چكيده لاتين :
Background: Early warning of potential damage to spinal cord
during major spinal surgery is highly desirable to prevent postoperative
neurological deficits. Wake-up test is a simple, safe
and reliable method of recognition of such a complication, and
has been extensively used in many spinal surgical units. The
present study is evaluating the remifentanil, propofol versus
alfentanil, propofol as a part of balanced anesthesia for rapid
performance of wake-up test during major spinal surgery.
Methods: Fifty patients undergoing elective spinal surgery
were randomized to receive either remifentanillpropofol
(group A) or alfentanillpropofol (group B). Premedicated patients
received remifentanil (a loading dose of 2 (MU)g/kg and a
continuous infusion of I (MU)g/kg/rnin), or alfentanil (a loading
dose of 25 (MU)g/kg and a continuous infusion of 1 (MU)g/kg/min).
Propofol was given as a loading dose of 1.5 mg/kg and a continuous
infusion of 100 (MU)g/kg/min.
The awakening was accomplished by withdrawing propofol
and N20 at 20 and 5 minutes before the test, respectively,
whereas remifentanil or alfentanil infusion continued through
the wake-up period at a rate of 0.02 ug/kg/min.
Results: The onset of intra-operative neurological examination
in remifentanillpropofol receiving group (4.6(PLUS-MINUS) 1.4 minutes)
was significantly faster than that for alfentanil/propofol
receiving group (7.5(PLUS-MINUS)1.8 minutes).
Conclusion: Combination of remifentanil and propofol induced
a balanced anesthesia for intra-operative awakening and
provided a faster opportunity for detecting any potential damage
that may occur during spinal instrumentation.
