EARLY EXTUBATION AFTER MITRAL-VALVE SURGERY - A TARGET-CONTROLLED INFUSION OF PROPOFOL AND LOW-DOSE SUFENTANIL

Objective: In the current study, the use of a target-controlled infusi on of low-dose propofol was combined with a continuous infusion of suf entanil for patients undergoing mitral valve surgery. The purpose of t he study was to evaluate the hemodynamic stability, the time to awaken ing and spontaneous ventilation, and the feasibility in an early extub ation setting of a total intravenous anesthetic technique. Design: Pro spective study. Setting: University hospital. Participants: Fifteen pa tients scheduled for elective mitral valve surgery. Interventions: Ind uction of anesthesia consisted of sufentanil (1 mu g/kg), propofol (1 mu g/mL) target plasma concentration achieved over 3 minutes, and atra curium (0.5 mg/kg). The propofol target-controlled infusion was mainta ined at 1 mu g/mL throughout surgery and stopped at skin closure. A co ntinuous infusion of sufentanil at 1.8 mu g/kg/hr was started after in duction and reduced to 0.9 mu g/kg/hr at the start of cardiopulmonary bypass and stopped at the end of bypass. Atracurium was infused at a r ate of 0.5 mg/kg/hr up to sternal closure. No inhalation agents were u sed. Measurements and Main Results: Hemodynamic data were within norma l limits. Six patients (40%) responded to verbal commands within 15 mi nutes postoperatively, 10 (67%) within the first hour, and all patient s recovered within 2 hours. Four patients (27%) resumed spontaneous ve ntilation within the first 15 postoperative minutes. The time to succe ssful spontaneous ventilation was 169 +/- 42 minutes. Spontaneous vent ilation was associated with a 21% increase in cardiac index. Total suf entanil dose was 328 +/- 28 mu g (4.6 +/- 0.2 pg/kg), whereas total pr opofol dose was 862 + 44 mg (13.1 +/- 1.2 mg/kg). No patient required reintubation. Conclusion: The simplicity of the method with only one c hange in infusion rate is a major advantage. The technique permits pre dictable recovery and return to spontaneous ventilation in all patient s. Its use in patients entering early extubation protocols is appealin g for its reproducibility, simplicity, and safety. Copyright (C) 1997 by W.B. Saunders Company.