Time to tracheal extubation after coronary artery surgery with isoflurane, sevoflurane, or target-controlled propofol anesthesia: a prospective, randomized, controlled trial.
OBJECTIVE
To determine if anesthesia with sevoflurane or target-controlled propofol reduced the time to tracheal extubation after coronary artery bypass graft surgery compared with isoflurane anesthesia.


METHODS
A 3-arm (isoflurane, sevoflurane, or propofol), randomized, controlled trial with patients and intensive care staff blinded to the drug allocation.


METHODS
A single, tertiary referral hospital affiliated with the University of Melbourne.


METHODS
Three hundred sixty elective coronary artery surgery patients.


METHODS
Patients received either isoflurane (control group, 0.5%-2% end-tidal concentration), sevoflurane (1%-4% end-tidal concentration), or target-controlled infusion of propofol (1-8 microg/mL plasma target concentration) as part of a balanced, standardized anesthetic technique including 15 microg/kg of fentanyl.


RESULTS
The primary outcome was time to tracheal extubation. The median time to tracheal extubation for the propofol group was 10.25 hours (interquartile range [IQR] 8.08-12.75), the sevoflurane group 9.17 hours (IQR 6.25-11.25), and the isoflurane group 7.67 hours (IQR 6.25-9.42). Intraoperatively, the propofol group required less vasopressor (p = 0.002) and more vasodilator therapy (nitroglycerin p = 0.01, nitroprusside p = 0.002). There was no difference among the groups in time to intensive care unit discharge.


CONCLUSIONS
The median time to tracheal extubation was significantly longer for the target-controlled propofol group. A significantly greater number in this group required the use of a vasodilator to control intraoperative hypertension.
Parker
Francis C
FC
Department of Anaesthesia, Austin Health, Heidelberg, Victoria, Australia.
Story
David A
DA
Poustie
Stephanie
S
Liu
Guoming
G
McNicol
Larry
L
D000368:Aged; D000700:Analgesics / Q000627:therapeutic use; D018685:Anesthetics, Inhalation / Q000627:therapeutic use; D018686:Anesthetics, Intravenous / Q000097:blood / Q000627:therapeutic use; D001026:Coronary Artery Bypass / Q000379:methods*; D005260:Female; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D007362:Intensive Care Units; D007442:Intubation, Intratracheal / Q000379:methods / Q000706:statistics & numerical data*; D007530:Isoflurane / Q000627:therapeutic use*; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008738:Methyl Ethers / Q000627:therapeutic use*; D008875:Middle Aged; D011184:Postoperative Period; D015742:Propofol / Q000097:blood / Q000627:therapeutic use*; D011446:Prospective Studies; D000077149:Sevoflurane; D013997:Time Factors; D016896:Treatment Outcome; D014665:Vasodilator Agents / Q000627:therapeutic use
D000700:Analgesics; D018685:Anesthetics, Inhalation; D018686:Anesthetics, Intravenous; D008738:Methyl Ethers; D014665:Vasodilator Agents; D000077149:Sevoflurane; D007530:Isoflurane; D015742:Propofol