title: Gender rather than choice of intermediate duration opioids affects emergence after craniotomy for large intracranial tumors.
abstract: BACKGROUND
  Opioid-based anesthetic techniques are commonly used during neurosurgical procedures. In the present randomized prospective study, we studied emergence after 4 anesthetic regimens combining intermediate duration opioids with isoflurane and nitrous oxide (N(2)O), in patients undergoing craniotomy for large (> 30 mm diameter with intracranial mass effect) intracranial tumors.
  
  
  METHODS
  One hundred seven patients were randomized into 4 groups: Group A: fentanyl (≤ 5 µg/kg) + isoflurane (≤ 1 minimum alveolar concentration [MAC]), Group B: sufentanil (1-2 µg/kg plus infusion) + isoflurane (≤ 0.5 MAC), Group C: sufentanil (2 µg/kg bolus only) + isoflurane (≤ 1 MAC), and Group D: alfentanil (100 µg/kg plus infusion) + isoflurane (≤ 0.5 MAC). Boluses were administered as divided doses during induction, laryngoscopy, head pinning, and incision. Blood pressure was controlled at ±25% of baseline levels. All infusions were discontinued at the start of dural closure. Emergence was assessed using a mini-neurologic examination consisting of 7 questions. Groups were compared on time to emergence using survival analysis methods.
  
  
  RESULTS
  The groups did not differ regarding extubation time, which occurred at a median of 4 to 6 minutes across groups after discontinuing N(2)O. The median emergence time ranged from 15 to 22.5 minutes and did not differ among groups. However, across all groups more women had emerged by 30 minutes compared with men (83% vs 57%, P  =  .002). The median emergence time in women was found to be significantly shorter (0-15 minutes) than in men (15-30 minutes) (P  =  .012).
  
  
  CONCLUSIONS
  No between-group differences in emergence time were observed; the study was stopped early because of evidence that no differences were likely to be found if the study were continued. However, in a post hoc analysis, female gender was associated with faster emergence.
authors: Anupa
authors: A
authors: Deogaonkar
authors: Mimi
authors: M
authors: Khin
authors: Samuel
authors: S
authors: Samuel
authors: Zeyd Y
authors: ZY
authors: Ebrahim
authors: Edward J
authors: EJ
authors: Mascha
authors: Armin
authors: A
authors: Schubert
references: Anesth Analg. 2000 Jul;91(1):163-9
references: 10866905
references: Anesthesiology. 2000 Aug;93(2):539-47
references: 10910505
references: Brain Res. 2001 Feb 16;892(1):208-10
references: 11172766
references: J Pharmacol Exp Ther. 1987 Jan;240(1):159-66
references: 3100765
references: J Clin Anesth. 1992 Sep-Oct;4(5):372-7
references: 1389190
references: Acta Anaesthesiol Scand. 2005 Apr;49(4):445-52
references: 15777290
references: Br J Anaesth. 1976 Jun;48(6):587-92
references: 952694
references: Anesthesiology. 2000 Nov;93(5):1245-54; discussion 6A
references: 11046213
references: Br J Anaesth. 2003 Dec;91(6):773-80
references: 14633743
references: Anesthesiology. 1991 Jan;74(1):53-63
references: 1824743
references: Can J Anaesth. 2002 Mar;49(3):249-55
references: 11861342
references: Biometrics. 1988 Jun;44(2):579-85
references: 3390511
references: Nat Med. 1996 Nov;2(11):1248-50
references: 8898754
references: Anesthesiology. 1997 Apr;86(4):836-47
references: 9105228
references: Anesthesiology. 1993 Jun;78(6):1005-20
references: 8512094
references: Can J Anaesth. 1991 Sep;38(6):710-6
references: 1914054
references: Anesthesiology. 1996 Sep;85(3):513-21
references: 8853081
references: J Clin Anesth. 1991 Mar-Apr;3(2):131-6
references: 2039640
references: BMJ. 2001 Mar 24;322(7288):710-1
references: 11264210
references: Anesthesiology. 1992 Mar;76(3):334-41
references: 1539843
references: Anesthesiology. 1990 Nov;73(5):896-904
references: 1978615
references: Anesthesiology. 1982 Dec;57(6):489-92
references: 7149306
references: Anesth Analg. 2001 Nov;93(5):1222-6
references: 11682402
references: Anesth Analg. 1982 May;61(5):430-3
references: 7199867
references: Anesthesiology. 1999 May;90(5):1283-7
references: 10319774
references: N Engl J Med. 1986 Apr 10;314(15):953-8
references: 3960059