A prospective, randomized, double-blind trial of 3 regimens for sedation and analgesia after cardiac surgery.
OBJECTIVE
The aim of this study was to evaluate cardiac risk as a consideration for selecting postoperative sedation and analgesia regimens used for cardiac surgical patients requiring cardiopulmonary bypass and early extubation.


METHODS
An observer-blind, randomized, controlled trial.


METHODS
A tertiary referral medical center involving an intensive care unit.


METHODS
One hundred forty-five adults requiring elective cardiac surgery.


METHODS
Patients were stratified preoperatively as low, moderate, or high cardiac risk based on established criteria and then assigned to 1 of 3 postoperative regimens: propofol infusion beginning at 25 μg/kg/min and morphine boluses (P), fentanyl infusion beginning at 2 μg/kg/h and midazolam boluses (F), or propofol and fentanyl infusions beginning at 25 μg/kg/min and 0.5 μg/kg/h (PF), respectively.


RESULTS
Postoperative regimen P was associated with a significantly reduced time to extubation (median value, 264 minutes; p = 0.05) compared with F (295 minutes) but not PF (278 minutes) in patients characterized as low cardiac risk. The time to extubation did not differ among regimens in patients of moderate/high cardiac risk.


CONCLUSIONS
Patients with low cardiac risk undergoing cardiac surgery had statistically significantly shorter times to extubation with propofol infusion and intermittent morphine than a fentanyl infusion and intermittent midazolam. These differences were not sustained in patients considered at higher cardiac risk. The time to extubation after cardiac surgery may further improve if postoperative sedation and analgesia are not administered uniformly to all patients but selected based on individual characteristics.
Oliver
William C
WC
Department of Anesthesiology, Mayo Medical School, Rochester, MN, USA. oliver.william@mayo.edu
Nuttall
Gregory A
GA
Murari
Terri
T
Bauer
Lori K
LK
Johnsrud
Kelly H
KH
Hall Long
Kirsten J
KJ
Orszulak
Thomas A
TA
Schaff
Hartzell V
HV
Hanson
Andrew C
AC
Schroeder
Darrell R
DR
Ereth
Mark H
MH
Abel
Martin D
MD
D000293:Adolescent; D000328:Adult; D000368:Aged; D000701:Analgesics, Opioid / Q000627:therapeutic use; D001784:Blood Gas Analysis; D006348:Cardiac Surgical Procedures; D002315:Cardiopulmonary Bypass; D003422:Critical Care / Q000191:economics / Q000706:statistics & numerical data; D004311:Double-Blind Method; D023381:Endpoint Determination; D005260:Female; D005283:Fentanyl / Q000627:therapeutic use; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D006993:Hypnotics and Sedatives / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D009020:Morphine / Q000627:therapeutic use; D010149:Postoperative Pain / Q000188:drug therapy*; D011182:Postoperative Care / Q000379:methods*; D011183:Postoperative Complications / Q000453:epidemiology; D020250:Postoperative Nausea and Vomiting / Q000453:epidemiology / Q000517:prevention & control; D015742:Propofol / Q000627:therapeutic use; D011446:Prospective Studies; D015656:Respiratory Mechanics / Q000187:drug effects; D018570:Risk Assessment; D015300:Ventilator Weaning; D055815:Young Adult
D000701:Analgesics, Opioid; D006993:Hypnotics and Sedatives; D009020:Morphine; D005283:Fentanyl; D015742:Propofol