Intraoperative wake-up test and postoperative emergence in patients undergoing
spinal surgery: a comparison of intravenous and inhaled anesthetic techniques
using short-acting anesthetics.
Author(s): Grottke O, Dietrich PJ, Wiegels S, Wappler F.
Affiliation(s): Department of Anesthesiology, University Witten/Herdecke, Hospital
Cologne-Merheim, Ostemerheimer Strassse 200, D-51109 Cologne, Germany.
Publication date & source: 2004, Anesth Analg. , 99(5):1521-7; table of contents
Surgical procedures on the vertebral column may result in spinal cord damage,
leading to neurological deficits that demand immediate therapeutical
intervention. We designed this study to determine which anesthetic regimen allows
a rapid wake-up test during and after surgery to detect neurological deficits.
Fifty-four patients were randomly allocated to the following groups: group PR
(propofol/remifentanil): target-controlled infusion with propofol (plasma
concentration, 2-4 microg/mL) and remifentanil 0.2-0.5 microg . kg(-1) . min(-1);
group PS (propofol/sufentanil): propofol (2-4 microg/mL) and repetitive boluses
of 0.1-0.2 microg/kg of sufentanil adjusted to patients requirements; and group
DR (desflurane/remifentanil): desflurane/air 3.0-4.0 vol% combined with
remifentanil 0.2-0.5 microg . kg(-1) . min(-1). Group PS required significantly
longer times for the onset of breathing (8.9 +/- 1.6 min), elevation of the head
(17.0 +/- 3.8 min), and motion of the feet (17.0 +/- 7.4 min) than group PR (6.9
+/- 2.6 min, 9.3 +/- 2.2 min, and 9.4 +/- 2.4 min, respectively) or group DR (5.4
+/- 0.8 min, 6.1 +/- 1.0 min, and 6.2 +/- 1.0 min, respectively). The anesthetic
regimen with desflurane and remifentanil allowed faster awakening during and
after surgery that permitted immediate neurological examination after spinal
surgery compared with propofol/remifentanil.
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