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.