Propofol-based anesthesia as compared with standard anesthetic techniques for middle ear surgery

Study Objective: To determine if a total intravenous (IV) technique with propofol and fentanyl is superior to isoflurane anesthesia in patients undergoing middle ear surgery. Design:Prospective, randomized study. Setting: Inpatient Otolaryngology service at a university medical center. Patients: 102 ASA status I and II nonobese patients with no significant history of diabetes, chronic cholecystitis, neuropathy, or neuromuscular disorders that could produce delayed gastric emptying. Interventions: Patients were admitted to the study and randomly divided into three equal groups. IV administration of thiopental sodium 5 mg/kg for induction of anesthesia followed by 60% air/oxygen (O 2) with isoflurane 1% to 2% end-tidal for maintenance anesthesia (group 1). The same anesthetic was given as above, with the addition of droperidol 25 mcg/kg given after induction (group 2). IV administration of propofol 2 mg/kg for induction of anesthesia followed by propofol 50 to 250 mcg/kg/min for maintenance anesthesia. All groups received fentanyl 3 mcg/kg IV after induction. Measurements and Main Results: Surgical duration, induction, maintenance, and total anesthesia times were recorded in addition to eye opening and extubation. Intergroup comparisons of postoperative nausea, vomiting, and pain were done, as were recovery scores using the Steward system. Patients receiving propofol had significantly less nausea than those receiving isoflurane only (4 of 34 versus 12 of 34, p < 0.05) as well as vomiting (2 of 34 versus 8 of 34, p < 0.05). Immediate recovery scores were significantly better for propofol compared with the isoflurane/droperidol group. Recovery at 30 minutes was also faster with propofol compared with isoflurane or isoflurane/ droperidol (5.1 ± 0.1 min versus 5.1 ± 0.2 min and 5.2 ± 0.2 mm, p < 0.05). Conclusions: Propofol-fentanyl seems to be a better anesthetic than isoflurane-fentanyl in reducing the incidence of nausea and vomiting after middle ear surgery. Though the addition of droperidol to the isoflurane anesthetic seemed as effective, emergence from anesthesia was slower. For middle ear surgeries producing emesis, propofol-based anesthetics produced a rapid emergence with less nausea and vomiting.