Remifentanil-clonidine-propofol versus sufentanil-propofol anesthesia for coronary artery bypass surgery

• Published in: Journal of cardiothoracic and vascular anesthesia 2002-12, Vol.16 (6), p.703-708
• Main Authors: Gerlach, K., Uhlig, Th, Hüppe, M., Kraatz, E., Saager, L., Schmitz, A., Dörges, V., Schmucker, P.
• Format: Article
• Language: English
• Subjects: Adjuvants, Anesthesia - administration & dosage; Adrenergic alpha-Agonists - administration & dosage; Adrenergic alpha-Agonists - adverse effects; Aged; Analgesics, Opioid - administration & dosage; Analgesics, Opioid - adverse effects; Anesthesia; Anesthesia Recovery Period; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Anesthetics, Combined - adverse effects; Anesthetics, Intravenous - administration & dosage; Anesthetics, Intravenous - adverse effects; Biological and medical sciences; Catecholamines - blood; clonidine; Clonidine - administration & dosage; Clonidine - adverse effects; Coronary Artery Bypass; coronary artery bypass graft (CABG) surgery; General anesthesia. Technics. Complications. Neuromuscular blocking. Premedication. Surgical preparation. Sedation; Hemodynamics; Humans; Intraoperative Complications; Male; Medical sciences; Middle Aged; Piperidines - administration & dosage; Piperidines - adverse effects; plasma catecholamine levels; Propofol - administration & dosage; Propofol - adverse effects; remifentanil; sufentanil; Sufentanil - administration & dosage; Sufentanil - adverse effects
• ISSN: 1053-0770; 1532-8422
• DOI: 10.1053/jcan.2002.128415

Objective: To compare a remifentanil-clonidine-propofol regimen with conventional sufentanil-propofol anesthesia. Design: Randomized, nonblinded trial. Setting: A single university hospital. Participants: Male patients scheduled for coronary artery bypass graft (CABG) surgery. Interventions: In the control group, anesthesia was induced with 0.5 μg/kg of sufentanil and 0.2 to 0.3 mg/kg of etomidate after preoxygenation. Propofol (50 to 100 μg/kg/min) and sufentanil (0.5 to 1.0 μg/kg/h) were started after endotracheal intubation. Sufentanil was stopped after aortic decannulation. In the remifentanil-clonidine group, anesthesia was started with remifentanil (0.15 to 0.3 μg/kg/min), followed by etomidate (0.2 to 0.3 mg/kg). Propofol was started at 50 to 100 μg/kg/min, and after endotracheal intubation, clonidine infusion was started (6 to 20 μg/h). Patients received piritramide (0.15 mg/kg) and metamizole (20 mg/kg) for transitional analgesia. In both groups, propofol infusion was reduced to 30 to 60 μg/kg/min at skin closure and stopped when assisted spontaneous breathing led to adequate gas exchange. Measurements and Main Results: The main outcomes were recovery times; somatic variables; plasma catecholamine levels; and self-recorded pain, nausea, and vomiting. Patients in the remifentanil-clonidine group were extubated earlier and had lower plasma epinephrine and norepinephrine levels. After transitional analgesia, the remifentanil-clonidine patients had similar postoperative analgesic use and self-reported pain and side-effect scores. Conclusion: Compared with a sufentanil-propofol regimen, an anesthetic regimen for CABG surgery that combines remifentanil, clonidine, and propofol provides similar hemodynamics. The remifentanil-clonidine regimen reduces catecholamine levels and hastens recovery from anesthesia. Copyright 2002, Elsevier Science (USA). All rights reserved.