After entry to the operating room, HR, BP, and peripheral oxygen saturation were recorded for all patients; subsequently, dexamethasone 0.1 mg/kg and glycopyrrolate 0.005 mg/kg were administered. After pre-oxygenation, propofol 2 mg/kg and rocuronium 0.8 mg/kg were administered. The anesthesia was maintained with desflurane and was adjusted according to the bispectral index (BIS) level goal, which is from 30 to 60.
In the case of the T group, the Ce of remifentanil before intubation was set to 5.0–7.0 ng/mL using the syringe pump with a Minto model (Orchestra® Base Primea, Fresenius Kabi, VL, France) [17 (link)]. During surgery, the patients’ BP and HR were monitored, and the Ce of remifentanil was adjusted within the range of 1.0–3.0 ng/mL. In the M group, 0.7–1 µg/kg of remifentanil was administered before intubation using an infusion pump (Terufusion® Infusion Pump, Terumo, Tokyo, Japan). During surgery, remifentanil was titrated within the range of 0.05–0.2 µg/min/kg against HR and BP within a 20% range of baseline measurements. In both groups, if vital signs could not be controlled by remifentanil alone, a vasoconstrictor (phenylephrine, 50 µg) or vasodilator (nicardipine, 500 µg) was administered.
Remifentanil was discontinued during skin closure, and desflurane was discontinued when the position was changed from lithotomy to supine after surgery, and glycopyrrolate 0.005 mg/kg and pyridostigmine 0.25 mg/kg were administered as reversal agents of neuromuscular blockers. At the end of surgery, fentanyl-based (17.5 µg/kg) intravenous patient-controlled analgesia was administered to all of the participants until POD2. Additional opioids or analgesics were administered when patients complained of pain with an NRS pain score of ≥3 or if the patient required analgesics. In the PACU, fentanyl was administered as a bolus dose of 1 µg/kg. On POD1, intravenous acetaminophen 750 mg and per os ibuprofen 200 mg were used, and on POD2, ibuprofen was administered alone.
In the case of the T group, the Ce of remifentanil before intubation was set to 5.0–7.0 ng/mL using the syringe pump with a Minto model (Orchestra® Base Primea, Fresenius Kabi, VL, France) [17 (link)]. During surgery, the patients’ BP and HR were monitored, and the Ce of remifentanil was adjusted within the range of 1.0–3.0 ng/mL. In the M group, 0.7–1 µg/kg of remifentanil was administered before intubation using an infusion pump (Terufusion® Infusion Pump, Terumo, Tokyo, Japan). During surgery, remifentanil was titrated within the range of 0.05–0.2 µg/min/kg against HR and BP within a 20% range of baseline measurements. In both groups, if vital signs could not be controlled by remifentanil alone, a vasoconstrictor (phenylephrine, 50 µg) or vasodilator (nicardipine, 500 µg) was administered.
Remifentanil was discontinued during skin closure, and desflurane was discontinued when the position was changed from lithotomy to supine after surgery, and glycopyrrolate 0.005 mg/kg and pyridostigmine 0.25 mg/kg were administered as reversal agents of neuromuscular blockers. At the end of surgery, fentanyl-based (17.5 µg/kg) intravenous patient-controlled analgesia was administered to all of the participants until POD2. Additional opioids or analgesics were administered when patients complained of pain with an NRS pain score of ≥3 or if the patient required analgesics. In the PACU, fentanyl was administered as a bolus dose of 1 µg/kg. On POD1, intravenous acetaminophen 750 mg and per os ibuprofen 200 mg were used, and on POD2, ibuprofen was administered alone.
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