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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
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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

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