Effects of remifentanil on in-hospital mortality and length of stay following clipping of intracranial aneurysm: a propensity score-matched analysis.

Abstract:

BACKGROUND:Remifentanil is an ultrashort-acting µ-opioid receptor agonist and is especially suitable for neuroanesthesia. We previously reported that general anesthesia with remifentanil for brain tumor resection was associated with lower postoperative mortality and shorter postoperative length of stay (LOS) when compared with surgeries without remifentanil. This phenomenon may also exist during clipping of intracranial aneurysms (ICAs), where brain tissue frequently suffers ischemia and reperfusion injury. We performed a propensity score-matching study to compare in-hospital mortality and postoperative LOS with and without remifentanil in such patients. METHODS:We used the Diagnosis Procedure Combination inpatient database in Japan that includes 926 acute care hospitals to identify patients who underwent clipping of ICAs under general anesthesia between July and December 2007. RESULTS:Of the 4502 patients who underwent ICA clipping, 1380 propensity-matched pairs (n=2760) were included for outcome comparison. The remifentanil group had significantly lower in-hospital mortality than the nonremifentanil group (4.2% vs. 7.7%; P<0.001). Use of remifentanil was an independent factor for lower in-hospital mortality (odds ratio=0.52; 95% confidence interval, 0.37-0.74; P<0.001). By contrast, postoperative LOS did not differ significantly between the 2 groups. There was no difference in the occurrence of postoperative complications except for hydrocephalus, which was more common with remifentanil. CONCLUSIONS:This retrospective observational study demonstrated a possible relationship between the use of remifentanil for neuroanesthesia and reduced mortality of patients undergoing clipping of ICAs with open craniotomy. Prospective interventional studies are necessary to confirm this relationship.

authors

Uchida K,Yasunaga H,Sumitani M,Horiguchi H,Fushimi K,Yamada Y

doi

10.1097/ANA.0000000000000039

subject

Has Abstract

pub_date

2014-10-01 00:00:00

pages

291-8

issue

4

eissn

0898-4921

issn

1537-1921

journal_volume

26

pub_type

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