α2-Adrenoceptor agonists in anaesthesia: a new paradigm

Total intravenous or balanced anaesthesia in ambulatory surgery?

General anaesthesia is still the most common anaesthetic technique in the ambulatory surgery setting. With the introduction of propofol, total intravenous anaesthesia gained widespread acceptance. Recently, the combination with remifentanil, an ultra-short acting opioid analgesic, allowed even more control over the duration of the anaesthetic. In comparison to propofol, however, the new inhalational anaesthetics desflurane and sevoflurane possess a pharmacokinetic profile that is preferable to that of propofol. Initial studies show that these pharmacokinetic advantages lead to a faster short-term recovery, although both substances have been associated with a higher incidence of postoperative nausea and vomiting. No differences have so far been demonstrated in respect to long-term recovery, discharge from the post-anaesthesia care unit and discharge from the ambulatory care centre. Currently the anaesthesiologist has the possibility to choose his preferred anaesthetic technique based on individual patient needs, the surgery performed and the side-effects each technique may have. However, in contrast to the situation at the beginning of the 1990s total intravenous anaesthesia is not the technique that fits all needs but balanced anaesthesia presents an alternative.