In a prospective randomized study we evaluated the advantages of sevoflurane anesthesia to propofol or thiopental anesthesia in 67 patients scheduled for day-case minor gynecologic procedures. After premedication with alfentanil 0,25–0,5 mg plus atropine 0,5 mg plus droperidol 1,25 mg, anesthesia was induced with sevoflurane (group S, n = 21) using singlebreath technique; anesthesia was maintained with the mixture of sevoflurane in nitrous oxide/oxygen mixture. In the group P (n = 23) anesthesia was induced with propofol 2–2,5 mg/kg and maintained with supplementary doses of 20–30 mgs of propofol; group T (n = 23) was induced with thiopental and maintained with supplemetary doses of 50–100 mg of thiopental. Patients in group P and T were ventilated with a mixture of nitrous oxide and oxygen. We assessed the onset of induction and time to recovery, smoothiness of induction, balance of anesthesia, side effects (circulatory, ventilatory, postoperative depression of consciousness, postoperative nausea and vomiting), time to spontaneous mobilization, time to fluid intake and micturition, time to hospital discharge, global final evaluation by the patient, anesthesiologists, gynecologists and the cost of anesthesia. Results: both groups of intravenous anesthesia had more rapid induction (p < 0,001: S 69,5 sec, P 26,3 sec, T 27,9 sec), the fastest recovery was in group P (p < 0,01: S 108,1 sec, P 44,6 sec, T 121 sec). We did not observe negative effects on hemodynamics. In all groups of patients there was a need to support the ventilation manually, most frequently in propofol group (p < 0,05). Only in group S there was observed a mild airway spasm. Patients in group S were most prone for movements during anesthesia (p < 0,05). In the postoperative course, sleepiness was most pronounced in group T (p < 0,001). Spontaneous mobilization was fastest in P (p < 0,05); there was not a difference in other parameters. There were not differences between groups in time to hospital dicharge which is based upon organizational aspects of day case surgery in the Department of Gynecology. Decrease in uterine tonus and increased blood loss was observed in S (p < 0,001); this method of anesthesia was refused by gynecologists. According to subjective assessment by patients, S protocol was considered worse (p < 0,05). Thiopental was evaluated worse by anesthesiologists (p < 0,001) for somnolence after operation. Thiopental anesthesia is cheapest compared to other protocols (p < 0,001; S 333 Czech crowns (CZK), P 255 CZK, T 31 CZK). In conclusion, sevoflurane appears to be absolutely unsuitable for minor gynecologic procedures due to increased blood losses. The advantage of propofol could be seen in better recovery of psychomotoric functions, while the advantage of thiopental anesthesia lies in its low cost.

        Key words: minor gynecologic procedures – out-patient anesthesia – sevoflurane – propofol – thiopental