Comparison of remifentanil with fentanyl for deep sedation in oral surgery.
OBJECTIVE
The aim of this study was to compare recovery for oral surgery patients given a deep sedation regimen of midazolam, propofol, and remifentanil with a standard control of fentanyl in place of remifentanil.


METHODS
This investigation was designed as a randomized, prospective, single-blinded controlled study. Group 1, the control, received midazolam 0.03 mg/kg, fentanyl 1 microg/kg, and propofol initially at 140 microg/kg/min. Group 2 received midazolam 0.03 mg/kg, remifentanil: propofol (1:500) given at an initial propofol infusion rate of 40 microg/kg/min. Outcome measures included time to response to verbal command, Aldrete score = 9, Postanesthesia Discharge Scoring System = 7, and assessment by the Digit Symbol Substitution Test.


RESULTS
Forty-seven subjects were entered in the study. Baseline findings were homogenous between the 2 groups. Subjects in group 2 recovered earlier (P < .005) and required less propofol for both the induction (0.8 +/- 0.4 versus 1.2 +/- 0.6 mg/kg; mean +/- SD, P < .01) and maintenance of deep sedation (46 +/- 9 versus 131 +/- 17 microg/kg/min; P < .005). There were minor differences in vital signs.


CONCLUSIONS
This study demonstrated that this remifentanil regimen provided significantly more rapid recovery and used significantly less propofol compared with the fentanyl regimen.
Lacombe
Gabriel F
GF
Montréal, Canada.
Leake
James L
JL
Clokie
Cameron M L
CM
Haas
Daniel A
DA
D000293:Adolescent; D000328:Adult; D000762:Anesthesia Recovery Period; D000766:Anesthesia, Dental; D019162:Anesthetics, Combined / Q000008:administration & dosage / Q000494:pharmacology*; D004812:Epidemiologic Methods; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage / Q000494:pharmacology*; D006801:Humans; D008297:Male; D008874:Midazolam / Q000008:administration & dosage; D008875:Middle Aged; D008964:Molar, Third / Q000601:surgery; D010880:Piperidines / Q000008:administration & dosage / Q000494:pharmacology*; D015742:Propofol / Q000008:administration & dosage; D020127:Recovery of Function / Q000187:drug effects*; D000077208:Remifentanil; D013997:Time Factors
D019162:Anesthetics, Combined; D010880:Piperidines; D000077208:Remifentanil; D008874:Midazolam; D005283:Fentanyl; D015742:Propofol