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A Journal on Anesthesiology, Resuscitation, Analgesia and Intensive Care


Official Journal of the Italian Society of Anesthesiology, Analgesia, Resuscitation and Intensive Care
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Minerva Anestesiologica 1999 November;65(11):791-8

Copyright © 2000 EDIZIONI MINERVA MEDICA

language: English

Total intravenous anesthesia with propofol and remifentanil for elective non-cardiac surgery

Pelosi G. 1, Gratarola A. 1, Pissaia C. 1, Mendola C. 1, Bellomo G. 2

1 Department of Anesthesiology and Intensive Care, University of Eastern Piedmont School of Medicine, Novara; 2 Department of Medical Sciences, University of Eastern Piedmont School of Medicine, Novara


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Back­ground. Remi­fen­tanil is a ­highly effec­tive μ ­opioid ago­nist ­with pre­dict­able phar­ma­cok­i­netics and a ­close con­cen­tra­tion-­effect rela­tion­ship. More­over, ­studies on anes­thetic ­drugs inter­ac­tions ­show ­that ­optimal pro­pofol con­cen­tra­tions ­decrease ­more sig­nif­i­cantly ­with remi­fen­tanil as com­pared ­with ­other opi­oids and ­recovery ­appears to be ­much ­faster ­than ­when pro­pofol is com­bined ­with ­other opi­oids com­bi­na­tions. ­This inter­ven­tion ­study was ­designed to eval­uate the effi­cacy of pro­pofol com­bined ­with remi­fen­tanil in elec­tive non car­diac inpa­tient sur­gery.
­Methods. N. 405 ­patients under­going intra­per­it­o­neal, ­head-­neck, intra­tho­racic, ­major ortho­paedics, ­breast and ­major vas­cular sur­gery ­received: remi­fen­tanil (1 μg·kg-1 at induc­tion; 0.50 µg·kg-1·min-1 at laryn­gos­copy; 0.25 μg·kg-1·min-1 at ­skin inci­sion; 0.25-0.30 µg·kg-1·min1 ­from ­skin inci­sion to end of ­skin ­suture) and pro­pofol (0.5-1 mg·kg-1 at induc­tion; 5 mg·kg-1·h-1 at laryn­gos­copy; 5 mg·kg-1·h-1 at ­skin inci­sion and 5 mg·kg1·h1 there­after). Intra­op­er­a­tive end-­points ­included ­somatic ­responses, tach­y­cardia and hyper­ten­sion to laryn­gos­copy and sur­gery. Inci­dence of intra­op­er­a­tive brad­y­cardia, hypo­ten­sion and ­muscle ­rigidity ­were ­also ­recorded. Post­op­er­a­tive end-­points ­included ­Aldrete ­score ≥ 9, ­pain imme­di­ately fol­lowing emer­gence and ­PONV.
­Results. Pro­pofol-remi­fen­tanil com­bi­na­tion effec­tively con­trolled ­responses to laryn­gos­copy and sur­gical ­stress. ­Drug ­related ­adverse ­events ­were tran­sient brad­y­cardia (<50 bpm) and hypo­ten­sion (SBP ≤80 ­mmHg) respec­tively: at pre­la­ryn­gos­copy 11.60-1.48% and at pre-­skin inci­sion 10.61-0.98%. N. 365 ­patients ­were dis­charged ­from ­PACU and the ­median ­time to ­first ­Aldrete ­score ≥9 was 22.3 min. The ­most fre­quent post­op­er­a­tive ­event was shiv­ering ­recorded in n. 46 ­patients (12%). ­Postoper­a­tive anal­gesic med­i­ca­tion was ­requested by n. 16 ­patients (4.4%) and ­PONV was ­noted in n. 6 ­patients (1.6%).
Con­clu­sions. ­When com­bined ­with pro­pofol, remi­fen­tanil effec­tively pro­vided for pro­found anal­gesia ­during sur­gery, ­stable anes­thetic con­di­tions, sim­plicity of use and pre­dict­able ­recovery.

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