[Remifentanil and alfentanil: Sympathetic-adrenergic effect in the first postoperative phase in patients at cardiovascular risk].
Extubation and the immediate postoperative period are critical periods with strong sympatho-adrenergic stimulation. The aim of the present study was to investigate this period after balanced anaesthesia with remifentanil and alfentanil in cardiac risk patients.


METHODS
52 patients with coronary artery disease or with risk factors for coronary heart disease scheduled for elective extraperitoneal and extrathoracic operation were included in this study. Anaesthesia was induced by intravenous administration of etomidate, vecuronium and remifentanil (n = 27, 1 microgram/kg) or alfentanil (n = 25, 25 micrograms/kg). Anaesthesia was maintained with an Isoflurane/N2O/O2 mixture and by continuous intravenous infusion of remifentanil (0.25 microgram/kg/min) or alfentanil (45 micrograms/kg/h). During the first 60 minutes after extubation haemodynamic parameters were monitored and catecholamines were determined at defined time intervals. Parameters of recovery, the requirement of analgesics and cardiac medications were compared in both groups. Myocardial ischaemia was assessed by two-channel Holter electrocardiography.


RESULTS
The beginning of spontaneous respiration and time of extubation were similar in both groups. The time interval until opening eyes and the time between the beginning of spontaneous respiration and extubation was shorter in the patients treated with remifentanil. In this group patients suffered earlier from pain and had a higher pain score. Although the plasma catecholamines were comparable in both groups, in the patients treated with remifentanil changes in haemodynamic parameters were more pronounced. The incidence of shivering and the requirements of analgesics and cardiac medications were higher in these patients. The incidence of ST-segment changes indicating myocardial ischaemia was similar.


CONCLUSIONS
After balanced anaesthesia with remifentanil a more pronounced sympatho-adrenergic stimulation occurs because of the more rapid clearance of the analgesic effect in the recovery period compared to alfentanil requiring more analgesics and medications for the control of the haemodynamic parameters. Because of these specific pharmacological effects the use of remifentanil in cardiac risk patients has to be critically discussed.
Apitzsch
H
H
Klinik und Poliklinik für Anästhesiologie und Intensivtherapie, Universität Leipzig.
Olthoff
D
D
Thieme
V
V
Wiegel
M
M
Bohne
V
V
Vetter
B
B
D000368:Aged; D015760:Alfentanil; D000771:Anesthesia, Intravenous; D018686:Anesthetics, Intravenous; D002318:Cardiovascular Diseases / Q000150:complications*; D002395:Catecholamines / Q000097:blood; D004562:Electrocardiography; D015716:Electrocardiography, Ambulatory; D005260:Female; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D008297:Male; D010880:Piperidines; D011183:Postoperative Complications / Q000139:chemically induced* / Q000503:physiopathology; D000077208:Remifentanil; D012307:Risk Factors; D013564:Sympathetic Nervous System / Q000187:drug effects*
D018686:Anesthetics, Intravenous; D002395:Catecholamines; D010880:Piperidines; D015760:Alfentanil; D000077208:Remifentanil
Remifentanil und Alfentanil: Sympathiko-adrenerge Effekte in der frühen postoperativen Phase beim kardiovaskulären Risikopatienten.