Anaesthesia for coronary artery surgery — a plea for a goal-directed approach

Hall, Richard

doi:10.1007/bf03009608

Cited by 33 publications

(4 citation statements)

References 193 publications

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“…Overall, the weighted mean infusion rate for remifentanil (R) during maintenance of anaesthesia (from pre-bypass to end of surgery) varied between 1.29 (0.69) mg kg ±1 min ±1 pre-bypass; 1. 23 During tracheal intubation, more patients in the remifentanil group showed signs of inadequate anaesthesia compared with those in the fentanyl group (R 24%, F 9%, P<0.001). Response to sternal skin incision (R 11%, F 36%, P<0.001), sternotomy (R 14%, F 60%, P<0.001) and MSS (R 11%, F 52%, P<0.001) were signi®cantly and clinically less in the remifentanil group.…”

Section: Ef®cacymentioning

confidence: 90%

Comparative efficacy and safety of remifentanil and fentanyl in ‘fast track’ coronary artery bypass graft surgery: a randomized, double-blind study

Möllhoff

Herregods

Moerman

et al. 2001

British Journal of Anaesthesia

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This multi-centre, parallel group, randomized, double-blind study compared the efficacy and safety of high-dose remifentanil administered by continuous infusion with an intermittent bolus fentanyl regimen, when given in combination with propofol for general anaesthesia in 321 patients undergoing elective coronary artery bypass graft surgery. A significantly lower proportion of the patients who received remifentanil had responses to maximal sternal spread (the primary efficacy endpoint) compared with those who received fentanyl (11% vs 52%; P<0.001). More patients who received remifentanil responded to tracheal intubation compared with those who received fentanyl (24% vs 9%; P<0.001). However, fewer patients who received remifentanil responded to sternal skin incision (11% vs 36%; P<0.001) and sternotomy (14% vs 60%; P <0.001). Median time to extubation was longer in the subjects who received remifentanil than for those who received fentanyl (5.1 vs 4.2 h; P=0.006). There were no statistically significant differences between the two groups in the times for transfer from intensive care unit or hospital discharge but time to extubation was significantly longer in the remifentanil group. Overall, the incidence of adverse events was similar but greater in the remifentanil group with respect to shivering (P<0.049) and hypertension (P<0.001). Significantly more drug-related adverse events were reported in the remifentanil group (P=0.016). There were no drug-related adverse cardiac outcomes and no deaths from cardiac causes before hospital discharge in either treatment group.

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Section: Ef®cacymentioning

confidence: 90%

Comparative efficacy and safety of remifentanil and fentanyl in ‘fast track’ coronary artery bypass graft surgery: a randomized, double-blind study

Möllhoff

Herregods

Moerman

et al. 2001

British Journal of Anaesthesia

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“…M AINTENANCE OF COMFORT while minimizing pain, anxiety, and cardiac instability secondary to sympathetic discharge are primary goals of sedation in postoperative cardiac surgery patients. 1 Proper sedation and analgesia can decrease physiologic stress responses and facilitate adequate mechanical ventilation. Many sedatives and analgesics are currently used in postoperative cardiac surgery patients to achieve the aforementioned goals; however, there is no consensus as to which agents are preferred for maximum safety, efficacy, and cost-effectiveness.…”

mentioning

confidence: 99%

Propofol-Based Versus Dexmedetomidine-Based Sedation in Cardiac Surgery Patients

Curtis

Hollinger

Jain

2013

Journal of Cardiothoracic and Vascular Anesthesia

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“…It has a very short half-life but a fast acting benzodiazepine. 8 It is a colourless crystal and it's each millimeter has 1.0 or 5.0mg midazolam with pH of 3.3 buffered. The acidic pH of midazolam is necessary to save the benzodiazepene ring when midazolam injected acidic environment of benzodiazepene close the ring and provide the chemical structure which is necessary for clinical efficacy of drug.…”

Section: Introductionmentioning

confidence: 99%

Propofol or Midazolam for Sedation and Early Extubation Following Coronary Artery Bypass Graft Surgery

Ali¹,

Khan²,

Malak³

et al. 2022

PJMHS

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Objective: To evaluate the efficacy of midazolam and propofol for postoperative sedation and early extubation following cardiac surgery. Methods: This randomized control trial was conducted at the Cardiac Surgery Department of the Choudhary Pervaiz Elahi Institute of Cardiology from February 2019 to February 2020. A total of 60 American Society of Anesthesiologists (ASA) III patients planned to undergo coronary artery bypass graft surgery were included. After shifting into intensive care unit (ICU), patients were divided in two groups by lottery method and study drugs propofol and midazolam were started. Both infusions were terminated after four hours and patients were assessed for postoperative sedation and extubation. Hemodynamic parameters, arterial blood gases and respiratory functions were assessed and recorded. Results: The mean time to awakening, time to extubation in midazolam group was 94.11±4.36 minutes, 94.47±6.11 minutes respectively and in propofol group it was 96.58±4.31 minutes, 91.91±3.94 minutes respectively. Difference was statistically significant. Conclusion: Results of our study reveal that there was no difference in both drugs regarding sedation and extubation time, both drugs are safe, effective and useful in patients of coronary artery bypass graft surgery. Keywords: Coronary artery bypass graft, Midazolam, Propofol, Extubation, Sedation.

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Anaesthesia for coronary artery surgery — a plea for a goal-directed approach

Cited by 33 publications

References 193 publications

Comparative efficacy and safety of remifentanil and fentanyl in ‘fast track’ coronary artery bypass graft surgery: a randomized, double-blind study

Comparative efficacy and safety of remifentanil and fentanyl in ‘fast track’ coronary artery bypass graft surgery: a randomized, double-blind study

Propofol-Based Versus Dexmedetomidine-Based Sedation in Cardiac Surgery Patients

Propofol or Midazolam for Sedation and Early Extubation Following Coronary Artery Bypass Graft Surgery

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