Opioid analgesics are commonly used along with propofol during general anesthesia. Due to dearth of data on the quality of anesthesia achieved with the this combination, the present meta-analysis was carried out.
Electronic databases were searched for appropriate studies using 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 the following: total propofol dose to achieve 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. Weighted mean difference [95% confidence intervals] was used as the effect estimates.
Fourteen studies were included in the systematic review and 13 included in the meta-analysis. 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.
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.