Remifentanil Compared With Sufentanil Does Not Enhance Fast-Track Possibilities in Cardiac Surgery—A Randomized Study

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• 作者：Rajesh Bhavsar ; MD ; Pia Katerina Ryhammer ; MD ; Jacob Greisen ; MD ; Linda A. Rasmussen ; RN ; Carl-Johan Jakobsen ; MD ; ^{cjj@dadlnet.dk" class="auth_mail" title="E-mail the corresponding author}
• 关键词：remifentanil ; sufentanil ; fast-track ; cardiac recovery ; ischemic heart disease
• 刊名：Journal of Cardiothoracic and Vascular Anesthesia
• 出版年：2016
• 出版时间：October 2016
• 年：2016
• 卷：30
• 期：5
• 页码：1212-1220
• 全文大小：1137 K

文摘

Progressive cost containment has resulted in a growing interest for fast-track cardiac surgery. Ventilation time and length of stay (LOS) in the intensive care unit (ICU) are important factors in patient turnover, a more efficient use of resources, and early patient mobilization. However, LOS in ICU is not an objective measure because, in addition to medical factors, patient discharge may be guided by logistics and policy, and thus more objective measures are warranted. The authors hypothesized that remifentanil compared with sufentanil would reduce ventilation time and LOS in the ICU and that remifentanil would have beneficial effects on the overall quality of recovery.

Design

A randomized, prospective study.

Participants

Sixty patients scheduled for elective coronary artery bypass grafting with or without aortic valve replacement.

Setting

A university hospital.

Interventions

Patients were assigned randomly to receive either remifentanil or sufentanil combined with propofol.

Measurements and Main Results

Patients with ejection fraction<0.3, myocardial infarction within the last 4 weeks, diabetes, and severe pulmonary or arterial hypertension were excluded. The primary outcome variables were ventilation time and time to eligibility of discharge from the cardiac recovery unit. Secondary outcomes were actual LOS in the cardiac recovery unit and quality of recovery. The groups were comparable in selected demographics and perioperative parameters. There were no differences in ventilation time or eligible ICU discharge time between the groups. Remifentanil patients received more morphine than did the sufentanil patients during recovery (20 mg v 10 mg; p = 0.040). No difference was found in pharmacologic support or use of a pacemaker.

Conclusion

In a fast-track protocol, remifentanil did not seem to be superior to a standard moderate- to high-dose sufentanil regimen.