Sevoflurane vs. propofol in post‐operative catheter‐related bladder discomfort: a prospective randomized study

• Published in: Acta anaesthesiologica Scandinavica 2017-08, Vol.61 (7), p.773-780
• Main Authors: Kim, H.‐C., Park, H.‐P., Lee, J., Jeong, M.‐H., Lee, K.‐H.
• Format: Article
• Language: English
• Subjects: Acetylcholine receptors (muscarinic); Activation analysis; Agitation; Anesthesia; Anesthetics, Inhalation - pharmacology; Anesthetics, Intravenous - pharmacology; Bladder; Catheters; Discomfort; Drugs; Female; Humans; Incidence; Korea - epidemiology; Male; Medical instruments; Methyl Ethers - pharmacology; Middle Aged; Pain, Postoperative - epidemiology; Pain, Postoperative - prevention & control; Patients; Propofol; Propofol - pharmacology; Prospective Studies; Receptor mechanisms; Sevoflurane; Surgery; Tramadol; Tumors; Urinary bladder; Urinary Bladder - surgery; Urinary Bladder Neoplasms - surgery; Urinary Catheterization - adverse effects
• ISSN: 0001-5172; 1399-6576
• DOI: 10.1111/aas.12922

Background Post‐operative catheter‐related bladder discomfort (CRBD) causes increased emergence agitation. Muscarinic receptor activation is a major mechanism in CRBD development. Experimental studies showed that sevoflurane has anti‐muscarinic effects whereas propofol does not. Our hypothesis was that sevoflurane anaesthesia would reduce the incidence of CRBD following bladder surgery. Methods In total, 82 patients undergoing transurethral bladder tumour excision (TURBT) were assigned randomly to two groups according to the maintenance anaesthetic agent received: sevoflurane (n = 41) or propofol (n = 41). The incidence of CRBD was evaluated at 0, 1, 6 and 24 h post‐operatively. The number of patients treated with a rescue medication (tramadol) for CRBD was noted. Results The incidence of CRBD at post‐operative 1 h was lower in the sevoflurane group than that in the propofol group (59% vs. 85%; P = 0.007). The differences in CRBD were 27% and 22% at 0 and 6 h post‐operatively (P = 0.008 and 0.047, respectively). CRBD occurred in 27 (66%) patients in the sevoflurane group vs. 38 (93%) in the propofol group from 0 to 24 h post‐operatively (P = 0.005). The number of patients treated with tramadol was lower in the sevoflurane group (13 [22%] vs. 22 [54%]; P = 0.044). Conclusion Sevoflurane, as a maintenance in general anaesthesia, decreased the incidence of early post‐operative CRBD and tramadol requirements in patients undergoing TURBT, compared with propofol.