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Remifentanil-clonidine-propofol versus sufentanil-propofol anesthesia for coronary artery bypass surgery.

Abstract：

OBJECTIVE:To compare a remifentanil-clonidine-propofol regimen with conventional sufentanil-propofol anesthesia. DESIGN:Randomized, nonblinded trial. SETTING:A single university hospital. PARTICIPANTS:Male patients scheduled for coronary artery bypass graft (CABG) surgery. INTERVENTIONS:In the control group, anesthesia was induced with 0.5 microg/kg of sufentanil and 0.2 to 0.3 mg/kg of etomidate after preoxygenation. Propofol (50 to 100 microg/kg/min) and sufentanil (0.5 to 1.0 microg/kg/h) were started after endotracheal intubation. Sufentanil was stopped after aortic decannulation. In the remifentanil-clonidine group, anesthesia was started with remifentanil (0.15 to 0.3 microg/kg/min), followed by etomidate (0.2 to 0.3 mg/kg). Propofol was started at 50 to 100 microg/kg/min, and after endotracheal intubation, clonidine infusion was started (6 to 20 microg/h). Patients received piritramide (0.15 mg/kg) and metamizole (20 mg/kg) for transitional analgesia. In both groups, propofol infusion was reduced to 30 to 60 microg/kg/min at skin closure and stopped when assisted spontaneous breathing led to adequate gas exchange. MEASUREMENTS AND MAIN RESULTS:The main outcomes were recovery times; somatic variables; plasma catecholamine levels; and self-recorded pain, nausea, and vomiting. Patients in the remifentanil-clonidine group were extubated earlier and had lower plasma epinephrine and norepinephrine levels. After transitional analgesia, the remifentanil-clonidine patients had similar postoperative analgesic use and self-reported pain and side-effect scores. CONCLUSION:Compared with a sufentanil-propofol regimen, an anesthetic regimen for CABG surgery that combines remifentanil, clonidine, and propofol provides similar hemodynamics. The remifentanil-clonidine regimen reduces catecholamine levels and hastens recovery from anesthesia.

journal_name

J Cardiothorac Vasc Anesth

journal_title

Journal of cardiothoracic and vascular anesthesia

authors

Gerlach K,Uhlig T,Hüppe M,Kraatz E,Saager L,Schmitz A,Dörges V,Schmucker P

doi

10.1053/jcan.2002.128415

keywords:

subject

Has Abstract

pub_date

2002-12-01 00:00:00

pages

703-8

issue

eissn

1053-0770

issn

1532-8422

pii

S105307700200126X

journal_volume

pub_type

临床试验,杂志文章,随机对照试验

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Remifentanil-clonidine-propofol versus sufentanil-propofol anesthesia for coronary artery bypass surgery.