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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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