[Remifentanil-propofol versus fentanyl-midazolam combinations for intracranial surgery: influence of anaesthesia technique and intensive sedation on ventilation times and duration of stay in the ICU].
BACKGROUND
After neurosurgery patients often need to be sedated and ventilated in the intensive care unit (ICU). However, rapid postoperative recovery and neurological examination are particularly important for the early recognition of complications. In this retrospective study two different strategies of anaesthesia technique and ICU sedation (fentanyl-midazolam versus remifentanil-propofol) were compared.


METHODS
Intraoperatively, patients received continuous infusions of either fentanyl (0.2-1.0 mg/h) and midazolam (2-10 mg/h) or remifentanil (0.2-0.5 microg/kg body weight/min) and propofol (3-6 mg/kg body weight/h). After arrival in the ICU fentanyl (0.03-0.2 mg/h) and midazolam (2-12 mg/h) or remifentanil (0.1-0.2 microg/kg body weight/min) and propofol (0.5-3 mg/kg body weight/h) were infused to reach a Ramsay score of 4. The times between termination of infusion and extubation and the length of stay in the ICU were examined.


RESULTS
A total of 60 patients (n=30 each group) undergoing supratentorial brain tumour surgery were enrolled. The groups were comparable for age, weight, ASA status (American Society of Anesthesiologists) and duration of drug administration (remifentanil-propofol 528+/-382 min versus fentanyl-midazolam 548+/-360 min). Extubation times were significantly shorter after remifentanil-propofol (47 min) than after fentanyl-midazolam (481 min), and the length of stay in the ICU was also significantly reduced (1.8 days versus 3.7 days). As a result of prolonged unconsciousness and impaired neurological assessability, a brain CT scan was necessary in 3 patients after fentanyl-midazolam to exclude neurosurgical complications.


CONCLUSIONS
This retrospective study demonstrates that remifentanil-propofol anaesthesia and ICU sedation are superior to the combination of fentanyl and midazolam in terms of ventilation time and length of ICU stay. Moreover, the use of fentanyl-midazolam may lead to unnecessary CT scans.
Bauer
C
C
Klinik für Anaesthesiologie, Intensivmedizin und Schmerztherapie, Universitätsklinikum des Saarlandes, 66421, Homburg/Saar, Deutschland. clemens.bauer@uniklinikum-saarland.de
Kreuer
S
S
Ketter
R
R
Grundmann
U
U
Wilhelm
W
W
D018686:Anesthetics, Intravenous; D016292:Procedural Sedation; D003422:Critical Care; D016208:Databases, Factual; D005283:Fentanyl; D007902:Length of Stay; D008874:Midazolam; D019635:Neurosurgical Procedures; D010880:Piperidines; D015742:Propofol; D000077208:Remifentanil; D012121:Respiration, Artificial; D012189:Retrospective Studies; D015173:Supratentorial Neoplasms / Q000601:surgery; D014057:Tomography, X-Ray Computed
D018686:Anesthetics, Intravenous; D010880:Piperidines; D000077208:Remifentanil; D008874:Midazolam; D005283:Fentanyl; D015742:Propofol