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2010 | 64 | 3-4 | 17-26
Article title

Remifentanil and fentanyl during induction

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EN
BACKGROUND Remifentanil is metabolized by non-specifi c esterases and is very shortacting. It is eliminated from all body compartments at the same time. AIM The aim of this study was to compare anesthetic induction with standard dose of etomidate and isofl urane combined either with fi xed rate remifentanil infusion or a single bolus dose of fentanyl. MATERIAL AND METHODS 54 patients (57.0±7.6 years) with stable CAD and EF > 40% scheduled for elective coronary revascularisation were recruited for this prospective, randomized trial. During induction, patients in group I received remifentanil infusion 0,5 mcg/kg/min., while group II received bolus dose 5 mcg/kg fentanyl. After initiation of remifentanil infusion or the injection of fentanyl, 0,2 mg/kg etomidate was given, followed by the injection of 0,1 mg/ kg pancuronium and the administration of 1% isofl urane. Haemodynamic parameters were measured before induction and after tracheal intubation. RESULTS Cardiac index decreased in both groups, heart rate and systemic blood pressure decreased only in remifentanil group, while systemic vascular resistance index increased only in fentanyl group. Heart rate, systemic blood pressure and systemic vascular resistance index after induction were signifi cantly higher in fentanyl group. CONCLUSIONS Remifentanil is more potent than fentanyl in blunting a cardiovascular response to tracheal intubation in patients with coronary artery disease. Low dose of fentanyl, used for the anaesthetic induction, may result in a clinically important increase of systemic vascular resistance.
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Year
Volume
64
Issue
3-4
Pages
17-26
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Contributors
  • Śląskie Centrum Chorób Serca 41-800 Zabrze, ul. Szpitalna 2 tel. +48 32 273 27 31, kardanest@sum.edu.pl
author
  • Department of Cardiac Anaesthesia, Silesian Centre for Heart Diseases, Zabrze, Poland
  • Department of Cardiac Anaesthesia, Silesian Centre for Heart Diseases, Zabrze, Poland
  • Department of Cardiac Anaesthesia, Silesian Centre for Heart Diseases, Zabrze, Poland
References
  • 1. Camu F., Royston D. Inpatient experience with remifentanil. Anesth Analg 1999; 89(Suppl.): S15-S21.
  • 2. Cohen J., Royston D., Remifentanil. Curr Opin Crit Care 2001; 7: 227-231.
  • 3. Häntschel D., Fassl J., Scholz M. et al. Leipzig fast-track protocol for cardio-anesthesia. Eff ective, safe and economical. Anaesthesist. 2009; 58(4): 379-386.
  • 4. Baltali S., Turkoz A., Bozdogan N. et al. The effi cacy of intravenous patientcontrolled remifentanil versus morphine anesthesia after coronary artery surgery. J Cardiothorac Vasc Anesth. 2009; 23(2): 170-174.
  • 5. Egan T.D. Pharmacokinetics and pharmacodynamics of remifentanil: an update in the year 2000. Curr Opin Anaesth 2000; 13: 449-455.
  • 6. Scholz J., Steinfath M. Is remifentanil an ideal opioid for anesthesiologic management in the 21st century? Anasthesiol Intensivmed Notfallmed Schmerzther 1996; 31: 592-607.
  • 7. Patel S.S. Spencer C.M. Remifentanil. Drugs 1996; 52: 417-428.
  • 8. Reves J.G. Educational considerations for the clinical introduction and use of remifentanil. Anesth Analg 1999; 89 (Suppl.): S4-S6.
  • 9. Yarmush J., D’Angelo R., Kirkhart B. et al. A comparison of remifentanil and morphine sulfate for acute postoperative analgesia after total intravenous anesthesia with remifentanil and propofol. Anesthesiology 1997; 87: 235-243.
  • 10. Mollhoff T., Herregods L., Moerman A. et al. Remifentanil Study Group. Comparative effi cacy and safety of remifentanil and fentanyl in ‘fast track’ coronary artery bypass graft surgery: a randomized, double-blind study. Br J Anaesth 2001; 87: 718-726.
  • 11. Bowler I., Djaiani G. Hall J., Pugh S., Dunne J., Intravenous remifentanil combined with intrathecal morphine decreases extubation times after elective coronary artery bypass graft (CABG) surgery. Anesth Analg. 2000; 90 (Suppl. 2): S33.
  • 12. Howie M.B., Cheng D., Newman M.F. et al. A randomized double-blinded multicenter comparison of remifentanil versus fentanyl when combined with isofl urane/propofol for early extubation in coronary artery bypass graft surgery. Anesth Analg. 2001; 92: 1084- 1093.
  • 13. Olivier P., Sirieix D., Dassier P., D’Attellis N, Baron J.F. Continuous infusion of remifentanil and target-controlled infusion of propofol for patients undergoing cardiac surgery: a new approach for scheduled early extubation. J Cardiothorac Vasc Anesth. 2000; 14: 29-35.
  • 14. Kazmaier S., Hanekop G.G., Buhre W. et al. Myocardial consequences of remifentanil in patients with coronary artery disease. Br J Anaesth. 2000; 84: 578-583.
  • 15. Elliott P., O’Hare R., Bill KM. Phillips A.S., Gibson F.M. Mirakhur RK. Severe cardiovascular depression with remifentanil. Anesth Analg. 2000; 91: 58-61.
  • 16. Wang J.Y., Winship S.M., Thomas S.D., Gin T. Russell GN. Induction of anaesthesia in patients with coronary artery disease: a comparison between sevofl urane-remifentanil and fentanyletomidate. Anaesth Intensive Care 1999; 27: 363-368.
  • 17. Herregods L., Larbuisson R. Van Dyck M., Feneck R., Barvais L., Kirkham A. Remifentanil versus fentanyl in patients with poor left ventricular function undergoing cabg surgery. Br J Anaesth. 1999; 82(Suppl.): 34-35.
  • 18. Agnew NM., Pennefather SH., Russell GN. Isofl urane and coronary heart disease. Anaesthesia 2002; 57: 338–347.
  • 19. Cheng DC., Newman MF., Duke P. et al. The effi cacy and resource utilization of remifentanil and fentanyl in fast-track coronary artery bypass graft surgery: a prospective randomized, double-blinded controlled, multi-center trial. Anesth Analg. 2001; 92: 1094-1102.
  • 20. Djaiani G.N., Ali M. Heinrich L., et al. Ultra-fast-track anesthetic technique facilitates operating room extubation in patients undergoing off -pump coronary revascularization surgery. J Cardiothorac Vasc Anesth. 2001; 15: 152-157.
  • 21. Latham P., Zarate E., White PF. et al. Fast-track cardiac anesthesia: a comparison of remifentanil plus intrathecal morphine with sufentanil in a desfl urane-based anesthetic. J Cardiothorac Vasc Anesth. 2000; 14: 645-651.
  • 22. Knapik M., Knapik P., Nadziakiewicz P. et al. Comparison of remifentanil or fentanyl administration during isofl urane anesthesia for coronary artery bypass surgery. Med Sci Monit. 2006; 12(8): PI33-38.
  • 23. Mangano D.T. Preoperative assessment of cardiac risk. In: Cardiac Anaesthesia, Red. Kaplan J. A, W. B. Saunders Company, Philadelphia-London-Toronto, 1999.
  • 24. Szafron B., Szafranek A., Kolka P. Zembala M. Prognozowanie ryzyka zgonu i pooperacyjnych powikłań w kardiochirurgii. W: Chirurgia naczyń wieńcowych. Red. M. Zembala, PZWL, Warszawa, 2002, 309 – 314.
  • 25. Michelsen L.G., Sadel. S., Glas K., Newman M. Bukenya D. Intraoperative hemodynamics during cardiac valve surgery using two diff erent anesthetic techniques. Anesth Analg. 1999; 88 (Suppl.4): 65.
  • 26. Glass P.S. Gan T.J., Howell S. A review of the pharmacokinetics and pharmacodynamics of remifentanil. Anesth.Analg. 1999; 89 (Suppl.): S7-S14.
  • 27. Egan T.D., Minto CF., Hermann DJ., Barr J., Muir K.T., Shafer S.L. Remifentanil versus alfentanil. Comparative pharmacokinetics and pharmacodynamics in healthy adult male volunteers. Anesthesiology 1996; 84: 821-833.
  • 28. Winterhalter M., Brandl K., Rahe-Meyer N. et al. Endocrine stress response and infl ammatory activation during CABG surgery. A randomized trial comparing remifentanil infusion to intermittent fentanyl. Eur J Anaesthesiol. 2008; 25(4): 326-335.
  • 29. But AK., Durmus M., Toprak H.I., Ozturk E., Demirbilek S., Ersoy M.O. Hemodynamic, hepatorenal, and postoperative eff ects of desfl urane-fentanyl and midazolam- fentanyl anesthesia in coronary artery bypass surgery. J Cardiothorac Vasc Anesth. 2005; 19(5): 597-602.
  • 30. Goździk W., Durek G., Falkiewicz Z., Kübler A. Znieczulenie całkowicie dożylne z zastosowaniem ciągłego wlewu remifentanylu oraz propofolu metodą TCI do zabiegów chirurgicznej rewaskularyzacji wieńcowej z zastosowaniem krążenia pozaustrojowego. Anest Inten Terap. 2002; 34: 105-109.
  • 31. Lehmann A., Boldt J. Remifentanil in cardiac surgery (letter). Anesth Analg. 2001; 92: 557-558.
  • 32. Pittarello D., Bonato R., Armellin G. Sorbara C. Alterations in left ventricular-arterial coupling and mechanical effi ciency produced by remifentanil during cardiac anesthesia. Minerva Anestesiol. 2001; 67: 133-147.
  • 33. Ahonen J., Olkkola K.T., Verkkala K., Heikkinen L., Jarvinen A., Salmenpera M. A comparison of remifentanil and alfentanil for use with propofol in patients undergoing minimally invasive coronary artery bypass surgery. Anesth Analg. 2000; 90: 1269–1274.
  • 34. Paris A., Scholz J., von Knobelsdorff G., Tonner PH. Schulte am Esch J. The eff ect of remifentanil on cerebral blood fl ow velocity. Anesth Analg. 1998; 87: 569-573.
  • 35. Thompson J.P., Hall A.P., Russell J., Cagney B., Rowbotham D.J. Eff ect of remifentanil on the haemodynamic response to orotracheal intubation. Br J Anaesth. 1998; 80: 467-469.
  • 36. Wong G.T., Huang Z., Ji S. Irvin M.G. Remifentanil Reduces the Release of Biochemical Markers of Myocardial Damage After Coronary Artery Bypass Surgery: A Randomized Trial. J Cardiothorac Vasc Anesth 2010; 24: 790-796.
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article
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bwmeta1.element.psjd-6b1f1019-4a05-4a29-987f-dbd53c4c6cc3
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