Quality of recovery from anesthesia of patients undergoing balanced or total intravenous general anesthesia. Prospective randomized clinical trial

doi:10.1016/j.jclinane.2016.08.022

Journal of Clinical Anesthesia

Volume 35, December 2016, Pages 369-375

https://doi.org/10.1016/j.jclinane.2016.08.022 Get rights and content

Highlights

•
Both intravenous and inhalation anesthesia exhibit specific individual advantages.
•
We assessed the quality of recovery (QoR-40) from both techniques.
•
Recovery from remifentanil/sevoflurane or remifentanil/propofol was compared.
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The lack of difference was demonstrated on the total QoR-40 score.

Abstract

Study objectives

The aim of the present study was to assess the quality of recovery from anesthesia of patients subjected to otorhinolaryngological (ORL) surgery under balanced or total intravenous general anesthesia by means of Quality of Recovery-40 (QoR-40) questionnaire.

Design

Prospective randomized clinical trial.

Setting

The setting is at an operating room, a postoperative recovery area, and a hospital ward.

Patients

One-hundred thirty American Society of Anesthesiologists physical status I or II patients scheduled to undergo general anesthesia for ORL interventions under remifentanil, in combination with sevoflurane (balanced technique) or propofol (total intravenous anesthesia).

Measurements

Occurrence of nausea, vomiting, body temperature less than 36°C, and length of stay in the postanesthesia care unit were recorded. The QoR-40 was administered by an investigator blind to group allocation 24 hours after surgery. The quality of recovery, as assessed by the score on the QoR-40, was compared between the groups.

Main results

There is no difference regarding the QoR-40 score among intravenous and inhalation anesthesia groups (190.5 vs 189.5, respectively; P = .33). Similarly, among the 5 dimensions of the QoR-40, the scores were comparable between the groups. Incidence of hypothermia (P = .58), nauseas or vomits (P = .39), and length of surgery (P = .16) were similar among groups. The evaluation of pain intensity (P = .80) and dose of morphine use in the postanesthesia care unit (P = .4) was also comparable between groups.

Conclusions

The quality of recovery from anesthesia assessed based on the patients' perception did not differ between the ones subjected to either inhalation or intravenous general anesthesia for ORL surgery based on QoR-40 questionnaire assessment.

Introduction

General anesthesia can be performed with intravenous and/or inhalation anesthetics. The most common agents used in everyday practice for such purposes are sevoflurane (inhalation anesthesia) and propofol (intravenous anesthesia). Although a large number of studies have been conducted to establish which technique is best, both exhibit specific advantages as a function of the assessed outcomes: nausea, vomiting, pain, cost, speed of recovery of cognitive functions, cardioprotection, and patient satisfaction [1]. Concerning patient satisfaction, an increasing number of authors have been assessing the quality of recovery from anesthesia by measures that probes quality of life from the perspective of the patient [1], [2], [3]. Quality of Recovery-40 (QoR-40) questionnaire, a validated instrument to assess the quality of recovery from anesthesia, allows for an objective evaluation of the factors that might influence the patients' perception upon comparing different therapeutic approaches [2]. A recent study using the QoR-40 questionnaire showed that the quality of recovery for female patients who underwent thyroid surgery was significantly better when intravenous anesthesia was used when compared with inhalation anesthesia with desflurane [4]. However, no study has yet used the QoR-40 to assess the quality of recovery of patients from both sexes undergoing intravenous anesthesia with propofol and remifentanil vs balanced anesthesia with sevoflurane and remifentanil.

Accordingly, the primary objective of the study was to assess the quality of recovery from anesthesia of patients undergoing otorhinolaryngological (ORL) surgical procedures under balanced or total intravenous general anesthesia through the application of the QoR-40 questionnaire. As secondary outcomes, we also assessed the rates of postoperative nausea, vomiting, and pain for each anesthetic technique.

Section snippets

Materials and methods

This double-blind, randomized trial was approved by the Research Ethics Committee of the School of Medical and Health Sciences, Pontifical Catholic University of São Paulo (Pontifícia Universidade Católica de São Paulo), CAAE 17618013.3.0000.5373 (http://aplicacao.saude.gov.br/plataformabrasil). Written consent form was obtained from all participants. One-hundred thirty patients aged 18 to 65 years, with an American Society of Anesthesiologists physical status I or II [5], who were scheduled to

Results

A total of 130 patients were first assessed for eligibility in this study; however, 10 were excluded because they refused participation, or met any of the exclusion criteria. Thus, 120 participants were randomly allocated to the study groups. Later, 4 participants in group I and 6 in group V were excluded due to protocol deviations. Therefore, 56 participants underwent balanced anesthesia, and 54 underwent intravenous anesthesia (Fig. 1).

The 2 studied groups were comparable with respect to age (

Discussion

This study compared the quality of recovery from 2 anesthetic techniques as assessed from the patients' perspective through the application of a specific validated questionnaire. The patient's perceived quality of recovery was similar in those receiving total intravenous vs those receiving balanced anesthesia when evaluated 24 hours after ORL surgery.

The search for techniques that achieve fast and smooth awakenings from general anesthesia resulted in increased use of remifentanil, an opioid

Acknowledgments

Gustavo Farinha Pinto Saraiva and Nathália Vianna de Matos Leite were granted a scholarship from PIBIC/CNPq.

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Methods and timing in the assessment of postoperative recovery: a scoping review
2022, British Journal of Anaesthesia
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The most frequently used time point for assessing postoperative recovery was 24 h postoperatively (n=159/195, 81.5%), followed by postoperative day (POD) 2 (n=57/195, 29.2%) and POD 3 (n=52/195, 26.7%) (Fig. 3). Postoperative recovery was assessed between 124–114 and 18115 times in the individual studies (mean, 2.4 times). It was most common to assess postoperative recovery only once (n=92/195, 47.2%).
There is no consensus about the type of instrument with which to assess postoperative recovery or the time points when assessments are most appropriate. It is also unclear whether instruments measure the four dimensions of postoperative recovery, that is physical, psychological, social, and habitual recovery. This scoping review had three objectives: (1) to identify and describe instruments used in clinical trials to assess postoperative recovery; (2) to determine how, when, and the number of times postoperative recovery was measured; and (3) to explore whether the four dimensions of postoperative recovery are represented in the identified instruments.
A literature search was conducted in CINAHL, MEDLINE, and Web of Science. The search terms were related to three search strands: postoperative recovery, instrument, and clinical trials. The limits were English language and publication January 2010 to November 2021. In total, 5015 studies were identified.
A total of 198 studies were included in the results. We identified 20 instruments measuring postoperative recovery. Different versions of Quality of Recovery represented 81.8% of the included instruments. Postoperative recovery was often assessed at one time point (47.2%) and most often on postoperative day 1 (81.5%). Thirteen instruments had items covering all four dimensions of postoperative recovery.
Assessing recovery is important to evaluate and improve perioperative care. We emphasise the importance of choosing the right instrument for the concept studied and, if postoperative recovery is of interest, of assessing more than once. Ideally, instruments should include all four dimensions to cover the whole recovery process.
The effect of methadone on postoperative quality of recovery in patients undergoing laparoscopic cholecystectomy: A prospective, randomized, double blinded, controlled clinical trial
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The QoR-40 is a validated 40-item scoring system developed to assess not only pain, but also many aspects of recovery following general anesthesia and surgery. It is considered the best instrument for evaluating the complex and multidimensional process of postoperative recovery in the general surgical population [22,26,27]. To our knowledge, only one [21], investigation has evaluated the use of methadone in patients undergoing remifentanil-based anesthesia, however, our study is the first to consider the quality of recovery as a primary outcome.
The aim of the present study was to assess the quality of recovery from anesthesia in patients undergoing laparoscopic cholecystectomy (LC) under total intravenous anesthesia, who received either methadone or morphine for post-surgical analgesia by means of questionnaire Quality of Recovery-40 (QoR-40).
Prospective Randomized Clinical Trial.
The setting was at an operating room, postoperative recovery area and hospital ward.
Seventy patients who underwent LC under remifentanil-based anesthesia were randomly assigned to receive methadone 0.1 mg kg⁻¹ or morphine 0.1 mg kg⁻¹.
The primary outcome was the quality of recovery, using the Quality of Recovery Questionnaire (QoR-40). Secondary outcomes included time to eye opening, the occurrence of nausea and vomiting, pain score, use of supplemental analgesics, and PACU length of stay.
No differences were observed in the total or individual QoR-40 dimension scores. During the PACU stay, the occurrence of PONV and pain scores were similar between groups. Opioid consumption (p < 0.02) and the level of sedation (p < 0.01) were higher in the morphine group. There were no differences in the amount of time required to achieve PACU discharge criteria. The frequency of nausea or emesis, the severity of pain, and tramadol consumption were comparable between both groups while on the ward.
Pain scores and the Quality of Recovery did not differ between patients who underwent LC under total intravenous anesthesia, who received either methadone or morphine for post-surgical analgesia.
The effect of sevoflurane compared to propofol maintenance on post-surgical quality of recovery in patients undergoing an ambulatory gynecological surgery: A prospective, randomized, double-blinded, controlled, clinical trial
2017, Journal of Clinical Anesthesia
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Subjects were contacted by telephone 24 h after the procedure by a research associate unaware of group allocation and were questioned regarding their analgesic consumption, pain score and the QoR-40 questionnaire was administered [12]. The questionnaire consists of 40 questions that examine 5 domains of patient recovery using a 5 point Likert scale: none of the time, some of the time, usually, most of the time and all of the time [13]. The five domains include physical comfort, pain, physical independence, psychological support and emotional state.
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Healthy female subjects were randomized to receive propofol or sevoflurane as anesthetic maintenance.
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^☆: Funding: None.

^☆☆: Attestation: ETM and LHCN attest to the integrity of the original data and the analysis reported in this manuscript. FCOL, BRN, FPS, and NVdML approved the final manuscript.

^★: Conflicts of interest: All authors have no conflicts of interest to report.

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Original ContributionQuality of recovery from anesthesia of patients undergoing balanced or total intravenous general anesthesia. Prospective randomized clinical trial☆,☆☆,★

Highlights

Abstract

Study objectives

Design

Setting

Patients

Measurements

Main results

Conclusions

Introduction

Section snippets

Materials and methods

Results

Discussion

Acknowledgments

Br J Anaesth

Br J Anaesth

Br J Anaesth

Br J Anaesth

J Clin Anesth

Contin Educ Anesth Crit Care Pain

J Clin Anesth

Surgery

Br J Anaesth

Br J Anaesth

Original Contribution
Quality of recovery from anesthesia of patients undergoing balanced or total intravenous general anesthesia. Prospective randomized clinical trial☆,☆☆,★