PL EN
 
3-4/2010 vol. 64
Pobierz cytowanie
Remifentanil and fentanyl during induction of anesthesia for coronary artery surgery – a comparative hemodynamic study
Małgorzata Knapik 1
,
 
Piotr Knapik 1
,
 
Paweł Nadziakiewicz 1
,
 
Wojciech Saucha 1
 
 
 
Więcej
Ukryj
1
Department of Cardiac Anaesthesia, Silesian Centre for Heart Diseases, Zabrze, Poland
 
 
Autor do korespondencji
Małgorzata Knapik   

Śląskie Centrum Chorób Serca 41-800 Zabrze, ul. Szpitalna 2 tel. +48 32 273 27 31
 
 
Ann. Acad. Med. Siles. 2010;64:18-25
 
Artykuł (PDF)
Referencje (36)
 
SŁOWA KLUCZOWE
anaesthetic induction
remifentanil
coronary artery surgery
 
STRESZCZENIE
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.

ISSN 0208-5607
 
REFERENCJE (36)
1.
Camu F., Royston D. Inpatient experience with remifentanil. Anesth Analg 1999; 89(Suppl.): S15-S21.
Google Scholar
 
 
2.
Cohen J., Royston D., Remifentanil. Curr Opin Crit Care 2001; 7: 227-231.
Google Scholar
 
 
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.
Google Scholar
 
 
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.
Google Scholar
 
 
5.
Egan T.D. Pharmacokinetics and pharmacodynamics of remifentanil: an update in the year 2000. Curr Opin Anaesth 2000; 13: 449-455.
Google Scholar
 
 
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.
Google Scholar
 
 
7.
Patel S.S. Spencer C.M. Remifentanil. Drugs 1996; 52: 417-428.
Google Scholar
 
 
8.
Reves J.G. Educational considerations for the clinical introduction and use of remifentanil. Anesth Analg 1999; 89 (Suppl.): S4-S6.
Google Scholar
 
 
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.
Google Scholar
 
 
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.
Google Scholar
 
 
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.
Google Scholar
 
 
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.
Google Scholar
 
 
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.
Google Scholar
 
 
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.
Google Scholar
 
 
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.
Google Scholar
 
 
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.
Google Scholar
 
 
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.
Google Scholar
 
 
18.
Agnew NM., Pennefather SH., Russell GN. Isofl urane and coronary heart disease. Anaesthesia 2002; 57: 338–347.
Google Scholar
 
 
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.
Google Scholar
 
 
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.
Google Scholar
 
 
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.
Google Scholar
 
 
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.
Google Scholar
 
 
23.
Mangano D.T. Preoperative assessment of cardiac risk. In: Cardiac Anaesthesia, Red. Kaplan J. A, W. B. Saunders Company, Philadelphia-London-Toronto, 1999.
Google Scholar
 
 
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.
Google Scholar
 
 
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.
Google Scholar
 
 
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.
Google Scholar
 
 
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.
Google Scholar
 
 
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.
Google Scholar
 
 
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.
Google Scholar
 
 
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.
Google Scholar
 
 
31.
Lehmann A., Boldt J. Remifentanil in cardiac surgery (letter). Anesth Analg. 2001; 92: 557-558.
Google Scholar
 
 
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.
Google Scholar
 
 
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.
Google Scholar
 
 
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.
Google Scholar
 
 
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.
Google Scholar
 
 
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.
Google Scholar
 
 
Udostępnij
Wyślij mailem
Indeksy
 
Indeks słów kluczowych
Indeks dziedzin
Indeks autorów
eISSN:1734-025X
Journals System - logo


© 2006-2024 Journal hosting platform by Bentus
Scroll to top