15242
document
Remifentanil with morphine transitional analgesia shortens neurological recovery compared to fentanyl for supratentorial craniotomy . PURPOSE To compare the recovery profiles , efficacy and safety of remifentanil and morphine for transitional analgesia with fentanyl in patients undergoing elective craniotomy for supratentorial mass lesions . METHODS Ninety-one patients were enrolled in this prospective , randomized , multicentre study . Anesthesia was induced with thiopental and remifentanil ( 1.0 micro g x kg ( -1 ) bolus and a 1 micro g x kg ( -1 ) x min ( -1 ) infusion ) or fentanyl ( 1 micro g x kg ( -1 ) bolus and a 1.0 micro g x kg ( -1 ) x min ( -1 ) infusion ) . The opioid infusion continued until the level of anesthesia was deemed appropriate for intubation . Anesthesia was maintained with N ( 2 ) O/O ( 2 ) , isoflurane 0.5 MAC and remifentanil 0.2 micro g x kg ( -1 ) x min ( -1 ) or fentanyl 0.04 micro g x kg ( -1 ) x min ( -1 ) . At bone flap replacement , either morphine 0.08 mg x kg ( -1 ) ( remifentanil group ) or saline ( fentanyl group ) was given . RESULTS Systolic blood pressure was greater in those receiving fentanyl during induction ( 145.6 +/-17.5 mmHg vs 128.8 +/-18.3 mmHg ; P = 0.006 ) and intubation ( 126.9 +/-17.1 vs 110.9 +/-16.5 mmHg ; P < 0.001 ) . Median time to tracheal extubation was similar but less variable in the remifentanil group ( remifentanil = 8 min : range = 2-44 min ; fentanyl = 8 min : range = 1-732 min ) . The fentanyl patients required a longer time to achieve the first normal neurological score ( fentanyl = 38.0 min ; remifentanil = 26.0 min ; P = 0.035 ) . Both the anesthesiologists and the recovery room nurses rated remifentanil better with respect to level of consciousness . Analgesics were required earlier in patients receiving remifentanil ; median time 0.5 vs 1.08 hr , P < 0.001 . CONCLUSIONS Remifentanil is a suitable alternative to fentanyl in supratentorial craniotomy . Time to preoperative neurological recovery is faster and morphine provides some transitional analgesia without compromising the quality of recovery .
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Intervention_Pharmacological
Anesthesia
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Intervention_Pharmacological
remifentanil ( 1.0 micro g x kg ( -1 ) bolus
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Intervention_Pharmacological
1 micro g x kg ( -1 ) x min ( -1 ) infusion )
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Intervention_Pharmacological
fentanyl ( 1 micro g x kg ( -1 ) bolus
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Intervention_Pharmacological
1.0 micro g x kg ( -1 ) x min ( -1 ) infusion
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Intervention_Pharmacological
opioid infusion
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Intervention_Pharmacological
anesthesia
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Intervention_Pharmacological
Anesthesia
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Intervention_Pharmacological
isoflurane 0.5 MAC
15252
Intervention_Pharmacological
remifentanil 0.2 micro g x kg ( -1 ) x min ( -1 )
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Intervention_Pharmacological
fentanyl 0.04 micro g x kg ( -1 ) x min ( -1 )
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Intervention_Physical
At bone flap replacement
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Intervention_Pharmacological
either morphine 0.08 mg
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Intervention_Pharmacological
remifentanil group )
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Intervention_Pharmacological
saline
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Outcome_Physical
neurological recovery
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Outcome_Physical
recovery profiles
15260
Outcome_Other
efficacy
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Outcome_Other
safety
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Outcome_Physical
Systolic blood pressure
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Outcome_Physical
Median time to tracheal extubation
15264
Outcome_Other
time to achieve the first normal neurological score
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Outcome_Mental
level of consciousness
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Outcome_Pain
Analgesics
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Outcome_Other
Time to preoperative neurological recovery
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Outcome_Pain
transitional analgesia
15269
Outcome_Other
quality of recovery
15270
Participant_Condition
elective craniotomy
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Participant_Condition
supratentorial mass lesions
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Participant_Sample-size
Ninety-one