Fast-Track Cardiac Anesthesia: Use of Remifentanil Combined with Intrathecal Morphine as an Alternative to Sufentanil During Desflurane Anesthesia

Zárate, Eduardo; Latham, Paige; White, Paul F.; Bossard, Robert; Morse, Lisa; Douning, Linda K.; Chen, Shi; Chi, Lei

doi:10.1213/00000539-200008000-00006

Cited by 9 publications

(8 citation statements)

References 20 publications

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“…Because of its potency and ultrashort pharmacokinetic profile, remifentanil has been proposed by some authors as an ideal opioid for patients with coronary artery disease. [2][3][4][5][6][7][8]19 Nevertheless, some clinical studies have reported that this opioid can induce significant cardiovascular disturbances that are potentially deleterious in coronary patients. 9 -12 This hemodynamic instability includes a decrease in systemic vascular resistances and cardiac output that is thought to be related to a decrease of both stroke volume and heart rate.…”

Section: Discussionmentioning

confidence: 99%

“…1 It has been proposed by some cardiac anesthesiologists as an agent of choice for patients undergoing fast-track cardiac surgery. [2][3][4] Although remifentanil is now clinically widely used in cardiac surgical patients, [2][3][4][5][6][7][8] some studies have indicated that this opioid may be associated to significant hemodynamic changes. 9 -12 These hemodynamic changes are characterized by decreases in arterial pressure, heart rate, cardiac output, and systemic vascular resistance.…”

mentioning

confidence: 99%

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Remifentanil Induces Systemic Arterial Vasodilation in Humans with a Total Artificial Heart

et al. 2004

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

Remifentanil Induces Systemic Arterial Vasodilation in Humans with a Total Artificial Heart

et al. 2004

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“…The use of smaller doses of opioid analgesics in combination with volatile anesthetics facilitates earlier tracheal extubation at the expense of increased postoperative pain. 22 Davy et al assessed fast-track cardiac anesthesia (FTCA) in terms of the safety and resource utilization after CABG over a 1-year period. One hundred and twenty patients were initially randomized to FTCA (n = 60) or conventional anesthetic (n = 60) for primary elective CABG surgery.…”

Section: Fast-track Cardiac Anesthesiamentioning

confidence: 99%

Newer Volatile Anesthetic Agents in Cardiac Anesthesia: Review of Literature

Mandke

Sarkar

Deshpande³

et al. 2021

Journal of Cardiac Critical Care TSS

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Myocardial protection with volatile anesthetic agents have been suggested by multiple studies. These studies, however, are scattered and are often limited to a particular aspect of cardiac anesthesia. Older inhalational agents like halothane is known to cause significant hepatic damage in patients undergoing long duration surgeries while isoflurane is known to have marked vasodilating properties that also affects the coronary arteries leading to coronary “steal” phenomenon. Additionally, newer agents, like sevoflurane and desflurane, have shown more prominent cardioprotective effects than older agents. We searched ScholarOne, Medline, Embase, and the Cochrane Central Register of Controlled Trials (CENTRAL) in the Cochrane Library. The medical subject headings (MeSH) terms “anaesthesia, inhalational,” “anaesthesia, intravenous, or TIVA,” and “Cardiac anaesthesia or Cardiac Surgery” were used. Additional studies were identified by review of the reference sections of all eligible studies. The aim of this review article is to bring together the evidences with newer inhalational agents and provide a holistic view of their benefits and shortcomings in cardiac anesthesia.

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“…56 Intrathecal analgesia in cardiac surgery has been used with great success since the 1980s. [57][58][59] Excellent pain control after cardiac surgery has been shown with both intrathecal 10,11,60,61 and epidural 15,[62][63][64] techniques. Furthermore, the addition of intrathecal clonidine appeared to augment the analgesic effect of morphine alone.…”

Section: Postoperative Analgesiamentioning

confidence: 99%

“…Regional anesthesia has played an integral part in many fast-track anesthesia protocols. [9][10][11][12][13][14][15] According to a recent multinational survey of regional anesthesia techniques in adult cardiac surgical procedures, spinal anesthesia is used by 7.6% and epidural anesthesia by 7% of practicing cardiac anesthesiologists. 16 Considering that more than 800,000 patients undergo cardiac surgery yearly worldwide, the neuraxial anesthesia is likely performed in thousands of patients each year.…”

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confidence: 99%

Regional Anesthesia in Cardiac Surgery: A Friend or A Foe?

Djaiani

Fedorko²,

Beattie³

2005

Semin Cardiothorac Vasc Anesth

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Escalating costs and change in the profile of patients presenting for cardiac surgery requires modification of perioperative management strategies. Regional anesthesia has played an integral part of many fast-track anesthesia protocols across North America and Europe. This review suggests that for patients undergoing coronary artery bypass graft surgery, the risk-to-benefit ratio is in favor of epidural and spinal anesthesia, provided there are no specific contraindications and the guidelines for the use of regional techniques in cardiac surgery are followed. Patients managed with regional techniques seem to benefit from superior postoperative analgesia, shorter postoperative ventilation, reduced incidence of supraventricular arrhythmia, and lower rates of perioperative myocardial infarction. The results of this analysis suggest that for each episode of neurologic complication, 20 myocardial infarctions and 76 episodes of atrial fibrillation would be prevented, thus, we would consider the regional anesthesia and analgesia to be an effective strategy that improves perioperative morbidity. However, other treatment modalities such as the addition of calcium channel blockers, aspirin, and beating heart surgery, are also suggested to be beneficial in cardiac surgical patients and may impose less risk than the use of regional techniques. We believe that the results presented in this review are encouraging enough to permit continued investigation. A prospective, randomized, controlled multicenter trial needs to be adequately powered to answer important clinical questions and allow for a long-term follow-up.

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Fast-Track Cardiac Anesthesia: Use of Remifentanil Combined with Intrathecal Morphine as an Alternative to Sufentanil During Desflurane Anesthesia

Cited by 9 publications

References 20 publications

Remifentanil Induces Systemic Arterial Vasodilation in Humans with a Total Artificial Heart

Remifentanil Induces Systemic Arterial Vasodilation in Humans with a Total Artificial Heart

Newer Volatile Anesthetic Agents in Cardiac Anesthesia: Review of Literature

Regional Anesthesia in Cardiac Surgery: A Friend or A Foe?

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