A Randomized, Blind Comparison of Remifentanil and Alfentanil During Anesthesia for Outpatient Surgery

Abstract

The pharmacological profile of remifentanil, a new opioid for use in anesthesia, suggests that rapid recovery will occur after its use. This study of 200 outpatients shows that the differences suggested from kinetic studies are not always borne out in clinical practice, although later recovery variables did, in fact, favor remifentanil.

Remifentanil for general anaesthesia: a systematic review

“…We eliminated 116 of the retrieved studies for the following reasons: two were review articles, 10 did not compare remifentanil with other opioids, nine were not randomised trials, 37 did not have relevant data or had data that could not be extrapolated from the published graphs, five did not mention the number of patients per group, 11 did not use general anaesthesia, 10 included data from children (age less than 18 years) and 20 used different anaesthetics in the remifentanil and comparator group. Of the 12 sources that could not be retrieved by interlibrary loan from the University of Louisville, five were abstracts for annual meetings and seven were non-English papers in journals of low circulation [106][107][108][109][110][111][112][113][114][115][116][117][118]. Of the 104 articles that could both be retrieved and that met inclusion criteria, 19 were found to contain duplicated data (i.e.…”

“…................................................................................................................................................................................................................ [8,23,24,32,33,57,70,73,79,87,89,95,100], cumulative occurrence of rigidity was not significantly higher (3.5%) than when it was administered at slower rates (2.9%) [27,81,86]. Accordingly, in the dose range of the included studies, remifentanil did not cause a clinically significant increase in rigidity compared with the other opioids, even when a bolus dose was employed.…”

Prevention of rocuronium‐induced withdrawal movement in children: a comparison of remifentanil with alfentanil

“…It is difficult to state the cost implications of the two opioid agents in this study because postoperative parameters such as the time to recovery or pain and nausea visual scale scores were not included. Studies comparing these two opioids used the method of infusion during the surgery (14–17). Some reported a similar time to recovery and incidence of postoperative complications (15,16).…”

“…Some reported a similar time to recovery and incidence of postoperative complications (15,16). Others reported conflicting results (14,17). As far as the withdrawal movement in this study is concerned, alfentanil, which costs less than remifentanil, is more cost effective because both opioid agents were effective without serious intraoperative events and time to recovery was unlikely to be affected because only a bolus dose was given during anesthesia induction.…”

Remifentanil and Other Opioids

“…with a regional technique). Clinically, remifentanil titratability translates into a better control over adrenergic stimuli whatever the type of surgery or the patients (Kapila et al 1995;Mouren et al 2001;Schuttler et al 1997;Cartwright et al 1997;Gemma et al 2002;Guy et al 1997;Howie et al 2001;McGregor et al 1998;Sneyd et al 2001;Ahonen et al 2000;Balakrishnan et al 2000;Casati et al 2000;Doyle et al 2001;Fleisher et al 2001;Natalini et al 1999;Twersky et al 2001;Wee et al 1999;Wilhelm et al 2001). For example, intubation is a stronger stimulus than laryngoscopy, which in turn is stronger than skin incision.…”