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.