The Comparison Of The Quality Of Recovery From General Anesthesia With Remifentanil And Fentanyl-remifentanil

Objective To compare the quality of recovery from anesthesia by using fentanyl combined with remifentanil and using remifentanil only.Methods Thirty ASAI-II patients of department of gynecology were randomely divided into two groups of 15 patients: group R(remifentanil) and FR(fentanyl combined with remifentanil). Anesthesia of the two groups were induced with remifentanil 1μg/kg or fentanyl 5μg/kg and midazolam 0.05mg/kg, vecuronium 0.1 mg/kg, propofol 1.5 mg/kg . In group R ,anesthesia was maintained with an infusion of 0.2μg/kg.min of remifentanil and 5-6 mg/kg.h of propofol ; In group FR, anesthesia was maintained with an infusion of 0.03μg/kg.min of fentanyl and 5-6 mg/kg.h of propofol till about one hour left to the end of the surgery .Then we used an infusion of 0.2μg/kg.min of remifentanil instead of fentanyl. Vecuronium was used accordingly. Both remifentanil and propofol were stopped at the end of the surgery. The following were recorded and compared between group R and FR: (1) BP, FIR and RPP at the following time: before anesthesia (T₀) ,end of surgery (T₁) ,reach the indication of tracheal extubation (T₂) ,tracheal extubation (T₃) ,1 min after extubation ( T₄ ) ,5 min after extubation (T₅) ,10 min after extubation (T₆ ) ,20 min after extubation ( T₇) ; (2) The duration from termination of surgery to full recovery of spontaneously breathing, eye opening, response to instruction and tracheal extubation; (3) Postoperative complications like chill, cough, nausea and vomiting ,low SPO₂ , restlessness, lethargy, et al ;(4)Ramsay score after operation;(5)VAS score at the following time: 5 min after extubation, 1 hour after extubation, 3 hours after extubation and 24 hours after extubation; (6)Side effect of drugs;(7)Awareness during operation.Results (1)BP, HR and RPP at T₂ and T₃ in both groups were higher than those at T₀; HR and RPP at T₃, T₄, T₅, T₆ in group FR were lower than those in group R;(2)There were no statistics difference of the duration from termination of surgery to full recovery of spontaneously breathing, eye opening, response to instruction and tracheal extubation between the two groups; (3)The incidence of postoperative restlessness and chill was lower in group FR than that in group R; (4)The patients of first grade of Ramsay score were fewer in group FR than in group R; (5) VAS scores at 5 min after extubation, 1 hour after extubation, 3 hours after extubation and 24 hours after extubation in group FR were significantly lower than those in group R and fewer patients needed analgesic; (6)There was no statistics difference of side effect of drugs in both groups; (7)There was no awareness during operation in both groups.Conclusions Using fentanyl combined with remifentanil is hemodynamically stabler, and it can reduce the incidence of postoperative pain. The duration from termination of surgery to eye opening and tracheal extubation does not prolong.