title: Comparison of the time to extubation after use of remifentanil or sufentanil in combination with propofol as anesthesia in adults undergoing nonemergency intracranial surgery: a prospective, randomized, double-blind trial.
abstract: BACKGROUND
  Anesthetics with a short context-sensitive half-time (ie, the time required for the effect-site concentration of an IV drug to decrease by 50% at steady state), such as the opioids remifentanil and sufentanil, are suitable for anesthesia when early neurologic assessment is desired to detect postoperative complications.
  
  
  OBJECTIVE
  This study compared the efficacy and safety profile of remifentanil and sufentanil in combination with propofol for anesthesia in adult patients undergoing nonemergency intracranial surgery.
  
  
  METHODS
  This was a prospective, randomized, double-blind study in adults aged 18 to 75 years who were scheduled to undergo a supratentorial neurosurgical procedure with a maximum anticipated duration of 480 minutes. Eligible patients had no incapacitating severe systemic disease (American Society of Anesthesiologists physical status class 1-3), and only those in whom immediate postoperative extubation was planned were included. Anesthesia was induced with propofol and either remifentanil 1 microg/kg or sufentanil 0.25 microg/kg. Propofol was continued using a target-controlled infusion (TCI) system. Maintenance infusion rates for remifentanil and sufentanil were 0.25 and 0.0025 microg.kg-1.min-1, respectively. The opioid and propofol infusions were adjusted based on hemodynamic parameters (mean arterial blood pressure, heart rate). The primary end point was the time to extubation. Secondary end points were hemodynamic stability (defined as the number of anesthetic adjustments required to maintain intraoperative hemodynamic parameters within 20% of preinduction values), postoperative IV morphine requirement, postoperative nausea/vomiting (PONV), and intraoperative anesthetic costs.
  
  
  RESULTS
  Sixty adults (29 remifentanil, 31 sufentanil) were included in the study. The 2 groups were similar with respect to sex, weight, indication for surgery, and duration of anesthesia. The sufentanil group was significantly older than the remifentanil group (55.3 vs 45.7 years, respectively; P=0.001). The median extubation time was similar in the remifentanil and sufentanil groups (10 minutes [interquartile range, 5-19 minutes] and 16 minutes [interquartile range, 10-30 minutes], respectively). Remifentanil was associated with the need for significantly fewer adjustments to maintain hemodynamic stability compared with sufentanil (0.8 vs 2.1; P=0.037), greater use of postoperative morphine (44.8% vs 22.6% of patients, P=0.01; mean IV morphine dose per patient: 4 vs 1.3 mg, P=0.016), and higher intraoperative opioid costs per patient euro vs euro P<0.001). The incidence of PONV did not differ significantly between groups. The total cost of intraoperative anesthetics per patient was similar in the 2 groups euro and euro as was the cost of propofol euro vs euro
  
  
  CONCLUSIONS
  In these adults undergoing nonemergency intracranial surgery, there was no significant difference in extubation time between those receiving remifentanil and sufentanil infusions adjusted based on hemodynamic parameters in combination with propofol administered by TCI.
authors.affiliation: Department of Neuro-Anaesthesia and Neuro-Intensive Care, Sainte Anne Hospital, Paris, France. mc.djian@ch-sainte-anne.fr
authors.forename: Marie-Christine
authors.initials: MC
authors.lastname: Djian
authors.forename: Benoit
authors.initials: B
authors.lastname: Blanchet
authors.forename: Florence
authors.initials: F
authors.lastname: Pesce
authors.forename: Alain
authors.initials: A
authors.lastname: Sermet
authors.forename: Monique
authors.initials: M
authors.lastname: Disdet
authors.forename: Vincent
authors.initials: V
authors.lastname: Vazquez
authors.forename: Charles
authors.initials: C
authors.lastname: Gury
authors.forename: François-Xavier
authors.initials: FX
authors.lastname: Roux
authors.forename: Jean-Loup
authors.initials: JL
authors.lastname: Raggueneau
authors.forename: Joel
authors.initials: J
authors.lastname: Coste
authors.forename: Luc-Marie
authors.initials: LM
authors.lastname: Joly
mesh_terms: D000328:Adult; D000368:Aged; D000768:Anesthesia, General / Q000009:adverse effects; D018686:Anesthetics, Intravenous / Q000009:adverse effects; D001921:Brain / Q000601:surgery; D003365:Costs and Cost Analysis; D003399:Craniotomy; D004311:Double-Blind Method; D023381:Endpoint Determination; D005260:Female; D005910:Glioma / Q000601:surgery; D006439:Hemodynamics; D006801:Humans; D007442:Intubation, Intratracheal; D008297:Male; D008579:Meningioma / Q000601:surgery; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D019635:Neurosurgical Procedures; D010880:Piperidines / Q000009:adverse effects; D015742:Propofol / Q000009:adverse effects; D011446:Prospective Studies; D000077208:Remifentanil; D017409:Sufentanil / Q000009:adverse effects; D015173:Supratentorial Neoplasms / Q000601:surgery
chemical_list: D018686:Anesthetics, Intravenous; D010880:Piperidines; D017409:Sufentanil; D000077208:Remifentanil; D015742:Propofol