Clinical comparison of remifentanil-sevoflurane vs. remifentanil-propofol for endoscopic endonasal transphenoidal surgery.
BACKGROUND
Endoscopic endonasal transphenoidal surgery has been recently proposed as a minimally invasive procedure for the treatment of pituitary adenomas. The main objective of the anaesthesiologist is to induce sufficient haemodynamic control together with rapid recovery at the end of surgery. The aim of this study was to examine recovery profile, surgical operative conditions and haemodynamic differences using remifentanil infusion with either propofol target controlled infusion system or sevoflurane.


METHODS
Forty-four adult patients were enrolled in a prospective, randomized, single-blind, two-group study: Group P received propofol target controlled infusion system and remifentanil; Group S received sevoflurane and remifentanil for maintenance of anaesthesia.


RESULTS
No statistically significant differences between the two groups with regards to the haemodynamic changes, operative conditions as assessed by a four-step bleeding score (0-3), were obtained. Recovery times were considerably shorter after remifentanil-sevoflurane in comparison with remifentanil-propofol target controlled infusion system group (7.4 vs. 12.8 min, P < 0.01).


CONCLUSIONS
This study demonstrates that sevoflurane-remifentanil gives a faster recovery and equivalent intraoperative status compared with propofol target controlled infusion system with remifentanil for the endoscopic endonasal transphenoidal approach.
Cafiero
T
T
Cardarelli Hospital, Department of Anesthesiology and Postoperative Intensive Care, Naples, Italy. tcafiero@tiscali.it
Cavallo
L M
LM
Frangiosa
A
A
Burrelli
R
R
Gargiulo
G
G
Cappabianca
P
P
de Divitiis
E
E
D000328:Adult; D000368:Aged; D000762:Anesthesia Recovery Period; D019162:Anesthetics, Combined / Q000009:adverse effects / Q000627:therapeutic use*; D018685:Anesthetics, Inhalation / Q000009:adverse effects / Q000627:therapeutic use; D018686:Anesthetics, Intravenous / Q000009:adverse effects / Q000627:therapeutic use; D001794:Blood Pressure / Q000187:drug effects; D004724:Endoscopy / Q000379:methods*; D005260:Female; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D008297:Male; D008738:Methyl Ethers / Q000009:adverse effects / Q000627:therapeutic use*; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D009296:Nasal Cavity / Q000601:surgery; D010880:Piperidines / Q000009:adverse effects / Q000627:therapeutic use*; D010900:Pituitary Diseases / Q000601:surgery*; D010911:Pituitary Neoplasms / Q000601:surgery*; D015742:Propofol / Q000627:therapeutic use*; D011446:Prospective Studies; D000077208:Remifentanil; D000077149:Sevoflurane; D016037:Single-Blind Method; D013100:Sphenoid Bone / Q000601:surgery; D016896:Treatment Outcome
D019162:Anesthetics, Combined; D018685:Anesthetics, Inhalation; D018686:Anesthetics, Intravenous; D008738:Methyl Ethers; D010880:Piperidines; D000077149:Sevoflurane; D000077208:Remifentanil; D015742:Propofol