A comparison of remifentanil and alfentanil for use with propofol in patients undergoing minimally invasive coronary artery bypass surgery

Most patients undergoing minimally invasive direct coronary artery bypass s urgery can be awakened and tracheally extubated in the operating room. We h ave compared two techniques of total IV anesthesia in this patient populati on: 30 patients (aged 44 to 74 yr; 24 male) premedicated with temazepam wer e randomly assigned to receive either remifentanil-propofol or alfentanil-p ropofol. Anesthesia was induced with remifentanil 2 mu g/kg or with alfenta nil 40 mu g/kg, with propofol, and maintained with remifentanil at 0.25 or 0.5 mu g.kg(-1).min(-1) or alfentanil at 0.5 or 1 mu g.kg(-1).min(-1). The stable maintenance infusion rate of propofol was adjusted for age. Times to awakening and tracheal extubation were recorded. Postoperatively, IV morph ine provided by patient-controlled analgesia was used for 48 h. Times to aw akening and tracheal extubation (mean +/- SD) were shorter (P < 0.01) in pa tients receiving remifentanil, and interpatient variations in times to awak ening and tracheal extubation smaller (awakening 25 +/- 7 vs 74 +/- 32 min, and extubation 27 +/- 7 vs 77 +/- 32 min). Analysis of variance revealed t hat postoperative consumption of morphine was dependent on both the intraop erative opioid and the time elapsed after surgery (P < 0.05): patient-contr olled analgesia morphine use during the first 3 h after awakening was more in patients receiving remifentanil (P < 0.01).