The recovery of cognitive function after remifentanilnitrous oxide anesthesia is faster than after an isoflurane-nitrous oxide-fentanyl combination in elderly patients

Alex Y. Bekker, Paul Berklayd, Irene P. Osborn, Marc Bloom, Joel Yarmush, Herman Turndorf

Research output: Contribution to journalArticle

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Abstract

We tested the hypothesis that remifentanil-nitrous oxide (N2O) anesthesia shortens postoperative emergence and recovery compared with an isoflurane-N2O-fentanyl combination in elderly patients undergoing spinal surgery. A total of 60 patients (>65 yr old) were randomly assigned to one of two groups for maintenance of anesthesia. After the induction with 3.6 ± 1.2 mg/kg IV thiopental and endotracheal intubation facilitated with 1.4 ± 0.5 mg/kg succinylcholine, patients were maintained with either 0.5%-1.5% isoflurane, 70% N2O, and up to 7 μg/kg fentanyl (iso/fent group) or 48 ± 11 μg/kg remifentanil and 70% N2O (remi group). A mini-mental status examination was used to assess cognitive ability preoperatively, at 15, 30, and 60 min after arrival at the postanesthesia care unit and again 12-24 h postoperatively. The time from the conclusion of anesthesia to spontaneous respiration was similar in both groups. Times to eye opening (4.8 ± 2.6 vs 2.3 ± 1.1 min), extubation (6.8 ± 3.8 vs 3.2 ± 2.1 min), and verbalization (9.9 ± 6.2 vs 3.9 ± 2.6 min) were significantly shorter for the remi group (P < 0.05). Postoperative mini-mental status examination scores were significantly lower in the iso/fent group at 15 (16.3 ± 5.8 vs 23.7 ± 3.3), 30 (20.2 ± 5.2 vs 26.3 ± 2.7), and 60 min (23.5 ± 4.4 vs 27.5 ± 2.0) (P < 0.001); however, the scores equalized after 12 h. Requirements for postoperative analgesics were similar in the two groups. More patients in the remi group were treated with antiemetics (21 vs 7, P = 0.06). Use of remifentanil-N2O for maintenance did not shorten the overall length of stay in the postanesthesia care unit; a stay is often related to multiple administrative issues, rather than cognitive recovery.

Original languageEnglish (US)
Pages (from-to)117-122
Number of pages6
JournalAnesthesia and Analgesia
Volume91
Issue number1
StatePublished - Jul 2000
Externally publishedYes

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Isoflurane
Recovery of Function
Nitrous Oxide
Fentanyl
Oxides
Cognition
Anesthesia
Maintenance
Succinylcholine
Aptitude
Antiemetics
Intratracheal Intubation
Thiopental
Analgesics
Length of Stay
Respiration
remifentanil

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

Cite this

The recovery of cognitive function after remifentanilnitrous oxide anesthesia is faster than after an isoflurane-nitrous oxide-fentanyl combination in elderly patients. / Bekker, Alex Y.; Berklayd, Paul; Osborn, Irene P.; Bloom, Marc; Yarmush, Joel; Turndorf, Herman.

In: Anesthesia and Analgesia, Vol. 91, No. 1, 07.2000, p. 117-122.

Research output: Contribution to journalArticle

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abstract = "We tested the hypothesis that remifentanil-nitrous oxide (N2O) anesthesia shortens postoperative emergence and recovery compared with an isoflurane-N2O-fentanyl combination in elderly patients undergoing spinal surgery. A total of 60 patients (>65 yr old) were randomly assigned to one of two groups for maintenance of anesthesia. After the induction with 3.6 ± 1.2 mg/kg IV thiopental and endotracheal intubation facilitated with 1.4 ± 0.5 mg/kg succinylcholine, patients were maintained with either 0.5{\%}-1.5{\%} isoflurane, 70{\%} N2O, and up to 7 μg/kg fentanyl (iso/fent group) or 48 ± 11 μg/kg remifentanil and 70{\%} N2O (remi group). A mini-mental status examination was used to assess cognitive ability preoperatively, at 15, 30, and 60 min after arrival at the postanesthesia care unit and again 12-24 h postoperatively. The time from the conclusion of anesthesia to spontaneous respiration was similar in both groups. Times to eye opening (4.8 ± 2.6 vs 2.3 ± 1.1 min), extubation (6.8 ± 3.8 vs 3.2 ± 2.1 min), and verbalization (9.9 ± 6.2 vs 3.9 ± 2.6 min) were significantly shorter for the remi group (P < 0.05). Postoperative mini-mental status examination scores were significantly lower in the iso/fent group at 15 (16.3 ± 5.8 vs 23.7 ± 3.3), 30 (20.2 ± 5.2 vs 26.3 ± 2.7), and 60 min (23.5 ± 4.4 vs 27.5 ± 2.0) (P < 0.001); however, the scores equalized after 12 h. Requirements for postoperative analgesics were similar in the two groups. More patients in the remi group were treated with antiemetics (21 vs 7, P = 0.06). Use of remifentanil-N2O for maintenance did not shorten the overall length of stay in the postanesthesia care unit; a stay is often related to multiple administrative issues, rather than cognitive recovery.",
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T1 - The recovery of cognitive function after remifentanilnitrous oxide anesthesia is faster than after an isoflurane-nitrous oxide-fentanyl combination in elderly patients

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AU - Yarmush, Joel

AU - Turndorf, Herman

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N2 - We tested the hypothesis that remifentanil-nitrous oxide (N2O) anesthesia shortens postoperative emergence and recovery compared with an isoflurane-N2O-fentanyl combination in elderly patients undergoing spinal surgery. A total of 60 patients (>65 yr old) were randomly assigned to one of two groups for maintenance of anesthesia. After the induction with 3.6 ± 1.2 mg/kg IV thiopental and endotracheal intubation facilitated with 1.4 ± 0.5 mg/kg succinylcholine, patients were maintained with either 0.5%-1.5% isoflurane, 70% N2O, and up to 7 μg/kg fentanyl (iso/fent group) or 48 ± 11 μg/kg remifentanil and 70% N2O (remi group). A mini-mental status examination was used to assess cognitive ability preoperatively, at 15, 30, and 60 min after arrival at the postanesthesia care unit and again 12-24 h postoperatively. The time from the conclusion of anesthesia to spontaneous respiration was similar in both groups. Times to eye opening (4.8 ± 2.6 vs 2.3 ± 1.1 min), extubation (6.8 ± 3.8 vs 3.2 ± 2.1 min), and verbalization (9.9 ± 6.2 vs 3.9 ± 2.6 min) were significantly shorter for the remi group (P < 0.05). Postoperative mini-mental status examination scores were significantly lower in the iso/fent group at 15 (16.3 ± 5.8 vs 23.7 ± 3.3), 30 (20.2 ± 5.2 vs 26.3 ± 2.7), and 60 min (23.5 ± 4.4 vs 27.5 ± 2.0) (P < 0.001); however, the scores equalized after 12 h. Requirements for postoperative analgesics were similar in the two groups. More patients in the remi group were treated with antiemetics (21 vs 7, P = 0.06). Use of remifentanil-N2O for maintenance did not shorten the overall length of stay in the postanesthesia care unit; a stay is often related to multiple administrative issues, rather than cognitive recovery.

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