A randomized double-blinded multicenter comparison of remifentanil versus fentanyl when combined with isoflurane/propofol for early extubation in coronary artery bypass graft surgery

We compared a fentanyl/isoflurane/propofol regimen with a remifentanil/isof lurane/propofol regimen for fast-track cardiac anesthesia in a prospective, randomized, double-blinded study on patients undergoing elective coronary artery bypass graft surgery. Anesthesia was induced with a 1-min infusion o f 0.5 mg/kg propofol followed by 10-mg boluses of propofol every 30 s until loss of consciousness. After 0.2 mg/kg cisatracurium, a blinded continuous infusion of remifentanil at I mug kg-l min-l or the equivalent volume rate of normal saline was then started. In addition, a blinded bolus syringe of 1 mug/kg remifentanil or 10 mug/kg fentanyl, respectively, was given over 3 min. Blinded remifentanil, 1 mug. kg(-1) min(-1) (or the equivalent volum e rate of normal saline), together with 0.5% isoflurane, were used to maint ain anesthesia. Significantly more patients (P < 0.01) in the fentanyl regi men experienced hypertension during skin incision and maximum sternal sprea d compared with patients in the remifentanil regimen. There were no differe nces between the groups in time until extubation, discharge from the surgic al intensive care unit, ST segment and other electrocardiogram changes, cat echolamine levels, or cardiac enzymes. The remifentanil-based anesthetic (c onsisting of a bolus followed by a continuous infusion) resulted in signifi cantly less response to surgical stimulation and less need for anesthetic i nterventions compared with the fentanyl regimen (consisting of an initial b olus, and followed by subsequent boluses only to treat hemodynamic response s) with both drug regimens allowing early extubation.