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NEUROSURGICAL ANESTHESIA

Remifentanil Provides Hemodynamic Stability and Faster Awakening Time in Transsphenoidal Surgery

Marco Gemma, MD^*, Concezione Tommasino, MD^*, Silvano Cozzi, MD^*, Simona Narcisi, MD^*, Pietro Mortini, MD, Marco Losa, MD, and Armando Soldarini, MD

Department of *Anesthesiology and Intensive Care, University of Milano; Departments of Neurosurgery and Neuropsychiatric Sciences, Division of Laboratory Medicine, IRCCS San Raffaele Hospital, Milano, Italy

Address correspondence to Concezione Tommasino, MD, Department of Anesthesiology and Intensive Care, University of Milano, Anesthesia Dpt., IRCCS San Raffaele Hospital, Via Olgettina, 60, 20132 Milano, Italy. Address e-mail to tommasino.concezione{at}hsr.it

In this prospective study, we evaluated the effects of remifentanil in ASA I–II patients undergoing transsphenoidal surgery. After the induction of anesthesia, patients were randomly allocated to the Isoflurane (n = 22, 60% nitrous oxide, isoflurane up to 2% end-tidal) or Remifentanil group (n = 21, 60% nitrous oxide, 0.5% end-tidal isoflurane, remifentanil up to 2 µg · kg^-1 · min^-1). If mean arterial pressure (MAP) increased >80 mm Hg during maximal dosage of isoflurane or remifentanil, labetalol was administered. At the end of anesthesia, extubation and awakening times, respiratory rate, SpO₂, MAP, heart rate, and adverse effects were recorded. Hemodynamics and bleeding (minimal, mild, moderate, severe) were not different between groups. Bleeding grade increased with MAP >80 mm Hg (P < 0.001). Labetalol was administered to 20 patients in the Isoflurane group, and 10 patients in the Remifentanil group (P < 0.01). The dose of labetalol was larger in the Isoflurane group (1.0 ± 0.6 versus 0.5 ± 0.7 mg/kg, P < 0.05). Time to extubation did not differ, whereas time to follow commands was shorter in Remifentanil patients (16 ± 8 versus 10 ± 2 min, P < 0.01). No adverse effects occurred in the early postoperative period.

IMPLICATIONS: In patients undergoing transsphenoidal surgery, balanced anesthesia with remifentanil (0.22 ± 0.17 µg · kg^-1 · min^-1) provides faster awakening time, as compared with large-dose volatile-based anesthesia, without the risk of postoperative opioid respiratory depression.

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Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999