title: Remifentanil-based anesthesia versus a propofol technique for otologic surgical procedures.
abstract: Otologic procedures require a still surgical field and are associated with a 50% incidence of emetic symptoms. Propofol reduces nausea and vomiting but not intraoperative movement. This study compares a remifentanil/propofol anesthetic to a propofol/fentanyl combination to determine which provides the best perioperative conditions for otologic microsurgery. Eighty healthy patients were randomly assigned to receive one of the anesthetic combinations. Demographic data, hemodynamic variables, movement, and bispectral index monitoring values in addition to anesthetic emergence, nausea, vomiting, pain, and other recovery variables were compared between groups with appropriate statistical methods. Both groups were similar. Times to eye opening (7.7 +/- 0.7 vs 12.4 +/- 1.2 minutes) and extubation (9.8 +/- 0.9 vs 12.4 +/- 1.0 minutes) were shorter with remifentanil. This group also had lower hemodynamic variables and movement (23% vs 65%) under anesthesia. Postoperative pain was mild in both groups, but remifentanil patients had more than the propofol group. All other postoperative parameters were similar. Remifentanil-based anesthesia produces better hemodynamic stability, less movement, and faster emergence after otologic surgery, with propofol's antiemetic effect, for the same cost.
authors.affiliation: Department of Anesthesiology, Loyola University Medical Center, Maywood, Illinois 60153, USA.
authors.forename: W S
authors.initials: WS
authors.lastname: Jellish
authors.forename: J P
authors.initials: JP
authors.lastname: Leonetti
authors.forename: A
authors.initials: A
authors.lastname: Avramov
authors.forename: E
authors.initials: E
authors.lastname: Fluder
authors.forename: J
authors.initials: J
authors.lastname: Murdoch
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000762:Anesthesia Recovery Period; D019162:Anesthetics, Combined; D018686:Anesthetics, Intravenous / Q000008:administration & dosage / Q000009:adverse effects; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage / Q000009:adverse effects; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D013506:Otologic Surgical Procedures; D010149:Postoperative Pain; D010880:Piperidines / Q000008:administration & dosage / Q000009:adverse effects; D020250:Postoperative Nausea and Vomiting; D015742:Propofol / Q000008:administration & dosage / Q000009:adverse effects; D000077208:Remifentanil
chemical_list: D019162:Anesthetics, Combined; D018686:Anesthetics, Intravenous; D010880:Piperidines; D000077208:Remifentanil; D005283:Fentanyl; D015742:Propofol