Hemodynamic effects, myocardial ischemia, and timing of tracheal extubation with propofol-based anesthesia for cardiac surgery

Paul S. Myles, Mark R. Buckland, Anthony M. Weeks, Michael A. Bujor, Roderick McRae, Mark Langley, John T. Moloney, Jennifer O. Hunt, Bruce B. Davis

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Recent interest in earlier tracheal extubation after coronary artery bypass graft (CABG) surgery has focused attention on the potential benefits of a propofol-based technique. We randomized 124 patients (34 with poor ventricular function) undergoing CABG surgery to receive either a propofol- based (5 mg · kg m-1 · h-1 prior to sternotomy, 3 mg · kg-1 · h-1 thereafter; n = 58) or enflurane-based (0.2%-1.0%, n = 66)anesthetic. Induction of anesthesia consisted of fentanyl 15 μg/kg and midazolam 0.05 mg/kg intravenously in both groups. The enflurane group received an additional bolus of fentanyl 5 μg/kg prior to sternotomy and fentanyl 10 μg/kg with midazolam 0.1 mg/kg at commencement of cardiopulmonary bypass (CPB). Patients receiving propofol were extubated earlier (median 9.1 h versus 12.3 h, P = 0.006), although there was no difference in time to intensive care unit (ICU) discharge (both 22 h, P = 0.54). Both groups had similar hemodynamic changes throughout (all P > 0.10), as well as metaraminol (P = 0.49) and inotrope requirements (P > 0.10), intraoperative myocardial ischemia (P = 0.12) and perioperative myocardial infarction (P = 0.50). The results of this trial suggest that a propofol-based anesthetic, when compared to an enflurane-based anesthetic requiring additional dosing of fentanyl and midazolam for CPB, can lead to a significant reduction in time to extubation after CABG surgery, without adverse hemodynamic effects, increased risk of myocardial ischemia or infarction.

Original languageEnglish
Pages (from-to)12-19
Number of pages8
JournalAnesthesia and Analgesia
Issue number1
Publication statusPublished - 1997

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