[Application of remifentanil in neurosurgical anesthesia: a multi-center study].
OBJECTIVE
To observe the hemodynamic changes, recovery profiles, and side effects of propofol and remifentanil anesthesia by target controlled infusion (TCI). At different neurosurgical stages in patients undergoing neurosurgical operations.


METHODS
230 patients were scheduled for elective craniotomy in five hospitals in Beijing, Changsha, and Guangzhou. During the general anesthesia the plasma target-concentration of propofol remained unchangeable and the dose of remifentanil changed at different stages before skin incision, during skull opening, during intracranial procedure, and at skull closing. The hemodynamics changes and anesthetic recovery profiles were recorded.


RESULTS
The plasma target-concentrations of remifentanil were set to 3.0, 3.5, 3.6 and 3.4 ng/ml respectively. The time of consciousness loss during induction was (2.0 +/- 0.9) min. The mean arterial pressure (MAP) and heart rate (HR) decreased after induction (both P < 0.05) and increased after intubation. The hemodynamic changes were stable at different surgical stages and the HR was significantly lower than the baseline value (P < 0.01). MAP and HR increased gradually when the spontaneous breathing was recovered. 80, 41, 9, and 12 patients received nicardipine, atropine, esmolol, and ephedrine respectively during the operation. The times of recovery of spontaneous breathing, eye opening, extubation, and orientation were (12 +/- 9) min, (13 +/- 7) min, (16 +/- 8) min, and (21 +/- 8) min respectively.


CONCLUSIONS
When combined with 3 microg/ml propofol, the plasma target-concentrations of remifentanil, 3.0, 3.5, 3.6, and 3.4 ng/ml before skin incision, during skull opening, during intracranial procedure, and at skull closing respectively, can provide rapid induction, faster emergence , and better hemodynamic stability.
Department of Anesthesiology, Tiantan Hospital Affiliated to Capital University of Medicine Sciences, Beijing 100050, China. xingyanc@163.com
Yan
Y
Xing
Bao-Guo
BG
Wang
Wei-Dong
WD
Mi
Jian-Xiong
JX
An
Qu-Lian
QL
Guo
Xiong-Qing
XQ
Huang
D000293:Adolescent; D000328:Adult; D000368:Aged; D000771:Anesthesia, Intravenous; D018686:Anesthetics, Intravenous / Q000008:administration & dosage*; D001794:Blood Pressure / Q000187:drug effects; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods*; D010880:Piperidines / Q000008:administration & dosage*; D015742:Propofol / Q000008:administration & dosage; D000077208:Remifentanil; D013997:Time Factors; D055815:Young Adult
D018686:Anesthetics, Intravenous; D010880:Piperidines; D000077208:Remifentanil; D015742:Propofol