title: Remifentanil vs fentanyl with a target controlled propofol infusion in patients undergoing craniotomy for supratentorial lesions.
abstract: OBJECTIVE
  Remifentanil hydrochloride is an ultra-short acting m-opioid receptor agonist. This study compared the use of remifentanil with that of fentanyl during elective supratentorial craniotomy in a target controlled infusion (TCI)-propofol anesthesia regimen and evaluated the quality of recovery from anesthesia.
  
  
  METHODS
  After written informed consent for this prospective study, 40 adult patients were randomly divided into 2 groups: in group F analgesia was provided with fentanyl 2-3 mg kg(-1) h(-1) and in group R with remifentanil 0.25 mg kg(-1) h(-1). Anesthesia was induced with thiopental and pancuronium bromide, and maintained with propofol-TCI, pancuronium, air and oxygen and fentanyl (group F) or remifentanil (group R), respectively. After tracheal intubation, infusion rate of remifentanil was reduced and then adjusted to maintain stable hemodynamics. Hemodynamics and recovery time were monitored for 60 min after surgery. Analgesic requirements, propofol intraoperative consumption, nausea and vomiting in postoperative period were monitored. Recovery was evaluated according to a modified Aldrete score.
  
  
  RESULTS
  Baseline hemodynamics were similar in both groups. Mean arterial pressure differed between the 2 groups (P<0.05) with the greatest decrease in group R during dura opening (P<0.001). Postoperative mean arterial pressure was higher in group R. Patients in group R exhibited a faster recovery. The incidence of nausea and vomiting was similar in the 2 groups. Noteworthy, there was a reduction in the amount of propofol used in group R.
  
  
  CONCLUSIONS
  Remifentanil appears to be a reasonable alternative to fentanyl during elective surgery of supratentorial lesions.
authors: Department of Anaesthesia and Intensive Care IRCCS H Casa Sollievo della Sofferenza, S. Giovanni Rotondo, Foggia, Italy. freddydelgaudio@tin.it
authors: A
authors: A
authors: Del Gaudio
authors: P
authors: P
authors: Ciritella
authors: F
authors: F
authors: Perrotta
authors: M
authors: M
authors: Puopolo
authors: E
authors: E
authors: Lauta
authors: P
authors: P
authors: Mastronardi
authors: P
authors: P
authors: De Vivo