Continuous infusion of remifentanil and target-controlled infusion of propofol for patients undergoing cardiac surgery: A new approach for scheduled early extubation

• Published in: Journal of cardiothoracic and vascular anesthesia 2000-02, Vol.14 (1), p.29-35
• Main Authors: Olivier, Philippe, Sirieix, Didier, Dassier, Patrick, D'Attellis, Nicola, Baron, Jean-Francois
• Format: Article
• Language: English
• Subjects: Anesthetics, Combined; Anesthetics, Intravenous - administration & dosage; Biological and medical sciences; cardiac surgery; Coronary Artery Bypass; fast track; Female; Hemodynamics; Humans; Intubation, Intratracheal; Male; Medical sciences; Middle Aged; Piperidines - administration & dosage; propofol; Propofol - administration & dosage; Prospective Studies; Remifentanil; rocuronium; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the heart; Time Factors
• ISSN: 1053-0770; 1532-8422
• DOI: 10.1016/S1053-0770(00)90052-1

Objective: To assess hemodynamic stability, postoperative pain management, and the control and timing of early extubation of a total intravenous anesthetic technique using propofol target-controlled infusion (TCI) and remifentanil in cardiac surgery. Design: Prospective study. Setting: University hospital. Participants: Fifty patients scheduled for elective cardiac surgery. Interventions: Premedication consisted of oral midazolam, 0.1 mg/kg. Anesthesia was induced with propofol TCI at a target concentration of 1.5 to 2 μg/mL; remifentanil, 1 μg/kg; and rocuronium. Anesthesia was maintained with propofol at the same target concentration and remifentanil titrated between 0.25 and 1 μg/kg/min. Thirty minutes before the end of surgery, a 0.1-mg/kg bolus of morphine was administered intravenously. Postoperative sedation was achieved by maintaining the propofol infusion until the patient was deemed ready for extubation. Postoperative pain relief was evaluated using a visual analog scale. The intervals between arrival in the intensive care unit, spontaneous ventilation, and extubation were recorded. Measurements and Main Results: Included in this study were 36 men and 14 women (American Society of Anesthesiologist = III; New York Heart Association = II) scheduled for cardiac surgery. All patients remained hemodynamically stable throughout the perioperative period. Thirty-seven patients were successfully extubated during the first 4 postoperative hours. Spontaneous breathing was achieved at a mean interval of 15 ± 5 minutes after propofol discontinuation. The mean interval to extubation was 163 ± 45 minutes after arrival in the intensive care unit. Extubation was performed 48 ± 12 minutes after patients were considered ready to awaken. During spontaneous ventilation, 36 patients received additional boluses of morphine (mean, 2.5 ± 1 mg). Subsequently, all patients achieved a visual analog scale less than 40 mm. Conclusion: The combination of remifentanil and propofol TCI resulted in hemodynamic stability and good postoperative analgesia. This technique allows physicians to schedule the time of extubation in patients undergoing cardiac anesthesia.