Assessment of depth of anesthesia and postoperative respiratory recovery after remifentanil- versus alfentanil-based total intravenous anesthesia in patients undergoing ear-nose-throat surgery
R. Wuesten et al., Assessment of depth of anesthesia and postoperative respiratory recovery after remifentanil- versus alfentanil-based total intravenous anesthesia in patients undergoing ear-nose-throat surgery, ANESTHESIOL, 94(2), 2001, pp. 211-217
Citations number
27
Categorie Soggetti
Aneshtesia & Intensive Care","Medical Research Diagnosis & Treatment
Background: The authors investigated whether total intravenous anesthesia (
TIVA) with precalculated equipotent infusion schemes for remifentanil and a
lfentanil would ensure appropriate analgesia and that remifentanil would re
sult in better recovery characteristics.
Methods: forty consenting patients (classified as American Society of Anest
hesiologists physical status I-III) scheduled for microlaryngoscopy were ra
ndomized to receive, in a double-blind manner, either remifentanil (loading
dose 1 mug/kg; maintenance infusion, 0.25 mug.kg(-1).min(-1)) or alfentani
l (loading dose, 50 mug/kg; maintenance infusion, 1 mug.kg(-1).min(-1)) as
the analgesic component of TIVA. They were combined with propofol (loading
dose, 2 mg/kg; maintenance infusion, 100 mug.kg(-1).min(-1)). To insure an
equal state of anesthesia, the opioids were titrated to maintain heart rate
and mean arterial pressure within 20% of baseline, and propofol was titrat
ed to keep the bispectral index (BIS) less than 60. Neuromuscular blockade
was achieved with succinylcholine. Drug dosages and the times from cessatio
n of anesthesia to extubation, verbal response, recovery of ventilation, an
d neuropsychological testing, orientation, and discharge readiness were rec
orded.
Results: Demographics, duration of surgery, and anesthesia were similar bem
een the two groups. Both groups received similar propofol doses. There wer
e no difference in BIS values preoperatively (mean, 96), intraoperatively (
mean, 55), and postoperatively (mean, 96). Recovery of BIS and times for ve
rbal response did not differ. At 20, 30, and 40 min after terminating the o
pioid infusion, the peripheral oxygen saturation and respiratory rate were
significantly higher in the remifentanil group compared with the alfentanil
group.
Conclusions: When both the hypnotic and analgesic components of a TIVA-base
d anesthetic are administered in equipotent doses, remifentanil provides a
more rapid respiratory recovery, even after brief surgical procedures, comp
ared with alfentanil.