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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 2003 March;69(3):127-36

language: English, Italian

Small doses of remifentanil and alfetanil in continuous total intravenous anesthesia in major abdominal surgery. A double blind comparison

Iannuzzi E., Iannuzzi M., Cirillo V., Viola G., Parisi R., Chiefari M.

Department of Anesthesiological, Surgical and Emergency Sciences, Second University of Naples, Naples, Italy


Aim. The pur­pose of ­this ­study was to ­test the safe­ty and effi­ca­cy of ­small dos­es of remi­fen­ta­nil and alfen­ta­nil in a con­tin­u­ous ­total intra­ve­nous anes­the­sia tech­nique for ­patients under­go­ing ­major abdom­i­nal sur­gery.
Methods. Sixty ­patients ­were ­enrolled in the ­study, and ­received in a dou­ble ­blind fash­ion ­either remi­fen­ta­nil (0.1 µg/kg/min) or alfen­ta­nil (alfen­ta­nil 0.75 µg/kg/min) in asso­ci­a­tion ­with pro­pof­ol (12 mg/kg/h at induc­tion; 6-9 mg/kg/h for main­te­nance) and cisat­ra­cu­ri­um. Hemodynamic ­data, hyp­no­sis mon­i­tor­ing ­data (Bispectral Index Score), ven­til­a­to­ry param­e­ters and set­tings, ­drug util­isa­tion ­were mon­i­tored dur­ing ­stress ­moments and dur­ing all the intra­op­er­a­tive peri­od. Patients ­were eval­u­at­ed ­also in the first 6 post­op­er­a­tive ­hours.
Results. Mean ­amount of pro­pof­ol for induc­tion (BIS<60) was low­er in the remi­fen­ta­nil ­group ­than in the alfen­ta­nil ­group. Significantly few­er ­patients receiv­ing remi­fen­ta­nil respond­ed to intu­ba­tion in com­par­i­son ­with ­patients receiv­ing alfen­ta­nil in ­terms of non inva­sive ­blood pres­sure (>30 mmHg) and ­heart ­rate vari­a­tions. Significantly ­more ­patients receiv­ing alfen­ta­nil had 1 or ­more respons­es to sur­gery. Incidence of hypo­ten­sion was sig­nif­i­cant­ly high­er in ­patients receiv­ing remi­fen­ta­nil. There ­were no dif­fer­enc­es ­between the 2 ­groups in the ­times for spon­ta­ne­ous res­pi­ra­tion, ade­quate res­pi­ra­tion, ade­quate respon­siv­ness (OAA/s=5) and dis­charge ­from the recov­ery ­room. Time to extu­ba­tion result­ed slight­ly short­er (p<0.05) in ­patients who ­received remi­fen­ta­nil. 
Conclusion. The use of remi­fen­ta­nil and alfen­ta­nil in asso­ci­a­tion ­with pro­pof­ol, in a con­tin­u­ous infu­sion ­total intra­ve­nous anes­the­sia tech­nique, dem­on­strat­ed to be ­safe and reli­able strat­e­gies.

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