Comparison of intraoperative blood loss during spinal surgery using either remifentanil or fentanyl as an adjuvant to general anesthesia

Abstract

BackgroundRemifentanil enhances intraoperative hemodynamic stability, suggesting that it may decrease intraoperative blood loss when included as an adjuvant to general anesthesia. This retrospective study compared intraoperative blood loss during spinal surgery in patients administered either remifentanil or fentanyl as an opioid adjuvant.MethodsWe reviewed clinical and surgical data from 64 consecutive laminoplasty or laminectomy patients treated at National Hospital Organization Zentsuji Hospital between April 2010 and March 2011. Patients received either remifentanil (n = 35) or fentanyl (n = 29) as an opioid analgesic during general anesthesia. In addition to intraoperative blood loss, indices of hemodynamic stability, including heart rate as well as systolic, mean, and diastolic blood pressure (BP), were compared over the entire perioperative period between remifentanil and fentanyl groups.ResultsThe remifentanil group exhibited significantly lower intraoperative arterial BP than the fentanyl group. Intraoperative blood loss was also significantly lower in the remifentanil group (125 ± 67 mL vs. 165 ± 82 mL, P = 0.035).ConclusionsIntraoperative blood loss during spinal surgery was decreased in patients who received remifentanil as an opioid adjuvant, possibly because of lower intraoperative BP. A larger-scale prospective randomized controlled trial is warranted to confirm our results and to test whether remifentanil can decrease intraoperative blood loss during other surgical procedures.

Protective effect of remifentanil on blood loss in endoscopic subcutaneous mastectomy: a retrospective study

“…Second, the remifentanil group had lower blood pressure at five intraoperative measurement points. Remifentanil use has been reported to be associated with lower blood loss in spinal surgery and rhinoplasty (Kawano et al 2013;Kosucu et al 2014). However, there have been no reports on the effect of remifentanil in any other type of endoscopic surgery with the exception of otolaryngology endoscopic surgery.…”

“…The hemodynamic stability provided by intraoperative remifentanil may reduce blood loss (Degoute et al 2001). Several studies have reported reduced blood loss in spinal surgery, rhinoplasty, and endoscopic sinus surgery (Komatsu et al 2007;Kawano et al 2013;Ha et al 2014;Kosucu et al 2014;Cardesin et al 2015). Those studies indicated that hemodynamic stability derived from intraoperative remifentanil use contributed to reduced blood loss.…”

Remifentanil Reduces Blood Loss During Orthognathic Surgery

“…17 In another study, when intraoperative blood pressure was maintained at either normal level or decreased level in patients undergoing Le Fort I osteotomy, blood loss was found to be less in patients maintained in a hypotensive state. 18 Maintenance of hypotension has thus been identified as an important factor in reducing blood loss during surgery.…”

Safe and Effective Performance of Pediatric Spinal Deformity Surgery in Patients Unwilling to Accept Blood Transfusion: A Clinical Study and Review of Literature

“…Preoperative strategies mainly consist of raising hemoglobin levels with recombinant human erythropoietin or iron supplementation [19,20]. Perioperative techniques include proper patient positioning [21], controlled hypotensive anesthesia (HA) [22][23][24], acute normovolemic hemodilution (ANH) [25], intraoperative cell salvage (ICS) [26][27][28], topical hemostatic agents [29], anti brinolytics (e.g. aminocaproic acid and tranexamic acid) [30][31][32][33][34][35], and lastly, certain surgical tools can also reduce blood loss such as full electrocautery dissection, bipolar tissue sealants [36], and ultrasonic bone cutting tools for performing osteotomies [37,38].…”