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 cordduring major spinal surgery is highly desirable to prevent postoperativeneurological deficits. wake-up test is a simple, safeand reliable method of recognition of such a complication, andhas been extensively used in many spinal surgical units. thepresent study is evaluating the remifentanil, propofol versusalfentanil, propofol as a part of balanced anesthesia for rapidperformance of wake-up test during major spinal surgery.methods: fifty patients undergoing elective spinal surgerywere randomized to receive either remifentanillpropofol(group a) or alfentanillpropofol (group b). premedicated patientsreceived remifentanil (a loading dose of 2 (mu)g/kg and acontinuous infusion of i (mu)g/kg/rnin), or alfentanil (a loadingdose of 25 (mu)g/kg and a continuous infusion of 1 (mu)g/kg/min).propofol was given as a loading dose of 1.5 mg/kg and a continuousinfusion of 100 (mu)g/kg/min.the awakening was accomplished by withdrawing propofoland n20 at 20 and 5 minutes before the test, respectively,whereas remifentanil or alfentanil infusion continued throughthe wake-up period at a rate of 0.02 ug/kg/min.results: the onset of intra-operative neurological examinationin remifentanillpropofol receiving group (4.6(plus-minus) 1.4 minutes)was significantly faster than that for alfentanil/propofolreceiving group (7.5(plus-minus)1.8 minutes).conclusion: combination of remifentanil and propofol induceda balanced anesthesia for intra-operative awakening andprovided a faster opportunity for detecting any potential damagethat may occur during spinal instrumentation.