Remifentanil-clonidine-propofol versus sufentanil-propofol anesthesia for coronary artery bypass surgery.
OBJECTIVE
To compare a remifentanil-clonidine-propofol regimen with conventional sufentanil-propofol anesthesia.


METHODS
Randomized, nonblinded trial.


METHODS
A single university hospital.


METHODS
Male patients scheduled for coronary artery bypass graft (CABG) surgery.


METHODS
In the control group, anesthesia was induced with 0.5 microg/kg of sufentanil and 0.2 to 0.3 mg/kg of etomidate after preoxygenation. Propofol (50 to 100 microg/kg/min) and sufentanil (0.5 to 1.0 microg/kg/h) were started after endotracheal intubation. Sufentanil was stopped after aortic decannulation. In the remifentanil-clonidine group, anesthesia was started with remifentanil (0.15 to 0.3 microg/kg/min), followed by etomidate (0.2 to 0.3 mg/kg). Propofol was started at 50 to 100 microg/kg/min, and after endotracheal intubation, clonidine infusion was started (6 to 20 microg/h). Patients received piritramide (0.15 mg/kg) and metamizole (20 mg/kg) for transitional analgesia. In both groups, propofol infusion was reduced to 30 to 60 microg/kg/min at skin closure and stopped when assisted spontaneous breathing led to adequate gas exchange.


RESULTS
The main outcomes were recovery times; somatic variables; plasma catecholamine levels; and self-recorded pain, nausea, and vomiting. Patients in the remifentanil-clonidine group were extubated earlier and had lower plasma epinephrine and norepinephrine levels. After transitional analgesia, the remifentanil-clonidine patients had similar postoperative analgesic use and self-reported pain and side-effect scores.


CONCLUSIONS
Compared with a sufentanil-propofol regimen, an anesthetic regimen for CABG surgery that combines remifentanil, clonidine, and propofol provides similar hemodynamics. The remifentanil-clonidine regimen reduces catecholamine levels and hastens recovery from anesthesia.
Gerlach
K
K
Department of Anesthesiology, University Lübeck, Lübeck, Germany. klaus.gerlach@medinf.mu-luebeck.de
Uhlig
Th
T
Hüppe
M
M
Kraatz
E
E
Saager
L
L
Schmitz
A
A
Dörges
V
V
Schmucker
P
P
D000759:Adjuvants, Anesthesia / Q000008:administration & dosage; D000316:Adrenergic alpha-Agonists / Q000008:administration & dosage / Q000009:adverse effects; D000368:Aged; D000701:Analgesics, Opioid / Q000008:administration & dosage* / Q000009:adverse effects; D000762:Anesthesia Recovery Period; D019162:Anesthetics, Combined / Q000009:adverse effects; D018686:Anesthetics, Intravenous / Q000008:administration & dosage* / Q000009:adverse effects; D002395:Catecholamines / Q000097:blood; D003000:Clonidine / Q000008:administration & dosage / Q000009:adverse effects; D001026:Coronary Artery Bypass; D006439:Hemodynamics; D006801:Humans; D007431:Intraoperative Complications; D008297:Male; D008875:Middle Aged; D010880:Piperidines / Q000008:administration & dosage / Q000009:adverse effects; D015742:Propofol / Q000008:administration & dosage / Q000009:adverse effects; D000077208:Remifentanil; D017409:Sufentanil / Q000008:administration & dosage / Q000009:adverse effects
D000759:Adjuvants, Anesthesia; D000316:Adrenergic alpha-Agonists; D000701:Analgesics, Opioid; D019162:Anesthetics, Combined; D018686:Anesthetics, Intravenous; D002395:Catecholamines; D010880:Piperidines; D017409:Sufentanil; D003000:Clonidine; D000077208:Remifentanil; D015742:Propofol