The efficacy and resource utilization of remifentanil and fentanyl in fast-track coronary artery bypass graft surgery: a prospective randomized, double-blinded controlled, multi-center trial.
We compared (a) the perioperative complications; (b) times to eligibility for, and actual time of the following: extubation, less intense monitoring, intensive care unit (ICU), and hospital discharge; and (c) resource utilization of nursing ratio for patients receiving either a typical fentanyl/isoflurane/propofol regimen or a remifentanil/isoflurane/propofol regimen for fast-track cardiac anesthesia in 304 adults by using a prospective randomized, double-blinded, double-dummy trial. There were no differences in demographic data, or perioperative mortality and morbidity between the two study groups. The mini-mental status examination at postoperative Days 1 to 3 were similar between the two groups. The eligible and actual times for extubation, less intense monitoring, ICU discharge, and hospital discharge were not significantly different. Further analyses revealed no differences in times for extubation and resource utilization after stratification by preoperative risk scores, age, and country. The nurse/patient ratio was similar between the remifentanil/isoflurane/propofol and fentanyl/isoflu-rane/propofol groups during the initial ICU phase and less intense monitoring phase. Increasing preoperative risk scores and older age (>70 yr) were associated with longer times until extubation (eligible), ICU discharge (eligible and actual), and hospital discharge (eligible and actual). Times until extubation (eligible and actual) and less intense monitoring (eligible) were significantly shorter in Canadian patients than United States' patients. However, there was no difference in hospital length of stay in Canadian and United States' patients. We conclude that both anesthesia techniques permit early and similar times until tracheal extubation, less intense monitoring, ICU and hospital discharge, and reduced resource utilization after coronary artery bypass graft surgery.


CONCLUSIONS
An ultra-short opioid technique was compared with a standard fast-track small-dose opioid technique in coronary artery bypass graft patients in a prospective randomized, double-blinded controlled study. The postoperative recovery and resource utilization, including stratification of preoperative risk score, age, and country, were analyzed.
Cheng
D C
DC
Division of Cardiac Anesthesia & Intensive Care, Toronto General Hospital, University of Toronto, Toronto, Ontario.
Newman
M F
MF
Duke
P
P
Wong
D T
DT
Finegan
B
B
Howie
M
M
Fitch
J
J
Bowdle
T A
TA
Hogue
C
C
Hillel
Z
Z
Pierce
E
E
Bukenya
D
D
D000368:Aged; D000701:Analgesics, Opioid / Q000008:administration & dosage*; D019162:Anesthetics, Combined; D018686:Anesthetics, Intravenous / Q000008:administration & dosage*; D001026:Coronary Artery Bypass; D004311:Double-Blind Method; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage; D006295:Health Resources / Q000706:statistics & numerical data*; D006801:Humans; D007262:Infusions, Intravenous; D007275:Injections, Intravenous; D007362:Intensive Care Units; D007431:Intraoperative Complications; D007442:Intubation, Intratracheal; D007530:Isoflurane / Q000008:administration & dosage; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic; D010880:Piperidines / Q000008:administration & dosage; D011183:Postoperative Complications; D015742:Propofol / Q000008:administration & dosage; D011446:Prospective Studies; D000077208:Remifentanil; D013997:Time Factors
D000701:Analgesics, Opioid; D019162:Anesthetics, Combined; D018686:Anesthetics, Intravenous; D010880:Piperidines; D007530:Isoflurane; D000077208:Remifentanil; D005283:Fentanyl; D015742:Propofol