TY - JOUR
T1 - A randomized double-blinded multicenter comparison of remifentanil versus fentanyl when combined with isoflurane/propofol for early extubation in coronary artery bypass graft surgery
AU - Howie, Michael B.
AU - Cheng, Davy
AU - Newman, Mark F.
AU - Pierce, Eric T.
AU - Hogue, Charles
AU - Hillel, Zak
AU - Bowdle, T. Andrew
AU - Bukenya, Deo
PY - 2001
Y1 - 2001
N2 - We compared a fentanyl/isoflurane/propofol regimen with a remifentanil/isoflurane/propofol regimen for fast-track cardiac anesthesia in a prospective, randomized, double-blinded study on patients undergoing elective coronary artery bypass graft surgery. Anesthesia was induced with a 1-min infusion of 0.5 mg/kg propofol followed by 10-mg boluses of propofol every 30 s until loss of consciousness. After 0.2 mg/kg cisatracurium, a blinded continuous infusion of remifentanil at 1/μg · kg-1 · min-1 or the equivalent volume rate of normal saline was then started. In addition, a blinded bolus syringe of 1/μg/kg remifentanil or 10/μg/kg fentanyl, respectively, was given over 3 min. Blinded remifentanil, 1/μg · kg-1 · min-1 (or the equivalent volume rate of normal saline), together with 0.5% isoflurane, were used to maintain anesthesia. Significantly more patients (P < 0.01) in the fentanyl regimen experienced hypertension during skin incision and maximum sternal spread compared with patients in the remifentanil regimen. There were no differences between the groups in time until extubation, discharge from the surgical intensive care unit, ST segment and other electrocardiogram changes, catecholamine levels, or cardiac enzymes. The remifentanil-based anesthetic (consisting of a bolus followed by a continuous infusion) resulted in significantly less response to surgical stimulation and less need for anesthetic interventions compared with the fentanyl regimen (consisting of an initial bolus, and followed by subsequent boluses only to treat hemodynamic responses) with both drug regimens allowing early extubation.
AB - We compared a fentanyl/isoflurane/propofol regimen with a remifentanil/isoflurane/propofol regimen for fast-track cardiac anesthesia in a prospective, randomized, double-blinded study on patients undergoing elective coronary artery bypass graft surgery. Anesthesia was induced with a 1-min infusion of 0.5 mg/kg propofol followed by 10-mg boluses of propofol every 30 s until loss of consciousness. After 0.2 mg/kg cisatracurium, a blinded continuous infusion of remifentanil at 1/μg · kg-1 · min-1 or the equivalent volume rate of normal saline was then started. In addition, a blinded bolus syringe of 1/μg/kg remifentanil or 10/μg/kg fentanyl, respectively, was given over 3 min. Blinded remifentanil, 1/μg · kg-1 · min-1 (or the equivalent volume rate of normal saline), together with 0.5% isoflurane, were used to maintain anesthesia. Significantly more patients (P < 0.01) in the fentanyl regimen experienced hypertension during skin incision and maximum sternal spread compared with patients in the remifentanil regimen. There were no differences between the groups in time until extubation, discharge from the surgical intensive care unit, ST segment and other electrocardiogram changes, catecholamine levels, or cardiac enzymes. The remifentanil-based anesthetic (consisting of a bolus followed by a continuous infusion) resulted in significantly less response to surgical stimulation and less need for anesthetic interventions compared with the fentanyl regimen (consisting of an initial bolus, and followed by subsequent boluses only to treat hemodynamic responses) with both drug regimens allowing early extubation.
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U2 - 10.1097/00000539-200105000-00003
DO - 10.1097/00000539-200105000-00003
M3 - Article
C2 - 11323327
AN - SCOPUS:0035035428
SN - 0003-2999
VL - 92
SP - 1084
EP - 1093
JO - Anesthesia and analgesia
JF - Anesthesia and analgesia
IS - 5
ER -