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    Comparison of propofol-alfentanil and propofol-remifentanil anaesthesia in percutaneous nephrolithotripsy
    (Cambridge Univ Press, 2005) Cicek, M; Koroglu, A; Demirbilek, S; Teksan, H; Ersoy, MO
    Background and objective: Percutaneous nephrolithotripsy (PCNL) is used for the fragmentation and removal of stones from the renal pelvis and renal calyceal systems. We compared the effects of propofol-alfentanil or propofol-remifentanil anaesthesia on haemodynamics, recovery characteristics and postoperative analgesic requirements during percutaneous nephrolithotripsy. Methods: Thirty non-premedicated patients were randomly allocated to receive either propofol-alfentanil (Group A) or propofol-remifentanil (Group R). The loading dose of the study drug was administered over 60 s (alfentanil 10 mu g kg(-1) or remifentanil 1 mu g kg(-1)) followed by a continuous infusion (alfentanil 15 mu g kg(-1) h(-1) or remifentanil 0.15 mu g kg(-1) min(-1)). Propofol was administered until loss of consciousness and maintained with a continuous infusion of 75 mu g kg(-1) min(-1) in both groups. Atracuriurn was given for endotracheal intubation at a dose of 0.5 mg kg(-1) and maintained with a continuous infusion of 0.4 mg kg(-1) h(-1) Mean arterial pressure heart rate, the total amount of propofol, time of recovery of spontaneous ventilation, extubation and eye opening in response to verbal stimulus and analgesic requirement were recorded. Results: In Group A, mean arterial pressure was higher at the first minute in the prone position, and during skin incision and lithotripsy, and heart rate was higher during skin incision and lithotripsy when compared with Group R (P < 0.05). The total amount of propofol did not differ between groups. Time of recovery of spontaneous ventilation, extubation and eye opening were significantly shorter in Group R than Group A (P < 0.05). Conclusions: Both propofol-remifentanil and propofol-alfentanil anaesthesia provided stable haemodynamics during percutaneous nephrolithotripsy, whereas propofol-remifentanil allowed earlier extubation.
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    Effects of fentanyl on the incidence of emergence agitation in children receiving desflurane or sevoflurane anaesthesia
    (Greenwich Medical Media Ltd, 2004) Demirbilek, S; Togal, T; Cicek, M; Aslan, U; Sizanli, E; Ersoy, MO
    Background and objective: In children, emergence agitation frequently complicates sevoflurane and desflurane anaesthesia. The effect of intravenous fentanyl 2.5 mug kg(-1) was examined on the incidence of emergence agitation in children who received desflurane or sevoflurane after midazolam premedication and intravenous thiopental induction. Methods: One hundred and twenty children (2-7 yr) undergoing adenoidectomy or tonsillectomy, or both, were studied. All children were premedicated orally with midazolam 0.5 mg kg(-1). After intravenous induction with thiopental and atracurium to facilitate endotracheal intubation, patients were randomly assigned to one of four groups: Patients in Groups I and 3 received physiological saline solution, whereas patients in Groups 2 and 4 received intravenous fentanyl 2.5 mug kg(-1) during induction. Anaesthesia was maintained with sevoflurane in Groups I and 2 and with desflurane in Groups 3 and 4. After discontinuation of the volatile anaesthetic, the times to tracheal extubation and response to verbal stimuli (emergence time), and emergence behaviours were recorded. Results: The time to tracheal extubation was significantly shorter in Groups 3 (5.2 +/- 1.7 min) and 4 (6.4 +/- 2.1 min) than in Groups 1 (8.1 +/- 2.1 min) (P = 0.0001 and 0.006, respectively) and 2 (8.8 +/- 1.9 min) (P = 0.0001). The emergence time was significantly shorter in Group 3 (10.0 +/- 3.9 min) than in Groups 1 (13.8 +/- 4.9 min) (P = 0.017) and 2 (14.9 +/- 4.1 min) (P = 0.003). The incidence rate of severe agitation was 13% in Groups 1 and 3, and 7 and 10% in Groups 2 and 4, respectively (P > 0.05). Conclusions: After midazolam premedication and intravenous induction of anaesthesia with thiopental, administration of intravenous fentanyl 2.5 mug kg(-1) did not provide any clinically significant benefit on emergence agitation in children who receive sevoflurane or desflurane anaesthesia.