title: Fast-track coronary artery bypass grafting surgery under general anesthesia with remifentanil and spinal analgesia with morphine and clonidine.
abstract: OBJECTIVE
  Effective postoperative analgesia is a critical part of fast-track cardiac surgery. This study compared the postoperative analgesic effect of fast-track anesthesia with remifentanil and spinal morphine and clonidine with that of sufentanil anesthesia followed by patient-controlled administration of intravenous morphine.
  
  
  METHODS
  Prospective, blinded, randomized study.
  
  
  METHODS
  Single private institution.
  
  
  METHODS
  Forty patients selected for coronary artery bypass graft surgery allocated randomly into 2 groups.
  
  
  METHODS
  General anesthesia was performed with etomidate, isoflurane, cisatracurium, and either remifentanil (0.10-0.25 microg/kg/min) or sufentanil (up to 3.5 microg/kg). In the remifentanil group, patients received spinal morphine (4 microg/kg) and clonidine (1 microg/kg) before induction. Postoperatively, patients in both groups were connected to an intravenous patient-controlled analgesia (PCA) morphine pump that delivered a 1-g bolus with a 7-minute lockout interval.
  
  
  RESULTS
  Patients were evaluated for pain on a visual analog scale (VAS), at rest and on deep breathing, and for intravenous PCA morphine consumption during 24 hours. The intravenous PCA morphine 24-hour cumulative dose was lower in the fast-track than in the control group (15.8+/-12.6 v 32.7+/-22.3 mg, p<0.05). Before extubation, VAS scores were higher in the fast-track group, but after they were lower both at rest and during deep breathing. Extubation delay was shorter in the fast-track group (156.5+/-46.1 v 272+/-116.4 minutes, p<0.05).
  
  
  CONCLUSIONS
  The combination of anesthesia with remifentanil and spinal analgesia with morphine and clonidine produces effective analgesia after coronary artery surgery and a rapid extubation time.
authors.affiliation: Institut Arnault Tzanck, Saint-Laurent du Var, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Lena
authors.forename: Norbert
authors.initials: N
authors.lastname: Balarac
authors.forename: Jean Jacques
authors.initials: JJ
authors.lastname: Arnulf
authors.forename: Jean Yves
authors.initials: JY
authors.lastname: Bigeon
authors.forename: Michel
authors.initials: M
authors.lastname: Tapia
authors.forename: Francis
authors.initials: F
authors.lastname: Bonnet
mesh_terms: D000368:Aged; D000768:Anesthesia, General / Q000379:methods*; D000775:Anesthesia, Spinal / Q000379:methods*; D003000:Clonidine / Q000008:administration & dosage*; D001026:Coronary Artery Bypass / Q000379:methods*; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009020:Morphine / Q000008:administration & dosage*; D010147:Pain Measurement / Q000187:drug effects / Q000379:methods; D010149:Postoperative Pain / Q000188:drug therapy; D010880:Piperidines / Q000008:administration & dosage*; D011446:Prospective Studies; D000077208:Remifentanil
chemical_list: D010880:Piperidines; D009020:Morphine; D003000:Clonidine; D000077208:Remifentanil