Abstract
•The feasibility and safety of low remifentanil effect-site concentrations (Ce) were studied to shorten the time to extubation readiness after cardiac surgery.•The use of remifentanil Ce 1, 2 and 3ng/ml produced comparative effects on times to extubation and hemodynamic responses to cardiac surgery performed under TCI propofol.•The three Ce resulted in immediate on-table extubation in 50% of patients.•The use of remifentanil Ce in the three patient groups lead to reduced length of stay in both hospital and ICU and reduced the overall costs of healthcare.
Assess different remifentanil effect-site concentrations (Ce) for readiness for extubation time after cardiac surgery.
Prospective, randomized, blinded, controlled study.
Single university hospital.
Seventy-three patients scheduled for cardiac surgery.
After ethical approval, patients scheduled for cardiac surgery with target-controlled propofol infusion were randomly assigned to receive remifentanil effect-site concentrations (Ce) of 1, 2, or 3 ng/mL (n = 25, 25, and 23, respectively).
The primary endpoint was readiness for extubation. Secondary outcomes were also recorded, including the cumulative doses and number of changes of propofol and remifentanil, hemodynamic variables, time to spontaneous eye opening and breathing, actual extubation, incidences of light anesthesia and myocardial ischemia, need for vasopressors and inotropes, and intensive care unit (ICU) and hospital stays. There was no difference in the time to readiness for extubation in any of the groups (0.1 ng/mL: 11.5 min (5-37); 0.2 ng/mL: 22 min (10-35); and 0.3 ng/mL: 21 min (10-49), p < 0.532); however, there was a significant difference among the 3 groups regarding the cumulative remifentanil doses (p < 0.001). Time to spontaneous eye opening and breathing, actual extubation, use of vasopressors and inotropes, incidences of light anesthesia and myocardial ischemia, and length of ICU and hospital stay were similar for all groups. Forty-six of the 73 patients were extubated on-table.
Remifentanil Ce 1, 2, and 3 ng/mL produced comparative effects on time to extubation and hemodynamic responses to cardiac surgery. The 3 Ce resulted in immediate on-table extubation in 50% of patients.