Background: In patients undergoing general anesthesia, the combination of remifentanil and propofol is widely used for its rapid onset, short context-sensitive half-time, and predictable pharmacokinetics. However, rising costs and drug shortages have prompted an evaluation of alternative adjuncts. This study aimed to determine whether remifentanil–propofol provides superior perioperative outcomes compared to propofol combined with other analgesics, including alfentanil, sufentanil, fentanyl, ketamine, dexmedetomidine, and lidocaine.
Methods: A narrative literature review was conducted using PubMed and Embase, focusing on randomized controlled trials, observational studies, and pharmacokinetic analyses relevant to anesthetic practice. Search terms included propofol, remifentanil, opioids, ketamine, dexmedetomidine, lidocaine, and pharmacokinetics. Studies relevant to pharmacokinetics and perioperative outcomes were selected, while non-clinical and non-comparative studies were excluded. Data were synthesized qualitatively, emphasizing elimination half-life, context-sensitive half-time, metabolism, and accumulation; formal quality assessment was not performed.
Results: Remifentanil demonstrated a unique context-insensitive half-life (3–10 minutes) with minimal accumulation, enabling precise titration and rapid emergence, supporting improved intraoperative control and shorter recovery times. In contrast, fentanyl, alfentanil, and sufentanil exhibited longer, infusion-dependent contextsensitive half-times, leading to accumulation and delayed or less predictable recovery. Ketamine, dexmedetomidine, and lidocaine provided favorable adjunctive effects such as hemodynamic stability and postoperative analgesia but demonstrated longer elimination profiles and less predictable offset.
Conclusion: Remifentanil–propofol is associated with improved perioperative outcomes, particularly in settings requiring rapid titration and predictable emergence. While alternative agents offer specific advantages, their pharmacokinetic limitations reduce their ability to consistently replicate this efficiency. These findings should be interpreted within the limitations of a narrative review without formal quality assessment.
Methods: A narrative literature review was conducted using PubMed and Embase, focusing on randomized controlled trials, observational studies, and pharmacokinetic analyses relevant to anesthetic practice. Search terms included propofol, remifentanil, opioids, ketamine, dexmedetomidine, lidocaine, and pharmacokinetics. Studies relevant to pharmacokinetics and perioperative outcomes were selected, while non-clinical and non-comparative studies were excluded. Data were synthesized qualitatively, emphasizing elimination half-life, context-sensitive half-time, metabolism, and accumulation; formal quality assessment was not performed.
Results: Remifentanil demonstrated a unique context-insensitive half-life (3–10 minutes) with minimal accumulation, enabling precise titration and rapid emergence, supporting improved intraoperative control and shorter recovery times. In contrast, fentanyl, alfentanil, and sufentanil exhibited longer, infusion-dependent contextsensitive half-times, leading to accumulation and delayed or less predictable recovery. Ketamine, dexmedetomidine, and lidocaine provided favorable adjunctive effects such as hemodynamic stability and postoperative analgesia but demonstrated longer elimination profiles and less predictable offset.
Conclusion: Remifentanil–propofol is associated with improved perioperative outcomes, particularly in settings requiring rapid titration and predictable emergence. While alternative agents offer specific advantages, their pharmacokinetic limitations reduce their ability to consistently replicate this efficiency. These findings should be interpreted within the limitations of a narrative review without formal quality assessment.