Comparison of Sufentanil and Remifentanil Infusion During General Anaesthesia for Removal of Wisdom Teeth in Ambulatory Surgery
Condition: Tooth Extractions
Study type: Interventional
Phase: Phase 4

Summary: 
      Wisdom teeth removal under general anaesthesia is usually suitable for ambulatory surgery.

      The choice of opioid in dental day surgery is based on the need for a rapid and full
      recovery, as well as less morphine administration. Whether remifentanil can achieve these
      goals remains to be proved, especially regarding remifentanil-induced hyperalgesia, the
      potential prolonged Post Anesthesia Care Unit (PACU) stay, or remifentanil-induced workload
      for nurses.
    

Detailed description: 
      Patients will be enrolled during the preoperative anaesthetic assessment. Premedication will
      be achieved with oral administration of hydroxyzine 1 mg/kg the morning before surgery.

      The induction of general anaesthesia will be achieved using TARGET CONTROLLED INFUSION (TCI)
      of propofol associated to TCI of remifentanil or sufentanil, depending on randomization.

      The conditions of endotracheal intubation will be evaluated by the Percentage Of Glottic
      Opening Score (POGO) and the Cormack and Lehane Score.

      Mechanical volume-controled ventilation will aim to maintain normocapnia. The baseline
      inspiratory gas will be a mixture of 45% oxygen and 55% nitrous oxide.

      Bispectral Index recording and vital signs monitoring (heart rate and arterial blood
      pressure) will be used to monitor the depth of anaesthesia.

      Dexamethasone 0.3 mg/kg will be administered after induction of general anaesthesia as part
      of our routine practice.

      Patients will be extubated as soon as possible after the end of the surgery and transferred
      to the PACU.

      Nurses in charge patients included in the study will be blinded to the opiod agent
      administered peroperatively.

      Postoperative pain will be assessed using the simple numeric scale. A pain score above 3/10
      will prompt the intravenous administration of titrated morphine chlorhydrate, as guided by a
      written protocol.

      Patient will be transferred from the PACU to the ambulatory surgery unit when the Aldrete
      score is greater or equal to 9. Every patient included will received 1 gr of intravenous
      paracetamol two hours after the arrival hour in the PACU.

      Pain monitoring will be continued in the ambulatory surgery unit, and morphine chlorhydrate
      will be orally administered (10 mg) if pain score is above 3/10.

      Post anaesthetic discharge for home readiness will be given when the Post Anesthetic
      Discharge Scoring System (PADSS) is greater or equal to 9.

      48 hours after the surgery, one of us, blinded to the opiod agent received by the patient,
      will contact every included patient by phone, in order to evaluate postoperative pain,
      potential side effects including nausea and vomiting, and patient satisfaction.
    

Intervention name(s): Remifentanil
Intervention type(s): Drug
Intervention description(s): Wisdom teeth removal under general anaesthesia is usually suitable for ambulatory surgery.
The choice of opioid in dental day surgery is based on the need for a rapid and full recovery, as well as less morphine administration. Whether remifentanil can achieve these goals remains to be proved, especially regarding remifentanil-induced hyperalgesia, the potential prolonged Post Anesthesia Care Unit (PACU) stay, or remifentanil-induced workload for nurses.
Intervention MeSH terms: Remifentanil
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Double (Participant, Care Provider)
Primary purpose: Treatment
Keywords: Remifentanil; Sufentanil; Surgical removal of three to four wisdom teeth; General anaesthesia; Ambulatory oral surgery; Target Controlled Infusion (TCI); Opioid induced hyperalgesia; Postoperative nausea and vomiting; Postoperative Morphine consumption; Under General anaesthesia; In Ambulatory surgery