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 plus intrathecal morphine with intravenous sufentanil infusion with respect to intraoperative hemodynamic variables, extubation times, and recovery profiles 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 bypass graft, aortic valve replacement, or mitral valve replacement surgery. Interventions: After a standardized anesthetic induction, anesthesia was maintained with a remifentanil infusion, 0.1 μg/kg/min, and desflurane, 3% to 10%, inspired (group I, n = 20) or a sufentanil infusion, 0.3 μg/kg/h, and desflurane, 3% to 10%, inspired (group II, n = 20). Patients receiving remifentanil were administered intrathecal morphine, 8 μg/kg, for postoperative analgesia. Measurements and Main Results: Both anesthetic regimens provided comparable intraoperative hemodynamic stability and similar recovery profiles, with extubation 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 did not facilitate earlier tracheal extubation or improve intraoperative hemodynamic stability compared with sufentanil alone for fast-track cardiac anesthesia. (C) 2000 by W.B. Saunders Company.