Hostname: page-component-cd9895bd7-mkpzs Total loading time: 0 Render date: 2024-12-27T22:06:15.206Z Has data issue: false hasContentIssue false
  • English
  • Français

Remifentanil vs. alfentanil infusion in non-paralysed patients: a randomized, double-blind study

Published online by Cambridge University Press:  28 January 2005

C. R. Mortensen ,
B. Larsen ,
J. Å. K. Petersen ,
P. Rotbøll ,
J. Riis ,
H. Thorshauge ,
J. Engbæk ,
S. Troelsen  and
J. Viby-Mogensen
C. R. Mortensen
Affiliation:
Copenhagen University Hospital, Centre of Head and Orthopaedics, Department of Anaesthesia and Operating Theatre Services, Rigshospitalet, Copenhagen, Denmark
B. Larsen
Affiliation:
Aalborg Hospital, Department of Anaesthesia and Intensive Care, Aalborg, Denmark Present address: Department of Anaesthesia and Intensive Care, Silkeborg Central Hospital, Falkevej 1–3, DK-8600 Silkeborg, Denmark.
J. Å. K. Petersen
Affiliation:
Viborg Hospital, Department of Anaesthesia and Intensive Care, Viborg, Denmark
P. Rotbøll
Affiliation:
Copenhagen University Hospital, Centre of Head and Orthopaedics, Department of Anaesthesia and Operating Theatre Services, Rigshospitalet, Copenhagen, Denmark
J. Riis
Affiliation:
Aalborg Hospital, Department of Anaesthesia and Intensive Care, Aalborg, Denmark
H. Thorshauge
Affiliation:
Aalborg Hospital, Department of Anaesthesia and Intensive Care, Aalborg, Denmark
J. Engbæk
Affiliation:
University of Copenhagen, Herlev Hospital, Department of Anaesthesia, Herlev, Denmark
S. Troelsen
Affiliation:
Viborg Hospital, Department of Anaesthesia and Intensive Care, Viborg, Denmark
J. Viby-Mogensen
Affiliation:
Copenhagen University Hospital, Academic Department of Anaesthesia and Intensive Care, Rigshospitalet, Copenhagen, Denmark
Get access

Extract

Summary

Background and objective: Remifentanil has a short duration of action and constant elimination, which allow administration of high doses, without prolonging recovery. Remifentanil has been compared to alfentanil, as part of a total intravenous anaesthetic technique, where remifentanil provided better anaesthetic conditions than alfentanil, without adverse effect on recovery. However, these results were obtained during anaesthesia involving neuromuscular blockade, which may mask both signs of insufficient anaesthesia and side-effects such as muscle rigidity. The aim of this study was to compare remifentanil with alfentanil for anaesthesia without neuromuscular blockade.

Methods: We performed a prospective, randomized, double-blind, four-centre study to compare remifentanil infusion 15 μg kg−1 h−1 and alfentanil infusion 60 μg kg−1 h−1, using a total intravenous technique for non-paralysed patients, and the laryngeal mask airway for airway management. We enrolled 192 patients, 18–65 yr of age with ASA I–II, undergoing minor surgery. The primary endpoint was the number of patients having pre-defined responses to surgical stimulation. A number of secondary criteria was evaluated to assess undesirable properties of the procedures.

Results: In the alfentanil group, 85% of patients responded to surgical stimulation, vs. 35% in the remifentanil group (P < 0.0001). No difference was found in recovery data, or in any other parameter than those related to insufficient anaesthesia.

Conclusions: The remifentanil-based technique provided significantly better anaesthetic conditions than the alfentanil-based technique in the setting of this study, without causing any significant adverse effects.

Keywords

ANALGESICS, OPIOID, alfentanil, remifentanilANAESTHESIA, INTRAVENOUS, total, propofolANAESTHESIA RECOVERY PERIOD, analgesiaANAESTHESIA, GENERAL
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 21 , Issue 10 , October 2004 , pp. 787 - 792
Copyright
© 2004 European Society of Anaesthesiology

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Feldman PL, James MK, Brackeen MF, et al. Design, synthesis, and pharmacological evaluation of ultrashort- to long-acting opioid analgetics. J Med Chem 1991; 34: 2002–2008.Google Scholar
James MK, Feldman PL, Schuster SV, Bilotta JM, Brackeen MF, Leighton HJ. Opioid receptor activity of GI 87084B, a novel ultrashort acting analgesic, in isolated tissues. J Pharm Exp Ther 1991; 259: 712–718.Google Scholar
Glass PS, Hardman D, Kamiyama Y, et al. Preliminary pharmacokinetics and pharmacodynamics of an ultrashort-acting opioid: remifentanil (GI87084B). Anesth Analg 1993; 77: 1031–1040.Google Scholar
Egan TD, Lemmens HJ, Fiset P, et al. The pharmacokinetics of the new short-acting opioid remifentanil (GI87084B) in healthy adult male volunteers. Anesthesiology 1993; 79: 881–892.Google Scholar
Westmoreland CL, Hoke JF, Sebel PS, Hug Jr CC, Muir KT. Pharmacokinetics of remifentanil (GI87084B) and its major metabolite (GI90291) in patients undergoing elective inpatient surgery. Anesthesiology 1993; 79: 893–903.Google Scholar
Philip BK, Scuderi PE, Chung F, et al. Remifentanil compared with alfentanil for ambulatory surgery using total intravenous anesthesia. Anesth Analg 1997: 84: 515–521.Google Scholar
Schüttler J, Albrecht S, Breivik H, et al. A comparison of remifentanil and alfentanil in patients undergoing major abdominal surgery. Anaesthesia 1997; 52: 307–317.Google Scholar
Nilsson L, Viby-Mogensen J, Møller JC, Fonsmark L, Østerggard D. Remifentanil vs alfentanil for direct laryngoscopy. Acta Anaesthesiol Belg 2002; 53: 213–219.Google Scholar
Alper I, Erhan E, Ugur G, Ozyar B. Remifentanil versus alfentanil in total intravenous anaesthesia for day case surgery. Eur J Anaesth 2003; 20: 61–64.Google Scholar
Aldrete JA, Kroulik D. A postanesthetic recovery score. Anesth Analg 1970; 49: 924–933.Google Scholar
Coriat P, Beaussier M. Fast-tracking after coronary artery bypass graft surgery. Anesth Analg 2001; 92: 1081–1083.Google Scholar
Wuesten R, Van Aken H, Glass PS, Buerkle H. Assessment of dept of anesthesia and postoperative respiratory recovery after remifentanil- versus alfentanil-based total intravenous anesthesia in patients undergoing ear–nose–throat surgery. Anesthesiology 2001; 94: 211–217.Google Scholar
Sneyd JR, Camu F, Doenicke A, et al. Remifentanil and fentanyl during anaesthesia for major abdominal and gynaecological surgery. An open, comparative study of safety and efficacy. Eur J Anaesth 2001; 18: 605–614.Google Scholar
Heidvall M, Hein A, Davidson S, Jakobsson J. Cost comparison between three different general anaesthetic techniques for elective arthroscopy of the knee. Acta Anaesthesiol Scand 2000; 44: 157–162.Google Scholar