A Randomized Comparison of Target-Controlled Infusion of Remifentanil and Propofol with Desflurane and Fentanyl for Laryngeal Surgery

Abstract

Aims: To compare the clinical profile of target-controlled infusion (TCI) of remifentanil (REM) + propofol (PRO) with fentanyl (FEN) bolus infusion with desflurane (DES) inhalation in direct laryngoscopic surgery. Methods: Sixty patients who were scheduled to undergo laryngoscopic surgery were randomly assigned to two groups (n = 30, respectively). One group of patients received a TCI of REM + PRO anesthetic treatment, while the patients in the other group received a bolus infusion of FEN and DES inhalation treatment. The hemodynamics, recovery profiles and unexpected events that occurred in both groups were recorded. Results: The hemodynamics of the patients in the TCI group was more stable during tracheal intubation, direct laryngoscope insertion and extubation. The mean arterial pressure was also significantly lower in the TCI group compared with the FEN/DES group. The TCI group also showed faster recovery profiles (e.g. a shorter time needed for response to verbal commands, autonomous breathing, tracheal extubation and orientation recovery). The FEN/DES group had lower Stewart recovery scores during the first 15 min determined at the postanesthesia care unit. However, there were no significant differences regarding the occurrence of unexpected events and postoperative complications between the two groups. Conclusions: TCI of REM + PRO anesthesia appears to be a reasonable alternative to FEN bolus infusion combined with DES inhalation during direct laryngoscopic surgery.

Total intravenous general anaesthesia vs. spinal anaesthesia for total hip arthroplasty: a randomised, controlled trial

“…During the first 24 post-operative hours, the median (IQR) consumption of morphine was 27 mg (13-40) in the GA group and 27 mg (10-45) in the SA group (n.s.). The median number (IQR) of administered PCA doses was 15 (10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26) in the GA group and 18 (8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26) in the SA group (n.s.). The median (IQR) number of requested, but not administered, PCA doses was 24 (5-91) in the GA group and 15…”

“…In contrast to older studies, we chose to use TCI as the GA method as it produces rapid emergence from anaesthesia. 3,15 Despite recommendations, we did not use intrathecal morphine in the SA group, 16 and this may have influenced our results. However, intrathecal morphine produces a limited analgesic effect and has undesirable side effects especially for elderly.…”

Recovery after total intravenous general anaesthesia or spinal anaesthesia for total knee arthroplasty: a randomized trial

“…The median (IQR) 24 h postoperative consumption of morphine was 19 mg (11-28) in the GA group and 54 mg (37-78) in the SA group (P,0.001). The median number (IQR) of administered PCA doses was 12 (10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22) in the GA group and 30 in the SA group (P,0.001). The median (IQR) number of requested, but not administered, PCA doses was 2 (0-7) in the GA group and 9 (1-26) in the Duration of surgery (min) 44 (11) 49 (7) Operative bleeding (ml) 208 (145 -267) 218 (132 -293) SA group (P,0.001).…”

“…Other differences compared with older studies are that we used TCI as the GA method as TCI is well tolerated with rapid and clear headed emergence. 15 Finally, all subjects received standardized opioid-sparing analgesia with cyclo-oxygenase-2 inhibitor and acetaminophen.…”

Faster extubation time with more stable hemodynamics during extubation and shorter total surgical suite time after propofol-based total intravenous anesthesia compared with desflurane anesthesia in lengthy lumbar spine surgery

“…Hohlrieder et al 11 found that TIVA is associated with significantly less coughing and reduces hemodynamic response when compared with inhalation anesthesia in elective lumbar disc surgery during emergence from anesthesia. In addition, Wang et al 21 demonstrated more stable hemodynamics in the TCI patient group and significantly lower mean arterial pressure and faster recovery profiles compared with the fentanyl/DES patient group. Variable doses of intraoperative fentanyl administrated between groups may explain these differences in findings.…”