Effects of opioids on recovery quality in elderly patients undergoing transurethral laser lithotripsy

Abstract

Objective The current study aimed to evaluate the effects of opioids on recovery quality in elderly patients undergoing transurethral laser lithotripsy. Methods We enrolled 134 patients aged 65-79 y with ASA Ⅰor Ⅱ who underwent laryngeal mask airway anesthesia for elective transurethral laser lithotripsy. The patients were randomly assigned to remifentanil group (group R, n=46), remifentanil and fentanyl combination group(group RF, n=44), fentanyl group(group F, n=44). In group R, propofol and remifentanil was administered by target-controlled infusion(TCI) for anesthesia induction and anesthesia maintenance. In group RF, propofol TCI and fentanyl single-dose 2 μg/kg was administered for anesthesia induction, propofol and remifentanil TCI was administered for anesthesia maintenance. In group F, propofol TCI and fentanyl single-dose 4 μg/kg was administered for anesthesia induction, propofol TCI for anesthesia maintenance. MAP and HR were recorded when patients were sent to the PACU(T1), 2 min before removal of the laryngeal mask airway(T2), the moment of removal of the laryngeal mask airway(T3) and 5 min after removal of the laryngeal mask airway(T4). VAS was evaluated after removal of the laryngeal mask airway and requirement for fentanyl analgesia was evaluated in PACU. Time to eye opening, time to removal of the laryngeal mask airway and length of stay in PACU were recorded and compared. Results MAP [(110±18), (122±13), (121±14) mmHg(1 mmHg=0.133 kPa)] and HR [(79±15), (97±17), (99±18) bpm] were significantly higher in group R than that in group RF(P<0.05). VAS(1.8±1.4) was higher in group R than that in group RF (0.9±0.9) and group F(0.9±0.9). The proportion of patients who needed fentanyl in group R was significantly higher(P<0.05). Time to eye opening, time to removal of the laryngeal mask airway and length of stay in PACU were significantly longer in group F than that in the other two groups(P<0.05). Conclusions Our results showed that the combined use of propofol with fentanyl and remifentanil in elderly patients undergoing transurethral laser lithotripsy who received total intravenous anesthesia provided hemodynamic stability during anesthetic recovery, provided early recovery and adequate postoperative analgesia compared to the administration of propofol in combination with remifentanil or fentanyl alone. Key words: Analgesic, opioid; Aged; Transurethral laser lithotripsy; Target-controlled infusion