Remifentanil in neuroanaesthesia - a multi-centre survey

The aim of a modern fast-track approach for neuroanaesthesia is the early e xtubation and neurological examination following neurosurgical intervention s. Haemodynamic stability, maintenance of the cerebral autoregulation and a fast recovery without respiratory depression should be guaranteed. This se ems to be achieved by the new ultra-short acting opioid remifentanil. The i ntention of this study was to investigate the quality of remifentanil-suppl emented anaesthesia in neurosurgery in a large number of patients under con ditions of clinical routine. After approval by the ethical committee and informed consent of the neurosu rgical patients (ASA I - IV) 938 anaesthesia with remifentanil as analgesic drug were evaluated. Apart from demographic data, remifentail dosage and h aemodynamics at determined timepoints interventions for haemodynamic stabil isation and negative side effects of remifentanil were recorded as well as vigilance and onset spontaneous ventilation during the recovery phase. In 24.4% of the cases volatile anaesthetics were used, in 75.6% TIVA was pe rformed using propofol. For induction of anaesthesia 0.49 +/- 0.35 mug(-1) kg(-1) min(-1) (mean, SD) remifentanil were administered. Intra operative a nalgesia was maintained applicating 0.23 +/- 0.14 mug(-1) kg(-1) min(-1). I n 229 cases (24.4%) additional remifentanil boli had been administered, mos tly because of changing operative conditions or increasing blood pressure. The duration of the remifentanil-infusion was 3.4 +/- 2.1 h, Spontaneous br eathing started 7.5 +/- 5.3 min following the remifentanil-infusion. The pa tients could be contacted after 10 +/- 7.4 min and were oriented after 15.4 +/- 12.3 min. 81.9% of the patients could be extubated in the operating th eatre. In 10 cases (= 1.1%) disadvantageous side effects of remifentanil ha d been documented (hypotension, brady-cardia, chest wall rigidity), None of these incidents had been classified "severe". Excellent control of analgesia, stable intraoperative haemodynamics as well as advantagous characteristics of postoperative recovery in our investigat ion demon-anaesthesia, especially when an early extubation is desired.