Remifentanil provides hemodynamic stability and faster awakening time in transsphenoidal surgery.
In this prospective study, we evaluated the effects of remifentanil in ASA I-II patients undergoing transsphenoidal surgery. After the induction of anesthesia, patients were randomly allocated to the Isoflurane (n = 22, 60% nitrous oxide, isoflurane up to 2% end-tidal) or Remifentanil group (n = 21, 60% nitrous oxide, 0.5% end-tidal isoflurane, remifentanil up to 2 microg x kg(-1) x min(-1)). If mean arterial pressure (MAP) increased >80 mm Hg during maximal dosage of isoflurane or remifentanil, labetalol was administered. At the end of anesthesia, extubation and awakening times, respiratory rate, SpO(2), MAP, heart rate, and adverse effects were recorded. Hemodynamics and bleeding (minimal, mild, moderate, severe) were not different between groups. Bleeding grade increased with MAP >80 mm Hg (P < 0.001). Labetalol was administered to 20 patients in the Isoflurane group, and 10 patients in the Remifentanil group (P < 0.01). The dose of labetalol was larger in the Isoflurane group (1.0 +/- 0.6 versus 0.5 +/- 0.7 mg/kg, P < 0.05). Time to extubation did not differ, whereas time to follow commands was shorter in Remifentanil patients (16 +/- 8 versus 10 +/- 2 min, P < 0.01). No adverse effects occurred in the early postoperative period.


CONCLUSIONS
In patients undergoing transsphenoidal surgery, balanced anesthesia with remifentanil (0.22 +/- 0.17 microg x kg(-1) x min(-1)) provides faster awakening time, as compared with large-dose volatile-based anesthesia, without the risk of postoperative opioid respiratory depression.
Gemma
Marco
M
Department of Anesthesiology and Intensive Care, University of Milano, Italy.
Tommasino
Concezione
C
Cozzi
Silvano
S
Narcisi
Simona
S
Mortini
Pietro
P
Losa
Marco
M
Soldarini
Armando
A
D000328:Adult; D000701:Analgesics, Opioid / Q000494:pharmacology*; D000762:Anesthesia Recovery Period; D018685:Anesthetics, Inhalation; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001794:Blood Pressure / Q000187:drug effects*; D005260:Female; D006339:Heart Rate / Q000187:drug effects*; D006801:Humans; D007530:Isoflurane; D007741:Labetalol / Q000627:therapeutic use; D008297:Male; D009609:Nitrous Oxide; D010880:Piperidines / Q000494:pharmacology*; D010902:Pituitary Gland / Q000601:surgery*; D011446:Prospective Studies; D000077208:Remifentanil; D012119:Respiration / Q000187:drug effects; D013100:Sphenoid Bone / Q000601:surgery*
D000701:Analgesics, Opioid; D018685:Anesthetics, Inhalation; D000959:Antihypertensive Agents; D010880:Piperidines; D007530:Isoflurane; D009609:Nitrous Oxide; D000077208:Remifentanil; D007741:Labetalol