Remifentanil-clonidine-propofol versus sufentanil-propofol anesthesia for coronary artery bypass surgery

Objective: To compare a remifentanil-clonidine-propofol regimen with conventional sufentanil-propofol anesthesia. Design: Randomized, nonblinded trial. Setting: A single university hospital. Participants: Male patients scheduled for coronary artery bypass graft (CABG) surgery. Interventions: In the control group, anesthesia was induced with 0.5 μg/kg of sufentanil and 0.2 to 0.3 mg/kg of etomidate after preoxygenation. Propofol (50 to 100 μg/kg/ min) and sufentanil (0.5 to 1.0 μg/kg/h) were started after endotracheal intubation. Sufentanil was stopped after aortic decannulation. In the remifentanil-clonidine group, anesthesia was started with remifentanil (0.15 to 0.3 μg/kg/min), followed by etomidate (0.2 to 0.3 mg/kg). Propofol was started at 50 to 100 μg/kg/min, and after endotracheal intubation, clonidine infusion was started (6 to 20 μg/h). Patients received piritramide (0.15 mg/kg) and metamizole (20 mg/kg) for transitional analgesia. In both groups, propofol infusion was reduced to 30 to 60 μg/kg/min at skin closure and stopped when assisted spontaneous breathing led to adequate gas exchange. Measurements and Main Results: The main outcomes were recovery times; somatic variables; plasma catecholamine levels; and self-recorded pain, nausea, and vomiting. Patients in the remifentanil-clonidine group were extubated earlier and had lower plasma epinephrine and norepinephrine levels. After transitional analgesia, the remifentanil-clonidine patients had similar postoperative analgesic use and self-reported pain and side-effect scores. Conclusion: Compared with a sufentanil-propofol regimen, an anesthetic regimen for CABG surgery that combines remifentanil, clonidine, and propofol provides similar hemodynamics. The remifentanil-clonidine regimen reduces catecholamine levels and hastens recovery from anesthesia.