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A randomized double-blinded multicenter comparison of remifentanil versus fentanyl when combined with isoflurane/propofol for early extubation in coronary artery bypass graft surgery.

Publication ,  Journal Article
Howie, MB; Cheng, D; Newman, MF; Pierce, ET; Hogue, C; Hillel, Z; Bowdle, TA; Bukenya, D
Published in: Anesth Analg
May 2001

UNLABELLED: We compared a fentanyl/isoflurane/propofol regimen with a remifentanil/isoflurane/propofol regimen for fast-track cardiac anesthesia in a prospective, randomized, double-blinded study on patients undergoing elective coronary artery bypass graft surgery. Anesthesia was induced with a 1-min infusion of 0.5 mg/kg propofol followed by 10-mg boluses of propofol every 30 s until loss of consciousness. After 0.2 mg/kg cisatracurium, a blinded continuous infusion of remifentanil at 1 microg. kg(-1). min(-1) or the equivalent volume rate of normal saline was then started. In addition, a blinded bolus syringe of 1 microg/kg remifentanil or 10 microg/kg fentanyl, respectively, was given over 3 min. Blinded remifentanil, 1 microg. kg(-1). min(-1) (or the equivalent volume rate of normal saline), together with 0.5% isoflurane, were used to maintain anesthesia. Significantly more patients (P < 0.01) in the fentanyl regimen experienced hypertension during skin incision and maximum sternal spread compared with patients in the remifentanil regimen. There were no differences between the groups in time until extubation, discharge from the surgical intensive care unit, ST segment and other electrocardiogram changes, catecholamine levels, or cardiac enzymes. The remifentanil-based anesthetic (consisting of a bolus followed by a continuous infusion) resulted in significantly less response to surgical stimulation and less need for anesthetic interventions compared with the fentanyl regimen (consisting of an initial bolus, and followed by subsequent boluses only to treat hemodynamic responses) with both drug regimens allowing early extubation. IMPLICATIONS: Both fentanyl and the newer opioid remifentanil, when each is combined with isoflurane and propofol, allowed for fast-track cardiac anesthesia. The remifentanil regimen used in this study resulted in significantly less hemodynamic response to surgical stimulation.

Duke Scholars

Published In

Anesth Analg

DOI

ISSN

0003-2999

Publication Date

May 2001

Volume

92

Issue

5

Start / End Page

1084 / 1093

Location

United States

Related Subject Headings

  • Remifentanil
  • Prospective Studies
  • Propofol
  • Piperidines
  • Norepinephrine
  • Middle Aged
  • Male
  • Isoflurane
  • Intubation, Intratracheal
  • Humans
 

Citation

APA
Chicago
ICMJE
MLA
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Howie, M. B., Cheng, D., Newman, M. F., Pierce, E. T., Hogue, C., Hillel, Z., … Bukenya, D. (2001). A randomized double-blinded multicenter comparison of remifentanil versus fentanyl when combined with isoflurane/propofol for early extubation in coronary artery bypass graft surgery. Anesth Analg, 92(5), 1084–1093. https://doi.org/10.1097/00000539-200105000-00003
Howie, M. B., D. Cheng, M. F. Newman, E. T. Pierce, C. Hogue, Z. Hillel, T. A. Bowdle, and D. Bukenya. “A randomized double-blinded multicenter comparison of remifentanil versus fentanyl when combined with isoflurane/propofol for early extubation in coronary artery bypass graft surgery.Anesth Analg 92, no. 5 (May 2001): 1084–93. https://doi.org/10.1097/00000539-200105000-00003.
Howie, M. B., et al. “A randomized double-blinded multicenter comparison of remifentanil versus fentanyl when combined with isoflurane/propofol for early extubation in coronary artery bypass graft surgery.Anesth Analg, vol. 92, no. 5, May 2001, pp. 1084–93. Pubmed, doi:10.1097/00000539-200105000-00003.
Howie MB, Cheng D, Newman MF, Pierce ET, Hogue C, Hillel Z, Bowdle TA, Bukenya D. A randomized double-blinded multicenter comparison of remifentanil versus fentanyl when combined with isoflurane/propofol for early extubation in coronary artery bypass graft surgery. Anesth Analg. 2001 May;92(5):1084–1093.

Published In

Anesth Analg

DOI

ISSN

0003-2999

Publication Date

May 2001

Volume

92

Issue

5

Start / End Page

1084 / 1093

Location

United States

Related Subject Headings

  • Remifentanil
  • Prospective Studies
  • Propofol
  • Piperidines
  • Norepinephrine
  • Middle Aged
  • Male
  • Isoflurane
  • Intubation, Intratracheal
  • Humans