Remifentanil in cardiac anesthesia: influence on postoperative ICU course

Introduction

Remifentanil (R) a new short-acting opioid, has been introduced in cardiac total intravenous anesthesia to solve the problems connected with the adminstration of long-acting opioids. Aim of our study was to evaluate the efficacy of R in optimizing mechanical ventilation and ICU stay after cardiac surgery.

Methods

We studied 30 consecutive pts, EF >40% scheduled for elective coronary surgery. Pts were randomized in two different groups: Group R (16 pts) receiving remifentanil, and group F treated with moderate dose fentanyl (14 pts). Induction of anesthesia was performed in both groups with fentanyl 15 μg/kg per min, vecuronium 0.15 mg/kg and thiopentone 0.5–1 mg/kg. In group R anesthesia was then maintained with continuous infusion of propofol 1–3 mg/kg per h and remifentanil 0.5–1 μg/kg per min running throughout the surgical procedure. In group F the maintenance was obtained with propofol 1–3 mg/kg per h and fenatyl 5–7 μg/kg per h running throughout the surgical procedure too. Propofol was continued at dose 0.5–1 mg/kg per h in the ICU until 30 min previous extubation in all pts. In adjunction pts of group R received remifentanil 0.1–0.2 μg/kg per min until extubation. In both groups we evaluated the duration of mechanical ventilation and of ICU stay. All data were analysed with t-test (P < 0.05).

Results

Mean time of mechanical ventilation was 4 ± 1.3 h in group F vs 9 ± 15 h in group R (P < 0.05). In group R mean ICU stay was shorter than group F: 18 h vs 27 h (P < 0.05). Global ICU cost charge/pt was $930 in group R vs $1390 in group F, according to DRG coefficients.

Discussion

Our experience suggests that remifentanil, combined with propofol, can improve early extubation and reduce ICU stay in uncomplicated CABG pts with good EF, so leading to a trend in cost reduction.