Hostname: page-component-78c5997874-fbnjt Total loading time: 0 Render date: 2024-11-16T05:22:04.306Z Has data issue: false hasContentIssue false
  • English
  • Français

Clinical comparison of remifentanil–sevoflurane vs. remifentanil–propofol for endoscopic endonasal transphenoidal surgery

Published online by Cambridge University Press:  01 May 2007

T. Cafiero ,
L. M. Cavallo ,
A. Frangiosa ,
R. Burrelli ,
G. Gargiulo ,
P. Cappabianca  and
E. de Divitiis
T. Cafiero*
Affiliation:
Cardarelli Hospital, Department of Anesthesiology and Postoperative Intensive Care, Naples, Italy
L. M. Cavallo
Affiliation:
Università degli Studi di Napoli Federico II, Department of Neurosurgery, Naples, Italy
A. Frangiosa
Affiliation:
Università degli Studi di Napoli Federico II, Department of Anesthesiology, Naples, Italy
R. Burrelli
Affiliation:
Università degli Studi di Napoli Federico II, Department of Anesthesiology, Naples, Italy
G. Gargiulo
Affiliation:
Università degli Studi di Napoli Federico II, Department of Anesthesiology, Naples, Italy
P. Cappabianca
Affiliation:
Università degli Studi di Napoli Federico II, Department of Neurosurgery, Naples, Italy
E. de Divitiis
Affiliation:
Università degli Studi di Napoli Federico II, Department of Neurosurgery, Naples, Italy
*
Correspondence to: Tullio Cafiero, Department of Anesthesiology and Postoperative Intensive Care, Cardarelli Hospital, Via B. Cavallino, 145, 80131 Napoli, Italy. E-mail: [email protected]; Tel/Fax: +390815456294
Get access

Summary

Background

Endoscopic endonasal transphenoidal surgery has been recently proposed as a minimally invasive procedure for the treatment of pituitary adenomas. The main objective of the anaesthesiologist is to induce sufficient haemodynamic control together with rapid recovery at the end of surgery. The aim of this study was to examine recovery profile, surgical operative conditions and haemodynamic differences using remifentanil infusion with either propofol target controlled infusion system or sevoflurane.

Method

Forty-four adult patients were enrolled in a prospective, randomized, single-blind, two-group study: Group P received propofol target controlled infusion system and remifentanil; Group S received sevoflurane and remifentanil for maintenance of anaesthesia.

Results

No statistically significant differences between the two groups with regards to the haemodynamic changes, operative conditions as assessed by a four-step bleeding score (0–3), were obtained. Recovery times were considerably shorter after remifentanil–sevoflurane in comparison with remifentanil–propofol target controlled infusion system group (7.4 vs. 12.8 min, P < 0.01).

Conclusion

This study demonstrates that sevoflurane–remifentanil gives a faster recovery and equivalent intraoperative status compared with propofol target controlled infusion system with remifentanil for the endoscopic endonasal transphenoidal approach.

Keywords

ANAESTHESIA INHALATIONALANAESTHETIC AGENTS, sevofluraneANAESTHESIA INTRAVENOUSPROPOFOLANALGESICS OPIOID, remifentanilSURGERY, pituitary, endoscopic, transphenoidal
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 24 , Issue 5 , May 2007 , pp. 441 - 446
Copyright
Copyright © European Society of Anaesthesiology 2007

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

This paper has been presented in part at the 13th World Congress of Anesthesiologists, Paris, April 18–23 2004.

References

1.Jho, HD, Carrau, RL, Ko, Y. Endoscopic pituitary surgery In: Wilkins, RH, Rengachary, SS, eds. Neurosurgical Operative Atlas. American Association of Neurological Surgeons: Park Ridge, Ill 5, 1996: 1–12.Google Scholar
2.de Divitiis, E, Cappabianca, P. Endoscopic Endonasal Transsphenoidal Surgery. Wien-New York: Springer-Verlag, 2003: 198.CrossRefGoogle Scholar
3.Cappabianca, P, de Divitiis, E. Endoscopy and transsphenoidal surgery. Neurosurgery 2004; 54: 1043–1050.CrossRefGoogle ScholarPubMed
4.de Divitiis, E, Cappabianca, P, Cavallo, LM. Endoscopic transsphenoidal approach: adaptability of the procedure to different sellar lesions. Neurosurgery 2002; 51: 699–707.Google Scholar
5.Nelskyla, K, Korttila, K, Yli-Hankala, A. Comparison of sevoflurane-nitrous oxide and propofol-alfentanil-nitrous oxide anaesthesia for minor gynaecological surgery. Br J Anaesth 1999; 83 (4): 376–379.CrossRefGoogle ScholarPubMed
6.Robinson, BJ, Uhrich, TD, Ebert, TJ. A review of recovery from sevoflurane anaesthesia: comparisons with isoflurane and propofol including meta-analysis. Acta Anaesthesiol Scand 1999; 43 (2): 185–190.CrossRefGoogle ScholarPubMed
7.Cafiero, T, Mastronardi, P, Gargiulo, G, Cappabianca, P, Cavallo, LM. Intraoperative analgesia with remifentanil for the endonasal endoscopic approach to pituitary lesions. Anesthesiology 2002; 96: A70.CrossRefGoogle Scholar
8.Gemma, M, Tommasino, C, Cozzi, S et al. . Remifentanil provides hemodynamic stability and faster awakening time in transsphenoidal surgery. Anesth Analg 2002; 94 (1): 163–168.CrossRefGoogle ScholarPubMed
9.JrHogue, CW, Bowdle, TA, O’Leary, C et al. . A multicenter evaluation of total intravenous anesthesia with remifentanil and propofol for elective inpatient surgery. Anesth Analg 1996; 83: 279–285.CrossRefGoogle ScholarPubMed
10.Degoute, CS, Ray, MJ, Manchon, M, Dubreuil, C, Banssillon, V. Remifentanil and controlled hypotension; comparison with nitroprusside or esmolol during tympanoplasty. Can J Anesth 2001; 48: 20–27.CrossRefGoogle ScholarPubMed
11.Maguire, AM, Kumar, N, Parker, JL, Rowbotham, DJ, Thompson, JP. Comparison of effects of remifentanil and alfentanil on cardiovascular response to tracheal intubation in hypertensive patients. Br J Anaesth 2001; 86 (1): 90–93.CrossRefGoogle ScholarPubMed
12.Ritchie, CM, Sheridan, B, Fraser, R et al. . Studies on the pathogenesis of hypertension in Cushing’s disease and acromegaly. Q J Med 1990; 76 (280): 855–867.Google ScholarPubMed
13.Gurkan, Y, Kilickan, L, Toker, K. Propofol-nitrous oxide versus sevoflurane-nitrous oxide for strabismus surgery in children. Paediatr Anaesth 1999; 9 (6): 495–499.CrossRefGoogle ScholarPubMed
14.Loop, T, Priebe, H-J. Recovery after anesthesia with remifentanil combined with propofol, desflurane or sevoflurane for otorhinolaryngeal surgery. Anesth Analg 2000; 91: 123–129.Google Scholar
15.Raeder, J, Gupta, A, Pedersen, FM. Recovery characteristics of sevoflurane- or propofol-based anaesthesia for day-care surgery. Acta Anaesthesiol Scand 1997; 41 (8): 988–994.CrossRefGoogle ScholarPubMed
16.Smith, M, Hirsch, NP. Pituitary disease and anaesthesia. Br J Anaesth 2000; 85: 3–14.Google Scholar
17.Burgess, LP, Derderian, SS, Morin, GV, Gonzalez, C, Zajtchuk, JT. Postoperative risk following uvulopalatopharyngoplasty for obstructive sleep apnea. Otolaryngol Head Neck Surg 1992; 106: 81–86.CrossRefGoogle ScholarPubMed
18.Kravath, RE, Pollak, CP, Borowiecki, B, Weitzman, ED. Obstructive sleep apnea and death associated with surgical correction of velopharyngeal incompetence. J Pediatr 1980; 96: 645–648.CrossRefGoogle ScholarPubMed
19.McColley, SA, April, MM, Carroll, JL, Naclerio, RM, Loughlin, GM. Respiratory compromise after adenotonsillectomy in children with obstructive sleep apnea. Arch Otolaryngol Head Neck Surg 1992; 118: 940–943.CrossRefGoogle ScholarPubMed
20.Taasan, V, Wynne, JW, Cassisi, N, Block, AJ. The effect of nasal packing on sleep-disordered breathing and nocturnal oxygen desaturation. Laryngoscope 1981; 91: 1163–1172.CrossRefGoogle ScholarPubMed