Recovery and neurological examination after remifentanil-desflurane or fentanyl-desflurane anaesthesia for carotid artery surgery

We studied 44 patients undergoing carotid endarterectomy (CEA) to compare, recovery after general anaesthesia with desflurane supplemented with either remifentanil or fentanyl. Remifentanil was infused at 0.1 mug kg(-1) min(-1) and desflurane was adjusted at 2 vol% end-tidal. Fentanyl was given as a bolus dose of 2 mug kg(-1) before induction and repeated at skin incision; desflurane was adjusted as needed. Times for early recovery and response to simple neurological tests (digit symbol substitution test (DSST) and Trieger dot test (TDT)) were measured 30, 60 and 90 min after operation. Emergence from remifentanil-desflurane anaesthesia was significantly quicker than that, from fentanyl-desflurane anaesthesia: mean times to extubation were 4.1 (SD 1.7) and 8.2 (4.9) min. respectively; mean times for patients to state their name correctly were 6.0 (2.8) and 13.8 (9.0) min, respectively. Patients in the remifentanil-desflurane group successfully performed neurological tests significantly earlier than those in the fentanyl-desflurane group; for example, patients in the former group completed the arm holding test at 7.9 (3.0) min, while those in the latter group did this at 20.6 (19.7) min (P less than or equal to0.01). Intermediate recovery was less impaired at 30 min (DSST, TDT) and at 60 min (DSST). More rapid awakening and an earlier opportunity for neurological examination suggest that remifentanil-desflurane is a suitable alternative to a standard fentanyl-based general anaesthetic technique in patients undergoing CEA.