title: Remifentanil-clonidine-propofol versus sufentanil-propofol anesthesia for coronary artery bypass surgery.
abstract: 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.
authors.affiliation: Department of Anesthesiology, University Lübeck, Lübeck, Germany. klaus.gerlach@medinf.mu-luebeck.de
authors.forename: K
authors.initials: K
authors.lastname: Gerlach
authors.forename: Th
authors.initials: T
authors.lastname: Uhlig
authors.forename: M
authors.initials: M
authors.lastname: Hüppe
authors.forename: E
authors.initials: E
authors.lastname: Kraatz
authors.forename: L
authors.initials: L
authors.lastname: Saager
authors.forename: A
authors.initials: A
authors.lastname: Schmitz
authors.forename: V
authors.initials: V
authors.lastname: Dörges
authors.forename: P
authors.initials: P
authors.lastname: Schmucker
mesh_terms: 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
chemical_list: 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