Supplemental remifentanil during coronary artery bypass grafting is followed by a transient postoperative cardiac depression.
BACKGROUND
The pharmacokinetic properties of the short-acting micro opioid receptor-agonist remifentanil makes it possible to give cardiac surgical patients a deep intraoperative anesthesia without experiencing postoperative respiratory depression and a prolonged stay in the intensive care unit (ICU). However, previous investigations have shown that patients who received remifentanil required additional analgesia during the early postoperative period as compared to patients who received fentanyl. The aim of the present study therefore was to investigate the effects of supplementing remifentanil to a standard fentanyl-based anesthesia in coronary artery bypass grafting (CABG).


METHODS
The study was prospective, randomized, double-blind, and placebo-controlled. Twenty male patients aged 55-70 years were included. All patients received a standard fentanyl and isoflurane-based anesthesia. In addition, the patients were randomized to receive either remifentanil 0.5 micro g kg(-1) min(-1) or placebo during surgery. Hemodynamic recordings and measurements of blood glucose and plasma adrenaline and noradrenaline were performed intra- and postoperatively.


RESULTS
Remifentanil reduced the hemodynamic and metabolic response to surgical stress compared to the standard fentanyl-based anesthetic regimen. However, the patients in the remifentanil group had a lower cardiac output (CO), left ventricular stroke work index (LVSWI), and mixed venous oxygen saturation (SvO(2)), and a higher central venous pressure (CVP) than the patients in the placebo group during the early postoperative phase, indicating a postoperative cardiac depression in the remifentanil group.


CONCLUSIONS
In CABG, remifentanil reduces the hemodynamic and metabolic responses during surgery but seems to give a cardiac depression in the early postoperative phase.
Pleym
H
H
Department of Anesthesiology, st Olav University Hospital, Trondheim, Norway. hide.pleym@stolav.no
Stenseth
R
R
Wiseth
R
R
Karevold
A
A
Dale
O
O
D000368:Aged; D000768:Anesthesia, General; D000771:Anesthesia, Intravenous; D018686:Anesthetics, Intravenous / Q000009:adverse effects*; D001145:Arrhythmias, Cardiac / Q000139:chemically induced / Q000453:epidemiology; D015415:Biomarkers; D001784:Blood Gas Analysis; D001026:Coronary Artery Bypass; D003402:Creatine Kinase / Q000097:blood; D003864:Depression, Chemical; D004311:Double-Blind Method; D015716:Electrocardiography, Ambulatory; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D007527:Isoenzymes / Q000097:blood; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D010880:Piperidines / Q000009:adverse effects*; D011183:Postoperative Complications / Q000139:chemically induced* / Q000503:physiopathology*; D015742:Propofol; D011446:Prospective Studies; D000077208:Remifentanil; D019210:Troponin I / Q000097:blood
D018686:Anesthetics, Intravenous; D015415:Biomarkers; D007527:Isoenzymes; D010880:Piperidines; D019210:Troponin I; D003402:Creatine Kinase; D000077208:Remifentanil; D015742:Propofol