Effectiveness of remifentanil versus traditional fentanyl-based anesthetic in high-risk outpatient surgery.
OBJECTIVE
To determine if remifentanil would offer a superior hemodynamic and recovery profile compared to the current standard of care, which implements a fentanyl-based technique.


METHODS
Randomized, single-blind study.


METHODS
Outpatient center associated with tertiary care center.


METHODS
75 outpatients undergoing microsuspension laryngoscopy.


METHODS
Patients were randomized to either a remifentanil induction (0.5 microg/kg/min) and maintenance (0.25 microg/kg/min) versus fentanyl (maximum of 250 microg) as the only opioid. All patients received propofol as part of the induction and maintenance with or without the use of nitrous oxide.


METHODS
Assessment of hemodynamics [heart rate (HR) and blood pressure(BP)], presence of perioperative myocardial ischemia on ambulatory electrocardiographic monitoring, and time to discharge.


RESULTS
Significantly fewer patients in the remifentanil group demonstrated episodes of tachycardia (HR > 100 beats per min) compared to the fentanyl group (14% vs. 40%, p<0.05), with significantly fewer episodes of tachycardia and hypertension per patient. Recovery profiles between the two groups did not show clinically significant differences.


CONCLUSIONS
Remifentanil, a new short-acting opioid, offers excellent hemodynamic control for brief, intense outpatient procedures performed in high-risk patients; however, its use was not associated with any improvement in recovery profiles.
Mackey
J J
JJ
Department of Anesthesiology, Johns Hopkins University, Baltimore, MD, USA.
Parker
S D
SD
Nass
C M
CM
Snyder
D S
DS
Curreri
S
S
Kazim
D
D
Zuckerman
R L
RL
Fleisher
L A
LA
D000368:Aged; D000556:Ambulatory Surgical Procedures; D018686:Anesthetics, Intravenous / Q000494:pharmacology*; D005260:Female; D005283:Fentanyl / Q000494:pharmacology*; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D007828:Laryngoscopy; D008297:Male; D008875:Middle Aged; D010880:Piperidines / Q000494:pharmacology*; D000077208:Remifentanil; D012306:Risk; D016037:Single-Blind Method
D018686:Anesthetics, Intravenous; D010880:Piperidines; D000077208:Remifentanil; D005283:Fentanyl