Comparison of remifentanil in combination with isoflurane or propofol for short-stay surgical procedures

• Published in: British journal of anaesthesia : BJA Vol. 80; no. 6; pp. 752 - 755
• Main Authors: Rowbotham, D J, Peacock, J E, Jones, R M, Speedy, H M, Sneyd, J R, Morris, R W, Nolan, J P, Jolliffe, D, Lang, G
• Format: Journal Article
• Language: English
• Published: Oxford Elsevier Ltd 01.06.1998; Oxford University Press; Oxford Publishing Limited (England)
• Subjects: Adolescent; Adult; Aged; Analgesics, Opioid; Anesthetics, Inhalation; Anesthetics, Intravenous; Anesthetics. Neuromuscular blocking agents; Biological and medical sciences; Female; Humans; Isoflurane; Length of Stay; Male; Medical sciences; Middle Aged; Neuropharmacology; Pain, Postoperative - prevention & control; Pharmacology. Drug treatments; Piperidines; Postoperative Complications; Propofol; Prospective Studies; Remifentanil; Volatile compound; Human; Intravenous administration; General anesthesia; Narcotic analgesic; Isoflurane; Remifentanil; Inhalation; General anesthetic; Surgery; Short lasting; Propofol; Comparative study
• ISSN: 0007-0912; 1471-6771
• DOI: 10.1093/bja/80.6.752

There are few data in the literature that describe the use of remifentanil when administered as a component of an inhalation or total i.v. anaesthetic (TIVA) technique. We studied 251 male and female patients, aged 18-75 years, ASA I-II, undergoing inguinal hernia repair, arthroscopic knee surgery or varicose vein surgery of at least 30 min duration without premedication. Patients were randomized to receive a remifentanil loading dose of 1.0 microgram kg-1 followed by a continuous infusion of 0.5 microgram kg-1 min-1 in combination with isoflurane (end-tidal concentration 0.6%), (Group I, n = 115) or propofol (initial infusion rate 9 mg kg-1 h-1 reduced to 6 mg kg-1 h-1 after 10 min), (Group P, n = 118). The remifentanil infusion rate was reduced by 50%, 5 min after tracheal intubation. Intraoperative stresses were treated with a remifentanil bolus (1 microgram kg-1) followed by an increase in the remifentanil infusion rate. At the insertion of the last suture, the remifentanil infusion and concomitant anaesthetic were switched off simultaneously. Times to spontaneous respiration, adequate respiration and tracheal extubation were significantly shorter in group I compared with group P (6.4 min vs 7.6 min, P < 0.01; 7.6 min vs 9.3, P < 0.003; 7.8 min vs 9.5 min, P < 0.015). Overall mean systolic blood pressures during surgery were greater in group P compared with group I (P < 0.05) but the absolute differences were clinically insignificant (4-5 mm Hg).