Comparison of the Effects of Different Anesthetic Agents on Hemodynamics, Recovery, and Postoperative Cognitive Function in Ambulatory Gynecologic Procedures

Abstract

ABSTRACT Objective: The aim of this study was to compare the effects of three different intravenous induction agents—propofol, etomidate, and thiopental—on hemodynamic parameters, recovery times, and postoperative cognitive functions in patients undergoing short-duration ambulatory vaginal gynecologic procedures. Methods: This prospective observational study was conducted at the Gynecology and Obstetrics Operating Room of Istanbul Training and Research Hospital between March and May 2010. A total of 120 patients, aged 25–75 years and classified as ASA physical status I–II, were included. Patients were randomly divided into three groups: Group P (Propofol 2 mg·kg⁻¹), Group E (Etomidate 0.3 mg·kg⁻¹), and Group T (Thiopental 5–7 mg·kg⁻¹). All groups received fentanyl 1.5 µg·kg⁻¹ for analgesia. Hemodynamic parameters, recovery times, Ramsey Sedation Scores, and Mini-Mental Test (MMT) scores were recorded and analyzed. Results: In Group P, significant decreases in systolic and diastolic blood pressure were observed following induction (p<0.05). Group E maintained hemodynamic stability, whereas Group T exhibited moderate hypotension. Recovery time was significantly shorter in Group P compared to the other groups (p<0.01). There were no significant differences in MMT scores among the groups at the postoperative 30ᵗʰ minute (p>0.05), whereas at the 2ⁿᵈ hour, Groups P and E showed higher scores than Group T (p<0.05). Conclusion: In ambulatory gynecologic procedures, propofol demonstrated a favorable profile with respect to rapid recovery and early improvement in postoperative cognitive function. Etomidate appeared advantageous in maintaining hemodynamic stability and may be considered a suitable alternative, particularly for patients with cardiovascular risk or hemodynamic vulnerability. However, anesthetic selection in the general population should be individualized based on patient characteristics and surgical conditions. Thiopental was associated with prolonged recovery and delayed cognitive restoration in some cases, and these findings warrant confirmation in larger, multicenter studies.

Keywords

• ambulatory surgery,
• intravenous anesthesia
• cognitive function
• hemodynamic response

Günübirlik Jinekolojik Girişimlerde Farklı Anestezik Ajanların Hemodinami, Derlenme ve Postoperative Kognitif Fonksiyonlar Üzerine Etkilerinin Karşılaştırılması

Abstract

ÖZET Amaç: Bu çalışmanın amacı, günübirlik kısa süreli vajinal jinekolojik girişimlerde kullanılan üç farklı indüksiyon ajanı olan propofol, etomidat ve tiyopentalin hemodinamik parametreler, derlenme süreleri ve postoperatif kognitif fonksiyonlar üzerine etkilerini karşılaştırmaktır. Yöntem: İstanbul Eğitim ve Araştırma Hastanesi Kadın Hastalıkları ve Doğum Ameliyathanesi’nde, Mart–Mayıs 2010 tarihleri arasında yürütülen bu prospektif, gözlemsel çalışmaya ASA I–II grubunda, 25–75 yaş aralığında toplam 120 hasta dahil edildi. Hastalar üç gruba ayrıldı: Grup P (Propofol 2 mg/kg), Grup E (Etomidat 0.3 mg/kg), Grup T (Tiyopental 5–7 mg/kg). Tüm gruplarda analjezi için 1.5 µg/kg fentanil uygulandı. Hemodinamik parametreler, derlenme süreleri, Ramsey Sedasyon Skoru ve Mini Mental Test (MMT) skorları kaydedildi. Bulgular: Grup P’de indüksiyon sonrası SKB (sistolik kan basıncı) ve DKB (diastolik kan basıncı)’de anlamlı düşüşler izlendi (p<0.05). Grup E’de hemodinamik stabilite korunurken, grup T’de orta dereceli hipotansiyon gözlendi. Derlenme süresi Grup P’de anlamlı derecede kısa bulundu (p<0.01). Postoperatif 30. dakikada MMT skorlarında üç grup arasında anlamlı fark saptanmadı (p>0.05), ancak 2. saat değerlendirmesinde grup P ve grup E’de skorlarının tiyopental grubuna göre daha yüksek olduğu görüldü (p<0.05). Sonuç: Günübirlik jinekolojik girişimlerde propofol, hızlı derlenme ve erken bilişsel toparlanma açısından avantajlı bir profil sergilemiştir. Etomidat, hemodinamik stabiliteyi koruması ve bilişsel fonksiyonları minimal düzeyde etkilemesiyle özellikle kardiyovasküler riski yüksek veya hemodinamik açıdan hassas hastalarda uygun bir alternatif olarak değerlendirilebilir. Tiyopental ise bazı olgularda uzamış derlenme süresi ve gecikmiş bilişsel iyileşme ile ilişkili bulunmuştur. Bununla birlikte, ajan seçiminin her hastada klinik özellikler ve cerrahi koşullar dikkate alınarak bireyselleştirilmesi önerilmektedir. Bulguların daha geniş örneklemli, çok merkezli çalışmalarla desteklenmesi gerekmektedir

Keywords

• günübirlik cerrahi
• intravenöz anestezi
• kognitif fonksiyon
• hemodinamik yanıt

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