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Anesthetic Pharmacology
Anesthesia and Pain Medicine 2008;3(3):172-177.
Published online July 30, 2008.
Comparison of Hemodynamic Responses and Postoperative Courses between Sevoflurane-Remifentanil Anesthesia and Sevoflurane-Nitrous Oxide Anesthesia for Gynecologic Surgery
Hee Yeon Park, Il Soon Son, Sang Hwan Do
1Department of Anesthesiology and Pain Medicine, Gil Medical Center, Gachon University of Medicine and Sicence, Incheon, Korea.
2Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul, Korea.
This study was designed to compare hemodynamic responses and postoperative courses between sevoflurane-remifentanil and sevoflurane-nitrous oxide anesthesia. METHODS: Forty ASA I or II patients undergoing gynecologic surgery were randomly assigned to receive sevoflurane-remifentanil (group R) or sevoflurane-nitrous oxide group (group N). In group R, remifentanil was continuously infused by using target-controlled infusion pump from anesthetic induction (effect-site target concentration: 4 ng/ml) to the end of surgery (1-5 ng/ml). In group N, fentanyl (2microg/kg) was administered before tracheal intubation and 50% N2O was used during anesthesia. In both groups, 2 vol% sevoflurane was used during anesthetic induction and then end-tidal sevoflurane concentrations were controlled between 1 to 3 vol% according to systolic blood pressure. We compared blood pressure (BP) and heart rate (HR) before and after tracheal intubation and frequencies of hemodynamic aberrations between the two groups. Postoperative nausea/vomiting, sedation, pain scores at 2 and 24 hours after operation were also compared. RESULTS: Changes of BP and HR after tracheal intubation were similar in group R and group N, but MAP at 1 and 2 min after intubation was significantly decreased versus baseline MAP in group N. Intraoperative hypertensive episodes (systolic BP > 140 mmHg) were more frequent in group N compared to group R, and hypotensive episodes (SBP < 90 mm Hg) were similar in both groups. There were no differences in postoperative nausea/vomiting, sedation and pain scores. CONCLUSIONS: Sevoflurane/remifentanil anesthesia provided more stable intraoperative hemodynamic status than sevoflurane/N2O and postoperative adverse effects were similar in both groups.
Key Words: nitrous oxide, remifentanil, sevoflurane

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