Efficacy and safety of remifentanil in coronary artery bypass graft surgery: a randomized, double-blind dose comparison study.

Abstract

OBJECTIVES:

To compare the efficacy and safety of 3 doses of remifentanil as part of a total intravenous anesthesia technique with low-dose propofol in patients undergoing coronary artery bypass graft (CABG) surgery.

DESIGN:

Multicenter, multinational, double-blind, randomized, dose comparison study.

SETTING:

Nine hospitals in 5 countries.

PARTICIPANTS:

One hundred forty-one patients undergoing first-time elective CABG surgery.

INTERVENTIONS:

Patients were premedicated with a short-acting oral benzodiazepine up to 2 h before surgery and randomized to receive continuous infusions of remifentanil 1.0 microg/kg/min (n = 45), 1.5 microg/kg/min (n = 44), or 2.0 microg/kg/min (n = 43), in combination with propofol 3 mg/kg/h. Nine patients received remifentanil 1.0 microg/kg/min on an open-label basis. Three different induction sequences (IS) were used. In IS 1 (n = 31), induction was started with remifentanil infusion followed 5 minutes later by propofol 0.5 mg/kg bolus and infusion at 3 mg/kg/h. Further bolus doses of propofol (10 mg) were given if loss of consciousness (LOC) was not attained after 5 minutes; pancuronium, 0.04 to 0.1 mg/kg, was administered at LOC. In IS 2 (n = 68), a priming dose of pancuronium, 0.015 mg/kg, was administered just before starting remifentanil. In IS 3 (n = 42), bolus doses of propofol, 10 mg every 10 seconds, were given until LOC, followed by pancuronium, 0.04 to 0.1 mg/kg, and the remifentanil and propofol infusions were started.

MEASUREMENTS AND MAIN RESULTS:

There were no significant differences among the remifentanil dose groups with regard to the primary outcome measure, responses to sternotomy/sternal spread/maximal sternal spread. Responses to these stimuli were recorded in 11%, 11%, and 14% of patients in the remifentanil 1.0, 1.5, and 2.0 microg/kg/min dose groups, respectively. Similarly, there were no significant differences in the responses to other surgical stimuli. There was a high incidence of muscle rigidity when remifentanil was used to induce anesthesia.

CONCLUSIONS:

All 3 remifentanil dose regimens provided profound suppression of responses to surgical stimuli in the majority of patients. There was no apparent advantage in starting the remifentanil infusion rate above 1.0 microg/kg/min. Remifentanil is not suitable for use as a sole induction agent.

• Authors: Ferd E A Geisler, Simon de Lange, David Royston, Roland Demeyere, David J R Duthie, Jean-Jacques Lehot, Monika Adt, Jean-Pierre Dupeyron, Martin Mansfield, Andrew J T Kirkham
• Journal: Journal of cardiothoracic and vascular anesthesia (J Cardiothorac Vasc Anesth) Vol. 17 Issue 1 Pg. 60-8 (Feb 2003) ISSN: 1053-0770 [Print] United States
• PMID: 12635062 (Publication Type: Clinical Trial, Comparative Study, Journal Article, Multicenter Study, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)
• Copyright: Copyright 2003, Elsevier Science (USA). All rights reserved.

Chemical References

• Analgesics, Opioid
• Anesthetics, Combined
• Anesthetics, Intravenous
• Piperidines
• Remifentanil
• Propofol

Topics

• Adult
• Aged
• Analgesics, Opioid (adverse effects, therapeutic use)
• Anesthetics, Combined (therapeutic use)
• Anesthetics, Intravenous (therapeutic use)
• Coronary Artery Bypass
• Dose-Response Relationship, Drug
• Double-Blind Method
• Female
• Humans
• Male
• Middle Aged
• Muscle Rigidity (chemically induced)
• Physical Stimulation
• Piperidines (adverse effects, therapeutic use)
• Propofol (therapeutic use)
• Remifentanil
• Time Factors