Propofol/remifentanil vs sevoflurane/remifentanil for long lasting surgical procedures: a randomised controlled trial

Department of Anaesthesiology and Intensive Care Medicine, University Hospital Schleswig-Holstein, Campus Kiel, Schwanenweg 21, D-24105, Kiel, Germany.
Anaesthesia (Impact Factor: 3.85). 08/2006; 61(8):752-7. DOI: 10.1111/j.1365-2044.2006.04715.x
Source: PubMed

ABSTRACT We compared the haemodynamics, emergence and recovery characteristics of total intravenous anaesthesia using propofol/remifentanil with sevoflurane/remifentanil anaesthesia, under bispectral index guidance, in 103 patients undergoing surgical procedures lasting > 3.5 h. Time to tracheal extubation was significantly shorter in the propofol group than in the sevoflurane group (mean (SD) 8.3 (3.5) min vs 10.8 (4.6) min, respectively; p = 0.0024), but further recovery was comparable in both groups. There were no significant differences in haemodynamic parameters, intensity of pain or postoperative nausea and vomiting. During and after anaesthesia of comparable depth for long lasting surgical procedures, both propofol/remifentanil and sevoflurane/remifentanil enable haemodynamic stability and fast emergence. The shorter time to extubation in the propofol group does not offer a relevant clinical advantage.

  • Source
    • "Most studies using BIS monitoring, like the study by Hö cker et al. regarding patients undergoing a variety of long-lasting procedures, tend to titrate intravenous or inhalation agents to maintain BIS values within certain limits, usually between 40 and 60 [10]. In the present study, our goal was BIS between 40 and 50. "
    [Show abstract] [Hide abstract]
    ABSTRACT: BACKGROUND: Spondylodesis is a procedure aiming at providing stability in one or more spinal segments. The aim of our study was to compare sevoflurane and propofol as induction and maintenance agents, focusing on hemodynamic stability, recovery characteristics, postoperative nausea and vomiting, and pain intensity. MATERIALS AND METHODS: Seventy patients, with a physical status according to American Society of Anesthesiologists (ASA) I-II, 50-72 y old, undergoing selective lumbar spondylodesis were enrolled. RESULTS: There was no statistically significant difference between groups in overall mean hemodynamic parameters. No differences in fluid administration and vasoactive substances used were noted. Postoperatively, there was a significant difference in overall mean visual analog score at rest and at cough, with the sevoflurane group showing lower values. No differences in the incidence of nausea, vomiting, shivering, postoperative sedation scores, and orientation to place were revealed. Orientation to time exhibited a statistically significant difference at the time just after transfer to the post-anesthesia care unit, where more patients of the sevoflurane group seemed to be well oriented. CONCLUSIONS: Sevoflurane and propofol anesthesia for lumbar spondylodesis surgery provide safe and comparable results.
    Journal of Surgical Research 10/2012; 179(1). DOI:10.1016/j.jss.2012.09.038 · 2.12 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Seventy-two patients undergoing routine surgical procedures under propofol-remifentanil anaesthesia were randomly assigned to receive either standard clinical practice (n = 35) or standard practice plus monitoring of depth of anaesthesia with M-Entropy (n = 37). Patients in the standard practice group received more propofol than the entropy group (mean (SD) 95 (14) vs 81 (22), respectively; p < 0.01), and less remifentanil (0.39 (0.08) vs 0.46 (0.08), respectively; p < 0.001). Loss of consciousness was best predicted by BIS (prediction probability (P(K)) 0.96) and response entropy (P(K) 0.93), whereas emergence was best predicted by response entropy (P(K) 0.94). The frequency of unwanted patient responses was higher in the standard practice group than in the entropy group (47 vs 27 total events, respectively; p < 0.01). Both regimens resulted in fast recovery with no clinical advantage for either one. There were no significant differences in haemodynamic parameters, postoperative nausea and vomiting or satisfaction with the procedure.
    Anaesthesia 12/2007; 62(12):1224-9. DOI:10.1111/j.1365-2044.2007.05252.x · 3.85 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: The aim of this study was to investigate the effect of bispectral index (BIS) monitoring on hemodynamic parameters, drug consumption and awareness during total intravenous anesthesia (TIVA) with remifentanil and propofol in lumbar discectomies. After institutional ethical committee approval, ASAI-II 56 patients were divided as control and BIS groups. Anesthesia was induced by bolus remifentanil 1 mug/kg in both groups; propofol 2 mg/kg in was used in the control group while propofol was titrated to BIS 45- 65 values in the BIS group. Anesthesia was maintained by remifentanil and propofol infusions. Drug consumption, time to extubation and awareness were recorded. Demographic parameters were similar between the groups. Consumption of propofol was lower, and time to extubation was shorter in the BIS group; there was no difference between awareness among groups. BIS monitoring was helpful for propofol titration and decreased propofol consumption, but not enough to prevent reaction to noxious stimuli. Standard anesthesia titration considering hemodynamic parameters was enough for most ASA I-II patients for lumbar discectomies. BIS might be more helpful for patients who cannot show hemodynamic responses to noxious stimuli. More studies are needed to investigate the correlation between positioning and awareness using BIS monitoring.
    Turkish neurosurgery 05/2008; 18(2):125-33. · 0.53 Impact Factor
Show more


1 Download