[Remifentanil-propofol anesthesia in vertebral disc operations: a comparison with desflurane-N2O inhalation anesthesia. Effect on hemodynamics and recovery].

OBJECTIVE: To ascertain whether there is a difference between total intravenous anaesthesia with propofol (P) and remifentanil (R) and inhalational anaesthesia with desflurane (D) and nitrous oxide (N) with regard to haemodynamic reactions, recovery profile and postoperative analgesic demand in patients scheduled for elective microsurgical vertebral disc resection.

METHODS: 50 patients (ASA I-II, 18-65 years) were randomly assigned to receive total intravenous anaesthesia with propofol and remifentanil or inhalational anaesthesia with desflurane and nitrous oxide. After standardised induction of anaesthesia in both groups (1 microgram.kg-1 remifentanil, 1.5 mg.kg-1 propofol 0.1 mg.kg-1 cisatracurium), anaesthesia was maintained in the D/N group with desflurane in 50% N2O. The patients of the P/R group received a constant infusion of 2 mg.kg-1.h-1 propofol and a constant infusion of 0.5 microgram.kg-1.min-1 remifentanil, which was reduced after 15 min by 50%. The administration of desflurane and the infusion of the anaesthetics were adjusted to maintain a surgical depth of anaesthesia. At the end of surgery the anaesthetics were discontinued and early emergence from anaesthesia was assessed by measuring time to spontaneous ventilation (VT > 4 ml/kg), tracheal extubation, opening of the eyes and stating correct name and data of birth. The frequency of analgesics and total demand for analgesics were determined using patient-controlled analgesia and recorded for 2 h postoperatively. In addition the pain level of the patients was measured on a visual analogue scale and the incidence of postoperative shivering, nausea and vomiting was noted.

RESULTS: Patients anaesthetised with desflurane responded to tracheal intubation and skin incision with increasing blood pressure and showed higher heart rates than patients anaesthetised with propofol and remifentanil, but there were no other haemodynamic differences between the groups in response to surgical stimuli. There were significantly shorter times to spontaneous ventilation (3.2 vs. 6.3 min), extubation (3.8 vs. 9.5 min), eye opening (3.0 vs. 11.5 min) and giving name and date of birth (4.8 vs. 14.3 min) in patients anaesthetised with remifentanil and propofol than in those receiving desflurane and nitrous oxide. In addition, patients anaesthetised with remifentanil and propofol had a greater incidence of postoperative shivering. There were no significant differences between the two groups in the patients' pain scores, analgesic demand and incidence of nausea and vomiting.

CONCLUSION: Patients anaesthetised with propofol and remifentanil have significantly shorter emergence times than patients anaesthetised with desflurane and nitrous oxide. The low incidence of postoperative pain after microsurgical vertebral disc resections requires no large-scale analgesic therapy, even after total intravenous anaesthesia including remifentanil.