Remifentanil as an adjuvant during desflurane anesthesia facilitates early recovery after ambulatory surgery.
OBJECTIVE
To investigate the effect of using a remifentanil infusion during desflurane anesthesia on the early recovery profile and side effects.


METHODS
Randomized, single-blind study.


METHODS
University-based ambulatory surgery unit.


METHODS
46 healthy, ASA physical status I and II women undergoing outpatient laparoscopic tubal ligation procedures.


METHODS
After premedication with midazolam 2 mg intravenously (IV), anesthesia was induced with propofol 2 mg.kg-1 i.v. and remifentanil 1 microgram.kg-1 i.v. Following tracheal intubation, anesthesia was maintained with desflurane 2% and nitrous oxide (N2O) 65% in both groups. During the maintenance period, hemodynamic stability was maintained using either a variable inspired concentration of desflurane, 2% to 8% (Control group), or a variable-rate infusion of remifentanil 0.05 to 0.2 microgram.kg-1.min-1 i.v. (Remi group). Ketorolac 30 mg i.v. and local anesthetic infiltration at the surgical portals were administered for preventive analgesia prior to skin closure.


RESULTS
Emergence times and times to achieving an Aldrete score of 10 (i.e., fast-tracking eligibility) were determined. Postoperative nausea and vomiting (PONV), as well as the need for analgesic and antiemetic rescue medications, were noted during the 24-hour follow-up period. A structural questionnaire was used to assess intraoperative recall. Compared to the Control group, the Remi group had shorter emergence times and reduced times to achieving an Aldrete score of 10. There were no differences between the two groups with respect to the incidence of PONV and the requirements for postoperative analgesic and antiemetic drugs. None of the patients experienced intraoperative recall.


CONCLUSIONS
The adjunctive use of a remifentanil infusion (0.07 +/- 0.03 microgram.kg-1.min-1) during desflurane-N2O anesthesia facilitated early recovery without increasing PONV, pain, or the need for rescue medication after laparoscopic surgery.
Song
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Department of Anesthesiology and Pain Management, University of Texas South-western Medical Center, Dallas, TX 75235-9068, USA.
White
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PF
D000556:Ambulatory Surgical Procedures; D018685:Anesthetics, Inhalation / Q000494:pharmacology*; D018686:Anesthetics, Intravenous / Q000494:pharmacology*; D000077335:Desflurane; D005260:Female; D006801:Humans; D007530:Isoflurane / Q000031:analogs & derivatives* / Q000494:pharmacology; D011939:Mental Recall / Q000187:drug effects; D010880:Piperidines / Q000494:pharmacology*; D020250:Postoperative Nausea and Vomiting / Q000517:prevention & control; D000077208:Remifentanil; D016037:Single-Blind Method; D013246:Sterilization, Tubal; D013997:Time Factors
D018685:Anesthetics, Inhalation; D018686:Anesthetics, Intravenous; D010880:Piperidines; D000077335:Desflurane; D007530:Isoflurane; D000077208:Remifentanil