title: Comparison of intraoperative blood loss during spinal surgery using either remifentanil or fentanyl as an adjuvant to general anesthesia.
abstract: BACKGROUND
  Remifentanil enhances intraoperative hemodynamic stability, suggesting that it may decrease intraoperative blood loss when included as an adjuvant to general anesthesia. This retrospective study compared intraoperative blood loss during spinal surgery in patients administered either remifentanil or fentanyl as an opioid adjuvant.
  
  
  METHODS
  We reviewed clinical and surgical data from 64 consecutive laminoplasty or laminectomy patients treated at National Hospital Organization Zentsuji Hospital between April 2010 and March 2011. Patients received either remifentanil (n = 35) or fentanyl (n = 29) as an opioid analgesic during general anesthesia. In addition to intraoperative blood loss, indices of hemodynamic stability, including heart rate as well as systolic, mean, and diastolic blood pressure (BP), were compared over the entire perioperative period between remifentanil and fentanyl groups.
  
  
  RESULTS
  The remifentanil group exhibited significantly lower intraoperative arterial BP than the fentanyl group. Intraoperative blood loss was also significantly lower in the remifentanil group (125 ± 67 mL vs. 165 ± 82 mL, P = 0.035).
  
  
  CONCLUSIONS
  Intraoperative blood loss during spinal surgery was decreased in patients who received remifentanil as an opioid adjuvant, possibly because of lower intraoperative BP. A larger-scale prospective randomized controlled trial is warranted to confirm our results and to test whether remifentanil can decrease intraoperative blood loss during other surgical procedures.
authors.affiliation: Department of Anesthesiology and Clinical Research, National Hospital Organization Zentsuji Hospital, Zentsuji, Japan. hir.kawano@gmail.com.
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Kawano
authors.forename: Sawa
authors.initials: S
authors.lastname: Manabe
authors.forename: Tomomi
authors.initials: T
authors.lastname: Matsumoto
authors.forename: Eisuke
authors.initials: E
authors.lastname: Hamaguchi
authors.forename: Michiko
authors.initials: M
authors.lastname: Kinoshita
authors.forename: Fumihiko
authors.initials: F
authors.lastname: Tada
authors.forename: Shuzo
authors.initials: S
authors.lastname: Oshita