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Authors
Larsen B. Seitz A. Larsen R.
Institution
Department of Anesthesiology and Intensive Care Medicine, University of
Saarland, Homburg/Saar, Germany.
Title
Recovery of cognitive function after remifentanil-propofol anesthesia: a
comparison with desflurane and sevoflurane anesthesia.
Source
Anesthesia & Analgesia. 90(1):168-74, 2000 Jan.
Abstract
We compared the recovery characteristics of remifentanil, desflurane, and sevoflurane when used for anesthesia in elective operative
procedures. Sixty ASA physical status I and II patients, aged 18-65 yr, were
randomly assigned to receive remifentanil-propofol, desflurane-N2O, or
sevoflurane-N2O anesthesia. Before the induction of anesthesia, the patients
of the desflurane and sevoflurane groups received fentanyl 2 microg/kg. In
all groups, anesthesia was induced with propofol and
maintained either with remifentanil 0.25 microg x kg(-1) x
min(-1), desflurane, or sevoflurane 0.85 MAC with 65% nitrous oxide in
oxygen. Anesthetics were titrated to achieve an adequate level of surgical
anesthesia and to maintain mean arterial pressure within 20% of baseline
values. Early recovery times and a modified Aldrete Recovery Score > 9 were
recorded. Trieger Dot Test and Digit Substitution Test (DSST) were performed
the day before surgery and in the postanesthesia care unit to evaluate
intermediate recovery. The remifentanil-propofol group had a
significantly faster emergence than desflurane or sevoflurane, with no
difference between both inhaled anesthetics. Thirty min after anesthesia
administration, patients in the remifentanil-propofol and in the desflurane
groups gave significantly more correct responses in the DSST compared with
sevoflurane (remifentanil 87%, desflurane 83%, sevoflurane
56%), the impairment in the sevoflurane patients corresponding to the effects
of a blood alcohol level of approximately 0.1% and, thus, being of clinical
importance. Ninety minutes after anesthesia administration, no significant
difference could be demonstrated among the groups in the DSST scores.
Emergence and return of cognitive function was significantly faster after remifentanil-propofol compared with
desflurane and sevoflurane up to 60 min after anesthesia administration.
IMPLICATIONS: We compared awakening and intermediate recovery times after
remifentanil-propofol anesthesia to
desflurane-N2O and sevoflurane-N2O anesthesia. Emergence and return of
cognitive function was significantly faster after remifentanil-propofol compared with
desflurane and sevoflurane up to 60 min after anesthesia administration.
