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Remifentanil–propofol versus sufentanil–propofol anaesthesia for supratentorial craniotomy: a randomized trial

Published online by Cambridge University Press:  11 July 2005

K. Gerlach ,
T. Uhlig ,
M. Hüppe ,
G. Nowak ,
A. Schmitz ,
L. Saager ,
A. Grasteit  and
P. Schmucker
K. Gerlach
Affiliation:
University Hospital Lübeck, Department of Anaesthesiology, Lübeck, Germany
T. Uhlig
Affiliation:
University Hospital Lübeck, Department of Anaesthesiology, Lübeck, Germany
M. Hüppe
Affiliation:
University Hospital Lübeck, Department of Anaesthesiology, Lübeck, Germany
G. Nowak
Affiliation:
University Hospital Lübeck, Department of Neurosurgery, Lübeck, Germany
A. Schmitz
Affiliation:
University Hospital Lübeck, Department of Anaesthesiology, Lübeck, Germany
L. Saager
Affiliation:
University Hospital Lübeck, Department of Anaesthesiology, Lübeck, Germany
A. Grasteit
Affiliation:
University Hospital Lübeck, Department of Anaesthesiology, Lübeck, Germany
P. Schmucker
Affiliation:
University Hospital Lübeck, Department of Anaesthesiology, Lübeck, Germany
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Summary

Background and objective: Remifentanil has unique pharmacokinetics that might allow faster recovery after neurosurgery. We investigated the effects of a propofol/sufentanil versus a remifentanil/propofol regimen on the primary end-point tracheal extubation time.

Methods: In the Neurosurgery Department of a University Hospital, 36 patients awaiting craniotomy for supratentorial tumour resection were randomly assigned to one of two study groups. In the sufentanil/propofol group, anaesthesia was induced with 0.5 μg kg−1 sufentanil and 1–2 mg kg−1 propofol. Propofol infusion and boluses of sufentanil were administered for maintenance. In the remifentanil/propofol group, anaesthesia was started with an infusion of remifentanil (0.2–0.35 μg kg−1 min−1) and a bolus of propofol (1.5–2 mg kg−1). Patients received a propofol infusion and a remifentanil infusion for maintenance of anaesthesia. Recovery times were taken from cessation of the propofol infusion. In addition, data about self-reported nausea and vomiting, pain and analgesic requirements were collected.

Results: Patients in the remifentanil/propofol group were extubated earlier (mean times 6.4 (±SD 4.7) versus 14.3 (±9.2) min; P = 0.003). The two groups were similar with respect to postoperative nausea and vomiting, and patient-reported pain scores. Fifty per cent of the remifentanil/propofol patients and 88% of the sufentanil/propofol patients required no analgesics within 1 h after operation (P= 0.03).

Conclusions: The remifentanil/propofol regimen provided quicker recovery. The two regimens were similar in terms of postoperative nausea and vomiting and patient-reported pain scores, but patients in the remifentanil/propofol group required more analgesics within 1 h postoperatively.

Keywords

ANAESTHESIA AND ANALGESIA, anaesthesia recovery periodANAESTHESIA GENERAL, anaesthetics intravenous, propofol, remifentanil, sufentanilSIGNS AND SYMPTOMS, nausea, pain, vomiting
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 20 , Issue 10 , November 2003 , pp. 813 - 820
Copyright
© 2003 European Society of Anaesthesiology

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