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Pharmacokinetic-based total intravenous anaesthesia using remifentanil and propofol for surgical myocardial revascularization

Published online by Cambridge University Press:  30 June 2005

F. Guarracino ,
D. Penzo ,
D. De Cosmo ,
A. Vardanega  and
R. De Stefani
F. Guarracino
Affiliation:
Umberto I Hospital, Department of Cardiac Anaesthesia and Intensive Care, Venezia-Mestre, Italy
D. Penzo
Affiliation:
Umberto I Hospital, Department of Cardiac Anaesthesia and Intensive Care, Venezia-Mestre, Italy
D. De Cosmo
Affiliation:
Umberto I Hospital, Department of Cardiac Anaesthesia and Intensive Care, Venezia-Mestre, Italy
A. Vardanega
Affiliation:
Umberto I Hospital, Department of Cardiac Anaesthesia and Intensive Care, Venezia-Mestre, Italy
R. De Stefani
Affiliation:
Umberto I Hospital, Department of Cardiac Anaesthesia and Intensive Care, Venezia-Mestre, Italy
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Extract

Summary

Background and objective: We investigated the following aspects of pharmacokinetic-guided total intravenous anaesthesia with remifentanil and propofol in patients undergoing surgical myocardial revascularization: anaesthetic efficacy, haemodynamic effects, impact on extubation of the trachea and analgesia after operation.

Methods: Thirty-two patients undergoing on-pump coronary bypass surgery received intravenous anaesthesia with remifentanil and propofol. Both drugs were dosed and titrated based on computer-assisted pharmacokinetic models to maintain constant plasma concentrations. The propofol target plasma concentration was 1.2 μg mL−1 throughout the procedure. A remifentanil target plasma concentration of 8 ng mL−1 was achieved over 2 min for induction. After tracheal intubation, the opioid plasma concentration was reduced to 4 ng mL−1, and then titrated up to 8 ng mL−1 during surgery. Postoperative analgesia was managed with remifentanil infusion until 4 h after tracheal extubation, and a continuous infusion of tramadol was started 1 h before the remifentanil was stopped.

Results: After induction of anaesthesia, heart rate (−20%) and cardiac index (−6%) decreased significantly. No hypotensive episodes (mean arterial pressure <60 mmHg) occurred. Intraoperative haemodynamics were stable. Three cases of myocardial ischaemia were detected: two by transoesophageal echocardiography and one with ST-segment monitoring. The duration of postoperative mechanical ventilation of the lungs was 95 ± 13 min and the time to extubation was 150 ± 18 min. Postoperative analgesia was satisfactory in all patients.

Conclusions: Pharmacokinetic-based total intravenous anaesthesia with remifentanil and propofol provides adequate anaesthesia during coronary surgery with cardiopulmonary bypass and allows safe early extubation after operation.

Keywords

ANAESTHESIA, INTRAVENOUSANAESTHETICS, INTRAVENOUS, propofolCARDIAC SURGICAL PROCEDURES, myocardial revascularization, coronary artery bypass
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 20 , Issue 5 , May 2003 , pp. 385 - 390
Copyright
2003 European Society of Anaesthesiology

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