Intraoperative wake-up test and postoperative emergence in patients undergoing spinal surgery: a comparison of intravenous and inhaled anesthetic techniques using short-acting anesthetics.
Surgical procedures on the vertebral column may result in spinal cord damage, leading to neurological deficits that demand immediate therapeutical intervention. We designed this study to determine which anesthetic regimen allows a rapid wake-up test during and after surgery to detect neurological deficits. Fifty-four patients were randomly allocated to the following groups: group PR (propofol/remifentanil): target-controlled infusion with propofol (plasma concentration, 2-4 microg/mL) and remifentanil 0.2-0.5 microg . kg(-1) . min(-1); group PS (propofol/sufentanil): propofol (2-4 microg/mL) and repetitive boluses of 0.1-0.2 microg/kg of sufentanil adjusted to patients requirements; and group DR (desflurane/remifentanil): desflurane/air 3.0-4.0 vol% combined with remifentanil 0.2-0.5 microg . kg(-1) . min(-1). Group PS required significantly longer times for the onset of breathing (8.9 +/- 1.6 min), elevation of the head (17.0 +/- 3.8 min), and motion of the feet (17.0 +/- 7.4 min) than group PR (6.9 +/- 2.6 min, 9.3 +/- 2.2 min, and 9.4 +/- 2.4 min, respectively) or group DR (5.4 +/- 0.8 min, 6.1 +/- 1.0 min, and 6.2 +/- 1.0 min, respectively). The anesthetic regimen with desflurane and remifentanil allowed faster awakening during and after surgery that permitted immediate neurological examination after spinal surgery compared with propofol/remifentanil.
Grottke
Oliver
O
*Department of Anesthesiology, University Hospital Eppendorf, Hamburg, Germany; and †Department of Anesthesiology, University Witten/Herdecke, Cologne, Germany.
Dietrich
Peter Johannes
PJ
Wiegels
Stefanie
S
Wappler
Frank
F
D000368:Aged; D016058:Analgesia, Patient-Controlled; D000762:Anesthesia Recovery Period; D000768:Anesthesia, General; D000769:Anesthesia, Inhalation; D000771:Anesthesia, Intravenous; D018686:Anesthetics, Intravenous; D001143:Arousal / Q000502:physiology*; D003071:Cognition / Q000502:physiology; D000077335:Desflurane; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007432:Intraoperative Period; D007530:Isoflurane / Q000031:analogs & derivatives*; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000379:methods*; D009460:Neurologic Examination; D010147:Pain Measurement / Q000187:drug effects; D010149:Postoperative Pain / Q000188:drug therapy; D010880:Piperidines; D011184:Postoperative Period; D015742:Propofol; D011597:Psychomotor Performance / Q000502:physiology; D000077208:Remifentanil; D013131:Spine / Q000601:surgery*; D017409:Sufentanil
D018686:Anesthetics, Intravenous; D010880:Piperidines; D017409:Sufentanil; D000077335:Desflurane; D007530:Isoflurane; D000077208:Remifentanil; D015742:Propofol