Effects of remifentanil on emergence characteristics from anesthesia in cervical spine surgery: a comparison of remifentanil- and sevoflurane-based anesthesia

Kim, Jee Ahn; Kwak, Kyung Hwa

Abstract

BACKGROUND
Smooth and rapid emergence from anesthesia without bucking, agitation or pain is ideal in terms of neck stabilization and early neurological assessment on potential complications immediately after cervical spine surgery. This study was designed to compare the severity of bucking, the level of awakening, and pain during the emergence from anesthesia with sevoflurane, remifentanil supplemented with sevoflurane or remifentanil supplemented with propofol in patients undergoing cervical spine surgery.
METHODS
Sixty American Society of Anesthesiologists physical status class I to II patients undergoing cervical spine surgery were randomized into one of three groups: maintenance solely with sevoflurane (group S, n = 20); maintenance with remifentanil and supplementation with less than 1% sevoflurane (group RS, n = 20); and maintenance of anesthesia with remifentanil and propofol target controlled infusion (TCI) (group RP, n = 20). The severity of bucking, the level of awakening, and the perception of pain during the emergence phase were assessed using predetermined scoring scales by a nurse blinded to the method of anesthesia.
RESULTS
The bucking, level of awakening, pain score were significantly better in both group RP and group RS than in the group S. However there was no significant difference between group RP and group RS.
CONCLUSIONS
The quality of emergence from anesthesia in patients with cervical spine surgery could be improved with remifentanil-based anesthesia, but no significant differences were found between the propofol TCI and less than 1% sevoflurane as a concomitant hypnotic adjunct.