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

Gerlach, K.*; Uhlig, T.*; Hüppe, M.*; Nowak, G.; Schmitz, A.*; Saager, L.*; Grasteit, A.*; Schmucker, P.*

European Journal of Anaesthesiology (EJA): October 2003 - Volume 20 - Issue 10 - p 813-820
Original Article

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.

University Hospital Lübeck, Departments of *Anaesthesiology andNeurosurgery, Lübeck, Germany

Correspondence to: Klaus Gerlach, Klinik für Anästhesiologie, Universitätsklinikum Lübeck, Ratzeburger Allee 160, D-23538 Lübeck, Germany. E-mail: klaus.gerlach@medinf.mu-luebeck.de; Tel: +49 451 500 4057; Fax: +49 451 500 3405

Accepted for publication December 2002 EJA 1125

© 2003 European Academy of Anaesthesiology