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VOLATILE INDUCTION AND MAINTENANCE OF ANESTHESIA (VIMA), VERSUS CONVENTIONAL APPROACH IN AMBULATORY ANESTHESIA

^* Department of Anesthesia, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario M5T 2S8, Brigham and
⁺ Women's Hospital, Harvard Medical School, Boston, Abbott Laboratories, Montreal

INTRODUCTION

The availability of rapid and shorter acting volatile and intravenous anesthetic agents facilitates early recovery in the ambulatory setting.1 Volatile induction and maintenance of anesthesia (VIMA), facilitates anesthesia without the need for intravenous (IV) drugs for induction and intubation. The objective of the study is to compare the efficacy of VIMA versus conventional IV induction, in ambulatory gynecology patients.

METHODS

With institutional approval and written informed consent, 64 patients were randomized to receive either 8% sevoflurane in 75% N2O/O2, volatile induction and maintenance of anesthesia (VIMA n=31) or intravenous induction with propofol 2-25 mg/kg, fentanyl 2 mg/kg (propofol n=33). Intubation in propofol group was facilitated by mivacurium 0.2 mg/kg. Anesthesia was maintained in both groups with 1-3% sevoflurane in 50% N2O/O2. All patients received ketorolac 30 mg IV and metoclopamide 10 mg IV. Propofol group received neostigmine/glycopyrrolate reversal. Psychomotor function tests, sedation score (Ramsay), Digital substitution test, pain score (100 mm VAS), nausea score (100 mm VAS) and Memory skill (picture card) were done preop. Adverse events of induction and intubation, including ease of intubation and light anesthesia were noted. Assessment of recovery of anesthesia was based on time to milestones, nausea score and psychomotor tests.

RESULTS

Baseline demographics and psychomotor function tests in both groups were similar. Induction and intubation side effects were similar in each group. Incidence of adverse anesthesia events, pain, nausea and sedation VAS were similar.

VIMA with sevoflurane is an acceptable alternative to conventional intravenous propofol induction and volatile maintenance in patients undergoing ambulatory surgery. There is no difference in recovery profile and side effects between the two induction techniques.

REFERENCE

1 BK Philip, LL Lombard, ER Roaf, LR Drager, I Calalang, JH Philip. Comparison of vital capacity induction with sevoflurane to intravenous induction with propofol for adult ambulatory anesthesia. Anesth Analg 1999; 89:623–7.[Abstract/Free Full Text]

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