Two
generations’ opioids in carotid endarterectomy.
Staikou
Ch., Papaioannou E., Karousos D., Lampadariou A.,
Vourdami K., Charalambides K., Salatas K., Alexiou E.
Carotid endarterectomy
is a surgical procedure characterized by haemodynamic changes and possible
danger of stroke, so that would be
preferable to use an analgesic that provides hemodynamic stability and fast
recovery, by means of rapid onset of action and short half life.
Aim of
this study was to evaluate the clinical behaviour of two generations opioids
(remifentanil and fentanyl) during carotid endarterectomy.
Patients-methods: We studied 55 patients (36 male, 19 female), aged 48-85 years old, ASA
II-III, undergoing carotid endarterectomy under general anaesthesia, who were
randomly assigned into two groups (A=28, B=27), according to the opioid used
for intraoperative analgesia (Group A: Remifentanil, Group B: Fentanyl). The
anaesthetic protocol was the same in both groups. In order to alleviate
postoperative pain we administered paracetamol 1 gr im and lornoxicam 8 mgr iv
at the beginning of the procedure. We recorded: 1) changes in the haemodynamic
parameters – blood pressure (BP) and cardiac rate (CR), 2) demands
of vasoactive agents throughout the procedure, 3) recovery time and 4) postoperative sedation during the first
hour after extubation using Aldrete’s scale.
Results: 1) No significant changes of the haemodynamic parameters were observed:
in group A BP ranged at ±23% and CR ±15% of
baseline rate and in group B ±25% and 18% respectively. 2)
The need for vasoactive drugs varied significantly between the two groups: 7
patients in group A (17%) and 25 patients in group B (92%) received some
vasoactive agent. 3) Recovery time varied also significantly (ranged from 3-35
min and 12-60 min in groups A and B respectively). 4) Postoperative sedation
did not differ significantly between the two groups. (Ranged from scores
8-10 and 7-10 in groups A
and B respectively.)
Conclusion: This study demonstrates that remifentanil, due to its pharmacologicel
profile, reduces the need for vasoactive agents and recovery time, so it
appears to be the intraoperative opioid of choice in carotid endarterectomy in
comparison to fentanyl.
References:
- Camu
F et al: Inpatient experience with remifentanil. Anest analg 1999 Oct;89(4 Suppl):S15-21
- Servin F: Remifentanil: when and how to use it. Eur J Anaesthhhhesiol Supl 1997 May;15:41-