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NEUROSURGICAL ANESTHESIA

Intraoperative Wake-Up Test and Postoperative Emergence in Patients Undergoing Spinal Surgery: A Comparison of Intravenous and Inhaled Anesthetic Techniques Using Short-Acting Anesthetics

Oliver Grottke, MD MSc^*, Peter Johannes Dietrich, MD^*, Stefanie Wiegels, MD^*, and Frank Wappler, MD

*Department of Anesthesiology, University Hospital Eppendorf, Hamburg, Germany; and Department of Anesthesiology, University Witten/Herdecke, Cologne, Germany

Address correspondence and reprint requests to Frank Wappler, MD, Department of Anesthesiology, University Witten/Herdecke, Hospital Cologne-Merheim, Ostemerheimer Strassse 200, D-51109 Cologne, Germany. Address e-mail to wapplerf{at}kliniken-koeln.de

Surgical procedures on the vertebral column may result in spinal cord damage, leading to neurological deficits that demand immediate therapeutical intervention. We designed this study to determine which anesthetic regimen allows a rapid wake-up test during and after surgery to detect neurological deficits. Fifty-four patients were randomly allocated to the following groups: group PR (propofol/remifentanil): target-controlled infusion with propofol (plasma concentration, 2–4 µg/mL) and remifentanil 0.2–0.5 µg · kg^–1 · min^–1; group PS (propofol/sufentanil): propofol (2–4 µg/mL) and repetitive boluses of 0.1–0.2 µg/kg of sufentanil adjusted to patients requirements; and group DR (desflurane/remifentanil): desflurane/air 3.0–4.0 vol% combined with remifentanil 0.2–0.5 µg · kg^–1 · min^–1. Group PS required significantly longer times for the onset of breathing (8.9 ± 1.6 min), elevation of the head (17.0 ± 3.8 min), and motion of the feet (17.0 ± 7.4 min) than group PR (6.9 ± 2.6 min, 9.3 ± 2.2 min, and 9.4 ± 2.4 min, respectively) or group DR (5.4 ± 0.8 min, 6.1 ± 1.0 min, and 6.2 ± 1.0 min, respectively). The anesthetic regimen with desflurane and remifentanil allowed faster awakening during and after surgery that permitted immediate neurological examination after spinal surgery compared with propofol/remifentanil.

IMPLICATIONS: The balanced anesthetic regimen with desflurane and remifentanil allows a more rapid initial awakening during and after surgery combined with an immediate neurological examination of good quality during spinal surgery compared with propofol and remifentanil.

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