A Multicenter Randomized Double-Blind Comparison of Remifentanil and Alfentanil During Total Intravenous Anaesthesia for Out-Patient Laparoscopic Gynaecologi- cal Procedures
THITIMA CIDNACHOTI, M.D.*, SIRILAK SUKSOMPONG, M.D.*, WASANA KITSAMPANWONG, M.D.*, NUTCHIRA SRIVAJANA, M.D.**, PHETCHAREE CHAINCHOP, B.Sc. (Nursing and Midwife)*, RATTANA CHANSERMKIT, M.D.**, PREMJIT RENGKOSUM, B.N.***, PHENPUCK SUW ATCHARAPHAN, B.N. **** THEWARUG WERAWATGANON,M.D.**, ANCHALEE TECHANIVATE,M.D.**, RASSANEE TANSUI, M.D.*, AURASA SILAPADECH, B.N.*, PENSRI NOOCHAROEN, B.N.*, NATTAYA CHATKITCHAROEN,M.D.**, ANONG CHAIY AKUL, Diploma in Nursing****,
Affiliation : *Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, **Department of Anesthesiology, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, ***Unit ofObstetic Nurse, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, **** Department of Nursing, Chulalongkorn Hospital, Bangkok 10330, Thailand.
We compared Remifentanil, an esterase-metabolized opioid, with Alfentanil as part of the total intravenous anesthesia with propofol and atracurium for out-patient laparoscopic gynaeco- logical procedures in a multicenter randomized, double-blind study. We chose Remifentanil I mg./kg.for bolus injection and a continuous infusion of 0.25-0.5 jlg./kg./min, compared to Alfen- tanil 20 11g./kg. For bolus injection and a continuous infusion of 0.5-1 jlg./kg./min. Fifty-nine patients received Remifentanil, and sixty-three received Alfentanil. Patients who received Remi- fetanil experienced significantly fewer stress responses to surgical stimuli (p < 0.05) and required fewer additional boluses of study drugs and propofol (p < 0.05) than Alfentanil during the intra- operative period. Response time to verbal commands, spontaneous respiration, adequate respira- tion and tracheal extubation, were not significantly different between these two opioids. Remifen- tanil patients, required more fentanyl for post operative pain control, 40 from 59 cases in the Remifen- tanil group and 22 from 63 cases in the· Alfentanil group (p < 0.05) but still showed significantly better recovery of psychomotor function by Aldrete score of ten at 50 and 60 min (p < 0.05) than Alfentanil patients. The incidence of intraoperative bradycardia was significantly higher with Remifentanil. Other incidences of nausea, emesis, urinary retention and postural hypotension were similar. All patients were ready to be discharged from the hospital within two hours after extuba- tion except for one patient in the Alfentanil group who needed five hours of hospital stay because of urinary retention, nausea and severe emesis.
Keywords : Remifentanil, Total Intravenous Anaesthesia, Out-Patient
