Comparison of Remifentanil and Alfentanil Bolus Dose on Extubation Emergence Hemodynamic Profiles, a Randomized Double-blinded Placebo- Controlled Trial

Hemodynamic instability is common during emergence from anesthesia which predisposes patients to development of different side effects. The primary purpose of the present study is to evaluate the effect of Remifentanil and Alfentanil on the hemodynamic profiles during and after extubation. Ninety-nine patients aged 20-50 years undergoing minor orthopedic surgery under general anesthesia were randomly allocated into control, Remifentanil and Alfentanil groups. Before extubation patients received Remifentanil (1 µg/kg), or Alfentanil (10 µg/kg) or 5 mL of Saline as a placebo based on their group. Baseline heart rate (HR), mean arterial pressure (MAP) plus systolic blood pressure (SBP) and diastolic blood pressure (DBP) were recorded and documented again on extubation, and 1, 3 and 5 minutes after extubation. Cough status before and after extubation was recorded. The basic characteristics of participants in all the three groups were similar. The rise in SBP on extubation in the placebo group was statistically significant compared to the Alfentanil (p=0.01) and the Remifentanil (p<0.001) groups. Mean arterial pressure decreased during the extubation in group R (97.0±13 mmHg) in contrast to other two groups (A=101.9±13 mmHg, P=101.4±13 mmHg). Heart rate increased in group A and P contrary to group R on extubation. Remifentanil (1µg/kg) and Alfentanil (10µg/kg) attenuate the rise in SBP on extubation but no significant changes were seen between these two drugs.