• Kanji Uchida, Hideo Yasunaga, Masahiko Sumitani, Hiromasa Horiguchi, Kiyohide Fushimi, and Yoshitsugu Yamada.
• Departments of *Anesthesiology ‡Health Management and Policy, Graduate School of Medicine †Department of Health Economics and Epidemiology Research, School of Public Health, The University of Tokyo §Department of Health Policy and Informatics, Graduate School of Medicine, Tokyo Medical and Dental University, Tokyo, Japan.
• J Neurosurg Anesthesiol. 2014 Oct 1;26(4):291-8.

BackgroundRemifentanil is an ultrashort-acting µ-opioid receptor agonist and is especially suitable for neuroanesthesia. We previously reported that general anesthesia with remifentanil for brain tumor resection was associated with lower postoperative mortality and shorter postoperative length of stay (LOS) when compared with surgeries without remifentanil. This phenomenon may also exist during clipping of intracranial aneurysms (ICAs), where brain tissue frequently suffers ischemia and reperfusion injury. We performed a propensity score-matching study to compare in-hospital mortality and postoperative LOS with and without remifentanil in such patients.MethodsWe used the Diagnosis Procedure Combination inpatient database in Japan that includes 926 acute care hospitals to identify patients who underwent clipping of ICAs under general anesthesia between July and December 2007.ResultsOf the 4502 patients who underwent ICA clipping, 1380 propensity-matched pairs (n=2760) were included for outcome comparison. The remifentanil group had significantly lower in-hospital mortality than the nonremifentanil group (4.2% vs. 7.7%; P<0.001). Use of remifentanil was an independent factor for lower in-hospital mortality (odds ratio=0.52; 95% confidence interval, 0.37-0.74; P<0.001). By contrast, postoperative LOS did not differ significantly between the 2 groups. There was no difference in the occurrence of postoperative complications except for hydrocephalus, which was more common with remifentanil.ConclusionsThis retrospective observational study demonstrated a possible relationship between the use of remifentanil for neuroanesthesia and reduced mortality of patients undergoing clipping of ICAs with open craniotomy. Prospective interventional studies are necessary to confirm this relationship.

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