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PubMed1993

Relationship between oxygen consumption and oxygen delivery during anesthesia in high-risk surgical patients.

OBJECTIVE: To identify critical oxygen delivery (DO2) and oxygen extraction ratio in high-risk surgical patients studied preoperatively and intraoperatively. DESIGN: Prospective study. Consecutive series of intraoperatively monitored patients. SETTING: The surgical ICU in a tertiary care center. PATIENTS: High-risk surgical patients undergoing major noncardiac surgery. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Twenty high-risk patients were studied during the preoperative and intraoperative periods. All patients were monitored with triple-lumen thermodilution catheters. Hemodynamic profiles consisted of determinations of intravascular pressures, cardiac output, and arterial and venous pulmonary gases. Oxygen transport variables were calculated by standard formulas. Multiple determinations were carried out during the perioperative period in each patient. The critical levels of DO2, determined by a polynomial regression method, were 375 and 390 mL/min/m2 in the preoperative and intraoperative periods, respectively. Oxygen extraction reached at the critical level of DO2 was significantly (p < .01) lower during the intraoperative period (31 +/- 4.5% vs. 18 +/- 2.3%). Critical mixed venous oxygen tension was significantly (p < .01) higher in the intraoperative period (36 +/- 5 vs. 46 +/- 4 torr [4.8 +/- 0.7 vs. 6.1 +/- 0.5 kPa]). CONCLUSIONS: Our data show that the intraoperative period might be associated with a reduction in tissue ability to extract oxygen. If this reduction in oxygen extraction is proportionately higher than the reduction in metabolic oxygen demand produced by anesthetic agents and hypothermia, then the critical value for DO2 may be similar to, or higher than, that value in the preoperative period. Thus, the intraoperative period represents, for this patient population, a high-risk condition for the development of a tissue oxygenation debt in the presence of a limitation in DO2. Cautious dosing of inhaled agents, maintenance of normothermia, and early optimization of the oxygen delivery/oxygen consumption relationship seem to constitute reasonable measures in the intraoperative handling of these patients in order to reduce perioperative morbidity and mortality.

Adult↗
PubMed1994

Cardiac sympathovagal balance and peripheral sympathetic vasoconstriction: epidural versus general anesthesia.

Both epidural and general anesthetics alter autonomic balance. However, the relative differences between epidural (EA) and general anesthetics (GA) with regard to cardiac and peripheral sympathovagal balance have not been described. Twenty consecutive patients scheduled for radical retropubic prostatectomy were randomized to receive EA (n = 10) or GA (n = 10). Power spectral analysis was performed on the electrocardiographic recordings, with the ratio of low (0.05-0.125 Hz)/high (0.125-0.5 Hz) frequency power used an index of cardiac sympathovagal balance. The forearm minus fingertip skin-surface temperature gradient (> 4 degrees C) was used as an indicator of sympathetically mediated peripheral vasoconstriction. Patients in the EA group demonstrated a significantly greater low/high frequency power ratio and a more frequent incidence of peripheral vasoconstriction than the GA group during the intraoperative period. During the postoperative period, the GA group demonstrated an increase in the low/high ratio and the incidence of vasoconstriction relative to the intraoperative period. Intraoperatively, upper body vasoconstriction appears to be accompanied by a significant shift in cardiac sympathovagal balance toward sympathetic predominance with EA relative to GA. Postoperatively, GA is associated with a shift in the sympathovagal balance toward sympathetic predominance. Further research is required to determine whether this results in cardiovascular compromise in the high-risk patient.

Anesthesia, Epidural↗
PubMed1999

Locoregional versus general anesthesia in carotid surgery: is there an impact on perioperative myocardial ischemia? Results of a prospective monocentric randomized trial.

PURPOSE: The incidence of cardiac morbidity and mortality in patients who undergo carotid surgery ranges from 0.7% to 7.1%, but it still represents almost 50% of all perioperative complications. Because no data are available in literature about the impact of the anesthetic technique on such complications, a prospective randomized monocentric study was undertaken to evaluate the role of local anesthesia (LA) and general anesthesia (GA) on cardiac outcome. METHODS: From November 1995 to February 1998, 107 patients were classified by the cardiologist as cardiac patients (IHD; history of myocardial infarction, previous myocardial revascularization procedures, or myocardial ischemia documented by means of positive electrocardiogram [ECG] stress test results) or noncardiac patients (NIHD; no history of chest pain or negative results for an ECG stress test). The patients were operated on after the randomization for the type of anesthesia (general or local). Continuous computerized 12-lead ECG was performed during the operative procedure and 24 hours postoperatively. The end points of the study were ECG modifications (upsloping or downsloping more than 2 mm) of the sinus tachycardia (ST) segment. RESULTS: Fifty-five patients were classified as IHD, and 52 were classified as NIHD. Twenty-seven of the 55 IHD patients (49%) and 24 of 52 NIHD patients (46%) were operated on under GA. Thirty-six episodes of myocardial ischemia occurred in 22 patients (20.5%). Episodes were slightly more frequent (58%) and longer in the postoperative period (intraoperative, 10 +/- 5 min; postoperative, 60 +/- 45 min; P <. 001). As expected, the prevalence of myocardial ischemia was higher in the group of cardiac patients than in noncardiac group (15 of 55 patients [27%] vs 7 of 52 patients [13%]; P <.02). By comparing the two anesthetic techniques in the overall population, we found a similar prevalence of patients who had myocardial ischemia (GA, 12 of 52 [23%]; LA, 10 of 55 [18%]; P = not significant) and a similar number of ischemic episodes per patient (GA, 1.5 +/- 0.4; LA, 1.8 +/- 0.6; P = not significant). Episodes of myocardial ischemia were similarly distributed in intraoperative and postoperative periods in both groups. It is relevant that under GA, IHD patients represent most of the population who suffered myocardial ischemia (83%). On the contrary, in the group of patients operated on under LA, the prevalence was equally distributed in the two subpopulations. CONCLUSION: The results confirm the different hemodynamic impact of the two anesthetic techniques. Patients who received LA had a rate of myocardial ischemia that was half that of patients who had GA. The small number of cardiac complications do not permit us to make any definitive conclusion on the impact of the two anesthetic techniques on early cardiac morbidity, but the relationship between perioperative ischemic burden and major cardiac events suggests that LA can be used safely, even in high-risk patients undergoing carotid endarterectomy.

Aged↗
PubMed2005

Intraoperative and recovery room outcome.

OBJECTIVES: To identify and quantitate anaesthesia related complications in the intraoperative period and in the post anaesthesia recovery room. DESIGN: A prospective study. SETTING: University of Benin Teaching Hospital; a University-affiliated tertiary centre. SUBJECTS: Patients scheduled for elective and emergency surgery under anaesthesia. Obstetric patients were excluded. RESULTS: Out of the 700 patients studied, intraoperative and postoperative complications were recorded in 221 (31.6%) patients. Data showed a higher incidence of postoperative complications. P = 0.0001, X2 = 19.343, Odds Ratio (OR) = 0.5116, 95% CI: 0.3800-0.6886. The differences were statistically significant. The incidence of cardiovascular, central nervous system and respiratory complications were also higher in the postoperative period than intraoperative period. There were two cases of cardiac arrest both in the intraoperative period and in the recovery room. A higher incidence of both intraoperative and recovery room complications was observed in females than in males. P = <0.0001; X2 = 16.951 (with Yate's correction); OR = 2.066; 95% CI: 1.468-2.908. The difference was considered extremely significant. There was one case of mortality intraoperatively and one postoperatively. P = 1.000; OR = 1.772; 95% CI: 0.1093-28.743. CONCLUSION: Our study showed a high incidence of complications both in the intraoperative period and in the recovery room. Complication rate was higher in females than males. The incidence of complications was also higher in the elderly patients.

Adolescent↗
PubMedDate not supplied

A "twilight period" of coronary perfusion: the risk of intraoperative infarction in surgery for main left coronary obstruction.

UNLABELLED: This study investigates the significance of an intraoperative period of low coronary perfusion pressure which may lead to ischemia, infarction, or both, in patients undergoing coronary bypass surgery for tight left main obstruction. "Twilight Period" (TP) was defined as the time interval from initiation of cardiopulmonary bypass to implementation of cold cardioplegia. Fifty-four patients with main left coronary obstruction (greater than 50%) were divided in three groups: Group I (20), TP less than 5 minutes; Group II (15), TP = 5-15 minutes; and Group III (19), TP greater than 15 minutes. Monitoring parameters included: systemic perfusion pressure during TP, perfusion flows, length of TP, time of ischemia, myocardial temperatures during ischemia, postoperative CK-MB level, EKG-detectable infarction, and postoperative therapeutic support requirements. RESULTS: Intraoperative myocardial infarction by EKG was 0% in Group I, 7% in Group II, and 26.3% in Group III; mortality was 0%, 0%, and 15.7%, respectively. CK-MB values were 18 +/- 3.2 IU, Group I; 18.3 +/- 2.5 IU, Group II; and 49.4 +/- 10.3 IU, Group III. Group I vs. III: P 0.01. Levels of postoperative support: Level A, less than 12 hours; Level B, 12-36 hours; and Level C, greater than 36 hours. Intra-aortic balloon pump (IABP) was considered Level C. In Group I, 75% (15/20) fell in Level A; 15% (3/20) in Level B and 10% (2/20) in Level C. In Group II, 60% (9/15) fell in Level A; 26.7% (4/15) in Level B; and 13% (2/15) in Level C. In Group III, 36.8% (7/19) fell in Level A; 15.8% (3/19) in Level B; and 47.4% (9/19) in Level C.(ABSTRACT TRUNCATED AT 250 WORDS)

Coronary Artery Bypass↗
PubMedDate not supplied

[Propofol in coronary diseases. Haemodynamic evaluation of some anesthetic regimes].

The haemodynamic effect of two regimens of propofol-fentanyl anaesthesia versus a standard isoflurane-fentanyl anaesthesia were compared perioperatively in 30 patients with good left ventricular function undergoing coronary artery bypass grafting. Anaesthesia was induced in all patients with fentanyl 14 micrograms/kg, pancuronium 0.1 mg/kg, and thiopental 1 mg/kg. Anaesthesia was maintained: in 10 patients with a constant propofol infusion of 200 micrograms/kg/min during the pre-bypass period and fentanyl boluses of 1 mg when required (PH Group); in 10 patients with a variable propofol infusion (from 43.09 to 22.42 micrograms/kg/min) during the pre-bypass period and a fixed infusion of 10.47 micrograms/kg/min during the post-bypass period (PL group) in 10 patients with a 1% isoflurane administration throughout the intraoperative period (F Group). The analgesia in the PL and F Groups was obtained with a fentanyl infusion of 0.3 microgram/kg/min during the prebypass period, 0.11 microgram/kg/min during the postbypass period. PL Group patients received 0.06 microgram/kg/min of fentanyl during the first three hours of the intensive care unit (TI) stay. The PL Group showed a significant better haemodynamic control of oxygen consumption indexes; PH Group patients had a major myocardial depression, routinely requiring the use of cardiokinetic agents in the post-bypass period. Intraoperative opioid consumption was similar in all Groups whereas the F Group showed a significantly higher fentanyl requirement during the TI period.

Anesthetics, General↗
PubMed2003

Perioperative perfusion strategies for optimal fluid management in liver transplant recipients with renal insufficiency.

Renal Insufficiency (RI) is a common finding in patients suffering from end-stage liver disease. The causes of RI are reported to be multifactorial and the degree of RI can range from early functional impairment to hepatorenal syndrome (HRS). The process of liver transplantation is highly likely to exacerbate the symptoms and sequelae of renal dysfunction. RI continues to be a cause of morbidity and mortality in the intraoperative and postoperative periods. With careful evaluation and monitoring in addition to appropriate intervention, a uniformly good outcome may be possible even for these most complicated patients. This paper will describe successful perfusion interventions carried out during the three phases of liver transplantation: pre-anhepatic, anhepatic and reperfusion at our institution for a three-year period. Intraoperative plasmapheresis (n = 3), continuous veno-venous hemofiltration (CVVH) (n = 7), intraoperative dialysis (n = 8), and intraoperative dialysis with fluid removal (n = 3) techniques will be presented for review.

Adult↗
PubMed2005

Patient selection in ambulatory surgery.

PURPOSE OF REVIEW: To evaluate the evidence regarding decisions made in the perioperative management of patients undergoing ambulatory surgery for the following: the elderly, hyper-reactive airways disease, coronary artery disease, diabetes, obesity, obstructive sleep apnea, the ex-premature infant and the child with an upper respiratory infection. RECENT FINDINGS: Major morbidity and mortality following ambulatory surgery is exceedingly low. Minor adverse cardiac events during the intraoperative period are associated with hypertension and the elderly. Minor adverse respiratory events during the intraoperative period are associated with obesity. Respiratory events during the postoperative period are associated with obesity, smoking and asthma. Prolonged stays following ambulatory surgery are predominantly caused by surgical factors or minor symptoms such as pain or nausea. Surgical factors are also the main causes of unplanned admissions. Age greater than 85, significant co-morbidity and multiple admissions to hospital in the 6 months preceding ambulatory surgery, however, are associated with higher readmission rates. SUMMARY: Evidence indicates that ambulatory anesthesia is currently very safe. Ambulatory surgery, however, is being offered to a population with increasing co-morbidity. As the population undergoing ambulatory surgery changes over time, the evidence regarding patient outcomes will need re-examination.

Journal Article↗
PubMed1995

One month follow-up of haemostatic variables in patients undergoing aortocoronary bypass surgery. Effect of aprotinin.

It is already known that activation of the coagulation and fibrinolytic system occurs in patients undergoing cardiopulmonary bypass (CPB). We have thus studied twenty patients (10 treated with aprotinin during CPB and 10 untreated) both during the intraoperative period and during thirty days follow up. In untreated patients D-dimer levels increased 4-fold during CPB and the levels were above baseline for the whole follow up (p < 0.0001). D-dimer levels were reduced in aprotinin treated patients in comparison to untreated patients (p = 0.0172); levels then gradually increased to the values of the untreated patients over the following 24 h later and remained higher during the thirty day follow up. The behavior of haemostatic variables in the 24 h after CPB did not vary between untreated and aprotinin treated patients. In particular, five minutes after protamine sulphate administration, levels of F1 + 2 and TAT rose significantly (p = 0.0054, p = 0.0022 respectively), whereas fibrinogen significantly decreased (p < 0.0001) and PAI-1 antigen levels were reduced. Two days after CPB the concentrations of F1 + 2 and TAT lowered, whereas fibrinogen and PAI-1 antigen levels increased. On the 5th, 8th and 30th days after CPB, F1 + 2 and TAT levels remained higher than those reported at baseline in both groups of patients, whereas fibrinogen levels increased over basal levels in aprotinin treated patients only. Thus, in addition to the activation of the coagulation and fibrinolytic system occurring during the intraoperative period, in patients undergoing CPB, there are alterations of haemostatic variables up to thirty days from surgery.

Aged↗
PubMed2002

Conventional approach to glucose management for diabetic patients undergoing coronary artery bypass surgery.

Continuous insulin infusion was not an effective mode of treatment in maintaining safe blood glucose levels (<200 mg/dl) during the intraoperative period of diabetic patients requiring open-heart surgery. The two modifications investigated to gain better control of the blood glucose were a change in the base solution of the cardioplegia and the use of a sliding insulin scale. Fifty patients including Type I and Type II diabetics were selected for the purpose of this study. The patients were then randomly divided into two groups categorized by the type of cardioplegic solution administered and the mode of insulin treatment. Group I patients received a dextrose 5%-based cardioplegic solution and blood glucose was treated via continuous intravenous insulin infusion. Group II patients received normal saline 0.9%-based cardioplegic solution and blood glucose was treated via sliding scale. Blood glucose levels were monitored pre- and postcardiopulmonary bypass (CPB) and every 30 min while on CPB. Glucose values were analyzed by group t test. A p value of <0.05 was considered statistically significant. When comparing Group I (mean=258 mg/dl) with Group II (mean=158 mg/dl), there was a statistically significant difference between the glucose values at each of the time intervals when the glucose values were recorded. In conclusion, Group II maintained an acceptable blood glucose level (<200 mg/dl) throughout the entire intraoperative period, which suggests that the combination of the sliding insulin scale and modification of the base cardioplegic solution was an effective mode of treatment.

Aged↗
PubMed1975

A master nurse clinician for intraoperative care.

The intraoperative period has long been the missing link in the chain of continuity of care for the surgical patient. An intraoperative clinical nurse specialist who is able to work with patients, families, and health care team members preoperatively, intraoperatively, and postoperatively can effectively bridge the gap in care. Nursing care given to patients in the O.R. should be no different qualitatively from nursing care given sedated and/or unconscious patients in other nursing units. The C.N.S. in the O.R. can help make such care a reality through giving care to patients and families as a role model, directing care as an expert through written care plans or physical presence, doing formal and informal teaching of patients, families, and staff, and through research. Operationalizing the role of the C.N.S. for surgical patients during the intraoperative period requires the specialist to move out of the O.R. to assess patients and families preoperatively and to evaluate the postoperative results of care. Implementation of the specialist role in the O.R. clinical nursing setting is accompanied by the same frustrations and problems met by master clinicians in other nursing specialty areas.

Family↗
PubMed1998

Changing transfusion practices in hip and knee arthroplasty.

BACKGROUND: This study was designed to examine changes in perioperative transfusion practices after the introduction of autologous blood conservation strategies into routine clinical practice. STUDY DESIGN AND METHODS: The existing medical records of all patients undergoing total hip or knee arthroplasty at Mayo Clinic in Rochester, MN, who resided in Olmsted County, were reviewed over three periods: 1981-82 (232 procedures), 1987-88 (269 procedures), and 1993-94 (398 procedures). RESULTS: The proportion of patients receiving any perioperative red cell (RBC) units significantly decreased (from 85% in 1981-82 to 65% in 1993-94). The timing of transfusion also changed; the proportion of RBC units transfused in the preoperative or intraoperative periods decreased from 68 percent in 1981-82 to 38 percent in 1993-94, with the balance of RBC units transfused in the postoperative period. Although the number of RBC units utilized per procedure in the intraoperative period significantly decreased, the number of RBC units transfused in the postoperative period significantly increased (from 0.6 +/- 1.0 to 1.1 +/- 1.4 units per procedure in 1981-82 and 1993-94, respectively, p < 0.05). CONCLUSION: Although blood conservation strategies have been successful in reducing RBC transfusion intraoperatively, avoidance of intraoperative transfusion may in some cases postpone, rather than prevent, transfusion.

Aged↗
PubMed1994

Haemostatic derangement in patients with intracranial tumours.

Forty-five patients with brain tumours were studied for evidence of any haemostatic abnormalities in the preoperative and intraoperative period. An abnormality was found in 44 of the patients in the preoperative period and in all the patients during the operation. One patient developed acute disseminated intravascular coagulation. A change in the haemostatic abnormality from the preoperative to the intraoperative period was demonstrated in 9 of the patients. The histological nature of the tumour did not influence the haemostatic derangement. A shortened euglobulin lysis time, prolonged thrombin time, increased fibrin degradation products and abnormal fibrinogen levels were the common isolated abnormalities. When considered together, chronic disseminated intravascular coagulation (DIC) with or without fibrinolysis and fibrinolysis with or without DIC were the commonest abnormalities. Although some degree of haemostatic derangement is found in a high proportion of patients with brain tumours, clinically relevant abnormalities are rare.

Adolescent↗
PubMedDate not supplied

[The choice of a method of general anesthesia for patients with cancer of the abdominal cavity].

Two variants of anesthesiological management have been used in 135 patients with gastrointestinal tumors. The first variant was intubation anesthesia with N2O+O2, ketamine or sodium hydroxybutyrate combined with classical neuroleptanalgesia technique. Pentamine was used to potentiate protection. This anesthesia technique was used in patients under 50 who had no concomitant diseases. The second variant was used in patients over 50 with concomitant diseases. In these cases combined prolonged epidural anesthesia was accompanied in the intraoperative period with intubation anesthesia with controlled lung ventilation using N2O+O2 and additional administration of promedol and droperidol. The second variant of anesthesia not only ensured a safe intraoperative period but also optimized the management of patients in the postoperative period.

Abdominal Neoplasms↗
PubMed2003

Risk factors for development of acute renal failure after liver transplantation.

BACKGROUND: Acute renal failure (ARF) is a common complication after liver transplantation (LTx). Identification of risk factors may prevent the development and attenuate the impact of ARF on patients outcome after LTX. METHODS: Retrospective analysis of variables in the pre, intra, and postoperative periods of 92 patients submitted to LTx was performed in order to identify risk factors for development of ARF after LTx. ARF was defined as serum creatinine > or = 2.0 mg/dL in the first 30 days after LTx. Univariate and multivariate analysis by logistic regression were performed. RESULTS: ARF group comprised 56 patients (61%). Preoperative serum creatinine was higher in ARF group. During the intraoperative period, ARF group required more blood transfusions, developed more episodes of hypotension and presented longer anesthesia time. In the postoperative period, ARF group presented higher serum bilirubin and more episodes of hypotension. Dialysis was required in 10 patients (11%). The identifled risk factors for development of ARF were: preoperative serum creatinine > 1.0 mg/dL. more than five blood transfusions in the intraoperative period, hypotension during intra and postoperative periods. The identified mortality risk factors were hypotension in the postoperative period and no recovery of renal function after 30 days. CONCLUSIONS: Several factors are involved in the pathogenesis of ARF after LTx and may influence patients outcome and mortality. Pretransplant renal function and hemodynamic conditions in the operative and postoperative periods were identified as risk factors for development of ARF after LTx. Nonrenal function recovery and postoperative hypotension were identified as mortality risk factors after LTx.

Acute Kidney Injury↗
PubMed1991

[Beta-endorphin and substance P in the perioperative period].

The modifying impact of anaesthesia on the stress reaction related to surgical trauma was investigated on the basis of the neuropeptidergic parameters of 66 patients who had to undergo a gynaecological radical operation. Anaesthesia was either performed as neuroleptanaesthesia or as epidural analgesia by using bupivacaine in combination with general anaesthesia. The plasma concentrations of substance P and beta-endorphin were taken as neuropeptidergic parameters. Both regulatory peptides show numerous corresponding synergisms. An acceleration of these neuropeptide systems is assumed to be present in severe disturbance of homeostasis. Plasma concentrations of substance P and beta-endorphin were examined at 11 measuring points in the perioperative and intraoperative periods. The plasma concentration of substance P significantly declines in the preoperative period while the concentration of beta-endorphin in the plasma remains at a relatively constant level. In the dynamics of beta-endorphin in the plasma significant differences between the two anaesthetic techniques become apparent in the intraoperative period. Those patients given epidural analgesia have a significantly higher maximum concentration at a later date. This difference is attributed to the possible loss of the adrenal medullary function due to partial sympathetic blocking. Single observations in patients pregnant in the last trimester testify to an extraordinary adaptability at the end of pregnancy.

Adult↗
PubMed1982

[Variations in vasopressin (ADH)-levels during NLA combined with epidural fentanyl-analgesia (author's transl)].

10 patients scheduled for thoracic, abdominal or vascular surgery received anaesthesia as a combination of neuroleptanalgesia plus epidural opiate-analgesia. Antidiuretic hormone levels (ADH), serum-electrolytes (Na+, K+) and plasma osmolality have been investigated preoperatively (twice), intraoperatively (six times), during the first postoperative day (three times) and for five days postoperatively (once a day). There was a significant increase in ADH in all patients intra- and postoperatively, whereas serum-electrolytes and plasma-osmolality stayed within normal range. Maximum ADH-values were measured during the intraoperative period, postoperatively ADH-levels reached the normal range after 5 days. This increase in plasma-ADH-levels was not accompanied by typical haemodynamic changes. From the aspect of metabolic endocrine response to surgery, our results indicate no advantage of the combination of neurolept-analgesia plus epidural opiate-analgesia for the intraoperative period.

Aged↗
PubMed2000

A comparison of remifentanil and sufentanil as adjuvants during sevoflurane anesthesia with epidural analgesia for upper abdominal surgery: effects on postoperative recovery and respiratory function.

UNLABELLED: We compared the recovery profile and postoperative SpO(2) after the administration of general anesthesia with either sevoflurane-remifentanil or sevoflurane-sufentanil in 30 healthy patients undergoing upper abdominal surgery. They were randomly allocated to receive general anesthesia with sevoflurane and small doses of either remifentanil (n = 15) or sufentanil (n = 15), followed by postoperative epidural analgesia. The median sevoflurane minimum alveolar anesthetic concentration-hour was 2.3 (1.2-6.3) in group Remifentanil and 2.6 (1.4-5.2) in group Sufentanil (P: = 0.39), while the median consumption of remifentanil was 1.3 mg (0.7-3.4 mg) and sufentanil 0.09 mg (0.05-0.6 mg). Tracheal extubation required 10 min (6-18 min) with remifentanil and 14 min (8-24 min) with sufentanil (P: = 0.05); however, no differences in time to discharge from the recovery area were reported (24 min [12-75 min] with remifentanil and 30 min [12-135 min] with sufentanil; P: = 0. 35). From the first to seventh hour after surgery, SpO(2) was decreased more in the sufentanil than in the remifentanil group (P: = 0.001), and seven patients in the sufentanil group showed at least one episode with SpO(2) < or = 90% for more than 1 min (P: = 0.006) (median: 1 episode; range: 0-17 episodes; P: = 0.003). When added to sevoflurane, remifentanil is as effective as sufentanil during the intraoperative period, but provides shorter time to tracheal extubation and fewer effects on postoperative SpO(2) in the first 7 h after surgery. IMPLICATIONS: In this double-blinded study, we evaluated the effects of adding small infusions of either remifentanil or sufentanil to sevoflurane in combination with postoperative epidural analgesia for upper abdominal surgery. We demonstrated that remifentanil is as effective as sufentanil during the intraoperative period, but that it provides shorter time to extubation and fewer effects on postoperative SpO(2) in the first 7 h after surgery.

Abdomen↗