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BJA Advance Access published online on March 27, 2006
British Journal of Anaesthesia, doi:10.1093/bja/ael075
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© The Board of Management and Trustees of the British Journal of Anaesthesia 2006. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org
Accepted February 10, 2006

Clinical Investigation

Propofol-alfentanil vs propofol-remifentanil for posterior spinal fusion including wake-up test

F. Imani 1 *, A. Jafarian 2, V. Hassani 1, and Z. H. Khan 3

1 Department of Anaesthesiology, Rasool-Akram Hospital, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
2 Department of Anaesthesiology, Shafa-Yahyaeian Hospital, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
3 Department of Anaesthesiology, Imam Khomeini Medical Center, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran

* To whom correspondence should be addressed.
F. Imani, E-mail: farimani{at}iums.ac.ir


  Abstract

Background. Wake-up test can be used during posterior spinal fusion (PSF) to ensure that spinal function remains intact. This study aims at assessing the characteristics of the wake-up test during propofol-alfentanil (PA) vs propofol-remifentanil (PR) infusions for PSF surgery.

Methods. Sixty patients with scoliosis and candidates for PSF surgery were randomly allocated in either alfentanil (PA) or remifentanil (PR) group. After an i.v. bolus of alfentanil 30 µg kg-1 in the PA group or remifentanil 1 µg kg-1 in the PR group, anaesthesia was induced with thiopental and atracurium. During maintenance, opioid infusion consisted of alfentanil 1 µg kg-1 min-1 or remifentanil 0.2 µg kg-1 min-1, in the PA group and the PR group, respectively. All patients received propofol 50 µg kg-1 min-1. Atracurium was given to maintain the required surgical relaxation. At the surgeon's request, all infusions were discontinued. Patients were asked to move their hands and feet. Time from anaesthetic discontinuation to spontaneous ventilation (T1), and from then until movement of the hands and feet (T2), and its quality were recorded.

Results. The average T1 and T2 were significantly shorter in the PR group [3.6 (2.5) and 4.1 (2) min] than the PA group [6.1 (4) and 7.5 (4.5) min]. Quality of wake-up test, however, did not show significant difference between the two groups studied.

Conclusion. Wake-up test can be conducted faster with remifentanil compared with alfentanil infusion during PSF surgery.

Keywords: anaesthetics i.v., propofol; analgesics opioid, alfentanil; analgesics opioid, remifentanil; measurement techniques, wake-up test.
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