Advances in Therapy

, Volume 24, Issue 3, pp 622–631 | Cite as

Remifentanil-propofol in vertebral disk operations: Hemodynamics and recovery versus desflurane-N2O inhalation anesthesia

  • Muhammet Gozdemir
  • Huseyin Sert
  • Nisa Yilmaz
  • Orhan Kanbak
  • Burhanettin Usta
  • Ruveyda Irem Demircioglu


The purpose of this study was to ascertain whether total intravenous anesthesia (TIVA) with propofol and remifentanil differs from inhalational anesthesia with desflurane and nitrous oxide in terms of hemodynamics, recovery profile, and postoperative analgesic demand in patients undergoing elective microsurgical vertebral disk resection. A total of 60 patients were randomly assigned to receive TIVA with propofol and remifentanil or inhalational anesthesia with desflurane and nitrous oxide. The TIVA group (n=30) then received 50%/50% N2O/O2. A constant infusion of remifentanil was provided at 0.125 μg/kg/min accompanied by propofol at 10 mg/kg/h in the first 10 min, 6 mg/kg/h in the second 10 min, then 4 mg/kg/h. The desflurane group (n=30) received 50%/ 50% N2O/O2, with 5% desflurane after intubation and 6% before incision; desflurane was administered in a minimum alveolar concentration 1 fashion during the operation. Hemodynamic, O2 saturation, and end-tidal CO2 data were recorded before induction, after intubation, after prone positioning, 5, 10, 15, 20, and 30 min into the operation, and at 15-min intervals thereafter until the end of the operation. Details on perioperative bradycardia, hypotension or hypertension, spontaneous breathing, extubation, eye opening, recovery time of ability to give name and date of birth, postoperative nausea and vomiting, shivering, agitation, and hypoxia were recorded. Patients anesthetized with desflurane responded to skin incision with increasing blood pressure and tachycardia; however, no other hemodynamic differences were noted between the 2 groups. In the TIVA group, recovery times were shorter for spontaneous ventilation (2.33–3.53 min), extubation (3.13–3.88 min), eye opening (4.06–6.23 min), and being able to give name and date of birth (5.4–7.9 min) compared with times in the desflurane group (P<.05). In theTIVA group, more postoperative shivering (16.7% of patients) and greater analgesic demand were seen than in the desflurane group. Although nausea and vomiting were more common in the desflurane group, no difference in bronchospasm was reported. In theTIVA group, a shorter recovery period and a greater demand for postoperative analgesia were seen. Because of the lack of residual analgesic effects, postoperative analgesic treatment should be initiated immediately in patients undergoing TIVA.


remifentanil propofol desflurane recovery hemodynamics 


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  1. 1.
    Pump B, Talleruphuus U, Christensen NJ, Warberg J, Norsk P. Effects of supine, prone, and lateral positions on cardiovascular and renal variables in humans.Am J Physiol Regul Integr Comp Physiol. 2002; 283: R174-R180.PubMedGoogle Scholar
  2. 2.
    Egan TD, Lemmens HJ, Fiset P, et al. The pharmacokinetics of the new short-acting opioid remifentanil (GI87084B) in healthy adult male volunteers.Anesthesiology. 1993; 79: 881–892.PubMedCrossRefGoogle Scholar
  3. 3.
    Cartwright DP, Kvalsvik O, Cassuto J, et al. A randomized, blind comparison of remifentanil and alfentanil during anesthesia for outpatient surgery.Anesth Analg. 1997; 85: 1014–1019.PubMedCrossRefGoogle Scholar
  4. 4.
    Hoke JF, Shlugman D, Dershwitz M, et al. Pharmacokinetics and pharmacodynamics of remifentanil in persons with renal failure compared with healthy volunteers.Anesthesiology. 1997; 87: 533–541.PubMedCrossRefGoogle Scholar
  5. 5.
    Dershwitz M, Randel GI, Rosow CE, et al. Initial clinical experience with remifentanil, a new opioid metabolized by esterases.Anesth Analg. 1995; 81: 619–623.PubMedCrossRefGoogle Scholar
  6. 6.
    Glass PS, Hardman D, Kamiyama Y, et al. Preliminary pharmacokinetics and pharmacodynamics of an ultra-short-acting opioid: remifentanil (GI87084B).Anesth Analg. 1993; 77: 1031–1040.PubMedCrossRefGoogle Scholar
  7. 7.
    Özköse Z, Ercan B, Unal Y, et al. Inhalation versus total intravenous anesthesia for lumbar disc herniation: comparison of hemodynamic effects, recovery characteristics, and cost.J Neurosurg Anesthesiol. 2001; 13: 296–302.PubMedCrossRefGoogle Scholar
  8. 8.
    Wroth R, Peacock J, Reilly CS, Rowbothham DJ, Jones R. Cardiovascular changes following administration of remifentanil in combination with either propofol or isoflurane.Br J Anaesth. 1997; 78: 461.Google Scholar
  9. 9.
    Avramov MN, Griffin JD, White PF. The effect of fresh gas flow and anesthetic technique on the ability to control acute hemodynamic responses during surgery.Anesth Analg. 1998; 87: 666–670.PubMedCrossRefGoogle Scholar
  10. 10.
    Eger EI II. Desflurane: an overview of its properties.Anesthesiology. 1993; 20: 87–92.Google Scholar
  11. 11.
    Lee DJH, Robinson DL, Soni N. Efficiency of a circle system for short surgical cases: comparison of desflurane with isoflurane.Br J Anaesth. 1996; 76: 780–782.PubMedGoogle Scholar
  12. 12.
    Philip BK, Scuderi PE, Chung F, et al. Remifentanil compared with alfentanil for ambulatory surgery using total intravenous anesthesia. The Remifentanil/Alfentanil Outpatient TIVA Group.Anesth Analg. 1997; 84: 515–521.PubMedCrossRefGoogle Scholar
  13. 13.
    Grudmann U, Risch A, Kleinschmidt S, Klatt R, Larsen R. Remifentanil-propofol anesthesia in vertebral disc operations: a comparison with desflurane-N2O inhalation anesthesia: effect on hemodynamics and recovery.Anaesthetist. 1998; 47: 102–110.CrossRefGoogle Scholar
  14. 14.
    Pendeville PE, Kabongo F, Veyckemans F. Use of remifentanil in combination with desflurane or propofol for ambulatory oral surgery.Acta Anaesthesiol Belg. 2001; 52: 181–186.PubMedGoogle Scholar
  15. 15.
    Weiskopf RB, Moore MA, Eger EI II, et al. Rapid increase in desflurane concentration is associated with greater transient cardiovascular stimulation than with rapid increase in isoflurane concentration in humans.Anesthesiology. 1994; 80: 1035–1045.PubMedCrossRefGoogle Scholar
  16. 16.
    Bennett JA, Mahadeviah A, Stewart J, Lingaraju N, Keykhah MM. Desflurane controls the hemodynamic response to surgical stimulation more rapidly than isoflurane.J Clin Anesth. 1995; 7: 288–291.PubMedCrossRefGoogle Scholar
  17. 17.
    Larsen B, Seitz A, Larsen R. Recovery of cognitive function after remifentanil-propofol anesthesia: a comparison with desflurane and sevoflurane anesthesia.Anesth Analg. 2000; 90: 168–174.PubMedCrossRefGoogle Scholar
  18. 18.
    Grudmann U, Silomon M, Bach F, et al. Recovery profile and side effects of remifentanil-based anaesthesia with desflurane or propofol for laparoscopic cholecystectomy.Acta Anaesthesiol Scand. 2001; 45: 320–326.CrossRefGoogle Scholar
  19. 19.
    Özköse Z, Yalcin Cok O, Tuncer B, Tufekcioglu S, Yardim S. Comparison of hemodynamics, recovery profile, and early postoperative pain control and costs of remifentanil versus alfentanil-based total intravenous anesthesia (TIVA).J Clin Anesth. 2002; 14: 161–168.PubMedCrossRefGoogle Scholar
  20. 20.
    Kleinschmidt S, Grudmann U, Rauber K, Bauer M. Anesthesia with remifentanil combined with desflurane or sevoflurane in lumbar intervertebral disk operations.Anaesthesiol Reanim. 2000; 25: 151–157.PubMedGoogle Scholar
  21. 21.
    Eger EI II, Bowland T, Ionescu P, et al. Recovery and kinetic characteristics of desflurane and sevoflurane in volunteers after 8-b exposure, including kinetics of degradation products.Anesthesiology. 1997; 87: 517–526.PubMedCrossRefGoogle Scholar
  22. 22.
    Wilhelm W, Schlaich N, Harrer J, Kleinschmidt S, Muller M, Larsen R. Recovery and neurological examination after remifentanil-desflurane or fentanyl-desflurane anaesthesia for carotid artery surgery.Br J Anaesth. 2001; 86: 44–49.PubMedCrossRefGoogle Scholar
  23. 23.
    López-Alvarez S, Bonome González C, Aymerich Cano H, Alvarez Refojo F, Rodríguez Rodríguez A, Cobian Llamas JM. The effect of propofol vs desflurane on recovery from anesthesia with remifentanil in outpatient surgery [in Spanish].Rev Esp Anestesiol Reanim. 2001; 48: 370–374.PubMedGoogle Scholar
  24. 24.
    Chillemi S, Sinardi D, Marino A, Mantarro G, Campisi R. The use of remifentanil for bloodless surgical field during vertebral disk resection.Minerva Anestesiol. 2002; 68: 645–649.PubMedGoogle Scholar
  25. 25.
    Wilhelm W, Huppert A, Brun K, Gruness V, Larsen R. Remifentanil with propofol or isoflurane: a comparison of the recovery times after arthroscopic surgery.Anaesthetist. 1997; 46: 335–338.CrossRefGoogle Scholar
  26. 26.
    Cheong KF, Low TC. Propofol and postanaesthetic shivering.Anaesthesia. 1995; 50: 550–552.PubMedCrossRefGoogle Scholar
  27. 27.
    Frank SM, Beattie C, Christopherson R, et al. Unintentional hypothermia is associated with postoperative myocardial ischemia. The Perioperative Ischemia Randomized Anesthesia Trial Study Group.Anesthesiology. 1993; 78: 468–476.PubMedCrossRefGoogle Scholar
  28. 28.
    Hartung J. Twenty-four of twenty-seven studies show a greater incidence of emesis associated with nitrous oxide than with alternative anesthetics.Anesth Analg. 1996; 83: 114–116.PubMedCrossRefGoogle Scholar
  29. 29.
    Watcha MF, Simeon RM, White PF, Stevens JL. Effect of propofol on the incidence of postoperative vomiting after strabismus surgery in pediatric outpatients.Anesthesiology. 1991; 75: 204–209.PubMedCrossRefGoogle Scholar
  30. 30.
    Dershwitz M, Michalowski P, Chang Y, Rosow CE, Conlay LA. Postoperative nausea and vomiting after total intravenous anesthesia with propofol and remifentanil or alfentanil: how important is the opioid?J Clin Anesth. 2002; 14: 275–278.PubMedCrossRefGoogle Scholar

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© Health Communications Inc 2007

Authors and Affiliations

  • Muhammet Gozdemir
    • 1
  • Huseyin Sert
    • 1
  • Nisa Yilmaz
    • 1
  • Orhan Kanbak
    • 1
  • Burhanettin Usta
    • 2
  • Ruveyda Irem Demircioglu
    • 2
  1. 1.Department of AnesthesiologyAtaturk Research and Training HospitalTurkey
  2. 2.Department of AnesthesiologyFatih University School of MedicineAnkaraTurkey

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