Anesth Pain Med.  2020 Oct;15(4):424-433. 10.17085/apm.20022.

Remifentanil-based propofol-supplemented vs. balanced sevoflurane-sufentanil anesthesia regimens on bispectral index recovery after cardiac surgery: a randomized controlled study

Affiliations
  • 1Department of Anesthesiology and Pain Medicine, Konyang University Hospital, College of Medicine, Konyang University, Daejeon, Korea
  • 2Department of Anesthesiology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
  • 3epartment of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
  • 4Department of Anesthesiology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
  • 5College of Life Science and Biotechnology, Korea University, Seoul, Korea

Abstract

Background
The present study was to compare the potential impact of remifentanil-based propofol-supplemented anesthesia regimen vs. conventional sevoflurane-sufentanil balanced anesthesia on postoperative recovery of consciousness indicated by c) values in patients undergoing cardiac surgery.
Methods
Patients undergoing cardiac surgery were randomly allocated to get the remifentanil-based propofol-supplemented anesthesia employing target-controlled infusion (TCI) of remifentanil and propofol (Group-PR, n = 15) or a balanced-anesthesia employing sevoflurane-inhalation and TCI-sufentanil (Group-C, n = 19). In Group-PR, plasma concentration (Cp) of TCI-remifentanil was fixed at 20 ng/ml, and the effect-site concentration of TCI-propofol was adjusted within 0.8–2.0 μg/ml to maintain BIS value of 40–60. In Group-C, sevoflurane dosage was adjusted within 1–1.5 minimum alveolar concentration to maintain BIS of 40–60, and Cp of TCI-sufentanil was fixed at 0.4 ng/ml. The inter-group difference in the time for achieving postoperative BIS > 80 (T-BIS80) in the intensive care unit was determined as the primary outcome. The inter-group difference in the extubation time was determined as the secondary outcome.
Results
T-BIS80, was shorter in Group-PR than Group-C (121.4 ± 64.9 min vs. 182.9 ± 85.1 min, respectively; the difference of means –61.5 min; 95% CI –115.7 to –7.4 min; effect size 0.812; P = 0.027). The extubation time was shorter in Group-PR than in Group-C (434.7 ± 131.3 min vs. 946.6 ± 393.3 min, respectively, P < 0.001).
Conclusions
Compared with the conventional sevoflurane-sufentanil balanced anesthesia, the remifentanil-based propofol-supplemented anesthesia showed significantly faster postoperative conscious recovery in patients undergoing cardiac surgery.

Keyword

Anesthetics; Bispectral index; Consciousness; Propofol; Recovery; Remifentanil

Figure

  • Fig. 1. Flow chart. Thirty-eight patients were randomly allocated into the Group-PR or Group-C, and four patients in the Group-PR were excluded because one patient required post-CPB cardiac pacing, and 3 patients were applied post-CPB use of double inotropic support. Group-PR: remifentanil-based propofol-supplemented regimen, Group-C: combined sevoflurane-sufentanil regimen, CPB: cardiopulmonary bypass.


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