A comparison of remifentanil and fentanyl in patients undergoing carotid endarterectomy

Background and aim We investigated the haemodynamic stability and emergence characteristics of isoflurane/nitrous oxide anaesthesia supplemented with remifentanil or fentanyl in patients undergoing carotid endarterectomy. Methods Anaesthesia was induced with propofol (1-2 mg kg(-1)) and either remifentanil (0.5 mug kg(-1)) or fentanyl (1 mug kg(-1)), followed by an infusion of remifentanil (0.2 mug kg(-1) min(-1)) or fentanyl (2 mug kg(-1) h(-1)). Results There were no significant differences between the groups in haemodynamic variables, postoperative pain, nausea or vomiting. After induction there was a significant decrease in mean arterial pressure for both groups (P<0.001) and a decrease in heart rate (P=0.001) in the remifentanil group. In both groups these haemodynamic changes continued during maintenance of anaesthesia (P<0.05). The lime to eye opening after surgery was significantly shorter with remifentanil compared with fentanyl (6.62 +/- 3.89 vs. 18.0 +/- 15.18 min, P=0.015). Conclusion Remifentanil appears to be a comparable opioid to fentanyl when supplementing isoflurane/nitrous oxide anaesthesia for carotid endarterectomy.