During combined endoscopy of the upper gastrointestinal and respiratory tracts sufficient anesthetic depth is needed but rapid recovery is desirable in patients with a compromised airway. In this unblinded, randomised trial we compared remifentanil-propofol anesthesia with alfentanil-propofol anesthesia. We compared perioperative hemodynamic responses and postoperative recovery and awakening. Forty patients were included and randomised. Blood pressure, heart rate and formal assessment of the conscious state (Maddox-wing and p-deletion tests) were used for perioperative evaluation. Recovery from anesthesia was measured using the Steward score together with the Maddox-wing test (done every 20 minutes in the postoperative period until preoperative values were reached). The p-deletion test was performed at 30, 60, and 120 minutes postoperatively. Results are presented as medians with [interquartile ranges]. Although differences were found in hemodynamic responses, these did not reach statistical significance. The remifentanil group had a significantly faster recovery compared to the alfentanil group (time (min) to extubation (7.5 [6-8.75] vs 11 [9-13]), p<0.01; time to reach a maximum Steward score (min) (3 [1-5] vs 10 [5-20]), p<0.001; time to reach the preoperative Maddox-wing values (min) 40 [20-60] vs 60 [40-80], p<0.01). The p-deletion test performance after 30 min was 67 [52-75] in the remifentanil group vs 26 [22-44] in the alfentanil group, p<0.001. After 60 minutes there was still a significant difference 84 [77-93] vs 55 [45-83] p<0.01. We conclude that compared with alfentanil-propofol, remifentanil-propofol offers a more brisk and alert post-operative patient after panendoscopy. This is associated with less cardiovascular instability.
|Number of pages||5|
|Journal||Nederlands Tijdschrift voor Anesthesiologie|
|Publication status||Published - 1 Jun 2006|