A Randomized Comparison of Target-Controlled Infusion of Remifentanil and Propofol with Desflurane and Fentanyl for Laryngeal Surgery

Aims: To compare the clinical profile of target-controlled infusion (TCI) of remifentanil (REM) + propofol (PRO) with fentanyl (FEN) bolus infusion with desflurane (DES) inhalation in direct laryngoscopic surgery. Methods: Sixty patients who were scheduled to undergo laryngoscopic surgery were randomly assigned to two groups (n = 30, respectively). One group of patients received a TCI of REM + PRO anesthetic treatment, while the patients in the other group received a bolus infusion of FEN and DES inhalation treatment. The hemodynamics, recovery profiles and unexpected events that occurred in both groups were recorded. Results:The hemodynamics of the patients in the TCI group was more stable during tracheal intubation, direct laryngoscope insertion and extubation. The mean arterial pressure was also significantly lower in the TCI group compared with the FEN/DES group. The TCI group also showed faster recovery profiles (e.g. a shorter time needed for response to verbal commands, autonomous breathing, tracheal extubation and orientation recovery). The FEN/DES group had lower Stewart recovery scores during the first 15 min determined at the postanesthesia care unit. However, there were no significant differences regarding the occurrence of unexpected events and postoperative complications between the two groups. Conclusions: TCI of REM + PRO anesthesia appears to be a reasonable alternative to FEN bolus infusion combined with DES inhalation during direct laryngoscopic surgery. Copyright (C) 2011 S. Karger AG, Basel