Early postoperative cognitive recovery after remifentanil-propofol or sufentanil-propofol anaesthesia for supratentorial craniotomy: a randomized trial.
OBJECTIVE
This study was designed to evaluate early postoperative cognitive recovery after total intravenous anaesthesia with remifentanil-propofol or sufentanil-propofol in patients undergoing craniotomy for supratentorial expanding lesions.


METHODS
Sixty patients were consecutively enrolled, and randomly assigned to one of two study groups: remifentanil-propofol or sufentanil-propofol anaesthesia. To evaluate cognitive function the Short Orientation Memory Concentration Test (SOMCT) and Rancho Los Amigos Scale (RLAS) were administered to all patients in a double-blind procedure before surgery at 15, 45 min and 3 h after extubation.


RESULTS
Mean extubation time was similar in the two groups (13 +/- 5 min vs. 19 +/- 6 min). A significantly larger number of patients in the remifentanil-propofol group than in the sufentanil-propofol group required antihypertensive medication postoperatively to maintain mean arterial pressure within 20% of baseline (18/30 vs. 4/29; P = 0.0004). Intergroup analysis showed no differences in baseline SOMCT scores (28 +/- 1 vs. 28 +/- 1) whereas mean SOMCT scores at 15, 45 min and 3 h after extubation were significantly higher in the remifentanil-propofol group (30 patients) than in the sufentanil-propofol group (29 patients) (22 +/- 3 vs. 16 +/- 3; P < 0.0001 and 27 +/- 1 vs. 22 +/- 3; P < 0.0001; 28 +/- 1 vs. 26 +/- 2; P = 0.0126).


CONCLUSIONS
In conclusion, propofol-remifentanil and propofol-sufentanil are both suitable for fast-track neuroanaesthesia and provide similar intraoperative haemodynamics, awakening and extubation times. Despite a higher risk of treatable postoperative hypertension propofol-remifentanil allows earlier cognitive recovery.
Bilotta
F
F
Department of Anesthesiology, Intensive Care and Pain Medicine, University of Rome La Sapienza, Viale Somalia 81, 00199 Rome, Italy. bilotta@tiscali.it
Caramia
R
R
Paoloni
F P
FP
Favaro
R
R
Araimo
F
F
Pinto
G
G
Rosa
G
G
D000704:Analysis of Variance; D000762:Anesthesia Recovery Period; D019162:Anesthetics, Combined / Q000009:adverse effects / Q000627:therapeutic use; D018686:Anesthetics, Intravenous / Q000009:adverse effects / Q000627:therapeutic use; D001794:Blood Pressure / Q000187:drug effects; D003071:Cognition / Q000187:drug effects*; D003399:Craniotomy / Q000379:methods*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007442:Intubation, Intratracheal / Q000379:methods; D008297:Male; D008570:Memory, Short-Term / Q000187:drug effects; D008875:Middle Aged; D010880:Piperidines / Q000009:adverse effects* / Q000627:therapeutic use; D011184:Postoperative Period; D015742:Propofol / Q000009:adverse effects* / Q000627:therapeutic use; D011446:Prospective Studies; D000077208:Remifentanil; D017409:Sufentanil / Q000009:adverse effects* / Q000627:therapeutic use; D015173:Supratentorial Neoplasms / Q000601:surgery*; D013997:Time Factors
D019162:Anesthetics, Combined; D018686:Anesthetics, Intravenous; D010880:Piperidines; D017409:Sufentanil; D000077208:Remifentanil; D015742:Propofol