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Mood change after anaesthesia with remifentanil or alfentanil

Published online by Cambridge University Press:  23 December 2004

T. A. Crozier ,
D. Kietzmann  and
B. Döbereiner
T. A. Crozier
Affiliation:
University of Göttingen, Department of Anaesthesiology, Göttingen, Germany
D. Kietzmann
Affiliation:
Uppsala University Hospital, Department of Anesthesia, Uppsala, Sweden
B. Döbereiner
Affiliation:
Øksnes legekontor, Myre, Norway
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Extract

Summary

Background and objective: There are anecdotal reports of dysphoria occurring in patients on the first day after anaesthesia with remifentanil. This study was performed to investigate this allegation and to find a possible relationship to postoperative shivering or to nausea and vomiting.

Methods: Patients undergoing otorhinolaryngeal surgery took part in a prospective, randomized, double-blind study comparing total intravenous anaesthesia with propofol (2 mg kg−1 bolus injection then 100 μg kg−1 min−1) and remifentanil (1 μg kg−1 bolus then 0.1–0.5 μg kg−1 min−1) or alfentanil (30 μg kg−1 bolus then 0.16–0.83 μg kg−1 min−1). The patients were carefully insulated and actively warmed by convective heating and rectal temperature was monitored continuously. Postoperative shivering was graded on a three-point scale, and the cumulative incidence of nausea and vomiting were registered at 24 h after surgery. Pre- and postoperative mood was measured with the von Zerssen mood scale (Befindlichkeits-Skala) and changes tested for significance. High scores reflect discontent and dysphoria.

Results: The data of 98 patients (49 in each group, ASA I–II, age 42 ± 13 yr, anaesthesia time 141 ± 60 min; mean ± SD; intergroup P values >0.1) were evaluated. Core temperature did not change perioperatively (before 36.6 ± 0.2°C; after 36.8 ± 0.3°C, inter- and intragroup P > 0.1). The incidence of nausea was the same in each group; vomiting occurred with equal frequency (6/49 vs. 7/49). Shivering was significantly more frequent after remifentanil (41% vs. 10%, P < 0.001). The patients' mood remained stable after remifentanil but worsened after alfentanil (von Zerssen score from 9.3 ± 2.5 to 13.9 ± 3.6; mean ±95% confidence intervals; P < 0.01).

Discussion: Postoperative shivering was more frequent after remifentanil but was unrelated to intraoperative heat loss. Contrary to preliminary informal observations, there was no evidence that remifentanil caused post-anaesthetic dysphoria on the day one after surgery.

Keywords

ANALGESICS, OPIOID, remifentanil, alfentanilBODY TEMPERATURE REGULATION, thermogenesis, shiveringDYSPHORIAMOOD CHANGESIGNS AND SYMPTOMS, DIGESTIVE, nausea, postoperative nausea and vomiting
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 21 , Issue 1 , January 2004 , pp. 20 - 24
Copyright
2004 European Society of Anaesthesiology

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