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Early postoperative cognitive recovery after remifentanil–propofol or sufentanil–propofol anaesthesia for supratentorial craniotomy: a randomized trial

Published online by Cambridge University Press:  29 August 2006

F. Bilotta ,
R. Caramia ,
F. P. Paoloni ,
R. Favaro ,
F. Araimo ,
G. Pinto  and
G. Rosa
F. Bilotta
Affiliation:
University of Rome ‘La Sapienza’, Department of Anesthesiology, Intensive Care and Pain Medicine, Rome, Italy
R. Caramia
Affiliation:
University of Rome ‘La Sapienza’, Department of Anesthesiology, Intensive Care and Pain Medicine, Rome, Italy
F. P. Paoloni
Affiliation:
G.I.M.E.M.A, Onlus, Rome, Italy
R. Favaro
Affiliation:
University of Rome ‘La Sapienza’, Department of Anesthesiology, Intensive Care and Pain Medicine, Rome, Italy
F. Araimo
Affiliation:
University of Rome ‘La Sapienza’, Department of Anesthesiology, Intensive Care and Pain Medicine, Rome, Italy
G. Pinto
Affiliation:
Ospedale S. Andrea, Department of Anesthesiology, Rome, Italy
G. Rosa
Affiliation:
University of Rome ‘La Sapienza’, Department of Anesthesiology, Intensive Care and Pain Medicine, Rome, Italy
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Abstract

Summary

Background and objective: This study was designed to evaluate early postoperative cognitive recovery after total intravenous anaesthesia with remifentanil–propofol or sufentanil–propofol in patients undergoing craniotomy for supratentorial expanding lesions. Methods: Sixty patients were consecutively enrolled, and randomly assigned to one of two study groups: remifentanil–propofol or sufentanil–propofol anaesthesia. To evaluate cognitive function the Short Orientation Memory Concentration Test (SOMCT) and Rancho Los Amigos Scale (RLAS) were administered to all patients in a double-blind procedure before surgery at 15, 45 min and 3 h after extubation. Results: Mean extubation time was similar in the two groups (13 ± 5 min vs. 19 ± 6 min). A significantly larger number of patients in the remifentanil–propofol group than in the sufentanil–propofol group required antihypertensive medication postoperatively to maintain mean arterial pressure within 20% of baseline (18/30 vs. 4/29; P = 0.0004). Intergroup analysis showed no differences in baseline SOMCT scores (28 ± 1 vs. 28 ± 1) whereas mean SOMCT scores at 15, 45 min and 3 h after extubation were significantly higher in the remifentanil–propofol group (30 patients) than in the sufentanil–propofol group (29 patients) (22 ± 3 vs. 16 ± 3; P < 0.0001 and 27 ± 1 vs. 22 ± 3; P < 0.0001; 28 ± 1 vs. 26 ± 2; P = 0.0126). Conclusions: In conclusion, propofol–remifentanil and propofol–sufentanil are both suitable for fast-track neuroanaesthesia and provide similar intraoperative haemodynamics, awakening and extubation times. Despite a higher risk of treatable postoperative hypertension propofol–remifentanil allows earlier cognitive recovery.

Keywords

NEUROANAESTHESIAPOSTOPERATIVE COGNITIVE RECOVERYTOTAL INTRAVENOUS ANAESTHESIAPROPOFOLREMIFENTANILSUFENTANIL
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 24 , Issue 2 , February 2007 , pp. 122 - 127
Copyright
2007 European Society of Anaesthesiology

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References

Bruder NJ. Awakening management after neurosurgery for intracranial tumors. Curr Opin Anesthesiol 2002; 15: 477–482.Google Scholar
Coles JP, Timothy SL, Monteiro JNet al. Propofol anesthesia for craniotomy: a double-blind comparison of remifentanil, alfentanil and fentanyl. J Neurosurg Anesthesiol 2000; 12: 15–20.Google Scholar
Balakrishnan G, Raudznes P, Samra SKet al. A comparison of remifentanil and fentanyl in patients undergoing surgery for intracranial mass lesion. Anesth Analg 2000; 91: 163–169.Google Scholar
Ergoren H, Luther G, Fenn-Buderer N. A comparison of fentanyl, sufentanyl and remifentanil for fast-track cardiac anesthesia. Anesth Analg 2001; 93(4): 859–864.Google Scholar
Gerlach K, Uhlig T, Huppe Met al. Remifentanil–propofol versus sufentanil–propofol anaesthesia for supratentorial craniotomy: a randomized trial. Eur J Anaesth 2003; 20: 813–820.Google Scholar
Davous P, Lamour Y, Debraud Eet al. A comparative evaluation of the short orientation memory concentration test of cognitive impairment. J Neurol Neurosurg Psych 1987; 50: 1312–1317.Google Scholar
Katzman R, Brown T, Fuld P, Peck A, Schechter R, Schimmel H. Validation of a short orientation-memory-concentration test of cognitive impairment. Am J Psychiat 1983; 140(6): 734–739.Google Scholar
Perry J, Garrett M, Gronley JK, Mulroy SJ. Classification of walking handicap in the stroke population. Stroke 1995; 26(6): 982–989.Google Scholar
Beauchamp K, Baker S, McDaniel Cet al. Reliability of nurses' neurological assessments in the cardiothoracic surgical intensive care unit. Am J Crit Care 2001; 10(5): 298–305.Google Scholar
Bilotta F, Pietropaoli P, La Rosa Iet al. Effects of shivering prevention on haemodynamic and metabolic demands in hypothermic postoperative neurosurgical patients. Anaesthesia 2001; 56(6): 514–519.Google Scholar
Aldrete JA. The post-anaesthesia recovery score revisited. J Clin Anesth 1995; 7: 89–91.Google Scholar
Muellejans B, Lopez A, Cross MHet al. Remifentanil versus fentanyl for analgesia based sedation to provide patient comfort in the intensive care unit: a randomized double blind controlled trial. Crit Care 2004; 8: 13–14.Google Scholar
Gelb AW, Salevsky F, Chung Fet al. Remifentanil with morphine transitional analgesia shortens neurological recovery compared to fentanyl for supratentorial craniotomy. Can J Anesth 2003; 50(9): 946–952.Google Scholar
Hood DD, Curry R, Eisenach JC. Intravenous remifentanil produces withdrawal hyperalgesia in volunteers with capsaicin-induced hyperalgesia. Anesth Analg 2003; 97(3): 810–815.Google Scholar
Delvaux B, Ryckwaert Y, Van Boven Met al. Remifentanil in the intensive care unit: tolerance and acute withdrawal syndrome after prolonged sedation. Anesthesiology 2005; 102(6): 1281–1282.Google Scholar