title: Comparison of Two Clinical Protocols for Total Intravenous Anesthesia (TIVA) for Breast Surgery Using Propofol Combined With Either Sufentanil or Alfentanil.
abstract: BACKGROUND
  Sufentanil and alfentanil have pharmacokinetic and dynamic properties which make them favourable substances for total intravenous anesthesia (TIVA) in combination with propofol.
  
  
  OBJECTIVE
  We planned to compare two clinical protocols for TIVA with propofol, and either sufentanil or alfentanil in regards to postoperative pain, hemodynamic stability during the case and time for emergence from anesthesia.
  Treaty eight patients scheduled for general anesthesia for breast surgery were included in this Double-blind, randomized, controlled trial. All patients received a standardized TIVA with propofol and either 0.2 µg kg(-1) sufentanil or 20 µg kg(-1) alfentanil for induction and 0.3 µg kg(-1) h(-1) sufentanil or 30 µg kg(-1) h(-1) alfentanil for maintenance with additional propofol boluses as needed. During anesthesia, heart rate, non-invasive blood-pressure, peripheral oxygen saturation and depth of anesthesia, were recorded. In the post anesthesia care unit, pain scores, nausea and vomiting as well as medications were recorded.
  
  
  RESULTS
  Patients in the sufentanil group required less often additional opioid and propofol boluses to maintain adequate anesthesia. We did not observe a significant difference in time to extubation. Postoperatively, patients in the sufentanil group had less pain (P = 0.03) and required less i.v. opioids (0.4 vs. 1.9 mg piritramid, P = 0.04).
  
  
  CONCLUSIONS
  Both protocols provide excellent anesthesia, but patients receiving sufentnail had more stable anesthesia and less postoperative pain.
authors.affiliation: Department of Anesthesia and Perioperative Care, San Francisco General Hospital, University of California in San Francisco, San Francisco, USA ; Department of Anesthesia, University Hospital of Dresden, Dresden, Germany.
authors.forename: Oliver C
authors.initials: OC
authors.lastname: Radke
authors.affiliation: Department of Visceral Surgery and Medicine, University Hospital Bern, Inselspital, Switzerland.
authors.forename: Darja
authors.initials: D
authors.lastname: Sippel
authors.affiliation: Department of Anesthesia and Perioperative Care, San Francisco General Hospital, University of California in San Francisco, San Francisco, USA ; Department of Anesthesia, University Hospital of Dresden, Dresden, Germany.
authors.forename: Katja
authors.initials: K
authors.lastname: Radke
authors.affiliation: Department of Medical Statistics, Georg-August-University of Göttingen, Göttingen, Germany.
authors.forename: Reinhard
authors.initials: R
authors.lastname: Hilgers
authors.affiliation: Department of Anesthesia, Intensive Care Medicine and Pain Medicine, Sana Kliniken Lübeck Gmbh, Lübeck, Germany.
authors.forename: Petra
authors.initials: P
authors.lastname: Saur
keywords: Alfentanil; Intravenous Anesthesia; Pharmacokinetics; Postoperative Pain; Sufentanil