Hemodynamic effects, myocardial ischemia, and timing of tracheal extubation with propofol-based anesthesia for cardiac surgery.
Recent interest in earlier tracheal extubation after coronary artery bypass graft (CABG) surgery has focused attention on the potential benefits of a propofol-based technique. We randomized 124 patients (34 with poor ventricular function) undergoing CABG surgery to receive either a propofol-based (5 mg.kg-1.h-1 prior to sternotomy, 3 mg.kg-1. h-1 thereafter; n = 58) or enflurane-based (0.2%-1.0%, n = 66) anesthetic. Induction of anesthesia consisted of fentanyl 15 micrograms/kg and midazolam 0.05 mg/kg intravenously in both groups. The enflurane group received an additional bolus of fentanyl 5 micrograms/kg prior to sternotomy and fentanyl 10 micrograms/kg with midazolam 0.1 mg/kg at commencement of cardiopulmonary bypass (CPB). Patients receiving propofol were extubated earlier (median 9.1 h versus 12.3 h, P = 0.006), although there was no difference in time to intensive care unit (ICU) discharge (both 22 h, P = 0.54). Both groups had similar hemodynamic changes throughout (all P > 0.10), as well as metaraminol (P = 0.49) and inotrope requirements (P > 0.10), intraoperative myocardial ischemia (P = 0.12) and perioperative myocardial infarction (P = 0.50). The results of this trial suggest that a propofol-based anesthetic, when compared to an enflurane-based anesthetic requiring additional dosing of fentanyl and midazolam for CPB, can lead to a significant reduction in time to extubation after CABG surgery, without adverse hemodynamic effects, increased risk of myocardial ischemia or infarction.
Myles
P S
PS
Department of Anaesthesia, Alfred Hospital, Melbourne, Australia.
Buckland
M R
MR
Weeks
A M
AM
Bujor
M A
MA
McRae
R
R
Langley
M
M
Moloney
J T
JT
Hunt
J O
JO
Davis
B B
BB
D000368:Aged; D000758:Anesthesia / Q000379:methods; D018685:Anesthetics, Inhalation / Q000494:pharmacology; D018686:Anesthetics, Intravenous / Q000494:pharmacology; D001026:Coronary Artery Bypass; D004737:Enflurane / Q000494:pharmacology; D005260:Female; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D007022:Hypotension / Q000188:drug therapy / Q000209:etiology; D007431:Intraoperative Complications / Q000188:drug therapy; D007442:Intubation, Intratracheal; D008297:Male; D008875:Middle Aged; D009200:Myocardial Contraction / Q000187:drug effects; D017202:Myocardial Ischemia / Q000209:etiology*; D015742:Propofol / Q000494:pharmacology; D011446:Prospective Studies; D012121:Respiration, Artificial; D013268:Stimulation, Chemical; D013997:Time Factors; D014662:Vasoconstrictor Agents / Q000627:therapeutic use; D018487:Ventricular Dysfunction, Left / Q000188:drug therapy / Q000209:etiology
D018685:Anesthetics, Inhalation; D018686:Anesthetics, Intravenous; D014662:Vasoconstrictor Agents; D004737:Enflurane; D015742:Propofol