Comparison of propofol-alfentanil and propofol-remifentanil anaesthesia in percutaneous nephrolithotripsy.
OBJECTIVE
Percutaneous nephrolithotripsy (PCNL) is used for the fragmentation and removal of stones from the renal pelvis and renal calyceal systems. We compared the effects of propofol-alfentanil or propofol-remifentanil anaesthesia on haemodynamics, recovery characteristics and postoperative analgesic requirements during percutaneous nephrolithotripsy.


METHODS
Thirty non-premedicated patients were randomly allocated to receive either propofol-alfentanil (Group A) or propofol-remifentanil (Group R). The loading dose of the study drug was administered over 60 s (alfentanil 10 microg kg(-1) or remifentanil 1 microg kg(-1)) followed by a continuous infusion (alfentanil 15 microg kg(-1) h(-1) or remifentanil 0.15 microg kg(-1) min(-1)). Propofol was administered until loss of consciousness and maintained with a continuous infusion of 75 microg kg(-1) min(-1) in both groups. Atracurium was given for endotracheal intubation at a dose of 0.5 mg kg(-1) and maintained with a continuous infusion of 0.4 mg kg(-1) h(-1). Mean arterial pressure heart rate, the total amount of propofol, time of recovery of spontaneous ventilation, extubation and eye opening in response to verbal stimulus and analgesic requirement were recorded.


RESULTS
In Group A, mean arterial pressure was higher at the first minute in the prone position, and during skin incision and lithotripsy, and heart rate was higher during skin incision and lithotripsy when compared with Group R (P < 0.05). The total amount of propofol did not differ between groups. Time of recovery of spontaneous ventilation, extubation and eye opening were significantly shorter in Group R than Group A (P < 0.05).


CONCLUSIONS
Both propofol-remifentanil and propofol-alfentanil anaesthesia provided stable haemodynamics during percutaneous nephrolithotripsy, whereas propofol-remifentanil allowed earlier extubation.
Cicek
M
M
Medical School of Inonu University, Department of Anaesthesiology, Malatya, Turkey. muslumcicek@inonu.edu.tr
Koroglu
A
A
Demirbilek
S
S
Teksan
H
H
Ersoy
M O
MO
D000328:Adult; D015760:Alfentanil / Q000008:administration & dosage*; D000700:Analgesics / Q000627:therapeutic use; D000762:Anesthesia Recovery Period; D019162:Anesthetics, Combined / Q000008:administration & dosage*; D018686:Anesthetics, Intravenous / Q000008:administration & dosage*; D001279:Atracurium / Q000008:administration & dosage; D001794:Blood Pressure / Q000187:drug effects; D005260:Female; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D007442:Intubation, Intratracheal; D007669:Kidney Calculi / Q000628:therapy; D007670:Kidney Calices / Q000473:pathology; D007682:Kidney Pelvis / Q000473:pathology; D008096:Lithotripsy / Q000379:methods*; D008297:Male; D003473:Neuromuscular Nondepolarizing Agents / Q000008:administration & dosage; D010880:Piperidines / Q000008:administration & dosage*; D015742:Propofol / Q000008:administration & dosage*; D000077208:Remifentanil; D012119:Respiration / Q000187:drug effects; D013997:Time Factors; D014851:Wakefulness / Q000187:drug effects
D000700:Analgesics; D019162:Anesthetics, Combined; D018686:Anesthetics, Intravenous; D003473:Neuromuscular Nondepolarizing Agents; D010880:Piperidines; D015760:Alfentanil; D001279:Atracurium; D000077208:Remifentanil; D015742:Propofol