Effect of high dose remifentanil or sufentanil on postoperative pulmonary function in patients undergoing coronary surgery

Introduction

Intraoperative use of high dose opioid anesthesia is common practice for hemodynamic control in patients undergoing coronary artery bypass grafting (CABG). It is unclear whether postoperative pulmonary function is affected by this practice. Remifentanil is an ultra-short acting μ-agonistic opioid [1]. We hypothesized that remifentanil is associated with improved pulmonary function, compared with longer acting opioids. Therefore, we performed a controlled randomized trial to evaluate pulmonary function in patients undergoing CABG with high dose remifentanil versus sufentanil.

Methods

Fifty patients undergoing CABG were randomized to receive intraoperative remifentanil or sufentanil via continuous infusion. Demographic data, surgery, and anaesthesia times, ICU and hospital LOS, Parsonett, and Tumanscore were recorded. Pulmonary function was evaluated by measuring functional residual capacity (FRC), CO₂-rebreathing method, spirometry, and chest radiography before surgery, and up to the third postoperative day.

Results

Demographic data, risk scores, weaning time, and surgery characteristics did not differ between groups. Lung volumes decreased to 21% vs 26% compared with preoperative values, and reached 48% vs 76% on the third postoperative day. Postoperative CO₂ sensivity was significantly decreased in both groups. Partial lung collapse on postoperative chest X-ray was present in half of the patients. No differences between groups could be detected for any measurement.

Conclusion

Pulmonary function is impaired after CABG. Despite its short half-life, intraoperative use of high dose remifentanil was not associated with an improvement of pulmonary function, compared with sufentanil.