Efficacy of Remifentanil in Patients Undergoing Cardiac Surgery: A Systematic Review and Network Meta-Analysis

Remifentanil, characterized by its ultra-short action duration and nonorgan-dependent metabolism, is applied in postcardiac surgery settings worldwide. While previous studies have compared its efficacy with that of other opioids, it has never been compared to a single specific opioid. Here, we evalu...

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Bibliographic Details
Published in:Curēus (Palo Alto, CA) CA), 2023-12, Vol.15 (12), p.e51278-e51278
Main Authors: Okano, Hiromu, Kataoka, Yuki, Sakuraya, Masaaki, Aoki, Yoshitaka, Okamoto, Hiroshi, Imai, Eriya, Yamazaki, Tsutomu
Format: Article
Language:English
Subjects:
Bias
Clinical trials
Critical care
Data collection
Extubation
Fentanyl
Heart surgery
Hemodynamics
Intensive care
Intervention
Morphine
Narcotics
Patients
Sensitivity analysis
Systematic review
Ventilators
Web portals
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Summary:Remifentanil, characterized by its ultra-short action duration and nonorgan-dependent metabolism, is applied in postcardiac surgery settings worldwide. While previous studies have compared its efficacy with that of other opioids, it has never been compared to a single specific opioid. Here, we evaluated whether remifentanil shortens mechanical ventilation (MV) times in patients after cardiac surgery. We identified randomized controlled trials that compared various opioids in adults (≥18 years) admitted to the intensive care unit after cardiac surgery. The primary outcome was the duration of MV, expressed as the mean difference (MD) in minutes, with a 95% confidence interval (CI). A 60-min reduction was considered significant based on prior research. Data were sourced from MEDLINE, the Cochrane Central Register of Controlled Trials, EMBASE, the World Health Organization International Clinical Trials Platforms Search Portal, and ClinicalTrials.gov, and a frequentist network meta-analysis was conducted. The eight identified studies indicate no differences in the duration of MV between remifentanil and fentanyl (MD 0.09 min; 95%CI -36.89-37.08), morphine (MD -19 min; 95%CI -55.86-16.21), or sufentanil (MD -2.44 min; 95%CI -67.52-62.55). Our study revealed that remifentanil did not reduce MV times in patients after cardiac surgery. The study protocol was registered with the Open Science Forum (https://osf.io/) (DOI 10.17605/OSF.IO/YAHW2).
ISSN:2168-8184
2168-8184
DOI:10.7759/cureus.51278