Remifentanil-propofol versus sufentanil-propofol anaesthesia for supratentorial craniotomy: a randomized trial.
OBJECTIVE
Remifentanil has unique pharmacokinetics that might allow faster recovery after neurosurgery. We investigated the effects of a propofol/sufentanil versus a remifentanil/propofol regimen on the primary end-point tracheal extubation time.


METHODS
In the Neurosurgery Department of a University Hospital, 36 patients awaiting craniotomy for supratentorial tumour resection were randomly assigned to one of two study groups. In the sufentanil/propofol group, anaesthesia was induced with 0.5 microg kg(-1) sufentanil and 1-2 mg kg(-1) propofol. Propofol infusion and boluses of sufentanil were administered for maintenance. In the remifentanil/propofol group, anaesthesia was started with an infusion of remifentanil (0.2-0.35 microg kg(-1) min(-1)) and a bolus of propofol (1.5-2 mg kg(-1)). Patients received a propofol infusion and a remifentanil infusion for maintenance of anaesthesia. Recovery times were taken from cessation of the propofol infusion. In addition, data about self-reported nausea and vomiting, pain and analgesic requirements were collected.


RESULTS
Patients in the remifentanil/propofol group were extubated earlier (mean times 6.4 (+/- SD 4.7) versus 14.3 (+/- 9.2) min; P = 0.003). The two groups were similar with respect to postoperative nausea and vomiting, and patient-reported pain scores. Fifty per cent of the remifentanil/propofol patients and 88% of the sufentanil/propofol patients required no analgesics within 1 h after operation (P = 0.03).


CONCLUSIONS
The remifentanil/propofol regimen provided quicker recovery. The two regimens were similar in terms of postoperative nausea and vomiting and patient-reported pain scores, but patients in the remifentanil/ propofol group required more analgesics within 1 h postoperatively.
University Hospital Lübeck, Department of Anaesthesiology, Lübeck, Germany. klaus.gerlach@medinf.mu-luebeck.de
K
K
Gerlach
T
T
Uhlig
M
M
Hüppe
G
G
Nowak
A
A
Schmitz
L
L
Saager
A
A
Grasteit
P
P
Schmucker
D000368:Aged; D000704:Analysis of Variance; D019162:Anesthetics, Combined / Q000627:therapeutic use*; D018686:Anesthetics, Intravenous / Q000627:therapeutic use; D003399:Craniotomy; D005260:Female; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D007442:Intubation, Intratracheal; D008297:Male; D008875:Middle Aged; D010880:Piperidines / Q000627:therapeutic use*; D020250:Postoperative Nausea and Vomiting / Q000517:prevention & control; D015742:Propofol / Q000627:therapeutic use*; D000077208:Remifentanil; D017409:Sufentanil / Q000627:therapeutic use*; D015173:Supratentorial Neoplasms / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome
D019162:Anesthetics, Combined; D018686:Anesthetics, Intravenous; D010880:Piperidines; D017409:Sufentanil; D000077208:Remifentanil; D015742:Propofol