Introduction: Remifentanil is frequently used during transsphenoidal surgery as an anesthetic adjunct during periods of intense noxious stimulation or to control blood pressure. It also allows for a rapid and well-controlled emergence, which is particularly desirable in transsphenoidal surgery when there is no surgical incision to close. Although some studies have examined the safety of remifentanil in patients undergoing neurosurgical procedures, none has examined its safety in transsphenoidal operations specifically. We analyzed 540 patients undergoing transsphenoidal surgery to evaluate the relative safety of intra-operative use of remifentanil.
Methods: All transsphenoidal operations performed by the senior author from 2008 to 2015 were retrospectively reviewed. Patients with missing anesthesia records were excluded.
Results: During the study period, 540 transsphenoidal operations were identified. Of these, 443 (82.0%) patients received remifentanil intra-operatively; 97 (18.0%) did not. The two groups were well-matched with regard to demographic categories, comorbidities, and pre-operative medications (p>0.05), except pre-operative tobacco use (p=0.021).
Patients were also well-matched with regard to radiographic features and surgical techniques. Patients who received remifentanil were more likely to harbor a macroadenoma (78.1% vs. 67.0%, p=0.025), and had slightly longer anesthesia time on average (269.2 min vs. 239.4 min, p=0.024). All pathologic diagnoses were well-matched between the two groups, except patients receiving remifentanil were more likely to harbor non-functioning adenoma (46.5% vs. 26.8%, p<0.001).
Analysis of post-operative complications showed no significant difference between patients who received remifentanil and those who did not. Complications included post-operative SIADH, transient diabetes insipidus (DI), permanent DI, cerebrospinal fluid leak, epistaxis, visual field deficit, reoperation, hemorrhage, sinus infection, readmission, carotid damage, abscess, meningitis, infection, and estimated blood loss.
Conclusions: In a well-matched series of 540 patients undergoing transsphenoidal surgery, remifentanil was found to be a safe anesthetic adjunct. There was no significant difference in post-operative complications in patients who did and did not receive intra-operative remifentanil.
Patient Care: Remifentanil is a frequently used anesthetic adjunct that has not been analyzed for safety among transsphenoidal operations. We aimed to determine whether remifentanil affects the rate of post-operative complications after pituitary surgery.
Learning Objectives: By the conclusion of this session, participants should be able to:
1) Understand the uses of remifentanil in transsphenoidal surgery
2) Discuss the safety of remifentanil in patients undergoing pituitary surgery