Comparison of The Effects of Remifentanil and Fentanyl Combined with Desflurane on Intraoperative Hemodynamic Parameters and Postoperative Recovery Period in Anesthesia for Day Case Surgery
Abstract
Objective: We aimed to compare the effects of two different opioids, fentanyl and remifentanil with short-acting inhalation agent, desflurane on intraoperative hemodynamics and recovery quality in the postoperative period in anesthesia for day case surgery.
Methods: A prospective randomized case control study was carried out at Anesthesia and Reanimation Clinics of The Istanbul Education and Research Hospital with the approval of the local ethics committee between 2001-2002. The study population (n=100) who has arthroscopic knee surgery was composed of patients between the ages of 18-65 classified as ASAI-II. The cases were randomized and divided into two groups. After giving fentanyl to patients in the first group and remifentanil infusion to patients in the second group, induction has administered by propofol and mivacurium was given as a muscle relaxant in both groups. After endotracheal intubation, systemic blood pressure, heart rate and peripheral oxygen saturation (SpO2) values were recorded every five minutes. When the surgery was completed, eye opening, following commands, saying her name, saying her birthday, sitting without help and getting the correct answer to the DSS test was recorded for both groups. Visual Pain Scale (VAS) and Modified Aldrete Score were evaluated and recorded at 0, 15, 30, and 60 minutes. Patients were observed and recorded in terms of side effects such as increased secretion, bradycardia, nausea, vomiting, dizziness, headache, and tremors in both groups.
Results : In terms of demographic features there was no statistically significant difference between the two groups. Generally; systemic blood pressures were significantly higher in the fentanyl group. Heart rate was significantly higher in fentanyl group during intubation and intraoperative periods . There was no statistically significant difference between groups in terms of Sp02 . Time until spontaneous breathing, extubation, eye opening, following commands, saying the name, DSST and unassisted sitting were significantly longer in the fentanyl group . The mean values of VAS scores at the 15th and 30th minutes were significantly higher in the remifentanil group . Similarly, the mean Aldrete recovery scale score scores at 15th and 30th minutes were significantly higher in the remifentanil group . When postoperative pathological findings were evaluated, the frequency of bradycardia was significantly higher in the remifentanil group, there was no difference in terms of other side effects.
Conclusion: According to the our study results; we concluded that it is a better alternative to use remifentanil together with desflurane which is preferred short-acting inhalation agent in ambulatory anesthesia; in terms of hemodynamic stability during the intubation, peroperative and extubation periods and rapid postoperative recovery.
Methods: A prospective randomized case control study was carried out at Anesthesia and Reanimation Clinics of The Istanbul Education and Research Hospital with the approval of the local ethics committee between 2001-2002. The study population (n=100) who has arthroscopic knee surgery was composed of patients between the ages of 18-65 classified as ASAI-II. The cases were randomized and divided into two groups. After giving fentanyl to patients in the first group and remifentanil infusion to patients in the second group, induction has administered by propofol and mivacurium was given as a muscle relaxant in both groups. After endotracheal intubation, systemic blood pressure, heart rate and peripheral oxygen saturation (SpO2) values were recorded every five minutes. When the surgery was completed, eye opening, following commands, saying her name, saying her birthday, sitting without help and getting the correct answer to the DSS test was recorded for both groups. Visual Pain Scale (VAS) and Modified Aldrete Score were evaluated and recorded at 0, 15, 30, and 60 minutes. Patients were observed and recorded in terms of side effects such as increased secretion, bradycardia, nausea, vomiting, dizziness, headache, and tremors in both groups.
Results : In terms of demographic features there was no statistically significant difference between the two groups. Generally; systemic blood pressures were significantly higher in the fentanyl group. Heart rate was significantly higher in fentanyl group during intubation and intraoperative periods . There was no statistically significant difference between groups in terms of Sp02 . Time until spontaneous breathing, extubation, eye opening, following commands, saying the name, DSST and unassisted sitting were significantly longer in the fentanyl group . The mean values of VAS scores at the 15th and 30th minutes were significantly higher in the remifentanil group . Similarly, the mean Aldrete recovery scale score scores at 15th and 30th minutes were significantly higher in the remifentanil group . When postoperative pathological findings were evaluated, the frequency of bradycardia was significantly higher in the remifentanil group, there was no difference in terms of other side effects.
Conclusion: According to the our study results; we concluded that it is a better alternative to use remifentanil together with desflurane which is preferred short-acting inhalation agent in ambulatory anesthesia; in terms of hemodynamic stability during the intubation, peroperative and extubation periods and rapid postoperative recovery.
Keywords
Remifentanil,Fentanyl,Day Case Surgery,Recovery,VAS,Aldrete
Project Number
yok
References
- Albertin A, Casati A, Deni F, Danelli G, Comotti R, Grifoni F, Fanelli G: Clinical comparison of either small doses of fentanyl or remifentanyl for bulunting cardiovascular changes induced by tracheal intubation. MınervaAnestesiologica, 66(10): 691-696, 2001.
- American Hospital Association; The Migration of Care to Non-hospital Settings: Have Regulatory Structures Kept Pace with Changes in Care Delivery?; July 2006. (Accessed on June 08, 2014).
- Barbier D, N'Dele D, Bennis M, Thevenin-Lemoine C. Et al, Day surgery for anterior cruciate ligament reconstruction in children: a prospective study on feasibility and satisfaction. J Child Orthop. 2019 Feb 1;13(1):100-106.
- Cafiero T, Mastronardi P, Burrelli R, Santoro R: The effects of remifentanil on hemodinamic response to intubation. A comparative study with fentanil. MinervaAnestesiol 2000 Nov; 66(11): 793-7.
- Choi JW, Joo JD, Kim DW, et al; Comparison of an Intraoperative Infusion of Dexmedetomidine, Fentanyl, and Remifentanil on Perioperative Hemodynamics, Sedation Quality, and Postoperative Pain Control. J Korean Med Sci. 2016 Sep;31(9):1485-90.
- Clayman MA, Seagle BM. Office surgery safety: the myths and truths behind the Florida moratoria--six years of Florida data. Plast Reconstr Surg 2006; 118:777.
- Coldiron B, Shreve E, Balkrishnan R. Patient injuries from surgical procedures performed in medical offices: three years of Florida data. Dermatol Surg 2004; 30:1435.
- Cook DR Stiller Rl. İn vitro metabolism of mivacurium chioride, Anaesth. Analg. 1989 ;68 :452-456
- Dershwitz M, RandelGl, Rosovv CE, Fragen RJ, et al: Initial clinical experience with remifentanyl, a new opioid metabolized by esterases. Anesth. Analg. 81:619, 1995
- Doris T, Frances C. Postoperative pain control in ambulatory surgery. Surg Clinics of North America. 1999 April; 79(2): 401