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CARDIOVASCULAR ANESTHESIA

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

Department of Anesthesiology and Pain Management, University of Texas, Southwestern Medical Center at Dallas, Dallas, Texas

Address correspondence to Paul F. White, PhD, MD, Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., F2.208, Dallas, TX 75235-9068. Address e-mail to paul.white{at}email.swmed.edu

The purpose of this cardiac fast-track study was to evaluate the use of remifentanil (R) combined with intrathecal (IT) morphine as an alternative to sufentanil (S) during desflurane anesthesia with respect to postoperative pain control. Prior to entering the operating room, patients in the R group (n = 20) received morphine, 8 µg/kg IT. Anesthesia was induced using a standardized anesthetic technique in all patients. In the R group, anesthesia was maintained with R, 0.1 µg · kg^-1 · min^-1 in combination with desflurane 3–10%. In the S group (n = 20), patients received S 0.3 µg · kg^-1 · h^-1 and desflurane 3–10%. There were no differences between the two groups with respect to time from arrival in the intensive care unit to tracheal extubation (5.1 ± 4.3 h vs 5.8 ± 6.7 h for R and S groups, respectively). After extubation, patients in the R group had significantly lower visual analog pain scores, reduced patient-controlled analgesic requirements, and greater satisfaction with their perioperative pain management, compared with patients in the S group. We conclude that R combined with IT morphine provided superior pain control after cardiac surgery compared with a S-based general anesthetic technique.

Implications: As part of a cardiac fast-tracking program involving desflurane anesthesia, the use of intrathecal morphine in combination with a remifentanil infusion provided improved postoperative pain control, compared with IV sufentanil alone.

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