• Rajesh Bhavsar, Pia Katerina Ryhammer, Jacob Greisen, Linda A Rasmussen, and Carl-Johan Jakobsen.
• Department of Anaesthesiology and Intensive Care, Aarhus University Hospital, Aarhus, Denmark.
• J. Cardiothorac. Vasc. Anesth. 2016 Oct 1; 30 (5): 1212-20.

ObjectiveProgressive cost containment has resulted in a growing interest for fast-track cardiac surgery. Ventilation time and length of stay (LOS) in the intensive care unit (ICU) are important factors in patient turnover, a more efficient use of resources, and early patient mobilization. However, LOS in ICU is not an objective measure because, in addition to medical factors, patient discharge may be guided by logistics and policy, and thus more objective measures are warranted. The authors hypothesized that remifentanil compared with sufentanil would reduce ventilation time and LOS in the ICU and that remifentanil would have beneficial effects on the overall quality of recovery.DesignA randomized, prospective study.ParticipantsSixty patients scheduled for elective coronary artery bypass grafting with or without aortic valve replacement.SettingA university hospital.InterventionsPatients were assigned randomly to receive either remifentanil or sufentanil combined with propofol.Measurements And Main ResultsPatients with ejection fraction<0.3, myocardial infarction within the last 4 weeks, diabetes, and severe pulmonary or arterial hypertension were excluded. The primary outcome variables were ventilation time and time to eligibility of discharge from the cardiac recovery unit. Secondary outcomes were actual LOS in the cardiac recovery unit and quality of recovery. The groups were comparable in selected demographics and perioperative parameters. There were no differences in ventilation time or eligible ICU discharge time between the groups. Remifentanil patients received more morphine than did the sufentanil patients during recovery (20 mg v 10 mg; p = 0.040). No difference was found in pharmacologic support or use of a pacemaker.ConclusionIn a fast-track protocol, remifentanil did not seem to be superior to a standard moderate- to high-dose sufentanil regimen.Copyright © 2016 Elsevier Inc. All rights reserved.

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