IOSR Journal of Dental and Medical Sciences (IOSR-JDMS)

e-ISSN: 2279-0853, p-ISSN: 2279-0861.Volume 16, Issue 8 Ver. IV(Aug. 2017), PP 73-77
www.iosrjournals.org

Comparison of Intraoperative Haemodynamic Parameters And

Cost Effectiveness Between Sevoflurane (Inhaltional) Anaesthesia
And Propofol (Tiva) Based Anaesthesia.
*Sahir Rasool1, Nandita Mehta2
1
(Deptt of Anaesthesiology & Critical care, ASCOMS, University of Jammu, India).
2
(Deptt of Anaesthesiology & Critical care, ASCOMS, University of Jammu, India).

Abstract
Background: Intravenous Propofol as Total Intravenous Anaesthesia (TIVA) is being widely used for the
induction and maintenance of anaesthesia. Sevoflurane is a relatively newer anaesthetic agent which is
expensive, but has the advantage of rapid induction and recovery characteristics.
Materials and Methods: Sixty patients ASA Grade I and II aged 18-65 yrs were randomly divided into two
groups. Group A received Sevoflurane inhalational induction via a vital capacity rapid inhalational induction
(VCRII) technique using 8% Sevoflurane from a closed circuit primed for 1 minute. Maintenance was done with
1.5-2% Sevoflurane. Group B patients were induced with Propofol i.v 2-2.5mg/kg. Intraoperative maintenance
was done with multistep Propofol infusion (8mg/kg/hr -3mg/kg/hr) via infusion pump.
Results: Induction time was faster in Sevoflurane group as compared to Propofol group (p<0.001), which was
highly significant. The intraoperative haemodynamics were comparable between the two groups with no
statistically significant difference. The recovery profile was significantly (p<0.001) better with Sevoflurane
group as regards the spontaneous eye opening, verbal communication and mental orientation. Although the
total volume of each agent used was almost similar in both groups, but the cost incurred in Sevoflurane
anaesthesia is still higher than the Propofol based anaesthesia.
Conclusion: Sevoflurane is a good alternative for Propofol as an induction and maintenance agent with better
recovery profile, but has cost limitations.
Keywords: Propofol, Sevoflurane, Total Intravenous Anaesthesia.
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Date of Submission: 22 -07-2017 Date of acceptance: 18-08-2017
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I. Introduction
Intravenous agents are commonly used for the induction of anaesthesia followed by inhalational agents
for the maintenance. A problem with this technique is the transition phase from the induction to maintenance.
The rapid redistribution of intravenous agent could lead to the lightning of anaesthesia before an adequate depth
is attained with the inhalational agent. This problem has prompted the rediscovery of “single agent” anaesthesia
which avoids the problems associated with the transition phase. Total intravenous anaesthesia (TIVA) is a
technique of anaesthesia which involves use of intravenous drugs to anaesthetize the patient without the use of
inhalational agents. The popularity of Propofol as a main component of TIVA has been attributed to its
pharmacokinetic and pharmacodynamic properties. Its shorter onset of action, rapid metabolism and no
significant accumulation on prolonged use makes it an ideal choice. With the advent of advanced computer drug
predictable. It allows the administration system, the i.v infusion of Propofol has become much safer and
anaesthesiologist to vary the depth of anaesthesia by just controlling the rate of infusion of the drug. The TIVA
concept is simple, less toxic than inhalational agents, less risk of malignant hyperthermia with no risk of any
environmental pollution14.
Sevoflurane is a relatively newer inhalational anaesthetic agent & was first synthesized by Regan at
Travenol laboratories in 1968, but was introduced in clinical practice in Japan in 1990. When compared to other
inhalational agents, it has better properties. Its insoluble nature, low blood gas partition coefficient, no pungency
and rapid wash in and rapid wash out makes it an ideal choice for the volatile induction and maintenance of
anaesthesia. Its good haemodynamic profile and non irritating nature also adds to its increased acceptance
amongst the anaesthesiologists. Use of Sevoflurane for the induction and maintenance of anaesthesia produces a
reduction in costs, predominantly through less drug wastage12. Since the introduction of small 50 ml
Sevoflurane bottles in our country and the cost also cutting down, we wanted to compare its haemodynamics
and the cost factor with the Propofol based anaesthesia.

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 Comparison of Intraoperative Haemodynamic Parameters And Cost Effectiveness….

II. Aim & Objectives

The aim was to compare the intraoperative haemodynamics recovery profile and cost effectiveness of
Sevoflurane and Propofol based anaesthesia.

III. Material & Methods

After informed consent, sixty ASA I and II patients, aged 18-65 yrs of either sex undergoing surgery
under general anaesthesia were randomly divided into two groups of 30 each. Patients with ASA III or above,
patients with significant cardiovascular, renal or pulmonary disease, history of malignant hyperthermia, any
documented allergy to the study drug, H/O any mental illness or use of sedative drugs.
Group A: Sevoflurane group.
Group B: Propofol group.
All the patients were kept fasting overnight and were premedicated with Inj. Ranitidine 50 mg i.v in the
pre operative room. On arrival in the operation room, i.v line was secured and baseline parameters were
recorded i.e, HR, NIBP and SpO2. Inj. Fentanyl 1 mcg/kg was given to all patients. In group A, patients were
induced with vital capacity rapid inhalational induction (VCRII) technique using 8% Sevoflurane with N 2O in
O2 (3L each) from a closed circuit which was primed for 1 minute. Patients were trained to perform vital
capacity breathing before the induction. The induction time was noted i.e, from the start of anaesthesia till loss
of eyelash reflex. For muscle relaxation, Inj. Rocuronium 0.6 mg/kg was given as loading dose and thereafter
1/3 as its maintenance dose for all patients in both groups. In the group B, patients were induced with Inj.
Propofol 2-2.5 mg/kg till the loss of eyelash reflex. Intraoperatively, Inj. Propofol infusion was started with
8mg/kg/hr for 1st ten min, 6 mg/kg/hr next ten min and 3 mg/kg/hr thereafter till end of surgery. Also, Inj.
Fentanyl was used as infusion of 1 mcg/kg/hr till the end of surgery. Inj. Ondensetron 0.1 mg/kg was given to all
the patients for PONV. Both the Sevoflurane and Propofol infusion were stopped at the end of surgery when the
skin sutures were being applied. The reversal, consisting of Inj. Neostigmine (50 mcg/kg) and Inj. Glycopyrolate
(10 mcg/kg) was given and patients were extubated after proper suctioning and on return of spontaneous
respiration.

IV. Observation And Results

There was no statistical difference between the two groups with respect to age, weight, gender, ASA
and duration of surgery. Induction time (sec) was faster in Sevoflurane group (48.4±5.04) as compared to
Propofol group (60.2±6.53) with a (p<0.001), which is highly significant. Also, the intraoperative
haemodynamic parameters consisting of heart rate and blood pressure were comparable between the two groups
with no statistically significant difference.

Table showing induction time (seconds) among studied groups

Induction time
Mean SD Range P-value Remarks
(Seconds)
Group A [n=30] 48.4 5.04 41-56
<0.001* HS
Group B [n=30] 60.2 6.53 50-59
NS : Non – Significant
HS : Highly Significant

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 Comparison of Intraoperative Haemodynamic Parameters And Cost Effectiveness….

Table showing comparison based on MAP (mmHg) among two groups at different time intervals
Group A [n=30] Group B [n=30]
Time Interval P-value Remarks
Mean SD Mean SD
Baseline 100.7 5.56 102.4 6.29 0.260 NS
Before Induction 98.7 6.00 97.2 7.17 0.377 NS
After Induction 89.8 6.45 88.0 7.52 0.311 NS
1 minute after intubation 91.5 6.33 89.5 6.98 0.263 NS
3 minutes after intubation 93.7 6.73 91.5 6.41 0.199 NS
5 minutes 96.4 6.07 94.3 6.38 0.192 NS
10 minutes 98.5 6.21 97.6 6.21 0.582 NS
15 minutes 100.0 6.09 97.8 5.96 0.163 NS
25 minutes 98.3 5.93 96.5 6.34 0.269 NS
35 minutes 99.1 7.00 97.4 7.25 0.355 NS
45 minutes 100.8 6.47 99.3 6.17 0.352 NS
55 minutes 100.9 3.92 99.8 5.34 0.443 NS
65 minutes 101.2 3.90 100.4 4.42 0.659 NS
75 minutes 102.7 5.25 102.0 5.65 0.785 NS
NS : Non – Significant.
S : Significant.

The recovery profile showed a significant difference as regards spontaneous eye opening (9.3±1.8 min
in Sevo gp and 13.1±1.67 min in Propofol gp), verbal communication (11.2±1.41 min Sevo gp and 14.4±1.33
The recovery profile showed a significant difference as regards spontaneous eye opening (9.3±1.8 min Propofol
gp) & mentalorientation (15.4±1.25 min Sevo gp and 19.3±1.23 min Propofol gp) after the agents were stopped
at the end of surgery (p<0.001), with Sevoflurane showing the better recovery profile.

Table showing recovery profile of studied groups

Recovery Profile Mean SD Range P-value Remarks
Time till spontaneous eye Group A [n=30] 9.3 1.80 7-12
<0.001* HS
opening (Minutes) Group B [n=30] 13.1 1.67 10-16
Time to verbal Group A [n=30] 11.2 1.41 9-14
<0.001* HS
communication (Minutes) Group B [n=30] 14.4 1.33 12-17
Time to mental orientation Group A [n=30] 15.4 1.25 14-18
<0.001* HS
(Minutes) Group B [n=30] 19.3 1.23 17-22
NS : Non – Significant HS : Highly Significant.

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 Comparison of Intraoperative Haemodynamic Parameters And Cost Effectiveness….

The total volume of Propofol used for the induction and the maintenance was noted. The amount of
Sevoflurane consumed was calculated using the Dion formula. Amount of Sevoflurane used = PTFM/2,412 d
(P= Vaporizer dial conc, F= Fresh gas flow l/m, T= time for which the conc was set in minutes, M= Mol. Mass
of Sevoflurane, D= Density of liquid Sevoflurane in milliliters). After substitution of the fixed variables, the
equation could be rewritten as Amount of Sevoflurane used = 0.00546 X Sevoflurane conc. X Time (sec). The
total Sevoflurane consumed was calculated by adding the amount used for priming, for induction and that used
for the maintenance of anaesthesia. The total volume of each agent used was comparable (42.5 ml in
Sevoflurane gp and 40.6 ml in Propofol gp), but in terms of cost comparison, the Sevoflurane still costs more
than the Propofol. The actual cost of Sevoflurane 50 ml bottle was about 750 rupees while the cost of same
volume of Propofol was around 500 rupees.

V. Discussion
Modern practice of medical science demands high quality anaesthesia, minimum side effects and rapid
recovery. The characteristics of the ideal anaesthetic technique are that the induction should be rapid and swift,
maintenance should be physiologically stable with readily adjustable anaesthetic depth and recovery be rapid
and complete allowing early return to normal activities. Generally both Propofol and Sevoflurane meet these
criteria. Propofol is a common i.v agent used a main component of TIVA. Sevoflurane used in high
concentration is suitable for induction and maintenance of anaesthesia because of low blood gas solubility and
non irritant property.We did not find any statistical difference between the two groups with respect to age,
weight, gender, ASA and duration of surgery. In our study, the mean time taken for induction in Sevoflurane
group was 48.4 seconds, whereas in Propofol group it was 60.2 seconds (p<0.001).The vital capacity breath
technique using 8 % Sevoflurane has been seen to cause faster induction as compared to the conventional
incremental dose technique. Lim KY et al1 found a shorter induction time with Sevoflurane VCRII technique as
compared to the i.v Propofol induction. EL - Radiadeh and El – Ghazo2 also reported a faster loss of
consciousness with Sevoflurane vital capacity breath technique than with Propofol. Sevoflurane has attributes
that facilitates rapid, smooth inhalational induction i.e, low blood gas solubility, relative absence of pungency
and a vaporizer with high over pressure capability. The vital capacity breath of Sevoflurane provides rapid
induction especially when used with N2O 50 % in oxygen. Besides, this technique has been seen to have better
patient acceptability. Induction characteristics of Sevoflurane comparing the vital capacity induction technique
with the tidal breathing technique has shown better patients acceptability and shorter induction time in the
VCRII technique.
Our observations were also in consonance with Hall JE et al3 who compared the single breath
inhalational induction of Sevoflurane with an intravenous bolus of Propofol. They found that 8% Sevoflurane
carried in N2O and O2 is rapid, reliable and safe method for the induction of anaesthesia and a good alternative
to i.v Propofol. Konstantopoulos K, Markis A, Moustaka A et al4 found that induction as well as maintenance
characteristics of Sevoflurane and Propofol based anaesthesia were comparable in terms of haemodynamic
stability, PONV and post operative sedation scores and orientation to places.Our observations with respect to the
intraoperative haemodynamics did not show any significant difference between the two groups. There was a
comparable reduction in both the heart rate and MAP during the induction of anaesthesia. A study by Bharti N
et al5 found that the intraoperative haemodynamics during induction and the maintenance were comparable in
both the groups. Our results were also in accordance with a study done by Amingad B and Prashanth Gowtham
Raj SK6. The patient’s orientation with respect to time and place provides a rough estimation of the recovery of

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 Comparison of Intraoperative Haemodynamic Parameters And Cost Effectiveness….

cognitive function. In our study, the recovery profile showed a statistically significant difference between the
two groups, with faster recovery in the Sevoflurane group. Our results were similar to a study done by Orhon
ZM et al7 and Kumar A et al8, who also found that recovery time after Sevoflurane anaesthesia was shorter than
with Propofol based anaesthesia. Shah A and Adoraja RN9 compared the emergence and post operative recovery
profile between Sevoflurane and Propofol. They found that Sevoflurane has a better recovery profile than the
intravenous Propofol. This effect of Sevoflurane has been attributed to its insoluble nature, rapid wash in and
out and low blood: gas partition coefficient, all of which lead to the rapid emergence. Another study by Cattano
D et al10 compared the total intravenous anaesthesia using Propofol and inhalational anaesthesia with
Sevoflurane for the post operative effects i.e, degree of pain, incidence of nausea and vomiting and duration of
recovery post operatively. They did not find any statistically significant difference between the two agents in
relation to the above effects. In our study we found that there was no significant difference between the two
groups in terms of the total volume of each agent used. But in terms of cost comparison, we found that
Sevoflurane based anaesthesia is still costlier than the Propofol based anaesthesia. Our results were supported by
Tang Jun at al11 who also saw that total cost was more with Sevoflurane as compared to Propofol based
anaesthesia. Similarly, a multi centric study done by Smith I et al12 found that the total intravenous anaesthesia
with Propofol was more expensive than the use of Sevoflurane for the induction and maintenance of anaesthesia.
Our results were not supported by Maratha V et al13 who found that Sevoflurane based anaesthesia was more
cost effective. The reason could be due to the amount of wastage caused by the unused medicine.

VI. Conclusion
We found that Sevoflurane is superior to Propofol in terms of faster induction and rapid recovery
profiles. The intraoperative haemodynamics were comparable between the two groups with no statistically
significant difference. The Sevoflurane based anaesthesia is however still costlier as compared to Propofol
which if solved will serve as excellent option of anaesthesia in the developing countries. As a final
recommendation, we believe that the cost effectiveness of Sevoflurane need to be further investigated as this
drug has better induction, haemodynamic and recovery characteristics.

VII. Conflicts of intrest

There are no conflicts of interest.

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*Sahir Rasool. "Comparison of Intraoperative Haemodynamic Parameters And Cost

Effectiveness Between Sevoflurane (Inhaltional) Anaesthesia And Propofol (Tiva) Based
Anaesthesia." IOSR Journal of Dental and Medical Sciences (IOSR-JDMS) 16.8 (2017): 73-77

DOI: 10.9790/0853-1608047377 www.iosrjournals.org 77 | Page