Abstract
Neurolept anaesthesia is used during awake craniotomy for epilepsy surgery. This study compares analgesia, sedation and the side effects of the newer opioids sufentanil and alfentanil, with those of fentanyl in patients undergoing awake craniotomy. Thirty patients were randomized into three groups, each received droperidol, dimenhydrinate and the chosen opioid as a bolus followed by an infusion. The opioid doses used were fentanyl 0.75 μg · kg−1 plus 0.01 μg · kg−1 · min−1; sufentanil 0.075 μg · kg−1 plus 0.0015 μg · kg−1 · min−1, and alfentanil 7.5 μg · kg−1 plus 0.5 μg · kg−1 · min−1. There were no differences in the requirements for droperidol, dimenhydrinate or in the incidence of complications among the three groups. The total doses of the opioids required were fentanyl 4.9 ±1.3 μg · kg−1, sufentanil 0.6 ±0.2 μg · kg−1 and alfentanil 149 ±36 μg · kg−1. Two patients became uncooperative requiring general anaesthesia. The conditions for surgery, electrocorticography and for stimulation testing were satisfactory in all other patients. We conclude that the newer opioids did not offer any benefit over fentanyl.
Résumé
Le traitement chirurgical de l’épilepsie par craniotomie se fait souvent à l’état vigile sous neuroleptanalgésie. Cette étude vise à comparer l’analgésie, la sédation et les effets secondaires des nouveaux morphiniques sulfentanil et alfentanil avec le fentanyl chez des malades en cours de cranitomie vigile. Trente patients sont distribués au hasard en trois groupes, chacun recevant dropéridol, dimenhydrinate et un des morphiniques en bolus suivi d’un perfusion. La posologie est pour le fentanyl de 0,75 μg · kg−1 et par la suite de 0,01 μg · kg−1 · min−1; pour le sufentanil de 0,075 μg · kg−1 et par la suite de 0,0015 μg · kg−1 · min−1 et pour l’alfentanil de 7,5 μg · kg−1 et par la suite de 0,5 μg · kg−1 · min−1. Les besoins de dropéridol et de dimenhydrinate et l’incidence de complication ont été les mêmes pour les trois groupes. La dose totale est pour le fentanyl 4,9 ±1,3 μg · kg−1, Ie sufentanil, 0,6 ±0,2 μg · kg−1 et l’alfentanil de 149 ±36 μg · kg−1. Deux malades qui ont cessé de collaborer, doivent être anesthésiés. Les conditions de la chirurgie, de l’électrocorticographie et des tests de stimulation sont satisfaisantes pour tous les autres patients. Nous concluons que les nouveaux morphiniques n’offrent aucun avantage sur le fentanyl.
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Gignac, E., Manninen, P.H. & Gelb, A.W. Comparison of fentanyl, sufentanil and alfentanil during awake craniotomy for epilepsy. Can J Anaesth 40, 421–424 (1993). https://doi.org/10.1007/BF03009510
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DOI: https://doi.org/10.1007/BF03009510