A retrospective analysis of prolonged propofol-remifentanil anesthesia in the neurosurgical patients

BACKGROUND: A rare, but fatal, propofol infusion syndrome has been reported in critically ill patients after prolonged use of propofol (more than 24-48 hours). But there are few reports on the clinical characteristics of prolonged anesthesia (more than 10 hours) using propofol, especially in the neurosurgical patients. METHODS: A retrospective study was conducted to find intra-and post-anesthetic characteristics (up to 7 postoperative days) and long-term outcomes (more than 1 and half years) in the neurosurgical patients who needed prolonged propofol-remifentanil anesthesia. Data were collected via medical records and descriptive analysis was conducted. RESULTS: Thirty one neurosurgical patients underwent 34 operations using propofol-remifentanil anesthesia for more than 10 hours from November 2005 to January 2007. Mean duration of anesthesia and surgery was 936 +/- 279 and 805 +/- 283 min, respectively. Propofol and remifentanil were administered with a mean infusion rate of 7.2 +/- 1.8 mg/kg/h and 8.6 +/- 2.4microg/kg/h, respectively. Vasopressors were used in six cases during anesthetic management. Intraoperative hypotension occurred in two patients. Even though hepatic, cardiac, and renal enzymes elevated transiently in some patients during postanesthetic course, any significant lactic acidosis did not occur in them. Two patients died of sepsis and GI bleeding thereafter. Median days of hospital admission and stay at neurosurgical care unit were 36.5 days and 8 days. CONCLUSIONS: A retrospective analysis of the prolonged propofol and remifentanil anesthesia for 34 neurosurgical cases did not show any morbidities and mortalities related to intravenous anesthetics.ope