Fast-track cardiac anesthesia: use of remifentanil combined with intrathecal morphine as an alternative to sufentanil during desflurane anesthesia.

UNLABELLED: The purpose of this cardiac fast-track study was to evaluate the use of remifentanil (R) combined with intrathecal (IT) morphine as an alternative to sufentanil (S) during desflurane anesthesia with respect to postoperative pain control. Prior to entering the operating room, patients in the R group (n = 20) received morphine, 8 microg/kg IT. Anesthesia was induced using a standardized anesthetic technique in all patients. In the R group, anesthesia was maintained with R, 0.1 microg. kg(-1). min(-1) in combination with desflurane 3-10%. In the S group (n = 20), patients received S 0.3 microg. kg(-1). h(-1) and desflurane 3-10%. There were no differences between the two groups with respect to time from arrival in the intensive care unit to tracheal extubation (5.1 +/- 4.3 h vs 5.8 +/- 6.7 h for R and S groups, respectively). After extubation, patients in the R group had significantly lower visual analog pain scores, reduced patient-controlled analgesic requirements, and greater satisfaction with their perioperative pain management, compared with patients in the S group. We conclude that R combined with IT morphine provided superior pain control after cardiac surgery compared with a S-based general anesthetic technique. IMPLICATIONS: As part of a cardiac fast-tracking program involving desflurane anesthesia, the use of intrathecal morphine in combination with a remifentanil infusion provided improved postoperative pain control, compared with IV sufentanil alone.

Fast-track cardiac anesthesia: a comparison of remifentanil plus intrathecal morphine with sufentanil in a desflurane-based anesthetic.

OBJECTIVE: To compare the effects of an intravenous remifentanil infusion plus intrathecal morphine with intravenous sufentanil infusion with respect to intraoperative hemodynamic variables, extubation times, and recovery profiles when administered as part of a desflurane-based fast-track anesthetic regimen for cardiac surgery. DESIGN: A prospective, randomized, nonblinded study. SETTING: University hospital. PARTICIPANTS: Forty patients undergoing elective primary coronary artery bypass graft, aortic valve replacement, or mitral valve replacement surgery. INTERVENTIONS: After a standardized anesthetic induction, anesthesia was maintained with a remifentanil infusion, 0.1 microg/kg/min, and desflurane, 3% to 10%, inspired (group I, n = 20) or a sufentanil infusion, 0.3 microg/kg/h, and desflurane, 3% to 10%, inspired (group II, n = 20). Patients receiving remifentanil were administered intrathecal morphine, 8 microg/ kg, for postoperative analgesia. MEASUREMENTS AND MAIN RESULTS: Both anesthetic regimens provided comparable intraoperative hemodynamic stability and similar recovery profiles, with extubation times of 5.1 +/- 4.3 hours (group I) and 5.8 +/- 6.7 hours (group II). CONCLUSIONS: Use of remifentanil in combination with intrathecal morphine did not facilitate earlier tracheal extubation or improve intraoperative hemodynamic stability compared with sufentanil alone for fast-track cardiac anesthesia.

Temperature corrected thrombelastography in hypothermic patients.

Thrombelastograms and other coagulation studies are performed at 37 degrees C, regardless of the patient's body temperature. This prospective study of 45 patients undergoing orthotopic liver transplantation was conducted to evaluate the effect on the thrombelastogram performed at the patient's actual body temperature compared with a control thrombelastogram heated in the standard fashion to 37 degrees C. Thrombelastograms were obtained after the induction of anesthesia and at various times throughout the operation when clinically indicated. A freshly drawn sample of the patient's blood was divided into two aliquots and run simultaneously on two thrombelastographs; one thrombelastograph was modified with a thermostat to perform the test at the patient's body temperature and the other was unmodified to serve as a control. The temperature of the patients in this study ranged from 36.9 degrees C to 32 degrees C. The variables of the thrombelastogram measured were: r (reaction time in minutes), r + K (coagulation time in minutes), alpha (coagulation rate in degrees), and MA (maximum amplitude in millimeters). Whenever the patient's body temperature was less than 37 degrees C, statistically significant prolongation of the reaction time, coagulation time, and decrease in the clot formation rate occurred compared with control variables at 37 degrees C. Overall means were as follows: r for control, 8.24 +/- 0.28 min; r for temperature corrected, 9.32 +/- 0.27 min; r + K for control, 15.4 +/- 0.65 min; r + K for temperature corrected, 17.5 +/- 0.81 min; and alpha for control, 39.8 +/- 1.22 degrees; alpha for temperature corrected, 37.7 +/- 1.23 degrees.(ABSTRACT TRUNCATED AT 250 WORDS)