Extubation time, hemodynamic stability, and postoperative pain control in patients undergoing coronary artery bypass surgery: an evaluation of fentanyl, remifentanil, and nonsteroidal antiinflammatory drugs with propofol for perioperative and postoperative management.
OBJECTIVE
To compare three anesthetic strategies with respect to the time of extubation after coronary artery bypass graft (CABG) surgery and to assess patient satisfaction with the procedure.


METHODS
Prospective, randomized, clinical study.


METHODS
Tertiary-care referral center.


METHODS
180 cardiac surgical patients undergoing primary CABG from January through June 2004.


METHODS
After induction of general anesthesia, patients were allocated to one of three groups. All three groups received a continuous infusion of intravenous (IV) propofol perioperatively and postoperatively. Group 1 (fentanyl infusion group, n = 60) received continuous IV fentanyl infusion perioperatively and postoperatively for analgesia. Group 2 (diclofenac group, n = 60) received fentanyl bolus doses intraoperatively and diclofenac suppository postoperatively. Group 3 (remifentanil group, n = 60) received continuous infusion of IV remifentanil perioperatively and IV fentanyl as an immediate postoperative bolus followed by continuous fentanyl infusion. Duration of postoperative ventilation up to the time of extubation, inotrope requirement, time at which analgesic infusion was discontinued, postextubation arterial blood gas analysis, pain evaluation via visual analog scale, need for rescue analgesia, awareness during surgery, and length of postcardiac surgical unit stay, were evaluated in each patient.


RESULTS
The diclofenac group exhibited the shortest time to extubation, the least inotrope use, and the fewest rescue doses of analgesic than did patients of the other two groups.


CONCLUSIONS
Intravenous propofol with bolus doses of IV fentanyl intraoperatively in combination with postoperative nonsteroidal antiinflammatory drugs had the best recovery profile in patients undergoing primary CABG than did the other two regimens studied.
Maddali
Madan Mohan
MM
Department of Anesthesia, Royal Hospital, Muscat 131 111, Oman. madan@omantel.net.om
Kurian
Elizabeth
E
Fahr
Jutta
J
D000768:Anesthesia, General / Q000379:methods; D018686:Anesthetics, Intravenous / Q000627:therapeutic use; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use*; D001784:Blood Gas Analysis / Q000379:methods / Q000706:statistics & numerical data; D001026:Coronary Artery Bypass / Q000379:methods*; D004008:Diclofenac / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D005260:Female; D005283:Fentanyl / Q000627:therapeutic use*; D006801:Humans; D007442:Intubation, Intratracheal / Q000379:methods / Q000706:statistics & numerical data*; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement / Q000379:methods; D010149:Postoperative Pain / Q000188:drug therapy*; D017060:Patient Satisfaction / Q000706:statistics & numerical data; D019990:Perioperative Care / Q000379:methods; D010865:Pilot Projects; D010880:Piperidines / Q000627:therapeutic use*; D011182:Postoperative Care / Q000379:methods; D015742:Propofol / Q000627:therapeutic use*; D011446:Prospective Studies; D000077208:Remifentanil; D012121:Respiration, Artificial / Q000379:methods / Q000706:statistics & numerical data; D013997:Time Factors
D018686:Anesthetics, Intravenous; D000894:Anti-Inflammatory Agents, Non-Steroidal; D010880:Piperidines; D004008:Diclofenac; D000077208:Remifentanil; D005283:Fentanyl; D015742:Propofol