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Remifentanil or sufentanil for coronary surgery: comparison of postoperative respiratory impairment

Published online by Cambridge University Press:  02 March 2006

H. Guggenberger ,
T. H. Schroeder ,
R. Vonthein ,
H.-J. Dieterich ,
S. K. Shernan  and
H. K. Eltzschig
H. Guggenberger
Affiliation:
Tübingen University Hospital, Department of Anesthesiology and Intensive Care Medicine, Tübingen, Germany
T. H. Schroeder
Affiliation:
Tübingen University Hospital, Department of Anesthesiology and Intensive Care Medicine, Tübingen, Germany
R. Vonthein
Affiliation:
Tübingen University Hospital, Department of Medical Biometry, Tübingen, Germany
H.-J. Dieterich
Affiliation:
Tübingen University Hospital, Department of Anesthesiology and Intensive Care Medicine, Tübingen, Germany
S. K. Shernan
Affiliation:
Harvard Medical School, Brigham and Women's Hospital, Department of Anesthesiology, Perioperative and Pain Medicine, Boston, MA, USA
H. K. Eltzschig
Affiliation:
Tübingen University Hospital, Department of Anesthesiology and Intensive Care Medicine, Tübingen, Germany
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Abstract

Summary

Background and objective: High-dose opioid anaesthesia contributes to decreasing metabolic and hormonal stress responses in patients undergoing cardiac surgery. However, the increase in context-sensitive half-life of opioids given as a high-dose regimen can affect postoperative respiratory recovery. In contrast, remifentanil can be given in high doses without prolonging context-sensitive half-life due to its rapid metabolism. Therefore, we performed a prospective, randomized trial to compare anaesthesia consisting of propofol/remifentanil or propofol/sufentanil with regard to postoperative respiratory function and outcome. Methods: Patients undergoing coronary artery bypass grafting were randomized to a propofol/remifentanil (0.5–1.0 μg kg−1 min−1) or propofol/sufentanil (30–40 ng kg−1 min−1) based anaesthetic. Carbon dioxide response, forced expiratory volume in one second, vital capacity, and functional residual capacity were measured 1 day prior to the operation, 1 h before extubation, 1, 24 and 72 h after extubation. In addition, the incidence of atelectasis, pulmonary infiltrates, intensive care unit and postoperative length of stay were compared. Patients and physicians were blinded to the treatment group. Results: Twenty-five patients in each treatment group completed the study. There was no difference between patients of the treatment groups regarding demographics, risk- or pain scores. In all patients, carbon dioxide response, forced expiratory volume in one second, vital capacity and functional residual capacity were decreased postoperatively compared to baseline. Patients randomized to remifentanil had less depression of carbon dioxide response, less atelectasis and shorter postoperative length of stay (12 d vs. 10 d) than after sufentanil (P < 0.05). Conclusions: Intraoperative use of high-dose remifentanil for coronary artery bypass grafting may be associated with improved recovery of pulmonary function and shorter postoperative hospital length of stay than sufentanil.

Keywords

RESPIRATORY FUNCTION TESTS, vital capacity, forced expiratory volumeATELECTASISCARDIAC SURGERYPOSTOPERATIVE PULMONARY FUNCTIONANALGESICS, OPIOID, sufentanil, remifentanil
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 23 , Issue 10 , October 2006 , pp. 832 - 840
Copyright
2006 European Society of Anaesthesiology

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References

Tonnesen E, Brinklov MM, Christensen NJ, Olesen AS, Madsen T. Natural killer cell activity and lymphocyte function during and after coronary artery bypass grafting in relation to the endocrine stress response. Anesthesiology 1987; 67: 526–533.Google Scholar
Anand K, Hickey P. Halothane–morphine compared with high-dose sufentanil for anesthesia and postoperative analgesia in neonatal cardiac surgery. New Engl J Med 1992; 326: 1–9.Google Scholar
Lappas DG, Geha D, Fischer JE, Laver MB, Lowenstein E. Filling pressures of the heart and pulmonary circulation of the patient with coronary-artery disease after large intravenous doses of morphine. Anesthesiology 1975; 42: 153–159.Google Scholar
Brix-Christensen V, Tonnesen E, Sorensen IJ, Bilfinger TV, Sanchez RG, Stefano GB. Effects of anaesthesia based on high versus low doses of opioids on the cytokine and acute-phase protein responses in patients undergoing cardiac surgery. Acta Anaesthesiol Scand 1998; 42: 63–70.Google Scholar
Caspi J, Klausner JM, Safadi T, Amar R, Rozin RR, Merin G. Delayed respiratory depression following fentanyl anesthesia for cardiac surgery. Crit Care Med 1988; 16: 238–240.Google Scholar
Rady MY, Ryan T, Starr NJ. Early onset of acute pulmonary dysfunction after cardiovascular surgery: risk factors and clinical outcome. Crit Care Med 1997; 25: 1831–1839.Google Scholar
Kollef M, Wragge T, Pasque C. Determinants of mortality and multiorgan dysfunction in cardiac surgery patients requiring prolonged mechanical ventilation. Chest 1995; 107: 1395–1401.Google Scholar
Messent M, Sullivan K, Keogh BF, Morgan CJ, Evans TW. Adult respiratory distress syndrome following cardiopulmonary bypass: incidence and prediction. Anaesthesia 1992; 47: 267–268.Google Scholar
Myles PS, Hunt JO, Fletcher Het al. Remifentanil, fentanyl, and cardiac surgery: a double-blinded, randomized, controlled trial of costs and outcomes. Anesth Analg 2002; 95: 805–812.Google Scholar
Schraag S, Mohl U, Hirsch M, Stolberg E, Georgieff M. Recovery from opioid anesthesia: the clinical implication of context-sensitive half-times. Anesth Analg 1998; 86: 184–190.Google Scholar
Mirenda J, Tabatabai M, Wong K. Delayed and prolonged rigidity greater than 24 h following high-dose fentanyl anesthesia. Anesthesiology 1988; 69: 624–625.Google Scholar
Kapila A, Glass PS, Jacobs JRet al. Measured context-sensitive half-times of remifentanil and alfentanil. Anesthesiology 1995; 83: 968–975.Google Scholar
Dershwitz M, Hoke JF, Rosow CEet al. Pharmacokinetics and pharmacodynamics of remifentanil in volunteer subjects with severe liver disease. Anesthesiology 1996; 84: 812–820.Google Scholar
Engoren M, Luther G, Fenn-Buderer N. A comparison of fentanyl, sufentanil, and remifentanil for fast-track cardiac anesthesia. Anesth Analg 2001; 93: 859–864.Google Scholar
Olivier P, Sirieix D, Dassier P, D'Attellis N, Baron JF. Continuous infusion of remifentanil and target-controlled infusion of propofol for patients undergoing cardiac surgery: a new approach for scheduled early extubation. J Cardiothorac Vasc Anesth 2000; 14: 29–35.Google Scholar
Nieuwenhuijs D, Bruce J, Drummond GB, Warren PM, Dahan A. Influence of oral tramadol on the dynamic ventilatory response to carbon dioxide in healthy volunteers. Br J Anaesth 2001; 87: 860–865.Google Scholar
Obrador GT, Pereira BJ, Kausz AT. Chronic kidney disease in the United States: an underrecognized problem. Semin Nephrol 2002; 22: 441–448.Google Scholar
Rubin LJ. Primary pulmonary hypertension. New Engl J Med 1997; 336: 111–117.Google Scholar
Conlon P, Stafford-Smith M, White Wet al. Acute renal failure following cardiac surgery. Nephrol Dial Transpl 1999; 14: 1158–1162.Google Scholar
Gust R, Pecher S, Gust A, Hoffmann V, Bohrer H, Martin E. Effect of patient-controlled analgesia on pulmonary complications after coronary artery bypass grafting. Crit Care Med 1999; 27: 2218–2223.Google Scholar
Lehmann A, Zeitler C, Thaler E, Isgro F, Boldt J. Comparison of two different anesthesia regimens in patients undergoing aortocoronary bypass grafting surgery: sufentanil–midazolam versus remifentanil–propofol. J Cardiothorac Vascul Anesth 2000; 14: 416–420.Google Scholar
Read DJ, Leigh J. Blood–brain tissue PCO2 relationships and ventilation during rebreathing. J Appl Physiol 1967; 23: 53–70.Google Scholar
Babenco HD, Conard PF, Gross JB. The pharmacodynamic effect of a remifentanil bolus on ventilatory control. Anesthesiology 2000; 92: 393–398.Google Scholar
Schibler A, Hammer J, Isler R, Buess C, Newth CJ. Measurement of lung volume in mechanically ventilated monkeys with an ultrasonic flow meter and the nitrogen washout method. Intensive Care Med 2003; 30 (1): 127–132.Google Scholar
Zinserling J, Wrigge H, Varelmann D, Hering R, Putensen C. Measurement of functional residual capacity by nitrogen washout during partial ventilatory support. Intensive Care Med 2003; 29: 720–726.Google Scholar
Parsonnet V, Dean D, Bernstein AD. A method of uniform stratification of risk for evaluating the results of surgery in acquired adult heart disease. Circulation 1989; 79: I3–I12.Google Scholar
Tuman KJ, McCarthy RJ, March RJ, Najafi H, Ivankovich AD. Morbidity and duration of ICU stay after cardiac surgery: a model for preoperative risk assessment. Chest 1992; 102: 36–44.Google Scholar
Van Der Linden PJ, Daper A, Trenchant A, De Hert SG. Cardioprotective effects of volatile anesthetics in cardiac surgery. Anesthesiology 2003; 99: 516–517.Google Scholar
Weissman C. Pulmonary function after cardiac and thoracic surgery. Anesth Analg 1999; 88: 1272–1279.Google Scholar
Mollhoff T, Herregods L, Moerman Aet al. Comparative efficacy and safety of remifentanil and fentanyl in fast-track coronary artery bypass graft surgery: a randomized, double-blind study. Br J Anaesth 2001; 87: 718–726.Google Scholar
Cheng DCH, Newman MF, Duke Pet al. The efficacy and resource utilization of Remifentanil and Fentanyl in fast-track coronary artery bypass graft surgery: a prospective randomized, double-blinded controlled, multi-center trial. Anesth Analg 2001; 92: 1094–1102.Google Scholar
Kern H, Kox WJ. Impact of standard procedures and clinical standards on cost-effectiveness and intensive care unit performance in adult patients after cardiac surgery. Intensive Care Med 1999; 25: 1367–1373.Google Scholar
Kogan A, Cohen J, Raanani Eet al. Readmission to the intensive care unit after “fast-track” cardiac surgery: risk factors and outcomes. Ann Thorac Surg 2003; 76: 503–507.Google Scholar
Yukioka H, Tanaka M, Fujimori M. Recovery of bowel motility after high dose fentanyl or morphine anaesthesia for cardiac surgery. Anaesthesia 1990; 45: 353–356.Google Scholar
Gunaydin B, Babacan A. Cerebral hypoperfusion after cardiac surgery and anesthetic strategies: a comparative study with high dose fentanyl and barbiturate anesthesia. Ann Thorac Cardiovasc Surg 1998; 4: 12–17.Google Scholar