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A Comparison of Remifentanil and Alfentanil for Use with Propofol in Patients Undergoing Minimally Invasive Coronary Artery Bypass Surgery

Most patients undergoing minimally invasive direct coronary artery bypass surgery can be awakened and tracheally extubated in the operating room. We have compared two techniques of total IV anesthesia in this patient population: 30 patients (aged 44 to 74 yr; 24 male) premedicated with temazepam were randomly assigned to receive either remifentanil-propofol or alfentanil-propofol. Anesthesia was induced with remifentanil 2 &mgr;g/kg or with alfentanil 40 &mgr;g/kg, with propofol, and maintained with remifentanil at 0.25 or 0.5 &mgr;g · kg−1 · min−1 or alfentanil at 0.5 or 1 &mgr;g · kg−1 · min−1. The stable maintenance infusion rate of propofol was adjusted for age. Times to awakening and tracheal extubation were recorded. Postoperatively, IV morphine provided by patient-controlled analgesia was used for 48 h. Times to awakening and tracheal extubation (mean ± sd) were shorter (P < 0.01) in patients receiving remifentanil, and interpatient variations in times to awakening and tracheal extubation smaller (awakening 25 ± 7 vs 74 ± 32 min, and extubation 27 ± 7 vs 77 ± 32 min). Analysis of variance revealed that postoperative consumption of morphine was dependent on both the intraoperative opioid and the time elapsed after surgery (P < 0.05): patient-controlled analgesia morphine use during the first 3 h after awakening was more in patients receiving remifentanil (P < 0.01). Implications Recovery of patients undergoing Minimally Invasive Direct Coronary Artery Bypass Surgery is significantly shorter and more predictable after total IV anesthesia with remifentanil-propofol than with alfentanil-propofol, which may be important if the goal is that patients will be awakened and tracheally extubated in the operating room.