Remifentanil-propofol versus sufentanil-propofol anaesthesia for supratentorial craniotomy:: a randomized trial

Background and objective: Remifentanil has unique pharmacokinetics that might allow faster recovery after neurosurgery. We investigated the effects of a propofol/sufentanit versus a remifentanil/propofol regimen on the primary end-point tracheal extubation time. Methods: In the Neurosurgery Department of a University Hospital, 36 patients awaiting craniotomy for supratentorial turnout resection were randomly assigned to one of two study groups. In the sufentanil/propofol group, anaesthesia was induced with 0.5 mug kg(-1) sufentanil and 1-2 mg kg(-1) propofol. Propofol infusion and boluses of sufentanil were administered for maintenance. In the remifentanil/propofol group, anaesthesia was started with an infusion of remifentanil (0.2-0.35 mug kg(-1) min(-1)) and a bolus of propofol (1.5-2 mg kg(-1)). Patients received a propofol infusion and a remifentanil infusion for maintenance of anaesthesia. Recovery times were taken from cessation of the propofol infusion. In addition, data about self-reported nausea and vomiting, pain and analgesic requirements were collected. Results: Patients in the remifentanil/propofol group were extubated earlier (mean times 6.4 (+/-SD 4.7) versus 14.3 (+/-9.2) min; P = 0.003). The two groups were similar with respect to postoperative nausea and vomiting, and patient-reported pain scores. Fifty per cent of the remifentanil/propofol patients and 8896 of the sufentanil/propofol patients required no analgesics within 1 h after operation (P =0.03). Conclusions: The remifentanil/propofol regimen provided quicker recovery. The two regimens were similar in terms of postoperative nausea and vomiting and patient-reported pain scores, but patients in the remifentanil/ propofol group required more analgesics within 1 h postoperatively.