Early recovery after remifentanil-pronounced compared with propofol-pronounced total intravenous anaesthesia for short painful procedures

Background. We compared recovery from high-dose propofol/low-dose remifentanil ('propofol-pronounced') compared with high-dose remifentanil/low-dose propofol ('remifentanil-pronounced') anaesthesia. Methods. Adult patients having panendoscopy, microlaryngoscopy, or tonsillectomy were randomly assigned to receive either propofol-pronounced (propofol 100 μg kg^-1 min^-1; remifentanil 0.15 μg kg^-1 min^-1) or remifentanil-pronounced (propofol 50 μg kg^-1 min^-1; remifentanil 0.45 μg kg^-1 min^-1) anaesthesia. In both groups, the procedure was started with remifentanil 0.4 μg kg^-1, propofol 2 mg k^-1, and mivacurium 0.2 mg kg^-1. Cardiovascular measurements and EEG bispectral index (BIS) were recorded. To maintain comparable anaesthetic depth, additional propofol (0.5 mg kg^-1) was given if BIS values were greater than 55 and remifentanil (0.4 μg kg^-1) if heart rate or arterial pressure was greater than 110% of pre-anaesthetic values. Results. Patient and surgical characteristics, cardiovascular measurements, and BIS values were similar in both groups. There were no differences in recovery times between the groups (time to extubation: 12.7 (4.5) vs 12.0 (3.6) min, readiness for transfer to the recovery ward: 14.4 (4.4) vs. 13.7 (3.6) min, mean (SD)). Conclusions. In patients having short painful surgery, less propofol does not give faster recovery as long as the same anaesthetic level (as indicated by BIS and clinical signs) is maintained by more remifentanil. However, recovery times were less variable following remifentanil-pronounced anaesthesia suggesting a more predictable recovery.