Clinical comparison of ‘single agent’ anaesthesia with sevoflurane versus target controlled infusion of propofol

The introduction of total intravenous anaesthesia (TIVA) and the use of volatile induction/maintenance anaesthesia (VIMA) has led to the rediscovery of ‘single agent’ anaesthesia, eliminating the transition phase from induction to maintenance. We compared quality, patient acceptability and cost of TIVA using target control infusion (TCI) with propofol and VIMA with sevoflurane. Forty patients undergoing spinal surgery of 1–3 h were assigned to one of two groups. Group I received propofol–air–oxygen for induction followed by propofol–air–oxygen for maintenance. Group II received 8% sevoflurane–oxygen for induction and sevoflurane–oxygen–nitrous oxide for maintenance. Propofol had a significantly faster mean (sd) induction time (67 (20) s) than sevoflurane (97 (38) s) but was associated with double the incidence of involuntary movements. Although not significant, twice the number of interventions by the anaesthetist were required to maintain an adequate level of anaesthesia in the sevoflurane group. Emergence times, characteristics, postoperative nausea, vomiting and pain were unaffected by the anaesthetic technique. However, a more predictable emergence time was found following sevoflurane. Cardiovascular stability was good and comparable in both groups. The majority of patients found either technique acceptable and would choose the same anaesthetic again. Induction and maintenance was substantially cheaper with sevoflurane (£28.06) compared with propofol (£41.43).