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CARDIOVASCULAR ANESTHESIA

The Continuous Recording of Blood Pressure in Patients Undergoing Carotid Surgery Under Remifentanil Versus Sufentanil Analgesia

Stéphane Mouren, MD PhD^*, Gaertrud De Winter, MD, Sandra P. Guerrero, MD, Christophe Baillard, MD, Michèle Bertrand, MD, and Pierre Coriat, MD

*Département Bloc-Anesthésie, Institut Mutualiste Montsouris, Paris, France; and Département d’Anesthésie-Réanimation, Hôpital Pitié-Salpétrière, Paris, France

Address correspondence to Stéphane Mouren, MD, PhD, Département Bloc-Anesthésie, Institut Mutualiste Montsouris, 42 Boulevard Jourdan, 75674 Paris Cedex 14, France.

We compared the hemodynamic stability during carotid endarterectomy of remifentanil with that of sufentanil anesthesia. Fifty-six patients were randomly assigned into Remifentanil (n = 27) or Sufentanil (n = 29) groups. In the Remifentanil group, IV propacetamol (2 g) and morphine (0.1 mg/kg) were infused 30 min before skin closure. In the Sufentanil group, patients received 2 g propacetamol. Beat-to-beat recordings of systolic arterial blood pressure (SBP) and heart rate (HR) were stored on a computer. The maximum and minimum values of BP and HR after induction, at intubation, during the surgical procedure, and after the operation and the coefficients of variation of SBP and HR were used as indices of hemodynamic stability. The coefficients of variation of SBP and HR were similar in both groups during and after surgery. However, at intubation, maximal SBP was higher in the Sufentanil group (P < 0.05). Decreased propofol doses and isoflurane end-tidal concentrations were used in the Remifentanil group. At recovery, a similar profile of SBP and HR was found in both groups. We conclude that intra- and posthemodynamic stability was similar with remifentanil or sufentanil in patients undergoing carotid endarterectomy. However, remifentanil was more effective for blunting the increase in SBP at intubation without increasing the blood pressure-decreasing effect of induction. Intraoperative remifentanil use was associated with a decreased amount of hypnotic drug administered.

IMPLICATIONS:Beat-to-beat recordings of heart rate and blood pressure in patients undergoing carotid surgery revealed that hemodynamic stability was similar with remifentanil or sufentanil anesthesia both during and after surgery. Remifentanil was more effective in limiting the increase in blood pressure associated with intubation without increasing the blood pressure-lowering effect of induction or the blood pressure response to recovery.

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