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Is a Desflurane-Remifentanil Based Anesthetic Really the Best for the Wake-Up Test?

Wappler, Frank MD

Letters to the Editor: Letters & Announcements

Department of Anesthesiology; University Witten/Herdecke; Hospital Cologne-Merheim; Cologne, Germany;

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In Response:

We appreciated Dr. Nafiu’s feedback to our recent article (1). He focused on three different issues. First, all patients received cisatracurium for muscle relaxation only for induction of anesthesia. The effects of cisatracurium were measured with relaxometry (train-of-four); thus we could ensure that neuromuscular functions were unaffected during the wake-up tests. Secondly, patients anesthetized with propofol and sufentanil were significantly older than patients from the desflurane and remifentanil group. However, there were differences compared with the third group receiving propofol and remifentanil. Therefore, the results of this study were not influenced by different ages in the groups treated with propofol. All patients, independently of age, required plasma concentrations between 2 and 4 μg/mL, as defined in the study design. Third, it is obvious that different types of surgery could affect postoperative requirements of analgesic treatment. However, in all cases multilevel spinal surgeries were performed; therefore this should not influence postoperative pain treatment.

Regarding pharmacokinetic and pharmacodynamic considerations and the results of this clinical investigation, we are convinced that the proposed anesthetic concept using a combination of remifentanil and desflurane for intraoperative as well as postoperative wake-up tests is beneficial in patients undergoing spinal surgery.

Frank Wappler, MD

Department of Anesthesiology

University Witten/Herdecke

Hospital Cologne-Merheim

Cologne, Germany

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1. Grottke O, Dietrich PJ, Wiegels S, Wappler F. Intra- and postoperative wake-up tests in patients undergoing spinal surgery: Which anesthetic regimen is superior? Anesth Analg 2004;99:1521–7.
© 2005 International Anesthesia Research Society