Desflurane reduces intraoperative remifentanil requirements more than sevoflurane: comparison using surgical pleth index-guided analgesia

Abstract

Background: Sevoflurane and desflurane are widely used in balanced anaesthesia in combination with opioid analgesics. The opioid remifentanil is frequently chosen because of its extremely rapid pharmacokinetics. However, intraoperative high-dose remifentanil is associated with increased postoperative pain and rescue analgesic use owing to acute tolerance and opioid-induced hyperalgesia. This study aimed to compare intraoperative remifentanil requirements during equiminimum alveolar concentration (MAC) sevoflurane and desflurane anaesthesia via surgical pleth index-guided remifentanil administration. Methods: Eighty-two subjects undergoing laparoscopic cholecystectomy were randomly allocated to two groups receiving either sevoflurane (n¼40) or desflurane (n¼42). Anaesthesia was maintained with the assigned inhaled anaesthetics and remifentanil. End-tidal anaesthetic concentration was maintained at age-corrected 1.0 MAC, and remifentanil infusion was continuously adjusted to achieve a surgical pleth index of 20e50. Mean remifentanil infusion rate, which was the primary outcome of the study, was calculated as the total infused remifentanil dose per kg body weight per minute of total operative time. Results: Mean remifentanil infusion rate [mean (standard deviation)] was significantly higher in the sevoflurane group than in the desflurane group [0.192 (0.064) vs. 0.099 (0.033) mg kg À1 min À1 ; difference, 0.093 (95% confidence interval, 0.071e0.115); P<0.001]. Conclusions: During equi-MAC anaesthesia of 1.0 MAC, sevoflurane and desflurane did not show similar intraoperative remifentanil consumption under surgical pleth index-guided opioid administration. Further studies using other monitors with different measuring mechanisms are warranted to determine the cause of this difference. Clinical trial registration: NCT02830243 (ClinicalTrials.gov).

Response to letter to the editor

“…In addition to our findings [2], they have shown that SPI was also different between equi-MAC desflurane and sevoflurane with tetanic stimulation [1]. They proved that the required dose of remifentanil with 1 MAC desflurane was smaller than that with 1 MAC sevoflurane to achieve SPI of 20-50 [3].…”

Anesthesia for Transoral Endoscopic Parathyroidectomy by Vestibular Approach (TOEPVA)

“…Opioids have an important influence on upper airway events, purposeful movements during surgery and recovery time [18], the requirements for propofol or volatile anaesthetics [18,19]. Remifentanil has rapid onset, short duration of action [18][19][20], great intraoperative analgesia [19][20][21], quick recovery time [19][20][21], excellent controllability [18] and metabolized by non-spesific esterase so elimination is independent from liver and renal [18,19]. But over-administered opioid analgesics during surgery delay recovery from anaesthesia and cause opioid related side effects [19,20].…”

Effects of sevoflurane and propofol anesthesia on intraoperative endothelial cell function in patients undergoing laparoscopic cholecystectomy

“…3 As general anesthetic drugs, sevoflurane and propofol have excellent properties such as fast onset, good controllability and rapid recovery. 4 In addition to the sedative and analgesic effects, both sevoflurane and propofol have certain anti-inflammatory effects that make it ideal for clinical application and for use in basic research. 5,6 In this study, we observed and compared P-selectin, ICAM-1, and TM expression in the blood of patients undergoing LC during anesthesia using sevoflurane or propofol by flow cytometry and immunoenzymatic techniques.…”