Fast-track cardiac anesthesia: A comparison of remifentanil plus intrathecal morphine with sufentanil in a desflurane-based anesthetic

Objective:To compare the effects of an intravenous remifentanil infusion pl us intrathecal morphine with intravenous sufentanil infusion with respect t o intraoperative hemodynamic variables, extubation times, and recovery prof iles when administered as part of a desflurane-based fast-track anesthetic regimen for cardiac surgery. Design: A prospective, randomized, nonblinded study. Setting: University hospital. Participants: Forty patients undergoing elective primary coronary artery by pass graft, aortic valve replacement, or mitral valve replacement surgery. Interventions: After a standardized anesthetic induction, anesthesia was ma intained with a remifentanil infusion, 0.1 mug/kg/min, and desflurane, 3% t o 10%, inspired (group I, n = 20) or a sufentanil infusion, 0.3 mug/kg/h, a nd desflutane, 3% to 10%, inspired (group II, n = 20). Patients receiving r emifentanil were administered intrathecal morphine, 8 mug/kg, for postopera tive analgesia. Measurements and Main Results: Both anesthetic regimens provided comparable intraoperative hemodynamic stability and similar recovery profiles, with e xtubation times of 5.1 +/- 4.3 hours (group I) and 5.8 +/- 6.7 hours (group II). Conclusions: Use of remifentanil in combination with intrathecal morphine d id not facilitate earlier tracheal extubation or improve intraoperative hem odynamic stability compared with sufentanil alone for fast-track cardiac an esthesia. Copyright (C) 2000 by W.B. Saunders Company.