title: Does functional ability in the postoperative period differ between remifentanil- and fentanyl-based anesthesia?
abstract: OBJECTIVE
  To compare patients' functional ability in the 24-hour postoperative period following a remifentanil compared to a hypnotic-fentanyl-treated anesthesia regimen using a 24-Hour Functional Ability Questionnaire.
  
  
  METHODS
  Prospective, 1:1 single-blind, randomized, controlled effectiveness study.
  
  
  METHODS
  Multicenter study including 156 hospitals and ambulatory surgery facilities.
  
  
  METHODS
  2438 patients (1496 outpatients and 942 inpatients) 18 years of age or older, scheduled for elective surgeries under general endotracheal anesthesia, with an expected duration of unconsciousness of > or =30 minutes.
  
  
  METHODS
  Patients were randomized to receive either intravenous remifentanil (0.5 microg/kg/min for induction and intubation; with the infusion rate decreased to 0.25 microg/kg/min after intubation) or fentanyl (administered according to anesthesiologists' usual practice) as the opioid during surgery. Concomitant hypnotic drugs were propofol and/or isoflurane (with or without nitrous oxide) titrated according to protocol. Transition analgesia with either morphine or fentanyl was given in the remifentanil patients and at the discretion of the anesthesiologists in the fentanyl patients.
  
  
  METHODS
  A validated set of measurements of functional ability, rather than more traditional clinical psychological methods, to compare the recovery of patients from remifentanil- and fentanyl-treated anesthetic regimens up to 24 hours after surgery.
  
  
  RESULTS
  Remifentanil was statistically superior to fentanyl for the four functional assessments evaluated: walking without dizziness, thinking clearly, concentration, and communicating effectively. These differences reflect events occurring within the first 24 hours after anesthesia and surgery.
  
  
  CONCLUSIONS
  A remifentanil-treated anesthetic demonstrated earlier return to some functions than a fentanyl-treated technique. Although functional assessment is a field that is still in its infancy, a questionnaire to assess functional ability during the 24 hours after anesthesia may provide more practical information about anesthetic recovery than previously used, traditional psychomotor evaluations.
authors.affiliation: Department of Anesthesiology, Johns Hopkins University Hospital, 600 N. Wolfe St., Baltimore, MD 21287, USA. lfleishe@jhmi.edu
authors.forename: L A
authors.initials: LA
authors.lastname: Fleisher
authors.forename: S
authors.initials: S
authors.lastname: Hogue
authors.forename: M
authors.initials: M
authors.lastname: Colopy
authors.forename: R S
authors.initials: RS
authors.lastname: Twersky
authors.forename: D S
authors.initials: DS
authors.lastname: Warner
authors.forename: B D
authors.initials: BD
authors.lastname: Jamerson
authors.forename: K J
authors.initials: KJ
authors.lastname: Tuman
authors.forename: P S
authors.initials: PS
authors.lastname: Glass
authors.forename: M F
authors.initials: MF
authors.lastname: Roizen
mesh_terms: D000701:Analgesics, Opioid / Q000494:pharmacology*; D000758:Anesthesia; D005283:Fentanyl / Q000494:pharmacology*; D006801:Humans; D010880:Piperidines / Q000494:pharmacology*; D011184:Postoperative Period; D011446:Prospective Studies; D000077208:Remifentanil; D016037:Single-Blind Method; D013997:Time Factors
chemical_list: D000701:Analgesics, Opioid; D010880:Piperidines; D000077208:Remifentanil; D005283:Fentanyl