• P Olivier, D Sirieix, P Dassier, N D'Attellis, and J F Baron.
• Department of Anesthesiology, Broussais Hospital, Paris, France.
• J. Cardiothorac. Vasc. Anesth. 2000 Feb 1;14(1):29-35.

ObjectiveTo assess hemodynamic stability, postoperative pain management, and the control and timing of early extubation of a total intravenous anesthetic technique using propofol target-controlled infusion (TCI) and remifentanil in cardiac surgery.DesignProspective study.SettingUniversity hospital.ParticipantsFifty patients scheduled for elective cardiac surgery.InterventionsPremedication consisted of oral midazolam, 0.1 mg/kg. Anesthesia was induced with propofol TCI at a target concentration of 1.5 to 2 microg/mL; remifentanil, 1 microg/kg; and rocuronium. Anesthesia was maintained with propofol at the same target concentration and remifentanil titrated between 0.25 and 1 microg/kg/min. Thirty minutes before the end of surgery, a 0.1-mg/kg bolus of morphine was administered intravenously. Postoperative sedation was achieved by maintaining the propofol infusion until the patient was deemed ready for extubation. Postoperative pain relief was evaluated using a visual analog scale. The intervals between arrival in the intensive care unit, spontaneous ventilation, and extubation were recorded.Measurements And Main ResultsIncluded in this study were 36 men and 14 women (American Society of Anesthesiologist = III; New York Heart Association = II) scheduled for cardiac surgery. All patients remained hemodynamically stable throughout the perioperative period. Thirty-seven patients were successfully extubated during the first 4 postoperative hours. Spontaneous breathing was achieved at a mean interval of 15+/-5 minutes after propofol discontinuation. The mean interval to extubation was 163+/-45 minutes after arrival in the intensive care unit. Extubation was performed 48+/-12 minutes after patients were considered ready to awaken. During spontaneous ventilation, 36 patients received additional boluses of morphine (mean, 2.5+/-1 mg). Subsequently, all patients achieved a visual analog scale less than 40 mm.ConclusionThe combination of remifentanil and propofol TCI resulted in hemodynamic stability and good postoperative analgesia. This technique allows physicians to schedule the time of extubation in patients undergoing cardiac anesthesia.

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