Comparison between high-dose sufentanil-oxygen and high-dose fentanyl-oxygen for neuroanaesthesia.

The cardiovascular responses to anaesthesia, neurosurgery and the postoperative administration of naloxone were studied in 20 patients. Ten patients were anaesthetized with sufentanil 20 micrograms kg-1 and 10 with fentanyl 100 micrograms kg-1, and oxygen. At 30-min intervals, sufentanil 50 micrograms or fentanyl 250 micrograms was given to maintain anaesthesia. Mean arterial pressure and heart rate did not increase following intubation, incision of the scalp or infusion of naloxone. Because of inadequate anaesthesia, thiopentone was administered at the end of surgery to one patient who had received sufentanil and seven patients who received fentanyl. Apart from one patient in each group the tracheal tubes were removed within 1 h of the start of the administration of naloxone. Recall of tracheal intubation or surgery was not reported by any patient. High-dose sufentanil-oxygen anaesthesia, like high-dose fentanyl-oxygen anaesthesia, was satisfactory for use in neurosurgery. However, high-dose narcotic anaesthesia, followed by the postoperative administration of naloxone, requires that skilled nursing care be available for many hours after surgery.