The efficacy and resource utilization of remifentanil and fentanyl in fast-track coronary artery bypass graft surgery: A prospective randomized, double-blinded controlled, multi-center trial

We compared (a) the perioperative complications; (b) times to eligibility f or, and actual time of the following: extubation, less intense monitoring, intensive care unit (ICU), and hospital discharge; and (c) resource utiliza tion of nursing ratio for patients receiving either a typical fentanyl/isof lurane/propofol regimen or a remifentanil/isoflurane/propofol regimen for f ast-track cardiac anesthesia in 304 adults by using a prospective randomize d, double-blinded, double-dummy trial. There were no differences in demogra phic data, or perioperative mortality and morbidity between the two study g roups. The minimental status examination at postoperative Days 1 to 3 were similar between the two groups. The eligible and actual times for extubatio n, less intense monitoring, ICU discharge, and hospital discharge were not significantly different. Further analyses revealed no differences in times for extubation and resource utilization after stratification by preoperativ e risk scores, age, and country. The nurse/patient ratio was similar betwee n theremifentanil/isoflurane/propofol and fentanyl/isoflurane/propofol grou ps during the initial ICU phase and less intense monitoring phase. Increasi ng preoperative risk scores and older age (>70 yr) were associated with lon ger times until extubation (eligible),ICU discharge (eligible and actual), and hospital discharge (eligible and actual). Times until extubation (eligi ble and actual) and less intense monitoring (eligible) were significantly s horter in Canadian patients than United States' patients. However, there wa s no difference in hospital length of stay in Canadian and United States' p atients. We conclude that both anesthesia techniques permit early and simil ar times until tracheal extubation, less intense monitoring, ICU and hospit al discharge, and reduced resource utilization after coronary artery bypass graft surgery.