title: Remifentanil in cardiac surgery: a meta-analysis of randomized controlled trials.
abstract: OBJECTIVE
  The authors conducted a review of randomized controlled trials to identify advantages in clinically relevant outcomes in patients undergoing cardiac surgery with remifentanil.
  
  
  METHODS
  Meta-analysis.
  
  
  METHODS
  Hospitals.
  
  
  METHODS
  A total of 1,473 patients from 16 randomized trials.
  
  
  METHODS
  None.
  
  
  RESULTS
  PubMed, BioMedCentral, and conference proceedings were searched (updated May 2010) for randomized trials that compared remifentanil with fentanyl or sufentanil in cardiac anesthesia. Four independent reviewers performed data extraction, with divergences resolved by consensus. Overall analysis showed that the use of remifentanil was associated with a significant reduction in postoperative mechanical ventilation (WMD = -139 min [-244, -32], p for effect = 0.01, p for heterogeneity < 0.001, I(2) = 89%); length of hospital stay (WMD = -1.08 days [-1.60, -0.57], p for effect < 0.0001, p for heterogeneity = 0.004, I(2) = 71%); and cardiac troponin-I release (WMD = -2.08 ng/mL [-3.93, -0.24], p for effect = 0.03, p for heterogeneity < 0.02, I(2) = 74%). No difference was noted in mortality (3/344 [0.87%] in the remifentanil group vs [1.06%] the control group, OR 0.76 [0.17-3.38], p for effect = 0.72, p for heterogeneity = 0.35, I(2) = 5%).
  
  
  CONCLUSIONS
  Remifentanil reduces cardiac troponin release, time of mechanical ventilation, and length of hospital stay in patients undergoing cardiac surgery.
authors.affiliation: Department of Anesthesiology and Intensive Care, Vita-Salute San Raffaele University, Milan, Italy.
authors.forename: Massimiliano
authors.initials: M
authors.lastname: Greco
authors.forename: Giovanni
authors.initials: G
authors.lastname: Landoni
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Biondi-Zoccai
authors.forename: Luca
authors.initials: L
authors.lastname: Cabrini
authors.forename: Laura
authors.initials: L
authors.lastname: Ruggeri
authors.forename: Nicola
authors.initials: N
authors.lastname: Pasculli
authors.forename: Veronica
authors.initials: V
authors.lastname: Giacchi
authors.forename: Jan
authors.initials: J
authors.lastname: Sayeg
authors.forename: Teresa
authors.initials: T
authors.lastname: Greco
authors.forename: Alberto
authors.initials: A
authors.lastname: Zangrillo
mesh_terms: D006348:Cardiac Surgical Procedures / Q000379:methods / Q000639:trends; D002318:Cardiovascular Diseases / Q000188:drug therapy* / Q000601:surgery*; D006801:Humans; D007902:Length of Stay / Q000639:trends; D010880:Piperidines / Q000627:therapeutic use*; D016032:Randomized Controlled Trials as Topic; D000077208:Remifentanil; D012121:Respiration, Artificial / Q000639:trends
chemical_list: D010880:Piperidines; D000077208:Remifentanil