Early extubation after cardiac surgery using combined intrathecal sufentanil and morphine

Swenson, Jeffrey D.; Hullander, R.Michael; Wingler, Kenneth; Leivers, David

doi:10.1016/1053-0770(94)90161-9

Cited by 56 publications

(11 citation statements)

References 25 publications

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“…3 Choice and advantages of the method used Recent evidence suggests that fast-track cardiac surgery is not only safe but may improve patient outcome by decreasing the incidence of postoperative cardiopulmonary morbidity and may lower the cost of cardiac surgery. [1][2][3]9 The optimal anesthetic technique to reach this goal remains debatable. TCI-propofol offers stable hemodynamics with minimal negative inotropism and a rapid and controlled recovery; it is widely used for noncardiac as well as cardiac surgery.…”

Section: Extubation Postoperative Analgesia and Complicationsmentioning

confidence: 99%

“…8,18,19 IT sufentanil is known to provide an intense and fast-onset analgesia. 8,9 We postulated that the combination of IT mor- phine and sufentanil could avoid deleterious effects and increase patient comfort because of their different peaks of activity. 8,16,17 In our study, the combination of IT morphine and sufentanil provided effective intraoperative analgesia.…”

Section: Extubation Postoperative Analgesia and Complicationsmentioning

confidence: 99%

“…7 IT sufentanil provides intense and fast-onset analgesia 8 and, along with IT morphine, appears to be a suitable choice for fast-track cardiac surgery. 9 The aim of this prospective randomized study was to assess the effect of intraoperative combined IT sufentanil and morphine in comparison to low-dose iv sufentanil in low-risk patients undergoing elective cardiac surgery. Both anesthetic techniques were combined with a target-controlled infusion of propofol.…”

Section: [L'administration Intrathécale Combinée De Sufentanil-morphimentioning

confidence: 99%

“…A two-hour sedation score using the Ramsay scale 11 and a four-hour analgesic score [visual analogue scale (VAS), [1][2][3][4][5][6][7][8][9][10] was recorded by the nurses in the ICU. Patients were questioned regarding the occurrence of pruritus, nausea and vomiting as well as intraoperative awareness.…”

Section: Postoperative Managementmentioning

confidence: 99%

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Intrathecal sufentanil-morphine shortens the duration of intubation and improves analgesia in fasttrack cardiac surgery

Béttex

Schmidlin

Chassot

et al. 2002

Can J Anesth/J Can Anesth

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P Pu ur rp po os se e: : To compare the effect of combined intrathecal morphine and sufentanil with low-dose iv sufentanil during propofol anesthesia for fast-track cardiac surgery.M Me et th ho od ds s: : Twenty-four consecutive patients with normal cardiopulmonary function who were scheduled for elective cardiac surgery were randomized to receive either a continuous iv infusion of sufentanil 0.9 to 1.8 µg·kg -1 ·min -1 (13 patients), or a single lumbar intrathecal dose of sufentanil 50 µg and morphine 500 µg (11 patients). We prospectively studied perioperative analgesia, time to extubation and early postoperative maximal inspiratory capacity in the two groups. In the intensive care unit, the medical and nursing staff were blinded to the analgesic technique.R Re es su ul lt ts s: : Intrathecal sufentanil morphine allowed a shorter duration of intubation (104 ± 56.5 min vs 213 ± 104 min; P = 0.01), reduced the need for postoperative analgesia with nicomorphine (equipotent to morphine) (0.7 ± 0.4 mg·hr -1 vs 1.2 ± 0.4 mg·hr -1 ; P = 0.008) and improved postoperative maximal inspiratory capacity (53.4 ± 16.1 vs 38.4 ± 12.5% of the norm; P = 0.05).C Co on nc cl lu us si io on n: : In low-risk patients undergoing coronary artery bypass graft or valve surgery, combined intrathecal sufentanil and morphine with a target-controlled infusion of propofol satisfies the goals of fast-track cardiac surgery. (0,7 ± 0,4 mg·h -1 vs 1,2 ± 0,4 mg·h -1 ; P = 0,008) et une amélioration de la capacité inspiratoire maximale postopératoire (53,4 ± 16,1 vs 38,4 ± 12,5 % de la norme ; P = 0,05 AST-TRACK cardiac surgery entails early postoperative extubation with intense control of pain and rapid transfer to the ward and is mostly applied to patients who have well-preserved pulmonary and ventricular function. C Ca ar rd di io ot th ho or ra ac ci ic c A An ne es st th he es si ia a, , R Re es sp pi ir ra at ti io on n a an nd d A Ai ir rw wa ay y

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Section: Extubation Postoperative Analgesia and Complicationsmentioning

confidence: 99%

Section: Extubation Postoperative Analgesia and Complicationsmentioning

confidence: 99%

Section: [L'administration Intrathécale Combinée De Sufentanil-morphimentioning

confidence: 99%

Section: Postoperative Managementmentioning

confidence: 99%

See 2 more Smart Citations

Intrathecal sufentanil-morphine shortens the duration of intubation and improves analgesia in fasttrack cardiac surgery

Béttex

Schmidlin

Chassot

et al. 2002

Can J Anesth/J Can Anesth

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“…11 No other opioids were used intraoperatively, and postoperative opioid requirements were low. However, that retrospective study examined the charts of only ten patients, without a cohort not receiving ITM, and mean extubation time was 6.3 ± 1.4 hr.…”

mentioning

confidence: 99%

Low dose intrathecal morphine facilitates early extubation after cardiac surgery: results of a retrospective continuous quality improvement audit

Parlow

Steele

O’Reilly

2005

Can J Anesth/J Can Anesth

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P Pu ur rp po os se e: : To document one centre's experience with a multimodal analgesic approach, with or without low dose intrathecal morphine (ITM), in facilitating "fast-track" recovery in patients undergoing cardiac surgery.M Me et th ho od ds s: : Records of 131 consecutive patients who underwent first time elective cardiac surgery during a four-month period in 2000 were reviewed. Patients were divided into two groups: those receiving and those not receiving preoperative low dose ITM (< 5 µg·kg -1 ) as part of a multimodal analgesic technique. Demographic and surgical characteristics, postoperative morphine use, time to extubation and requirement for antiemetics were recorded. R Re es su ul lt ts s: : Overall, 75% of patients were extubated within two hours, and 93% within six hours. Fifty-five patients received, and 76 did not receive, ITM (mean ± SD 259 ± 53 µg) along with a multimodal analgesic technique (parasternal infiltration, acetaminophen and indomethacin, and postoperative iv morphine). Anesthetic technique involved modest dose opioids, volatile agent and propofol infusion. The groups were similar with respect to preoperative, intraoperative and anesthetic characteristics.Mean extubation time for fast-track patients receiving vs not receiving ITM was 75 ± 65 vs 117 ± 85 min (P = 0.003). Intravenous morphine use for the first 12 hr after surgery was also reduced in the ITM group (4.6 ± 4.1 vs 10.0 ± 14.8 mg, P = 0.009). There was no difference in rescue antiemetic or antipruritic requirements, failed fast-tracking, or serious adverse events.C Co on nc cl lu us si io on ns s: : Multimodal postoperative analgesia allowed for uneventful early extubation and low opioid requirements. Low dose ITM further facilitated early extubation, and reduced postoperative analgesic requirements. MIT (4,6 ± 4,1 vs 10,0 ± 14,8 mg, P = 0,009

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Pharmacodynamics of doxacurium during cardiac surgery with hypothermic cardio-pulmonary bypass

et al. 1996

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Early extubation after cardiac surgery using combined intrathecal sufentanil and morphine

Cited by 56 publications

References 25 publications

Intrathecal sufentanil-morphine shortens the duration of intubation and improves analgesia in fasttrack cardiac surgery

Intrathecal sufentanil-morphine shortens the duration of intubation and improves analgesia in fasttrack cardiac surgery

Low dose intrathecal morphine facilitates early extubation after cardiac surgery: results of a retrospective continuous quality improvement audit

Pharmacodynamics of doxacurium during cardiac surgery with hypothermic cardio-pulmonary bypass

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