• J J Mackey, S D Parker, C M Nass, D S Snyder, S Curreri, D Kazim, R L Zuckerman, and L A Fleisher.
• Department of Anesthesiology, Johns Hopkins University, Baltimore, MD, USA.
• J Clin Anesth. 2000 Sep 1;12(6):427-32.

Study ObjectiveTo determine if remifentanil would offer a superior hemodynamic and recovery profile compared to the current standard of care, which implements a fentanyl-based technique.DesignRandomized, single-blind study.SettingOutpatient center associated with tertiary care center.Patients75 outpatients undergoing microsuspension laryngoscopy.InterventionsPatients were randomized to either a remifentanil induction (0.5 microg/kg/min) and maintenance (0.25 microg/kg/min) versus fentanyl (maximum of 250 microg) as the only opioid. All patients received propofol as part of the induction and maintenance with or without the use of nitrous oxide.MeasurementsAssessment of hemodynamics [heart rate (HR) and blood pressure(BP)], presence of perioperative myocardial ischemia on ambulatory electrocardiographic monitoring, and time to discharge.Main ResultsSignificantly fewer patients in the remifentanil group demonstrated episodes of tachycardia (HR > 100 beats per min) compared to the fentanyl group (14% vs. 40%, p<0.05), with significantly fewer episodes of tachycardia and hypertension per patient. Recovery profiles between the two groups did not show clinically significant differences.ConclusionsRemifentanil, a new short-acting opioid, offers excellent hemodynamic control for brief, intense outpatient procedures performed in high-risk patients; however, its use was not associated with any improvement in recovery profiles.

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