Continuous infusion of remifentanil and target-controlled infusion of propofol for patients undergoing cardiac surgery: A new approach for scheduled early extubation

Objective: To assess hemodynamic stability, postoperative pain management, and the control and timing of early extubation of a total intravenous anest hetic technique using propofol target-controlled infusion (TCI) and remifen tanil in cardiac surgery. Design: Prospective study. Setting: University hospital. Participants: Fifty patients scheduled for elective cardiac surgery. Interventions: Premedication consisted of oral midazolam, 0.1 mg/kg. Anesth esia was induced with propofol TCI at a target concentration of 1.5 to 2 mu g/mL; remifentanil, 1 mu g/kg; and rocuronium. Anesthesia was maintained w ith propofol at the same target concentration and remifentanil titrated bet ween 0.25 and 1 mu g/kg/min. Thirty minutes before the end of surgery, a 0. 1-mg/kg bolus of morphine was administered intravenously. Postoperative sed ation was achieved by maintaining the propofol infusion until the patient w as deemed ready for extubation. Postoperative pain relief was evaluated usi ng a visual analog scale. The intervals between arrival in the intensive ca re unit, spontaneous ventilation, and extubation were recorded. Measurements and Main Results: Included in this study were 36 men and 14 wo men (American Society of Anesthesiologist = III; New York Heart Association = II) scheduled for cardiac surgery. All patients remained hemodynamically stable throughout the perioperative period. Thirty-seven patients were suc cessfully extubated during the first 4 postoperative hours, Spontaneous bre athing was achieved at a mean interval of 15 +/- 5 minutes after propofol d iscontinuation. The mean interval to extubation was 163 +/- 45 minutes afte r arrival in the intensive care unit Extubation was performed 48 +/- 12 min utes after patients were considered ready to awaken. During spontaneous ven tilation, 36 patients received additional boluses of morphine (mean, 2.5 +/ - 1 mg). Subsequently, all patients achieved a visual analog scale less tha n 40 mm. Conclusion: The combination of remifentanil and propofol TCI resulted in he modynamic stability and good postoperative analgesia. This technique allows physicians to schedule the time of extubation in patients undergoing cardi ac anesthesia. Copyright (C) 2000 by W.B. Saunders Company.