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Background: The aim of this paper was to determine if there were any significant differences between the effects of fentanyl delivered as a bolus or remifentanil delivered as a continuous infusion on the QT interval and QT dispersion (QTD) during the induction of anesthesia and tracheal intubation., Methods: This was a prospective, randomized and single blind study. A total of 50 ASA I-II patients scheduled to undergo elective minor abdominal surgery were divided into two groups. In the remifentanil group (N=25), patients received a continuous infusion (c.i.) of remifentanil (0.25 mcg/kg · min). In the fentanyl group (N=25), a bolus dose of fentanyl (2.0 mcg/kg) was administered. The QT interval, the difference between QTmax and QTmin (QTD), the heart rate-corrected QT (QTc) and the QT dispersion (QTcD) were calculated using a 12-lead computerized electrocardiogram (ECG)., Results: In both groups, there was no significant change in QT or QTc intervals during the study period. In the remifentanil group, a significant decrease in QTD and QTcD was observed during induction compared with baseline values (P<0.05). There was a significant increase in QTD at 1 min and in QTcD at 1 and 3 min after intubation in the fentanyl group (P<0.05)., Conclusion: Both remifentanil and fentanyl did not prolong the QT interval. QTD decreased after the induction of anesthesia and did not increase after tracheal intubation in patients receiving c.i. remifentanil in comparison with fentanyl. Overall, remifentanil infusion may be the opioid-based treatment regimen of choice in patients at risk of dysrhythmias.

Background and Objective: To evaluate the use of remifentanil-propofol administered as target-controlled infusion during awake fibreoptic intubation for anticipated difficult tracheal intubation in acromegalic patients., Method: In all, 20 consecutive acromegalic patients underwent elective endonasal endoscopic transsphenoidal pituitary surgery. After premedication with midazolam 0.03 mg kg(-1), initially a target-controlled infusion of remifentanil 1.0 ng mL(-1) and propofol 1.5 microg mL(-1) was started. The fibreoptic intubation was performed by the same physician experienced with the fibreoptic technique. During the fibreoptic procedure the target concentrations of remifentanil and propofol ranged between 1.0 and 5.0 ng mL(-1), and between 1.5 and 3.5 microg mL(-1), respectively. Changes in heart rate and mean arterial pressure were recorded during airway manipulation, during tracheal intubation, and at 1 and 3 min after. On the first postoperative day, patient recall and level of discomfort during fibreoptic intubation were evaluated., Results: Endotracheal intubation was efficaciously and quickly secured in all patients. A significant increase in mean arterial pressure and heart rate was recorded only during tracheal intubation (P < 0.05). Oxygenation was sufficient and no bradypnea or apnoea was recorded. All patients later described their anaesthetic experience as satisfactory. During fibreoptic intubation, remifentanil (ng mL(-1)) and propofol (microg mL(-1)) mean effect-site concentrations were 3.2 +/- 0.3 and 2.0 +/- 1.0, respectively., Conclusion: Remifentanil and propofol target-controlled infusion provided satisfactory conscious sedation allowing for successful oral fibreoptic intubation in acromegalic patients with no recall.

Aim: The transition from intraoperative analgesia to postoperative analgesia must be planned carefully after remifentanil-based anesthesia, due to the short duration of action of remifentanil. The aim of this study is to compare the efficacy and safety of 2 transition strategies using sufentanil or tramadol for early postoperative pain relief in patients who had major abdominal surgery under general anesthesia with remifentanil/sevoflurane., Methods: Sixty patients participated in this double-blind, prospective study and were randomly assigned to either sufentanil (S) group or tramadol (T) group. Twenty minutes before the end of surgery the patients received either a bolus of 0.15 microg kg(-1) sufentanil (group S) or tramadol 100 mg (group T). Mean arterial pressure (MAP), heart rate (HR) and rate pressure product (RPP=systolic arterial pressure (SAP)xHR), analgesia by a verbal rating score (VRS) and sedation by a sedation score (SS) were evaluated at emergence from anesthesia., Results: A statistically significant difference in HR between the 2 groups was recorded at extubation (78+/-13 in group S vs 86+/-24 in group T). A significant decrease of RPP values at extubation and 5 minutes later were found in group S in comparison with group T. VRS values were significantly lower in sufentanil group at 5 and 10 minutes after awakening., Conclusions: Sufentanil provided more effective transition analgesia in comparison with tramadol. The effects of remifentanil dissipated rapidly and analgesia with major opioids was required. A bolus dose of sufentanil 0.15 microg kg(-1) was efficacious in controlling the hemodynamic parameters at awakening from anesthesia. The lower HR values and, consequently the lower RPP values are of utmost importance especially in the aged cardiovascular risk patient.

The anesthetic management of a 58 year-old-male suffering from idiopathic pulmonary fibrosis associated with a previous experience of altered dose-response relationship to muscle relaxants is reported. He underwent a gastroendoscopic surgical procedure. After intravenous atropine, remifentanil 3.0 microg kg(-1) was injected over 90 sec. Sixty seconds after the start of remifentanil bolus dose, propofol 2.0 mg kg(-1) was injected and intubation was performed 1 min after the administration of propofol. Anesthesia was maintained by N(2)O, oxygen, sevoflurane (0.5-0.8%) and remifentanil titrated infusion (mean dose of 0.15 mg kg(-1) min(-1)) under spontaneous respiration or assisted ventilation, if the patient was apnoic. The intubating conditions were good, a 30 per cent reduction in MAP was observed after propofol administration. The patient regained consciousness 5 minutes after the end of remifentanil administration and his trachea was extubated without any troubles. Recovery was uneventful without the need of long-term intensive therapy.

Background: The aim of this study was to evaluate the effects of remifentanil in comparison with those of fentanyl on the hemodynamic response to orotracheal intubation., Experimental Design: prospective comparative and randomized study., Setting: operating room in a neurosurgery department at University., Patients: 50 patients, ASA I or II with age ranging from 32 to 64 years were divided in two groups randomly., Interventions: 25 patients received fentanyl as single bolus dose of 2.0 micrograms/kg and atropine 0.01 mg/kg i.v. as premedication while the remainders received atropine 0.01 mg/kg i.v. and remifentanil 0.2 microgram/kg/min as infusion. All patients were induced with propofol 2.0 mg/kg and cisatracurium 0.15 mg/kg for muscle relaxation and were intubated 4 min after induction of anesthesia., Measurements: Heart rate, SAP, DAP, MAP and RPP were recorded at different times: baseline, induction, intubation, 1, 2, 3 and 4 min after intubation; ECG and pulsoximetry were monitored continuously. Statistical analysis was carried out using ANOVA for repeated measures and Bonferroni t-test a value of p < 0.05 was considered to be significant., Results: Significant increases in PAS were recorded, at intubation and at 1 min after in patients treated with fentanyl; in the remifentanil group significant decreases in SAP at induction and at 4 min after intubation were recorded. HR increased significantly at intubation and at 1, 2 and 3 min after in the fentanyl group. RPP showed a significant decrease at induction in the remifentanil group and significant increases at intubation and at 1, 2 and 3 min after in patients treated with fentanyl., Conclusion: In conclusion remifentanil was found to properly control the hemodynamic response to intubation in comparison with fentanyl.

Background: The aim of this study was to evaluate the effects of sufentanil in comparison with those of fentanyl during balanced anesthesia in patients undergoing neurosurgery., Experimental Design: prospective randomized study., Setting: operating room in a neurosurgery University department., Patients: 50 patients, ASA I and II with age ranging from 18 to 77 years were divided in two groups randomly., Interventions: 25 patients received sufentanil as single bolus dose of 0.2 microgram/kg i.v. as premedication and supplemental bolus doses of 0.15 microgram/kg during the maintenance of anesthesia while the remainders received fentanyl 2.0 micrograms/kg as premedication and supplemental boluses of 1.5 micrograms/kg. All patients were induced with propofol 2.5 mg/kg, were intubated after cisatracurium 0.15 mg/kg for muscle relaxation, then were ventilated with sevoflurane and O2:N2O (1:1)., Measurements: heart rate, SAP, DAP and MAP were recorded at different times and ECG, ETCO2 and pulsoximetry were monitored continuously. Furthermore postoperative analgesia by VAS, recovery time and inspiratory concentrations of the volatile anesthetic were evaluated. Statistical analysis was carried out using ANOVA for repeated measures and Bonferroni "t"-test; a value of p < 0.05 was considered to be significant., Results: Significant changes in MAP (at IOT and 1 and 2 min after IOT), in HR (at IOT) and in RPP (at IOT and 1, 2 and 3 min after IOT) were recorded in group F. Recovery time was shorter in group S than in group F and postoperative analgesia was more prolonged in group S. Inspiratory concentrations of volatile agent were lower in patients treated with sufentanil than in those treated with fentanyl., Conclusions: In patients treated with sufentanil a better cardiocirculatory stability was achieved with lower inspiratory concentrations of volatile agent and a well relaxed brain. Sufentanil can be considered a valid alternative to fentanyl as analgesic agent in balanced anesthesia for neurosurgery.

Background: To evaluate the efficacy of propofol as the sole anaesthetic agent for the anaesthetic management of the trigeminal rhizolysis., Experimental Design: retrospective study., Setting: operating room of the Neurosurgery Department at University., Patients: 200 patients were studied, 115 males and 85 females, with mean age of 62.8 +/- 3.6 years, ASA status I, II or III and with various underlying medical problems., Interventions: patients were premedicated with atropine 0.01 mg/kg i.v. 10 min before the induction of anaesthesia. The induction dose of P was titrated to the desired level in according to age and clinical conditions. After induction of anaesthesia the surgeon started the needle placement through the foramen ovale in the trigeminal cistern., Measurements: during both procedures the mean dose of P, induction and recovery times, side effects and complications and quality of anaesthesia were assessed. Statistical analysis of the data was carried out using ANOVA for repeated measures and Bonferroni "t"-test and a value of p < 0.05 was considered to be significant., Results: Anaesthesia was successfully induced after a mean dose of 1.9 mg/kg of P during PG and of 2.1 mg/kg during PR. A few side effects and short recovery time were recorded in all cases. P also provided an adequate cardiovascular stability during PG and PR., Conclusions: In conclusion, P can be considered suitable for this particular neurosurgical procedure requiring short period of anaesthesia and rapid recovery time in order to communicate with the neurosurgeon during the sensory testing.