Comparison of Remifentanil and Fentanyl in Patients Undergoing Craniotomy for Supratentorial Space-occupying Lesions

Guy, John; Hindman, Bradley J.; Baker, Kristy Z.; Borel, Cecil O.; Maktabi, Mazen A.; Ostapkovich, Noeleen; Kirchner, Jerry; Todd, Michael M.; Franco, Patricia; Yancy, Verna J.; Sokoll, Martin D.; McAllister, A.; Roland, Carl L.; Young, William L.; Warner, David S.

doi:10.1097/00000542-199703000-00002

Cited by 183 publications

(68 citation statements)

References 18 publications

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“…The infusion rates of propofol and remifentanil used in this study were those normally used for maintenance of anesthesia and showed efficacy and safety as previously described. 12,14,15,16 In conclusion, the present study showed that remifentanil combined with propofol in a propofol-TIVA, was interesting in reducing middle ear blood flow and providing good surgical conditions in terms of quality of operative field and provided convenient induced hypotension for tympanoplasty with no need for additional use of a potent hypotensive agent.…”

Section: Discussionmentioning

confidence: 58%

“…Compared with other comparable drugs such as fentanyl 1 2 or alfentanil, [13][14][15] remifentanil appears to offer a superior intraoperative hemodynamic stability during stressful surgical events and maintains intact cerebral blood flow reactivity. 12,16 Meanwhile, it appears to provoke moderate to mild hypotension. 15,17 Since we replaced alfentanil by remifentanil in our clinical practice, we noted that this side effect led us to stop the use of nitroprusside, or esmolol for controlled hypotension.…”

mentioning

confidence: 99%

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Remifentanil and controlled hypotension; comparison with nitroprusside or esmolol during tympanoplasty

Degoute

Ray

Manchón

et al. 2001

Can J Anesth/J Can Anesth

144

108

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Section: Discussionmentioning

confidence: 58%

mentioning

confidence: 99%

Remifentanil and controlled hypotension; comparison with nitroprusside or esmolol during tympanoplasty

Degoute

Ray

Manchón

et al. 2001

Can J Anesth/J Can Anesth

144

108

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“…In recent years, remifentanil as a short acting opioid receptor agonist has been used for this purpose in order for a mild to moderate reduction of blood pressure and as an effective agent for controlled hypotension [12] . Nevertheless, high doses of remifentanil during surgery have its limits, with pain management after surgery and hyperalgesia in these patients [13] . Currently, remifentanil with propofol is used for total intravenous anesthesia.…”

Section: Introductionmentioning

confidence: 99%

Comparative induction of controlled circulation by magnesium and remifentanil in spine surgery

Ghodraty

Homaee

Farazmehr

et al. 2014

WJO

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of blood loss, urine output, fluid intake and surgeon' s satisfaction were recorded. Data was analyzed with SPSS version 13.0 and P values less than 0.05 were considered significant. RESULTS:Twenty patients in the MGS group and 19 patients in the REM group were studied. There was no difference between the two groups in the hemodynamic variables, blood loss, urine output, fluid requirement and surgeon's satisfaction for exposure. The target MAP was achieved in 75% of Mg and 58% of remifentanil groups. Although a higher number of patients in the REM group required nitroglycerin (42.1%) to reach the target MAP than those in the MGS group (25%), this difference was not statistically significant (P = 0.32). CONCLUSION:Our findings showed that in patients undergoing lumbar PSF surgery, remifentanil and MGS have a similar hypotensive effect and comparable amount of blood loss without any significant adverse effects.© 2014 Baishideng Publishing Group Co., Limited. All rights reserved.Key words: Controlled hypotension; Magnesium sulfate; Remifentanil; Spine surgery; Blood loss Core tip: We conducted a relatively small sized prospective randomized clinical trial comparing intravenous infusion of remifentanil with magnesium in controlling blood pressure during posterior spine fusion in order to decrease the intraoperative blood loss. Our experiments showed no difference between the two administered regimens in reducing mean arterial blood pressure and intraoperative blood loss, and satisfaction of the operating surgeons. METHODS:In this randomized clinical trial, 40 patients with the American Society of Anesthesiologists Ⅰ and Ⅱ physical status undergoing lumbar PSF were randomized to receive remifentanil (REM) 0.15 μg/kg or MGS 50 mg/kg for controlled hypotension. The administering anesthesiologist was blinded to the medication. Continuous infusion was maintained at a fixed volume rate to deliver precalculated doses of either study drugs. All other aspects of anesthesia and surgery were similar in the two groups. The target mean arterial pressure (MAP) range used in this study was 60-70 mmHg. In the course of surgery, the hemodynamic variables, volume BRIEF ARTICLE

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“…This result contrasted with the results we obtained in our previous study with supratentorial craniotomy. 6 Guy et al 3 were the first to publish a study comparing remifentanil and fentanyl for intracranial surgery, and they found that systolic blood pressure (SBP) was greater in the remifentanil group than in the fentanyl group in the postoperative period, but transitional analgesia was not used in the remifentanil group. In our study, five patients in the block group received antihypertensive drugs, but only in the PACU; whereas in the morphine group, two patients received antihypertensive drugs in the operating room and four in the PACU.…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3][4] With the rapid metabolism of this agent, the patient may experience significant pain on awakening and a higher incidence of early postoperative hypertension. 3,4 Hence the need for a transitional method of analgesia in order to ensure a smooth and pain-free emergence from general anesthesia.…”

Section: Résumémentioning

confidence: 99%

Superficial cervical plexus block for transitional analgesia in infratentorial and occipital craniotomy: a randomized trial

Girard

Quentin

Charbonneau

et al. 2010

Can J Anesth/J Can Anesth

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Background In this study, we compared the quality of transitional analgesia provided by bilateral superficial cervical plexus block (SCPB) or morphine following a remifentanilbased anesthesia for infratentorial or occipital craniotomy. Methods In this randomized controlled and double-blind study, 30 patients scheduled for infratentorial or occipital craniotomy were divided randomly into two groups: group morphine (morphine 0.1 mgÁkg -1 iv after dural closure and a SCPB performed with 20 mL of 0.9% saline at the end of the surgery) or group block (10 mL of 0.9% saline iv instead of morphine after dural closure and a SCPB performed with 20 mL of a 1:1 mixture of 0.5% bupivacaine and 2% lidocaine at the end of the surgery). Postoperative pain was assessed at one, two, four, eight, 12, 16, and 24 hr using an 11-point (0-10) numerical rating scale (NRS). Analgesia was provided with subcutaneous codeine. Results Average NRS scores were similar between the two groups at each time interval over the study period. The average scores (with 95% confidence interval) were 3.9 (3.4-4.4) and 4.3 (3.8-4.9) for the block and morphine groups, respectively (P = 0.25). The delay before administration of the first dose of codeine was not statistically different between the two groups: 25 min (5-2,880) vs 21.5 min (5-90), median and range for the block and morphine groups, respectively. The incidence of nausea and vomiting was similar between the two groups. Conclusion Bilateral superficial cervical plexus block provides transitional analgesia that is clinically equivalent to morphine following remifentanil-based anesthesia in patients undergoing occipital or infratentorial craniotomies. RésuméContexte Dans le cadre de cette e´tude, nous avons compare´la qualite´de l'analge´sie transitionnelle produite par un bloc bilate´ral du plexus cervical superficiel (SCPB) ou par la morphine a`la suite d'une anesthe´sie au re´mifentanil lors d'une craniotomie sous-tentorielle ou occipitale. Méthode Dans cette e´tude randomise´e et contrôle´e en double aveugle, 30 patients ayant subi une craniotomie sous-tentorielle ou occipitale ont e´te´divise´s ale´atoirement en deux groupes: le groupe morphine (morphine 0,1 mgÁkg -1 intraveineuse apre`s la fermeture de la dure-me`re et un SCPB effectue´avec 20 mL de solution sale´e à 0,9 % a`la fin de la chirurgie) ou le groupe bloc (10 mL de solution sale´e à 0,9 % intraveineuse au lieu de la morphine apre`s la fermeture de la dure-me`re, et un SCPB effectueá vec 20 mL d'un me´lange 1:1 de bupivacaı¨ne a`0,5 % et de lidocaı¨ne a`2 % à la fin de la chirurgie). La douleur postope´ratoire a e´te´mesure´e à une, deux, quatre, huit, 12, 16 et 24 h a`l'aide d'une e´chelle d'e´valuation nume´rique

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Comparison of Remifentanil and Fentanyl in Patients Undergoing Craniotomy for Supratentorial Space-occupying Lesions

Abstract: Remifentanil appears to be a reasonable alternative to fentanyl during elective supratentorial craniotomy.

Cited by 183 publications

References 18 publications

Remifentanil and controlled hypotension; comparison with nitroprusside or esmolol during tympanoplasty

Remifentanil and controlled hypotension; comparison with nitroprusside or esmolol during tympanoplasty

Comparative induction of controlled circulation by magnesium and remifentanil in spine surgery

Superficial cervical plexus block for transitional analgesia in infratentorial and occipital craniotomy: a randomized trial

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