Comparison of two different anesthesia regimens in patients undergoing aortocoronary bypass grafting surgery: Sufentanil-midazolam versus remifentanil-propofol

Objective: To compare intraoperative hemodynamics and depth of anesthesia u sing sufentanil-midazolam (SM) versus remifentanil-propofol (RP) anesthesia . Design: Prospective, randomized study. Setting: Clinical investigation in an urban, university affiliated hospital . Participants: Forty patients undergoing elective first-time coronary artery bypass graft surgery. Interventions: Twenty patients were anesthetized using SM and 20 patients u sing RP. Measurements and Main Results: Hemodynamic monitoring included a 5-lead ele ctrocardiogram, a radial artery catheter, and a pulmonary artery catheter. Depth of anesthesia was assessed using bispectral index (BIS). Data were ob tained after induction of anesthesia (Tl), after sternotomy (T2), after per icardiotomy (T3), 5 minutes after cardiopulmonary bypass (CPB) (T4), after closure of thorax (T5), and at the end of surgery (T6). The 2 groups were c omparable with regard to demographic and perioperative data. There were no significant differences of any hemodynamic parameter at any time between th e 2 groups. In both groups, systemic vascular resistance increased at T2 an d decreased at T4 from baseline value (p < 0.05). Cardiac index increased a t T4 in both groups from baseline value (p < 0.05): 55% of the patients of both groups needed low-dose dobutamine after CPB. During CPB, 40% of the RP patients needed norepinephrine versus 35% of the SM patients. BIS was lowe r in the RP than in the SM group at T2 and T3 (p < 0.05). sis values indica ting intraoperative awareness were not noted. Conclusion: Both anesthesia regimens provided stable hemodynamics and adequ ate anesthesia in patients undergoing coronary artery bypass graft surgery. Copyright (C) 2000 by W.B. Saunders Company.