Propofol-alfentanil vs propofol-remifentanil for posterior spinal fusion including wake-up test

Background. Wake-up test can be used during posterior spinal fusion (PSF) to ensure that spinal function remains intact. This study aims at assessing the characteristics of the wake-up test during propofol-alfentanil (PA) vs propofol-remifentanil (PR) infusions for PSF surgery. Methods. Sixty patients with scoliosis and candidates for PSF surgery were randomly allocated in either alfentanil (PA) or remifentanil (PR) group. After an i.v. bolus of alfentanil 30 μg kg-1 in the PA group or remifentanil 1 μg kg-1 in the PR group, anaesthesia was induced with thiopental and atracurium. During maintenance, opioid infusion consisted of alfentanil 1 μg kg-1 min-1 or remifentanil 0.2 μg kg-1 min-1, in the PA group and the PR group, respectively. All patients received propofol 50 μg kg-1 min-1. Atracurium was given to maintain the required surgical relaxation. At the surgeon's request, all infusions were discontinued. Patients were asked to move their hands and feet. Time from anaesthetic discontinuation to spontaneous ventilation (T1), and from then until movement of the hands and feet (T2), and its quality were recorded. Results. The average T1 and T2 were significantly shorter in the PR group 3.6 (2.5) and 4.1 (2) min than the PA group 6.1 (4) and 7.5 (4.5) min. Quality of wake-up test, however, did not show significant difference between the two groups studied. Conclusion. Wake-up test can be conducted faster with remifentanil compared with alfentanil infusion during PSF surgery. © 2006 Oxford University Press