ISSN : 1301-5680
e-ISSN : 2149-8156
Turkish Journal of Thoracic and Cardiovascular Surgery     
An efficacy comparison of fentanyl and remifentanil during off-pump coronary artery bypass graft surgery
Tuğba Aşkın1, Ümit Karadeniz2, Süheyla Ünver3, Ertay Boran4, Özcan Erdemli2
1Department of Anaesthesiology and Reanimation, Afyon State Hospital, Afyon, Turkey
2Department of Anaesthesiology and Reanimation, Türkiye Yüksek İhtisas Training and Research Hospital, Ankara, Turkey
3Department of Anaesthesiology and Reanimation, Dr. Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital, Ankara, Turkey
4Department of Anaesthesiology and Reanimation, İzmir Training and Research Hospital, İzmir, Turkey
DOI : 10.5606/tgkdc.dergisi.2013.7309
Background: This study aims to compare the effects of fentanyl and remifentanil on hemodynamic stability, release of troponin-I and early extubation during off-pump coronary artery bypass graft (CABG) surgery.

Methods: Forty patients who were scheduled for elective offpump CABG surgery were randomly assigned to two groups. The remifentanil group received 1 μg/kg-1 remifentanil over one minute for induction, followed by 0.1-1 μg/kg-1 min-1 continuous infusion plus midazolam 0.1-0.15 mg/kg-1 for maintenance dose. The fentanyl group received 10-15 μg/kg-1 fentanyl over one minute for induction and 0.1-1 μg/kg-1 min-1 continuous infusion plus midazolam 0.1-0.15 mg/kg-1 for maintenance dose. Rocuronium bromide at 0.6-0.8 mg/kg-1 was administered to facilitate tracheal intubation. Midazolam infusion at 0.4-1 μg/kg-1 min-1 was initiated for maintenance therapy.

Results: The depth of anesthesia was adjusted to maintain a BIS value between 40-60. Following skin incision and sternotomy, systolic arterial pressure was lower in the remifentanil group compared to the fentanyl group (115±14 mmHg vs. 130±22 mmHg p<0.05; 125±14 mmHg vs. 135±19 mmHg, p<0.05). Total dose of midazolam was significantly higher in the remifentanil group compared to the fentanyl group (13.9±3.7 mg vs. 11.6±3.7 mg, p<0.05). Intraoperative use of beta blockers, nitroglycerine and sodium nitroprusside was similar in both groups. The median time to extubation and the length of stay in the intensive care unit were shorter in the remifentanil group (6.5±3 h vs. 10±3 h, p<0.05; 14±6 h vs. 20±6 h, p<0.05). The incidence of postoperative electrocardiographic changes and troponin I measurements were similar in both groups.

Conclusion: Although remifentanil infusion offers a better intraoperative hemodynamic stability and postoperative recovery, both agents have similar effects on myocardial injury during offpump CABG surgery.

Keywords : Anesthesia; myocardial protection; off-pump surgery; remifentanil
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