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GENERAL ARTICLES

Onset Time, Recovery Duration, and Drug Cost with Four Different Methods of Inducing General Anesthesia

Edith Fleischmann, MD^*,, Ozan Akça, MD^*,, Thomas Wallner, MD^*,, Cem F. Arkiliç, MD^*,, Andrea Kurz, MD^*,, Randy S. Hickle, MD^,§, Michael Zimpfer, MD^*,, and Daniel I. Sessler, MD^*,,||

Department of Anesthesia and General Intensive Care ( *A) and ( B), and Outcomes Research^TM, University of Vienna; §Apotheus Laboratories, Ltd., Lubbock, Texas; ||Department of Anesthesia, University of California-San Francisco, San Francisco, California; and ||Ludwig Boltzmann Institute for Clinical Anesthesia and Intensive Care, Vienna, Austria

Address correspondence to Dr. Ozan Akça, Department of Anesthesia and General Intensive Care (A), University of Vienna, Währinger-Gürtel 18–20, A-1090 Vienna, Austria. Address e-mail to 73674.63{at}CompuServe.com

We compared two conventional induction techniques (thiopental and propofol), an inhaled induction with sevoflurane using a circle system, and a rebreathing method. Fentanyl 1 µg/kg was given to women undergoing 10- to 20-min procedures. Anesthesia was induced (n = 20 each) with one of the following: 1) sevoflurane and N₂O from a rebreathing bag (Sevo/Bag). A 5-L bag was prefilled with a mixture of sevoflurane 7% and N₂O 60% in oxygen. The bag was connected between the normal circle system, separated by a spring-loaded valve; 2)sevoflurane 8% and N₂O 60% from a circle system on a conventional anesthesia machine with a total fresh gas flow of 6 L/min (Sevo/Circle); 3) propofol 3 mg/kg as an IV bolus; 4) thiopental sodium 5 mg/kg as an IV bolus. Postoperative nausea and vomiting was treated with ondansetron. Induction times were comparable with each method. Recovery duration was shortest with sevoflurane, intermediate with propofol, and longest with thiopental. Induction drug costs were lowest with Sevo/Bag and thiopental, intermediate with Sevo/Circle, and highest with propofol. However, sevoflurane (by either method) caused considerable nausea and vomiting that required treatment. Consequently, total drug cost was least with thiopental, intermediate with Sevo/Bag and propofol, and greatest with Sevo/Circle. Thus, no single technique was clearly superior.

Implications: Anesthetic induction techniques influence awakening time, recovery duration, and drug costs. We tested two IV methods and two inhaled techniques. However, none of the four tested methods was clearly superior to the others.

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