Comparison of adenosine and remifentanil infusions as adjuvants to desflurane anesthesia.
BACKGROUND
Because adenosine has been alleged to produce both anesthetic and analgesic sparing effects, a randomized, double-blinded study was designed to compare the perioperative effects of adenosine and remifentanil when administered as intravenous adjuvants during general anesthesia for major gynecologic procedures.


METHODS
Thirty-two women were assigned randomly to one of two drug treatment groups. After premedication with 0.04 mg/kg intravenous midazolam, anesthesia was induced with 2 micro/kg intravenous fentanyl, 1.5 mg/kg intravenous propofol, and 0.6 mg/kg intravenous rocuronium, and maintained with desflurane, 2%, and nitrous oxide, 65%, in oxygen. Before skin incision, an infusion of either remifentanil (0.02 microg x kg(-1) x min(-1)) or adenosine (25 microg x kg(-1) x min(-1)) was started and subsequently titrated to maintain systolic blood pressure, heart rate, or both within 10-15% of the preincision values.


RESULTS
Adenosine and remifentanil infusions were effective anesthetic adjuvants during lower abdominal surgery. Use of adenosine (mean +/- SEM, 166+/-17 microg x kg(-1) x min(-1)) was associated with a significantly greater decrease in systolic blood pressure and higher heart rate values compared with remifentanil (mean +/- SEM, 0.2+/-0.03 microg kg(-1) x min(-1)). Total postoperative opioid analgesic use was 45% and 27% lower in the adenosine group at 0-2 h and 2-24 h after surgery, respectively.


CONCLUSIONS
Adjunctive use of a variable-rate infusion of adenosine during desflurane-nitrous oxide anesthesia was associated with acceptable hemodynamic stability during the intraoperative period. Compared with remifentanil, intraoperative use of adenosine was associated with a decreased requirement for opioid analgesics during the first 24 h after operation.
Zárate
E
E
Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center at Dallas, 75235-9068, USA.
Sá Rêgo
M M
MM
White
P F
PF
Duffy
L
L
Shearer
V E
VE
Griffin
J D
JD
Whitten
C W
CW
D000241:Adenosine / Q000009:adverse effects / Q000494:pharmacology*; D000328:Adult; D000701:Analgesics, Opioid / Q000494:pharmacology*; D018685:Anesthetics, Inhalation / Q000494:pharmacology*; D001794:Blood Pressure / Q000187:drug effects; D000077335:Desflurane; D005260:Female; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D007530:Isoflurane / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000494:pharmacology; D008875:Middle Aged; D010880:Piperidines / Q000009:adverse effects / Q000494:pharmacology*; D000077208:Remifentanil
D000701:Analgesics, Opioid; D018685:Anesthetics, Inhalation; D010880:Piperidines; D000077335:Desflurane; D007530:Isoflurane; D000241:Adenosine; D000077208:Remifentanil