Recovery and neurological examination after remifentanil–desflurane or fentanyl–desflurane anaesthesia for carotid artery surgery

Abstract

We studied 44 patients undergoing carotid endarterectomy (CEA) to compare recovery after general anaesthesia with desflurane supplemented with either remifentanil or fentanyl. Remifentanil was infused at 0.1 microg kg(-1) min(-1) and desflurane was adjusted at 2 vol% end-tidal. Fentanyl was given as a bolus dose of 2 microg kg(-1) before induction and repeated at skin incision; desflurane was adjusted as needed. Times for early recovery and response to simple neurological tests (digit symbol substitution test (DSST) and Trieger dot test (TDT)) were measured 30, 60 and 90 min after operation. Emergence from remifentanil-desflurane anaesthesia was significantly quicker than that from fentanyl-desflurane anaesthesia: mean times to extubation were 4.1 (SD 1.7) and 8.2 (4.9) min, respectively; mean times for patients to state their name correctly were 6.0 (2.8) and 13.8 (9.0) min, respectively. Patients in the remifentanil-desflurane group successfully performed neurological tests significantly earlier than those in the fentanyl-desflurane group; for example, patients in the former group completed the arm holding test at 7.9 (3.0) min, while those in the latter group did this at 20.6 (19.7) min (P < or = 0.01). Intermediate recovery was less impaired at 30 min (DSST, TDT) and at 60 min (DSST). More rapid awakening and an earlier opportunity for neurological examination suggest that remifentanil-desflurane is a suitable alternative to a standard fentanyl-based general anaesthetic technique in patients undergoing CEA.

The Role of Carotid Artery Stenting and Carotid Endarterectomy in Cognitive Performance

“…Studies were excluded when dealing with pharmacology recovery after anesthesia (nϭ2), 11,12 lacking postoperative assessment (nϭ1), 13 case reports (nϭ2), 14,15 review articles (nϭ4), [7][8][9][10] or ongoing trials without available results (nϭ3). One study was considered a duplicate 16 of another included study 17 (Figure).…”

Effects of maintaining intravenous infusion of remifentanil or propofol on anesthesia and palinesthesia during anesthesia and analepsia

“…In order to prevent a high dynamic response and choking in the recovery process of general anesthesia and extubation, many methods, such as deep anesthesia extubation, the use of local anesthetics, vasodilators, short-acting opioid drugs, and other methods, have been used in the clinic (Shajar et al, 1999;Hohlrieder et al, 2007). Studies have reported that the application of general anesthesia with propofol or remifentanil could make the recovery process of patients smoother (Shajar et al, 1999;Wilhelm et al, 2001;Blayney et al, 2003;Hohlrieder et al, 2007). However, propofol and remifentanil, which are more conducive to allowing patients to pass through the recovery period safely, have been less characterized.…”

“…It has been widely used in clinical anesthesia (Hughes et al, 1992;Kapila et al, 1995;Soltesz et al, 2001). Recent studies have shown that the use of remifentanil can benefit patients who are awake (Shajar et al, 1999;Wilhelm et al, 2001;Hohlrieder et al, 2007). The purpose of this study was to investigate the effect of maintaining an intravenous infusion of remifentanil or propofol on the performance of general anesthesia, including the cardiovascular response, choking, and irritability at the end of general anesthesia, in order to assess the effect of a maintenance intravenous infusion of remifentanil or propofol.…”

Remifentanil and Other Opioids

“…with a regional technique). Clinically, remifentanil titratability translates into a better control over adrenergic stimuli whatever the type of surgery or the patients (Kapila et al 1995;Mouren et al 2001;Schuttler et al 1997;Cartwright et al 1997;Gemma et al 2002;Guy et al 1997;Howie et al 2001;McGregor et al 1998;Sneyd et al 2001;Ahonen et al 2000;Balakrishnan et al 2000;Casati et al 2000;Doyle et al 2001;Fleisher et al 2001;Natalini et al 1999;Twersky et al 2001;Wee et al 1999;Wilhelm et al 2001). For example, intubation is a stronger stimulus than laryngoscopy, which in turn is stronger than skin incision.…”