Remifentanil for intraoperative analgesia during the endoscopic surgical treatment of pituitary lesions

Aim. The authors have evaluated remifentanil for intraoperative analgesia in endonasal endoscopic surgery for pituitary lesions. Methods. Experimental design: a perspective, randomized and comparative study between remifentanil and fentanyl for intraoperative analgesia was performed in an operating room of the neurosurgical department at University. Sixty patients of both sexes were studied and randomly divided into 2 groups. Patients were premedicated with fentanyl 0.15 μg·kg-1 and atropine 0.01 mg·kg -1 (group F) or with atrophic and remifentanil 0.25 mg·kg -1 min-1 (group R); induction was with propofol 2.0 mg·kg-1 and maintenance with titrated infusion of propofol and for intraoperative analgesia, fentanyl as bolus injection of 1.0-1.5 μg·kg-1 (group F) or a titrated infusion of remifentanil (group R). The following parameters were studied: MAP, HR, bleeding, awakening times, adverse effects and VAS. Results. Much more stable hemodynamic parameters during surgery in patients treated with remifentanil; labetalol was administered in 10% of patients in group F; no significant differences as regards the adverse effects and VAS. Faster awakening time was obtained in the remifentanil group as compared with the fentanyl group. Conclusion. Remifentanil analgesia (mean dose of 0.37 μg·kg-1·min -1) in patients undergoing endonasal endoscopic surgery of the sellar region provides a more efficacious cardiocirculatory control with reduced bleeding and faster psychosensorial recovery.