The Comparison of Remifentanil and Alfentanil for Reflex Hemodynamic Responses to Direct Endoscopic Laryngoscopy, Awakening Times, Complications and Costs

Abstract

Early recovery is also important in addition to control of acute hemodynamic response, during out-patient surgery as direct endoscopic laryngoscopy (DL). In our study, we aimed to compare remifentanil and alfentanil for hemodynamic responses, awakening times, complications and costs during DL. Fourty ASA physical status I-II patients were randomly divided into two groups. Group I patients were given 1 μg kg-1 remifentanil and Group II patients 5 μg kg-1 alfentanil i.v. before induction. Anesthesia was induced with 2-3 mg kg-1 propofol and 1.5 mg kg-1 succinylcholine and intubation was performed. Anesthesia was maintained with O<inf>2</inf>+ 66% N<inf>2</inf>O and 2% sevoflorane. For each patient, heart rate (HR, sistolic arterial pressure (S.A.P) and peripheric oxygen saturation (SpO<inf>2</inf>) were recorded at the preoperative period, after opioid injection, following intubation, the 1.,.5., 10., 15. minutes of DL, following extubation. The complications such as thorax rigidity, respiratory depression, vomiting, cough, laryngospasm, and awakening times, opioid costs (TL) were investigated. HR was similar between groups after opioid injection, following intubation, first and fifth minutes of DL. HR was higher at intubation in Group II than preoperative value (p< 0.01). The awakening time was shorter in Group I than Group II (p<0.05). The incidence of thorax rigidity was higher in Group I than Group II (p< 0.005). The opioid costs was lower in Group I than Group II (p< 0.001). In conclusion, remifentanil is superior to alfentanil because of its adequate suppression of hemodynamic responses, short awakening time and cost-effectiveness in out-patient surgery as DL.