Propofol-alfentanil vs propofol-remifentanil for posterior spinal fusion including wake-up test.
BACKGROUND
Wake-up test can be used during posterior spinal fusion (PSF) to ensure that spinal function remains intact. This study aims at assessing the characteristics of the wake-up test during propofol-alfentanil (PA) vs propofol-remifentanil (PR) infusions for PSF surgery.


METHODS
Sixty patients with scoliosis and candidates for PSF surgery were randomly allocated in either alfentanil (PA) or remifentanil (PR) group. After an i.v. bolus of alfentanil 30 microg kg(-1) in the PA group or remifentanil 1 microg kg(-1) in the PR group, anaesthesia was induced with thiopental and atracurium. During maintenance, opioid infusion consisted of alfentanil 1 microg kg(-1) min(-1) or remifentanil 0.2 microg kg(-1) min(-1), in the PA group and the PR group, respectively. All patients received propofol 50 microg kg(-1) min(-1). Atracurium was given to maintain the required surgical relaxation. At the surgeon's request, all infusions were discontinued. Patients were asked to move their hands and feet. Time from anaesthetic discontinuation to spontaneous ventilation (T(1)), and from then until movement of the hands and feet (T(2)), and its quality were recorded.


RESULTS
The average T(1) and T(2) were significantly shorter in the PR group [3.6 (2.5) and 4.1 (2) min] than the PA group [6.1 (4) and 7.5 (4.5) min]. Quality of wake-up test, however, did not show significant difference between the two groups studied.


CONCLUSIONS
Wake-up test can be conducted faster with remifentanil compared with alfentanil infusion during PSF surgery.
Department of Anaesthesiology, Rasool-Akram Hospital, School of Medicine, Iran University of Medical Sciences Tehran, Iran. farimani@iums.ac.ir
F
F
Imani
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A
Jafarian
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V
Hassani
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ZH
Khan
D000293:Adolescent; D000328:Adult; D015760:Alfentanil; D000701:Analgesics, Opioid; D019162:Anesthetics, Combined; D018686:Anesthetics, Intravenous; D001307:Auditory Perception / Q000187:drug effects*; D005260:Female; D006801:Humans; D007430:Intraoperative Care / Q000379:methods; D008297:Male; D009068:Movement; D010880:Piperidines; D015742:Propofol; D011930:Reaction Time; D000077208:Remifentanil; D012600:Scoliosis / Q000601:surgery; D013119:Spinal Cord Injuries / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D013123:Spinal Fusion / Q000009:adverse effects
D000701:Analgesics, Opioid; D019162:Anesthetics, Combined; D018686:Anesthetics, Intravenous; D010880:Piperidines; D015760:Alfentanil; D000077208:Remifentanil; D015742:Propofol