Remifentanil as an adjuvant during desflurane anesthesia facilitates early recovery after ambulatory surgery.

Study Objective: To investigate the effect of using a remifentanil infusion during desflurane anesthesia on the early recovery profile and side effects.

Design: Randomized, single-blind study.

Setting: University-based ambulatory surgery unit.

Patients: 46 healthy, ASA physical status I and II women undergoing outpatient laparoscopic tubal ligation procedures.

Interventions: After premedication with midazolam 2 mg intravenously (IV), anesthesia was induced with propofol 2 mg.kg-1 i.v. and remifentanil 1 microgram.kg-1 i.v. Following tracheal intubation, anesthesia was maintained with desflurane 2% and nitrous oxide (N2O) 65% in both groups. During the maintenance period, hemodynamic stability was maintained using either a variable inspired concentration of desflurane, 2% to 8% (Control group), or a variable-rate infusion of remifentanil 0.05 to 0.2 microgram.kg-1.min-1 i.v. (Remi group). Ketorolac 30 mg i.v. and local anesthetic infiltration at the surgical portals were administered for preventive analgesia prior to skin closure.

Measurements And Main Results: Emergence times and times to achieving an Aldrete score of 10 (i.e., fast-tracking eligibility) were determined. Postoperative nausea and vomiting (PONV), as well as the need for analgesic and antiemetic rescue medications, were noted during the 24-hour follow-up period. A structural questionnaire was used to assess intraoperative recall. Compared to the Control group, the Remi group had shorter emergence times and reduced times to achieving an Aldrete score of 10. There were no differences between the two groups with respect to the incidence of PONV and the requirements for postoperative analgesic and antiemetic drugs. None of the patients experienced intraoperative recall.

Conclusions: The adjunctive use of a remifentanil infusion (0.07 +/- 0.03 microgram.kg-1.min-1) during desflurane-N2O anesthesia facilitated early recovery without increasing PONV, pain, or the need for rescue medication after laparoscopic surgery.