A randomized double-blinded multicenter comparison of remifentanil versus fentanyl when combined with isoflurane/propofol for early extubation in coronary artery bypass graft surgery

Michael B. Howie, Davy Cheng, Mark F. Newman, Eric T. Pierce, Charles Hogue, Zak Hillel, T. Andrew Bowdle, Deo Bukenya

Research output: Contribution to journalArticle

Abstract

We compared a fentanyl/isoflurane/propofol regimen with a remifentanil/isoflurane/propofol regimen for fast-track cardiac anesthesia in a prospective, randomized, double-blinded study on patients undergoing elective coronary artery bypass graft surgery. Anesthesia was induced with a 1-min infusion of 0.5 mg/kg propofol followed by 10-mg boluses of propofol every 30 s until loss of consciousness. After 0.2 mg/kg cisatracurium, a blinded continuous infusion of remifentanil at 1/μg · kg-1 · min-1 or the equivalent volume rate of normal saline was then started. In addition, a blinded bolus syringe of 1/μg/kg remifentanil or 10/μg/kg fentanyl, respectively, was given over 3 min. Blinded remifentanil, 1/μg · kg-1 · min-1 (or the equivalent volume rate of normal saline), together with 0.5% isoflurane, were used to maintain anesthesia. Significantly more patients (P <0.01) in the fentanyl regimen experienced hypertension during skin incision and maximum sternal spread compared with patients in the remifentanil regimen. There were no differences between the groups in time until extubation, discharge from the surgical intensive care unit, ST segment and other electrocardiogram changes, catecholamine levels, or cardiac enzymes. The remifentanil-based anesthetic (consisting of a bolus followed by a continuous infusion) resulted in significantly less response to surgical stimulation and less need for anesthetic interventions compared with the fentanyl regimen (consisting of an initial bolus, and followed by subsequent boluses only to treat hemodynamic responses) with both drug regimens allowing early extubation.

Original languageEnglish (US)
Pages (from-to)1084-1093
Number of pages10
JournalAnesthesia and Analgesia
Volume92
Issue number5
StatePublished - 2001
Externally publishedYes

Fingerprint

Isoflurane
Fentanyl
Propofol
Coronary Artery Bypass
Transplants
Anesthesia
Anesthetics
Unconsciousness
Syringes
Critical Care
Catecholamines
Intensive Care Units
remifentanil
Electrocardiography
Hemodynamics
Hypertension
Skin
Enzymes
Pharmaceutical Preparations

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

Cite this

A randomized double-blinded multicenter comparison of remifentanil versus fentanyl when combined with isoflurane/propofol for early extubation in coronary artery bypass graft surgery. / Howie, Michael B.; Cheng, Davy; Newman, Mark F.; Pierce, Eric T.; Hogue, Charles; Hillel, Zak; Bowdle, T. Andrew; Bukenya, Deo.

In: Anesthesia and Analgesia, Vol. 92, No. 5, 2001, p. 1084-1093.

Research output: Contribution to journalArticle

Howie, Michael B. ; Cheng, Davy ; Newman, Mark F. ; Pierce, Eric T. ; Hogue, Charles ; Hillel, Zak ; Bowdle, T. Andrew ; Bukenya, Deo. / A randomized double-blinded multicenter comparison of remifentanil versus fentanyl when combined with isoflurane/propofol for early extubation in coronary artery bypass graft surgery. In: Anesthesia and Analgesia. 2001 ; Vol. 92, No. 5. pp. 1084-1093.
@article{666e15bb09c746f9b008131567870d8b,
title = "A randomized double-blinded multicenter comparison of remifentanil versus fentanyl when combined with isoflurane/propofol for early extubation in coronary artery bypass graft surgery",
abstract = "We compared a fentanyl/isoflurane/propofol regimen with a remifentanil/isoflurane/propofol regimen for fast-track cardiac anesthesia in a prospective, randomized, double-blinded study on patients undergoing elective coronary artery bypass graft surgery. Anesthesia was induced with a 1-min infusion of 0.5 mg/kg propofol followed by 10-mg boluses of propofol every 30 s until loss of consciousness. After 0.2 mg/kg cisatracurium, a blinded continuous infusion of remifentanil at 1/μg · kg-1 · min-1 or the equivalent volume rate of normal saline was then started. In addition, a blinded bolus syringe of 1/μg/kg remifentanil or 10/μg/kg fentanyl, respectively, was given over 3 min. Blinded remifentanil, 1/μg · kg-1 · min-1 (or the equivalent volume rate of normal saline), together with 0.5{\%} isoflurane, were used to maintain anesthesia. Significantly more patients (P <0.01) in the fentanyl regimen experienced hypertension during skin incision and maximum sternal spread compared with patients in the remifentanil regimen. There were no differences between the groups in time until extubation, discharge from the surgical intensive care unit, ST segment and other electrocardiogram changes, catecholamine levels, or cardiac enzymes. The remifentanil-based anesthetic (consisting of a bolus followed by a continuous infusion) resulted in significantly less response to surgical stimulation and less need for anesthetic interventions compared with the fentanyl regimen (consisting of an initial bolus, and followed by subsequent boluses only to treat hemodynamic responses) with both drug regimens allowing early extubation.",
author = "Howie, {Michael B.} and Davy Cheng and Newman, {Mark F.} and Pierce, {Eric T.} and Charles Hogue and Zak Hillel and Bowdle, {T. Andrew} and Deo Bukenya",
year = "2001",
language = "English (US)",
volume = "92",
pages = "1084--1093",
journal = "Anesthesia and Analgesia",
issn = "0003-2999",
publisher = "Lippincott Williams and Wilkins",
number = "5",

}

TY - JOUR

T1 - A randomized double-blinded multicenter comparison of remifentanil versus fentanyl when combined with isoflurane/propofol for early extubation in coronary artery bypass graft surgery

AU - Howie, Michael B.

AU - Cheng, Davy

AU - Newman, Mark F.

AU - Pierce, Eric T.

AU - Hogue, Charles

AU - Hillel, Zak

AU - Bowdle, T. Andrew

AU - Bukenya, Deo

PY - 2001

Y1 - 2001

N2 - We compared a fentanyl/isoflurane/propofol regimen with a remifentanil/isoflurane/propofol regimen for fast-track cardiac anesthesia in a prospective, randomized, double-blinded study on patients undergoing elective coronary artery bypass graft surgery. Anesthesia was induced with a 1-min infusion of 0.5 mg/kg propofol followed by 10-mg boluses of propofol every 30 s until loss of consciousness. After 0.2 mg/kg cisatracurium, a blinded continuous infusion of remifentanil at 1/μg · kg-1 · min-1 or the equivalent volume rate of normal saline was then started. In addition, a blinded bolus syringe of 1/μg/kg remifentanil or 10/μg/kg fentanyl, respectively, was given over 3 min. Blinded remifentanil, 1/μg · kg-1 · min-1 (or the equivalent volume rate of normal saline), together with 0.5% isoflurane, were used to maintain anesthesia. Significantly more patients (P <0.01) in the fentanyl regimen experienced hypertension during skin incision and maximum sternal spread compared with patients in the remifentanil regimen. There were no differences between the groups in time until extubation, discharge from the surgical intensive care unit, ST segment and other electrocardiogram changes, catecholamine levels, or cardiac enzymes. The remifentanil-based anesthetic (consisting of a bolus followed by a continuous infusion) resulted in significantly less response to surgical stimulation and less need for anesthetic interventions compared with the fentanyl regimen (consisting of an initial bolus, and followed by subsequent boluses only to treat hemodynamic responses) with both drug regimens allowing early extubation.

AB - We compared a fentanyl/isoflurane/propofol regimen with a remifentanil/isoflurane/propofol regimen for fast-track cardiac anesthesia in a prospective, randomized, double-blinded study on patients undergoing elective coronary artery bypass graft surgery. Anesthesia was induced with a 1-min infusion of 0.5 mg/kg propofol followed by 10-mg boluses of propofol every 30 s until loss of consciousness. After 0.2 mg/kg cisatracurium, a blinded continuous infusion of remifentanil at 1/μg · kg-1 · min-1 or the equivalent volume rate of normal saline was then started. In addition, a blinded bolus syringe of 1/μg/kg remifentanil or 10/μg/kg fentanyl, respectively, was given over 3 min. Blinded remifentanil, 1/μg · kg-1 · min-1 (or the equivalent volume rate of normal saline), together with 0.5% isoflurane, were used to maintain anesthesia. Significantly more patients (P <0.01) in the fentanyl regimen experienced hypertension during skin incision and maximum sternal spread compared with patients in the remifentanil regimen. There were no differences between the groups in time until extubation, discharge from the surgical intensive care unit, ST segment and other electrocardiogram changes, catecholamine levels, or cardiac enzymes. The remifentanil-based anesthetic (consisting of a bolus followed by a continuous infusion) resulted in significantly less response to surgical stimulation and less need for anesthetic interventions compared with the fentanyl regimen (consisting of an initial bolus, and followed by subsequent boluses only to treat hemodynamic responses) with both drug regimens allowing early extubation.

UR - http://www.scopus.com/inward/record.url?scp=0035035428&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0035035428&partnerID=8YFLogxK

M3 - Article

VL - 92

SP - 1084

EP - 1093

JO - Anesthesia and Analgesia

JF - Anesthesia and Analgesia

SN - 0003-2999

IS - 5

ER -