated the effect site concentration (Ce) of remifentanil for preventing cough during emergence from anaesthesia with propofol–remifentanil target-controlled infusion. Twenty-three ASA I–II grade female patients, aged 23–66 yr undergoing elective thyroidectomy were enrolled in this study. EC₅₀ and EC₉₅ of remifentanil for preventing cough were determined using Dixon's up-and-down method and probit analysis. Propofol effect site concentration at extubation, mean arterial pressure, and heart rate (HR) were compared in patients with smooth emergence and without smooth emergence. Three out of 11 patients with remifentanil Ce of 1.5 ng ml⁻¹ and all seven patients with Ce of 2.0 ng ml⁻¹ did not cough during emergence; the EC₅₀ of remifentanil that suppressed coughing was 1.46 ng ml⁻¹ by Dixon's up-and-down method, and EC₉₅ was 2.14 ng ml⁻¹ by probit analysis. Effect site concentration of propofol at awakening was similar in patients with a smooth emergence and those without smooth emergence, but HR and arterial pressure were higher in those who coughed during emergence. Clinically significant hypoventilation was not seen in any patient. We found that the EC₉₅ of effect site concentration of remifentanil to suppress coughing at emergence from anaesthesia was 2.14 ng ml⁻¹. Maintaining an established Ce of remifentanil is a reliable method of abolishing cough and thereby targeting smooth emergence from anaesthesia.