Recovery and neurological examination after remifentanil-desflurane or fentanyl-desflurane anaesthesia for carotid artery surgery

We studied 44 patients undergoing carotid endarterectomy (CEA) to compare, recovery after general anaesthesia with desflurane supplemented with either remifentanil or fentanyl. Remifentanil was infused at 0.1 mug kg(-1) min(- 1) and desflurane was adjusted at 2 vol% end-tidal. Fentanyl was given as a bolus dose of 2 mug kg(-1) before induction and repeated at skin incision; desflurane was adjusted as needed. Times for early recovery and response t o simple neurological tests (digit symbol substitution test (DSST) and Trie ger dot test (TDT)) were measured 30, 60 and 90 min after operation. Emerge nce from remifentanil-desflurane anaesthesia was significantly quicker than that, from fentanyl-desflurane anaesthesia: mean times to extubation were 4.1 (SD 1.7) and 8.2 (4.9) min. respectively; mean times for patients to st ate their name correctly were 6.0 (2.8) and 13.8 (9.0) min, respectively. P atients in the remifentanil-desflurane group successfully performed neurolo gical tests significantly earlier than those in the fentanyl-desflurane gro up; for example, patients in the former group completed the arm holding tes t at 7.9 (3.0) min, while those in the latter group did this at 20.6 (19.7) min (P less than or equal to0.01). Intermediate recovery was less impaired at 30 min (DSST, TDT) and at 60 min (DSST). More rapid awakening and an ea rlier opportunity for neurological examination suggest that remifentanil-de sflurane is a suitable alternative to a standard fentanyl-based general ana esthetic technique in patients undergoing CEA.