Comparison of adenosine and remifentanil infusions as adjuvants to desflurane anesthesia

Eduardo Zárate, Mônica M. Sá Rêgo, Paul F. White, Larry Duffy, Vance E. Shearer, James D. Griffin, Charles W. Whitten

Research output: Contribution to journalArticlepeer-review

49 Scopus citations

Abstract

Background: Because adenosine has been alleged to produce both anesthetic and analgesic sparing effects, a randomized, double-blinded study was designed to compare the perioperative effects of adenosine and remifentanil when administered as intravenous adjuvants during general anesthesia for major gynecologic procedures. Methods: Thirty-two women were assigned randomly to one of two drug treatment groups. After premedication with 0.04 mg/kg intravenous midazolam, anesthesia was induced with 2 μg/kg intravenous fentanyl, 1.5 mg/kg intravenous propofol, and 0.6 mg/kg intravenous rocuronium, and maintained with desflurane, 2%, and nitrous oxide, 65%, in oxygen. Before skin incision, an infusion of either remifentanil (0.02 μg · kg-1 · min-1) or adenosine (25 μg · kg-1 · min-1) was started and subsequently titrated to maintain systolic blood pressure, heart rate, or both within 10-15% of the preincision values. Results: Adenosine and remifentanil infusions were effective anesthetic adjuvants during lower abdominal surgery. Use of adenosine (mean ± SEM, 166 ± 17 μg · kg-1 · min-1) was associated with a significantly greater decrease in systolic blood pressure and higher heart rate values compared with remifentanil (mean ± SEM, 0.2 ± 0.03 μg · kg-1 · min-1). Total postoperative opioid analgesic use was 45% and 27% lower in the adenosine group at 0-2 h and 2-24 h after surgery, respectively. Conclusions: Adjunctive use of a variable-rate infusion of adenosine during desflurane- nitrous oxide anesthesia was associated with acceptable hemodynamic stability during the intraoperative period. Compared with remifentanil, intraoperative use of adenosine was associated with a decreased requirement for opioid analgesics during the first 24 h after operation.

Original languageEnglish (US)
Pages (from-to)956-963
Number of pages8
JournalAnesthesiology
Volume90
Issue number4
DOIs
StatePublished - Apr 1 1999

Keywords

  • Antinociception
  • Pain

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

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