Inhalational Anesthetic Technique in Microlaryngeal Surgery: A Comparison between Sevoflurane-Remifentanil and Sevoflurane-Alfentanil Anesthesia

Abstract

We studied the effects of sevoflurane, remifentanil hydrochloride, and alfentanil anesthesia in terms of the hemodynamic responses and emergence characteristics of patients scheduled for elective microlaryngeal surgery. Sixty patients (ASA I to III) were randomly allocated into 2 groups: group S-R (sevoflurane-remifentanil) and group S-A (sevoflurane-alfentanil; 1:20 and 1:4 ratios of remifentanil to alfentanil for induction and maintenance of anesthesia, respectively; doses not strictly equipotent). The mean arterial pressure and heart rate were measured before and after induction of anesthesia, 1 and 3 minutes after endotracheal intubation, at the insertion of the operating laryngoscope, and every 3 minutes during surgery. The emergence times and side effects during the first 30 minutes after surgery were also recorded. The mean arterial pressure values at the insertion of the operating laryngoscope and throughout the procedure were significantly greater (p < .05) in group S-A than in group S-R. The emergence times and postoperative side effects did not differ, except for the greater pain score (p < .05) in group S-R. In conclusion, sevoflurane with remifentanil seems to maintain cardiovascular stability during microlaryngeal surgery more effectively than sevoflurane with alfentanil. Both anesthetic regimens seem to provide rapid and uneventful emergence.

Incidence of postoperative shivering comparing remifentanil with other opioids: a meta-analysis

“…6 8 ; P b . 0 0 0 0 1 ) [1][2][3][10][11][12]17,18,[26][27][28][29][30][31][32][33][34]. The test for heterogeneity gave I 2 = 0.00% (Cochran's Q = 8.68) (Fig.…”

“…When we separated the study protocols to enable a comparison of remifentanil use with the administration of alfentanil, fentanyl, or sufentanil, we found that remifentanil was associated with an increased incidence of postoperative shivering compared with alfentanil (RR = 2.73; 95% CI, 1.72-4.34; P b .0001; I 2 = 0.00%; Cochran's Q = 5.27) [1,2,11,[16][17][18][19][20][21][22][23][24][25][26][27][28]31,32] or fentanyl (RR = 2.04; 95% CI, 1.60-2.60; P b .00001; I 2 = 0.00%; Cochran's Q = 1.13) [3,10,12,19,30,33,34], but no significant difference was seen when compared with sufentanil (RR = 2.13; 95% CI, 0.67-6.74; P = .20; I 2 = 0.00%; Cochran's Q = 1.07) [17,18,29] as shown in Figure 2. The study protocol included the use of propofol or inhalation anesthesia for the maintenance of anesthesia.…”

“…However, other studies have shown that the use of remifentanil in anesthesia does not increase the incidence of postoperative shivering [10][11][12]. In a previous meta-analysis by Komatsu et al [13], remifentanil was compared with other opioids in terms of the incidence of postoperative shivering.…”

Remifentanil for general anaesthesia: a systematic review

“…This difference appears to be smaller in patients with a high postoperative analgesics requirement [11,62,73,94], and larger in patients with low postoperative analgesic requirement [10,25,39,51,57,61,88]. Most of the latter studies [10,25,57,61,88] involved minor surgical procedures that were less likely to cause severe postoperative pain. The reason for the larger discrepancy in postoperative rescue analgesic requirements between remifentanil and control opioids in these less stimulating procedures is unknown.…”

“…The second possibility is that shivering in remifentanil-treated patients is non-thermoregulatory, and is mediated instead by pain [127]. Remifentanil dissipates quickly after surgery and thus leaves patients in more pain relative to those receiving other opioids [10,25,58,88]. The third possibility is that shivering is a sign of opioid withdrawal caused by acute tolerance.…”