title: Small doses of remifentanil and alfetanil in continuous total intravenous anesthesia in major abdominal surgery. A double blind comparison.
abstract: OBJECTIVE
  The purpose of this study was to test the safety and efficacy of small doses of remifentanil and alfentanil in a continuous total intravenous anesthesia technique for patients undergoing major abdominal surgery.
  
  
  METHODS
  Sixty patients were enrolled in the study, and received in a double blind fashion either remifentanil (0.1 microg/kg/min) or alfentanil (alfentanil 0.75 microg/kg/min) in association with propofol (12 mg/kg/h at induction; 6-9 mg/kg/h for maintenance) and cisatracurium. Hemodynamic data, hypnosis monitoring data (Bispectral Index Score), ventilatory parameters and settings, drug utilisation were monitored during stress moments and during all the intraoperative period. Patients were evaluated also in the first 6 postoperative hours.
  
  
  RESULTS
  Mean amount of propofol for induction (BIS<60) was lower in the remifentanil group than in the alfentanil group. Significantly fewer patients receiving remifentanil responded to intubation in comparison with patients receiving alfentanil in terms of non invasive blood pressure (>30 mmHg) and heart rate variations. Significantly more patients receiving alfentanil had 1 or more responses to surgery. Incidence of hypotension was significantly higher in patients receiving remifentanil. There were no differences between the 2 groups in the times for spontaneous respiration, adequate respiration, adequate responsivness (OAA/s=5) and discharge from the recovery room. Time to extubation resulted slightly shorter (p<0.05) in patients who received remifentanil.
  
  
  CONCLUSIONS
  The use of remifentanil and alfentanil in association with propofol, in a continuous infusion total intravenous anesthesia technique, demonstrated to be safe and reliable strategies.
authors.affiliation: Department of Anesthesiological, Surgical and Emergency Sciences, Second University of Naples, Naples, Italy. micheleiannuzzi@libero.it
authors.forename: E
authors.initials: E
authors.lastname: Iannuzzi
authors.forename: M
authors.initials: M
authors.lastname: Iannuzzi
authors.forename: V
authors.initials: V
authors.lastname: Cirillo
authors.forename: G
authors.initials: G
authors.lastname: Viola
authors.forename: R
authors.initials: R
authors.lastname: Parisi
authors.forename: M
authors.initials: M
authors.lastname: Chiefari
mesh_terms: D000005:Abdomen / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015760:Alfentanil / Q000009:adverse effects; D000771:Anesthesia, Intravenous / Q000009:adverse effects; D018686:Anesthetics, Intravenous / Q000009:adverse effects; D003243:Consciousness / Q000187:drug effects; D004311:Double-Blind Method; D005260:Female; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D010880:Piperidines / Q000009:adverse effects; D000077208:Remifentanil
chemical_list: D018686:Anesthetics, Intravenous; D010880:Piperidines; D015760:Alfentanil; D000077208:Remifentanil