title: Influence of Remifentanil/Propofol Anesthesia on Ventilator-associated Pneumonia Occurence After Major Cardiac Surgery.
abstract: The study is designed to evaluate the influence of remifentanil/propofol anesthesia on ventilator-associated pneumonia (VAP) occurrence and respiratory support (RS) time after major cardiac surgery.
  
  
  METHODS
  In retrospective-prospective study we investigated the respiratory support time and VAP occurrence in group of 47 patients with remifentanil/propofol and 35 patients with fentanil/midazolam anesthesia after major cardiac surgery in period June 2009-December 2011. Groups are divided in subgroups depending of who underwent cardiac surgery with or without cardiopulmonary by pass (CPB).
  
  
  RESULTS
  The time of respiratory support (RS) was the shortest in remifentanil group without CPB (R/Off 63min ± 44.3 vs R/On 94min ± 49.2 p=0,22), but was longer in fentanil group (F/Off 142 min ± 102.2 vs F/On 212 min ± 102.2 p=0.0014). The duration of RS of ON pump remifentanil group was shorter than in ON pump fentanil group (R/On 94 min vs F/On 212 min p=0.0011). The time of RS of OFF pump remifentanil group was lower than in Off pump entangle group (R/Off 63min ± 44,3 vs F/Off 142min ± 102.2 p=0,021) with statistically significance. Ventilator-associated pneumonia was detected in 7 patients (8.5 %). Six patients (17.1%) were from entangle group and one patient (2.1%) from remifentanil group. The most common isolates were Pseudomonas aeruginosa in all patients and both Pseudomonas aeruginosa and Klebsiella pneumonia in one patient.
  
  
  CONCLUSIONS
  The remifentanil anesthesia regimen in cardiac surgery decreases length of respiratory support duration and can prevent development of VAP. The role of remifentanil anesthesia in preventing VAP, as one of the most important risk factor of in-hospital mortality after cardiac surgery is still incompletely understood and should be investigated further.
authors.affiliation: Clinic for Cardiovascular Disease, University Clinical Centre Tuzla, Tuzla, Bosnia and Herzegovina.
authors.forename: Alisa
authors.initials: A
authors.lastname: Krdzalic
authors.affiliation: Department for Anaesthesia and Intensive Care, University Clinic Hospital Mostar, Mostar, Bosnia and Herzegovina.
authors.forename: Anita
authors.initials: A
authors.lastname: Kosjerina
authors.affiliation: Clinic for Cardiovascular Disease, University Clinical Centre Tuzla, Tuzla, Bosnia and Herzegovina.
authors.forename: Elmir
authors.initials: E
authors.lastname: Jahic
authors.affiliation: Surgery Clinic, University Clinical Center Tuzla, Tuzla, Bosnia and Herzegovina.
authors.forename: Zijah
authors.initials: Z
authors.lastname: Rifatbegovic
authors.affiliation: Surgery Clinic, University Clinical Center Tuzla, Tuzla, Bosnia and Herzegovina.
authors.forename: Goran
authors.initials: G
authors.lastname: Krdzalic
mesh_terms: D000368:Aged; D000771:Anesthesia, Intravenous / Q000009:adverse effects; D017522:Bosnia and Herzegovina; D006348:Cardiac Surgical Procedures / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010880:Piperidines / Q000008:administration & dosage* / Q000009:adverse effects; D053717:Pneumonia, Ventilator-Associated / Q000453:epidemiology* / Q000209:etiology; D011183:Postoperative Complications / Q000453:epidemiology*; D015742:Propofol / Q000008:administration & dosage* / Q000009:adverse effects; D011446:Prospective Studies; D000077208:Remifentanil; D012121:Respiration, Artificial / Q000009:adverse effects; D012189:Retrospective Studies; D013997:Time Factors
chemical_list: D010880:Piperidines; D000077208:Remifentanil; D015742:Propofol
keywords: cardiac surgery; remifentanil/propofol anesthesia; ventilator-associated pneumonia