Early postoperative cognitive recovery after remifentanil–propofol or sufentanil–propofol anaesthesia for supratentorial craniotomy: a randomized trial

Abstract

In conclusion, propofol-remifentanil and propofol-sufentanil are both suitable for fast-track neuroanaesthesia and provide similar intraoperative haemodynamics, awakening and extubation times. Despite a higher risk of treatable postoperative hypertension propofol-remifentanil allows earlier cognitive recovery.

Effects of aminophylline on cognitive recovery after sevoflurane anesthesia

“…Moreover, Katzman and colleagues [12] have validated the SOMCT as a measure of cognitive impairment, as they showed it could discriminate between mild, moderate, and severe cognitive deficits. In addition, several previous studies have used the SOMCT to assess postoperative cognitive dysfunction after anesthesia [2,5,24].…”

Early Post-operative Surveillance after Brain Surgery

“…Neurologic and cognitive status at patients arrival in the duty should be immediately evaluated and recorded since the loss of a neurological and or cognitive ability might represent the initial sign of intracranial postoperative bleeding [2,7]. Surveillance of these functions should be performed on a pre defined time schedule and according a systematic approach.…”

Esmolol blunts postoperative hemodynamic changes after propofol-remifentanil total intravenous fast-track neuroanesthesia for intracranial surgery

“…Remifentanil is an easily titratable opioid, and it also combines good intraoperative hemodynamic control with early recovery of consciousness, regardless of the infused dose and length of anesthesia [9][10][11][12]. Remifentanil has the potential clinical disadvantage of further increasing postoperative sympathetic overdrive, possibly through the rapid development of acute opioid tolerance (60-90 min in volunteers) [9,12,13] or abrupt cessation of analgesia.…”

“…Remifentanil is an easily titratable opioid, and it also combines good intraoperative hemodynamic control with early recovery of consciousness, regardless of the infused dose and length of anesthesia [9][10][11][12]. Remifentanil has the potential clinical disadvantage of further increasing postoperative sympathetic overdrive, possibly through the rapid development of acute opioid tolerance (60-90 min in volunteers) [9,12,13] or abrupt cessation of analgesia. Although the underlying mechanism is unclear, compared with longer-acting opioids, remifentanil-based anesthesia increases the risk of postoperative hypertension, the need for postoperative antihypertensive drugs, and the need for postoperative analgesics [5,6,[11][12][13].…”

“…Remifentanil has the potential clinical disadvantage of further increasing postoperative sympathetic overdrive, possibly through the rapid development of acute opioid tolerance (60-90 min in volunteers) [9,12,13] or abrupt cessation of analgesia. Although the underlying mechanism is unclear, compared with longer-acting opioids, remifentanil-based anesthesia increases the risk of postoperative hypertension, the need for postoperative antihypertensive drugs, and the need for postoperative analgesics [5,6,[11][12][13]. Whether discontinuing remifentanil is related to an increased frequency of arterial hypertension in the early postoperative period because of a higher sympathetic tone or to acute tolerance and the related withdrawal syndrome remains unclear [12][13][14][15].…”