Time to extubation during propofol anesthesia for spine surgery with sufentanil compared with fentanyl: a retrospective cohort study.

STUDY DESIGN

Retrospective cohort study.

OBJECTIVE

This study compares time to extubation between major spine surgery patients anesthetized with fentanyl versus sufentanil infusions in combination with propofol.

SUMMARY OF BACKGROUND DATA

In patients undergoing spinal fusion with intraoperative electrophysiological monitoring of the spinal cord, total intravenous anesthesia with a propofol/opioid combination results in better electrophysiological signals compared with volatile anesthetics. Pharmacokinetic data suggest that total intravenous anesthesia with sufentanil should lead to more rapid emergence from anesthesia than with fentanyl. However, this has never been tested in the spine surgery patient population.

METHODS

With institutional review board approval, all major spine patients receiving a propofol-based total intravenous anesthesia with fentanyl were compared with those receiving sufentanil. Time to extubation, defined as the time from surgical closure to tracheal extubation, was the study outcome. Relevant demographic, anthropomorphic, anesthetic, and surgical data were collected. Association between type of opioid and time to extubation was tested for statistical significance. Multiple linear regression analysis was used to control for confounders.

RESULTS

A total of 167 patients met inclusion criteria (fentanyl = 72, sufentanil = 95). There was no statistically significant difference between the 2 groups in terms of baseline characteristics. Time from surgical closure to extubation in the fentanyl versus sufentanil groups was not statistically different (mean [SD]: 40.2 [26.7] min vs. 45.0 [36.9] min; P = 0.36). On multivariate analysis, total dose of propofol and male sex were associated with increased time to extubation.

CONCLUSION

The use of sufentanil may not reduce time to extubation compared with fentanyl despite its favorable pharmacokinetic profile. Higher doses of propofol and male sex were associated with longer time to extubation and seem to play a greater role than choice of opioid.

LEVEL OF EVIDENCE