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Can remifentanil replace nitrous oxide during anesthesia for ambulatory orthopedic surgery with desflurane and fentanyl?
Anesth Analg. 2008 Jan; 106(1):101-8, table of contents.A&A

Abstract

BACKGROUND

The administration of nitrous oxide (N2O) may be associated with side effects and toxicities. Remifentanil shares characteristics with N2O, including MAC-reducing and antinociceptive effects and a rapid decrease in clinical effect when discontinued. We compared the outcome after ambulatory orthopedic surgery with desflurane and fentanyl supplemented with clinically equivalent doses of either N2O or remifentanil.

METHODS

Seventy patients undergoing ambulatory orthopedic surgery were studied. Thirty-five received 66% N2O and 35 received remifentanil 0.085 microg x kg(-1) x min(-1) in addition to desflurane, titrated to a bispectral index (BIS) value of 50, and a fentanyl infusion. The principle outcome measure was time to awakening to verbal stimulation. Secondary outcome measures included neuropsychological testing, time to orientation, hemodynamic values, pain and nausea visual analog scores, discharge times, and satisfaction scores. The average end-tidal desflurane concentration and fentanyl effect-site concentration were determined.

RESULTS

The median time (interquartile range) to awakening to verbal stimulation, 3.0 min (3.0-5.0 min) in the remifentanil group and 4.6 min (3.0-8.1 min) in the N2O group was not significantly different. Median time to orientation was significantly faster in the remifentanil group: 6.0 min (5.0-8.5 min) compared with 8.0 min (5.0-12.8 min) for the N2O group. There was no difference between groups in desflurane or fentanyl administration, neuropsychological testing, or any other outcome measure.

CONCLUSIONS

This study demonstrates that a remifentanil infusion of 0.085 microg x kg(-1) x min(-1) may be substituted for 66% N2O during desflurane/fentanyl anesthesia without any clinically significant change in outcome.

Authors+Show Affiliations

Department of Anesthesiology, St. Vincent Catholic Medical Centers, St. Vincent's Manhattan, New York, USA. dmathews@svcmcny.orgNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Randomized Controlled Trial

Language

eng

PubMed ID

18165562

Citation

Mathews, Donald M., et al. "Can Remifentanil Replace Nitrous Oxide During Anesthesia for Ambulatory Orthopedic Surgery With Desflurane and Fentanyl?" Anesthesia and Analgesia, vol. 106, no. 1, 2008, 101-8, table of contents.
Mathews DM, Gaba V, Zaku B, et al. Can remifentanil replace nitrous oxide during anesthesia for ambulatory orthopedic surgery with desflurane and fentanyl? Anesth Analg. 2008;106(1):101-8, table of contents.
Mathews, D. M., Gaba, V., Zaku, B., & Neuman, G. G. (2008). Can remifentanil replace nitrous oxide during anesthesia for ambulatory orthopedic surgery with desflurane and fentanyl? Anesthesia and Analgesia, 106(1), 101-8, table of contents. https://doi.org/10.1213/01.ane.0000289526.20117.26
Mathews DM, et al. Can Remifentanil Replace Nitrous Oxide During Anesthesia for Ambulatory Orthopedic Surgery With Desflurane and Fentanyl. Anesth Analg. 2008;106(1):101-8, table of contents. PubMed PMID: 18165562.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Can remifentanil replace nitrous oxide during anesthesia for ambulatory orthopedic surgery with desflurane and fentanyl? AU - Mathews,Donald M, AU - Gaba,Vijay, AU - Zaku,Bledi, AU - Neuman,George G, PY - 2008/1/1/pubmed PY - 2008/10/23/medline PY - 2008/1/1/entrez SP - 101-8, table of contents JF - Anesthesia and analgesia JO - Anesth Analg VL - 106 IS - 1 N2 - BACKGROUND: The administration of nitrous oxide (N2O) may be associated with side effects and toxicities. Remifentanil shares characteristics with N2O, including MAC-reducing and antinociceptive effects and a rapid decrease in clinical effect when discontinued. We compared the outcome after ambulatory orthopedic surgery with desflurane and fentanyl supplemented with clinically equivalent doses of either N2O or remifentanil. METHODS: Seventy patients undergoing ambulatory orthopedic surgery were studied. Thirty-five received 66% N2O and 35 received remifentanil 0.085 microg x kg(-1) x min(-1) in addition to desflurane, titrated to a bispectral index (BIS) value of 50, and a fentanyl infusion. The principle outcome measure was time to awakening to verbal stimulation. Secondary outcome measures included neuropsychological testing, time to orientation, hemodynamic values, pain and nausea visual analog scores, discharge times, and satisfaction scores. The average end-tidal desflurane concentration and fentanyl effect-site concentration were determined. RESULTS: The median time (interquartile range) to awakening to verbal stimulation, 3.0 min (3.0-5.0 min) in the remifentanil group and 4.6 min (3.0-8.1 min) in the N2O group was not significantly different. Median time to orientation was significantly faster in the remifentanil group: 6.0 min (5.0-8.5 min) compared with 8.0 min (5.0-12.8 min) for the N2O group. There was no difference between groups in desflurane or fentanyl administration, neuropsychological testing, or any other outcome measure. CONCLUSIONS: This study demonstrates that a remifentanil infusion of 0.085 microg x kg(-1) x min(-1) may be substituted for 66% N2O during desflurane/fentanyl anesthesia without any clinically significant change in outcome. SN - 1526-7598 UR - https://www.unboundmedicine.com/medline/citation/18165562/Can_remifentanil_replace_nitrous_oxide_during_anesthesia_for_ambulatory_orthopedic_surgery_with_desflurane_and_fentanyl L2 - https://doi.org/10.1213/01.ane.0000289526.20117.26 DB - PRIME DP - Unbound Medicine ER -