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Remifentanil provides better protection against noxious stimuli during cardiac surgery than alfentanil

Published online by Cambridge University Press:  23 December 2004

J. H. Heijmans ,
J. G. Maessen  and
P. M. H. J. Roekaerts
J. H. Heijmans
Affiliation:
University Hospital Maastricht, Department of Anaesthesiology, Maastricht, The Netherlands
J. G. Maessen
Affiliation:
University Hospital Maastricht, Department of Cardio-Thoracic Surgery, Maastricht, The Netherlands
P. M. H. J. Roekaerts
Affiliation:
University Hospital Maastricht, Department of Anaesthesiology, Maastricht, The Netherlands
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Abstract

Summary

Background and objective: We hypothesized that remifentanil–propofol cardiac anaesthesia, plus administration of pirinitramide (piritramide) upon cessation of the remifentanil infusion, would be associated with a shorter time to tracheal extubation than alfentanil–propofol anaesthesia, without the occurrence of major haemodynamic instability.

Methods: Haemodynamic stability and recovery characteristics of two remifentanil infusion regimens (0.5 μg kg−1 min−1; 0.25 μg kg−1 min−1) were therefore compared with an alfentanil infusion regimen (1 μg kg−1 min−1), in combination with target-controlled infusion of propofol, in a randomized blinded trial in 75 coronary artery surgery patients.

Results: Pirinitramide provided good postoperative analgesia without prolonging extubation times: median extubation time in minutes after stopping the opioid-sedative drugs was 300 in the higher-dose remifentanil group and 270 in the lower-dose remifentanil group and alfentanil group (P = 0.606). Significant time-by-treatment interactions were seen for systolic arterial pressure (P = 0.015), mean arterial pressure (P = 0.009) and diastolic arterial pressure (P = 0.006). No significant interaction (P = 0.489) and no constant treatment effect were seen for heart rate (P = 0.288). Time effects were highly significant (P < 0.0001) for all haemodynamic variables. Heart rate remained stable in all groups. In the higher-dose remifentanil group, blood pressure was significantly different and lower during surgery and in this group less bolus doses of the opioid-sedative drugs (P = 0.015) had to be given.

Conclusion: The higher-dose remifentanil infusion provided superior suppression of haemodynamic responses to noxious stimuli with better haemodynamic stability.

Keywords

ANAESTHETICS, INTRAVENOUS, alfentanil, propofol, remifentanilARTIFICIAL, ventilator weaningCARDIOVASCULAR SURGICAL PROCEDURESHAEMODYNAMICSINTENSIVE CARERESPIRATION
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 21 , Issue 8 , August 2004 , pp. 612 - 618
Copyright
2004 European Society of Anaesthesiology

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References

Phillips AS, McMurray TJ, Mirakhur RK, Gibson FM, Elliott P. Propofol–fentanyl anesthesia: a comparison with isoflurane–fentanyl anesthesia in coronary artery bypass grafting and valve replacement surgery. J Cardiothorac Vasc Anesth 1994; 8: 289–296.Google Scholar
Hall RI, Murphy JT, Landymore R, Pollak PT, Doak G, Murray M. Myocardial metabolic and hemodynamic changes during propofol anesthesia for cardiac surgery in patients with reduced ventricular function. Anesth Analg 1993; 77: 680–689.Google Scholar
Roekaerts PMHJ, Gerrits HJ, Timmerman BE, De Lange S. Continuous infusions of alfentanil and propofol for coronary artery surgery. J Cardiothorac Vasc Anesth 1995; 9: 362–367.Google Scholar
Glass PSA, Hardman D, Kamiyama Y, et al. Preliminary pharmacokinetics and pharmacodynamics of an ultra-short-acting opioid: remifentanil (G187084B). Anesth Analg 1993; 77: 1031–1040.Google Scholar
Gray JM, Kenny GN. Development of the technology for ‘Diprifusor’ TCI systems. Anaesthesia 1998; 53 (Suppl 1): 22–27.Google Scholar
Sebel PS, Lowdon JD. Propofol: a new intravenous anesthetic. Anesthesiology 1989; 71: 260–277.Google Scholar
Kapila A, Glass PSA, Jacobs JR, et al. Measured context-sensitive half-times of remifentanil and alfentanil. Anesthesiology 1995; 83: 968–975.Google Scholar
Burkle H, Dunbar S, Van Aken H. Remifentanil: a novel, short-acting, μ-opioid. Anesth Analg 1996; 83: 646–651.Google Scholar
Bowdle TA, Ready LB, Kharasch ED. Transition to post-operative epidural or patient-controlled intravenous analgesia following total intravenous anaesthesia with remifentanil and propofol for abdominal surgery. Eur J Anaesthesiol 1997; 14: 374–379.Google Scholar
Albrecht S, Schuttler J, Yarmush J. Postoperative pain management after intraoperative remifentanil. Anesth Analg 1999; 89: S40–S45.Google Scholar
Fletcher D, Pinaud M, Scherpereel P, Clyti N, Chauvin M. The efficacy of intravenous 0.15 vs. 0.25 mg/kg intraoperative morphine for immediate postoperative analgesia after remifentanil-based anesthesia for major surgery. Anesth Analg 2000; 90: 666–671.Google Scholar
Yarmush J, D’Angelo R, Kirkhart B, et al. A comparison of remifentanil and morphine sulfate for acute postoperative analgesia after total intravenous anesthesia with remifentanil and propofol. Anesthesiology 1997; 87: 235–243.Google Scholar
Elliott P, O’Hare R, Bill KM, Phillips AS, Gibson FM, Mirakhur RK. Severe cardiovascular depression with remifentanil. Anesth Analg 2000; 91: 58–61.Google Scholar
Kazmaier S, Hanekop GG, Buhre W, et al. Myocardial consequences of remifentanil in patients with coronary artery disease. Br J Anaesth 2000; 84: 578–583.Google Scholar
Kumar N, Rowbotham DJ. Piritramide. Br J Anaesth 1999; 82: 3–5.Google Scholar
Ramsay MA, Savege TM, Simpson BR, Goodwin R. Controlled sedation with alphaxalone–alphadolone. BMJ 1974; 2: 656–659.Google Scholar
Barvais L, Rausin I, Glen JB. Administration of propofol by target-controlled infusion in patients undergoing coronary artery surgery. J Cardiothorac Vasc Anesth 1996; 10: 877–883.Google Scholar
Vuyk J, Mertens MJ, Olofsen E, Burm AG, Bovill JG. Propofol anesthesia and rational opioid selection. Anesthesiology 1997; 87: 1549–1562.Google Scholar
Olivier P, Sirieix D, Dassier P, D’Attellis N, Baron JF. Continuous infusion of remifentanil and target-controlled infusion of propofol for patients undergoing cardiac surgery: a new approach for scheduled early extubation. J Cardiothorac Vasc Anesth 2000; 14: 29–35.Google Scholar
Philbin DM, Rosow CE, Schneider RC, Koski G, D'Ambra MN. Fentanyl and sufentanil anesthesia revised: how much is enough? Anesthesiology 1990; 73: 5–11.Google Scholar
Hogue CWJ, Bowdle TA, O'Leary C. A multicenter evaluation of total intravenous anesthesia with remifentanil and propofol for elective inpatient surgery. Anesth Analg 1996; 83: 279–285.Google Scholar
Schraag S, Checketts MR, Kenny GNC. Lack of rapid development of opioid tolerance during alfentanil and remifentanil infusions for postoperative pain. Anesth Analg 1999; 89: 753–757.Google Scholar
Cortinez LI, Brandes V, Munoz HR, Guerrero ME, Mur M. No clinical evidence of acute opioid tolerance after remifentanil-based anaesthesia. Br J Anaesth 2001; 87: 866–869.Google Scholar
Coriat P, Beaussier M. Fast tracking after coronary artery bypass graft surgery. Anesth Analg 2001; 92: 1081–1083.Google Scholar