Comparison of Fentanyl, Remifentanil, Sufentanil and Alfentanil in Combination with Propofol for General Anesthesia: A Systematic Review and Meta-analysis of Randomized Controlled Trials.

IF 3.2 Q2 Pharmacology, Toxicology and Pharmaceutics Current clinical pharmacology Pub Date : 2019-01-01 DOI:10.2174/1567201816666190313160438
Kannan Sridharan, Gowri Sivaramakrishnan
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引用次数: 23

Abstract

Background: Opioid analgesics are commonly used along with propofol during general anesthesia. Due to the dearth of data on the quality of anesthesia achieved with this combination, the present meta-analysis was carried out.

Methods: Electronic databases were searched for appropriate studies using a suitable search strategy. Randomized clinical trials comparing the combination of remifentanil/sufentanil/alfentanil with propofol with fentanyl and propofol, were included. The outcome measures were as follows: total propofol dose to achieve the desired general anesthesia; time of onset and duration of general anesthesia; depth of general anesthesia; and recovery time (time for eye-opening and time taken for extubation). Risk of bias was assessed and Forest plots were generated for eligible outcomes. The weighted mean difference [95% confidence intervals] was used as the effect estimate.

Results: Fourteen studies were included in the systematic review and 13 were included in the metaanalysis. Statistically significant differences were observed for remifentanil in comparison to fentanyl when combined with propofol: Propofol dose (in mg) -76.18 [-94.72, -57.64]; time of onset of anesthesia (min) -0.44 [-0.74, -0.15]; time taken for eye-opening (min) -3.95 [-4.8, -3.1]; and time for extubation (min) -3.53 [-4.37, -2.7]. No significant differences were observed for either sufentanil or alfentanil about the dose of propofol required and due to scanty data, pooling of the data could not be attempted for other outcome measures for either sufentanil or alfentanil.

Conclusion: To conclude, we found that remifentanil has a statistically significant anesthetic profile than fentanyl when combined with propofol. Scanty evidence for both alfentanil and sufentanil precludes any such confirmation.

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芬太尼、瑞芬太尼、舒芬太尼和阿芬太尼联合异丙酚全麻的比较:随机对照试验的系统评价和meta分析。
背景:阿片类镇痛药常与异丙酚一起用于全身麻醉。由于缺乏这种联合麻醉质量的数据,因此进行了本荟萃分析。方法:采用合适的检索策略在电子数据库中检索合适的研究。纳入比较瑞芬太尼/舒芬太尼/阿芬太尼联合异丙酚与芬太尼和异丙酚的随机临床试验。观察指标为:异丙酚总剂量达到预期的全麻效果;全麻起效时间及持续时间;全身麻醉深度;恢复时间(睁眼时间和拔管时间)。对偏倚风险进行了评估,并为符合条件的结果生成了森林图。采用加权均值差[95%置信区间]作为效果估计。结果:系统评价纳入14项研究,荟萃分析纳入13项研究。瑞芬太尼与芬太尼联用异丙酚时差异有统计学意义:异丙酚剂量(mg) -76.18 [-94.72, -57.64];麻醉起效时间(min) -0.44 [-0.74, -0.15];睁眼时间(min) -3.95 [-4.8, -3.1];拔管时间(min) -3.53[-4.37, -2.7]。未观察到舒芬太尼和阿芬太尼所需异丙酚的剂量有显著差异,由于数据不足,无法对舒芬太尼和阿芬太尼的其他结局指标进行数据汇总。结论:综上所述,我们发现瑞芬太尼与异丙酚联合使用时比芬太尼具有统计学上显著的麻醉效果。阿芬太尼和舒芬太尼的证据不足,因此无法作出任何确认。
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Current clinical pharmacology
Current clinical pharmacology PHARMACOLOGY & PHARMACY-
CiteScore
3.60
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期刊介绍: Current Clinical Pharmacology publishes frontier reviews on all the latest advances in clinical pharmacology. The journal"s aim is to publish the highest quality review articles in the field. Topics covered include: pharmacokinetics; therapeutic trials; adverse drug reactions; drug interactions; drug metabolism; pharmacoepidemiology; and drug development. The journal is essential reading for all researchers in clinical pharmacology.
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