Comparison of the effects of remifentanil or fentanyl on anaesthetic induction characteristics of propofol, thiopental or etomidate.
OBJECTIVE
This prospective, randomized, double-blinded study was designed to compare the effects of remifentanil or fentanyl on anaesthetic induction characteristics of propofol, thiopental or etomidate.


METHODS
Seventy-two patients were enrolled in six groups of 12 individuals each. In three groups, fentanyl was given as a bolus dose of 1.5 microg kg(-1), whereas the others received a remifentanil infusion at 0.5 microg kg(-1) min(-1). Five minutes later, propofol, thiopental or etomidate were titrated to a state of unresponsiveness. Assessment included the amounts of drug necessary for induction, haemodynamics and the times to apnoea, loss of eyelash reflex, and the release of a water-filled syringe held in the patient's hand.


RESULTS
Induction times to loss of the eyelash reflex were significantly shorter in the remifentanil than in the fentanyl groups: with propofol 50.7 +/- 13.6s (mean +/- SD) versus 74.9 +/- 27.0s (P < 0.01), with thiopental 42.9 +/- 16.8s versus 77.2 +/- 27.8s (P < 0.01) and with etomidate 54.7 +/- 17.6s versus 72.3 +/- 24.0s (P < 0.05). The times to respiratory arrest or for the syringe to fall were significantly shorter with remifentanil than with fentanyl for propofol and for thiopental, but not for etomidate. In terms of dosages per kg body weight necessary to achieve unresponsiveness, less propofol (-29%, P < 0.05), thiopental (-25%, P < 0.05) or etomidate (-32%, P < 0.01) was necessary with remifentanil than with fentanyl. Haemodynamic responses to tracheal intubation were controlled more effectively with remifentanil. However, within the remifentanil groups, mean arterial pressure significantly decreased during induction: -26% with propofol, -181% with thiopental and -14% with etomidate (all P < 0.01).


CONCLUSIONS
During anaesthetic induction, a remifentanil infusion of 0.5 microg kg(-1) min(-1) over 5 min is a suitable alternative to a 1.5 microg kg(-1) bolus dose of fentanyl: induction times are shorter with reduced amounts of propofol, thiopental or etomidate.
Wilhelm
W
W
University of Saarland, Department of Anaesthesiology and Intensive Care Medicine, Homburg/Saar, Germany. wolfram.wilhelm@t-online.de
Biedler
A
A
Huppert
A
A
Kreuer
S
S
Bücheler
O
O
Ziegenfuss
T
T
Larsen
R
R
D000328:Adult; D018686:Anesthetics, Intravenous / Q000494:pharmacology*; D004311:Double-Blind Method; D005045:Etomidate / Q000494:pharmacology; D005140:Eyelashes / Q000187:drug effects; D005260:Female; D005283:Fentanyl / Q000494:pharmacology*; D006339:Heart Rate / Q000187:drug effects*; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D007442:Intubation, Intratracheal; D008297:Male; D008875:Middle Aged; D010880:Piperidines / Q000494:pharmacology*; D015742:Propofol / Q000494:pharmacology; D011446:Prospective Studies; D012018:Reflex / Q000187:drug effects*; D000077208:Remifentanil; D012119:Respiration / Q000187:drug effects; D013874:Thiopental / Q000494:pharmacology
D018686:Anesthetics, Intravenous; D010880:Piperidines; D013874:Thiopental; D000077208:Remifentanil; D005283:Fentanyl; D015742:Propofol; D005045:Etomidate