Effectiveness of remifentanil versus traditional fentanyl-based anesthetic in high-risk outpatient surgery

Study Objective: To determine if remifentanil would offer a superior hemodynamic and recovery Profile compared to the current standard of care, which implements a fentanyl-based technique. Design: Randomized, single-blind study. Setting: Outpatient center associated with tertinuy rare center Patients: 75 outpatients undergoing microsuspension laryngoscopy. Interventions: Patients were randomized to either a remifentanil induction (0.5 mug/kg/min) and maintenance (0.25 mug/kg/min) versus fentanyl (maximum of 250 muh) as the only opioid. All patients received propofol as part of the induction and maintenance with or without the use of nitrous oxide. Measurements: Assessment of hemodynamics [heart rate (HR) and blood pressure(BP)], presence of perioperative myocardial ischemia on ambulatory electrocardiographic monitoring, and time to discharge. Main Results: Significantly fewer patients in the remifentanil group demonstrated episodes of tachycardia (HR > 100 beats per min) compared to the fentanyl group (14 % vs. 40 %, p < 0.05), with significantly fewer episodes of tachycardia and hypertension per patient. Recovery profiles between the two groups did not show clinically significant differences. Conclusions: Remifentanil, a new short-acting opioid, offers excellent hemodynamic control for brief intense outpatient procedures Performed in high-risk patients; however, its use was not associated with any improvement in recovery profiles. (C) 2000 by Elsevier Science Inc.