Abstract

LLACER, M. et al. Remifentanyl in neurosurgery: Impact on early extubation and implications for the early postoperative period. Rev. Soc. Esp. Dolor [online]. 2005, vol.12, n.3, pp.141-145. ISSN 1134-8046.

Objectives: To determine whether the use of a new opioid such as remifentanyl modifies the standard care provided to patients undergoing elective neurosurgery in our hospital. To assess the time of extubation and the length of stay in the Intensive Care Unit (ICU). Material and method: Retrospective study of a cohort of neurosurgical patients free from complications undergoing elective supratentorial tumor surgery through craniotomy. All consecutive patients between November 2003 and February 2004 were included in the study. Data were obtained from pre-anesthesia, anesthesia and intensive care medical records. Age, sex, ASA risk, anesthetic technique, length of the surgical procedure, intraoperative opiate use, time and place of extubation, as well as length of stay in the ICU, were recorded. In order to study the impact of intraoperative opiate use on the time of extubation and the postoperative stay, patients were divided in two groups: remifentanyl and fentanyl. The descriptive analysis of quantitative endpoints is shown with mean values, standard deviations and quartiles, and is graphically shown using box charts; for qualitative endpoints, contingency tables were used. Intergroup comparisons were performed using the chi-square test for qualitative endpoints and the Student´s t or Mann Whitney test for quantitative endpoints. Results: Thirty two elective craniotomies were performed for resection of supratentorial tumors in patients free from complications, and data were obtained from 31 patients. The statistical analysis did not show differences regarding sex, age or ASA classification between patients receiving remifentanyl (18) and patients receiving fentanyl (13) intraoperatively. When remifentanyl was used in 67% of patients, total intravenous anesthesia (TIVA) was provided for anesthetic maintenance, while sevoflurane was used in 77% of patients with fentanyl. Length of surgical-anesthetic procedure was greater in the fentanyl group, with a mean difference of almost one hour. Extubation was performed in the operating room in 67% of patients in the remifentanyl group and in the ICU in 100% of patients in the fentanyl group; however, this did not result in an earlier discharge from the Intensive Care Unit. Conclusion: Data suggest that remifentanyl facilitates the extubation. New pharmacological options allow variations of the clinical practice that can benefit our patients. However, these changes do not lead to a shorter stay in the ICU, since that does not only depends on clinical factors, but also on organizational factors.

Keywords : Remifentanyl; Neurosurgery; Extubation; Postoperative.

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