Comparison of adenosine and remifentanil infusions as adjuvants to desflurane anesthesia

Citation
E. Zarate et al., Comparison of adenosine and remifentanil infusions as adjuvants to desflurane anesthesia, ANESTHESIOL, 90(4), 1999, pp. 956-963
Citations number
27
Categorie Soggetti
Aneshtesia & Intensive Care","Medical Research Diagnosis & Treatment
Journal title
ANESTHESIOLOGY
ISSN journal
00033022 → ACNP
Volume
90
Issue
4
Year of publication
1999
Pages
956 - 963
Database
ISI
SICI code
0003-3022(199904)90:4<956:COAARI>2.0.ZU;2-U
Abstract
Background: Because adenosine has been alleged to produce both anesthetic a nd analgesic sparing effects, a randomized, double-blinded study was design ed to compare the perioperative effects of adenosine and remifentanil when administered as intravenous adjuvants during general anesthesia for major g ynecologic procedures. Methods: Thirty-two women were assigned randomly to one of two drug treatme nt groups, After premedication with 0.04 mg/kg intravenous midazolam, anest hesia was induced with 2 mu g/kg Intravenous fentanyl, 1.5 mg/kg intravenou s propofol, and 0.6 mg/kg intravenous rocuronium, and maintained with desfl urane, 2%, and nitrous oxide, 65%, in oxygen. Before skin incision, an infu sion of either remifentanil (0.02 mu g . kg(-1) . min(-1)) or adenosine (25 mu g . kg(-1) . min(-1)) was started and subsequently titrated to maintain systolic blood pressure, heart rate, or both within 10-15% of the preincis ion values. Results: Adenosine and remifentanil infusions were effective anesthetic adj uvants during lower abdominal surgery. Use of adenosine (mean +/- SEM, 166 +/- 17 mu g . kg(-1) . min(-1)) was associated with a significantly greater decrease in systolic blood pressure and higher heart rate values compared with remifentanil (mean +/- SEM, 0.2 +/- 0.03 mu g . kg(-1) . min(-1)). Tot al postoperative opioid analgesic use was 45% and 27% lower in the adenosin e group at 0-2 h and 2-24 h after surgery, respectively. Conclusions: Adjunctive use of a variable-rate infusion of adenosine during desflurane-nitrous oxide anesthesia was associated with acceptable hemodyn amic stability during the intraoperative period. Compared with remifentanil , intraoperative use of adenosine was associated with a decreased requireme nt for opioid analgesics during the first 24 h after operation.