A Comparative Study of Remifentanil/Propofol versus Alfentanil/Propofol for Wake-up Test in Major Spinal Surgery

Background: Early warning of potential damage to spinal cord during major spinal surgery is highly desirable to prevent post-operative 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 remifentanil/propofol (group A) or alfentanil/propofol (group B). Premedicated patients received remifentanil (a loading dose of 2 μg/kg and a continuous infusion of 1 μg/kg/min), or alfentanil (a loading dose of 25 μg/kg and a continuous infusion of 1 μg/kg/min). Propofol was given as a loading dose of 1.5 mg/kg and a continuous infusion of 100 μg/kg/min.The awakening was accomplished by withdrawing propofol and N2O 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 remifentanil/propofol receiving group (4.6±1.4 minutes) was significantly faster than that for alfentanil/propofol receiving group (7.5±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.Iran J Med Sci 2006; 31(4): 196-199. Keywords ● Surgery ●