Continuous infusion of remifentanil and target-controlled infusion of propofol for coronary surgery in elderly patients: comparison with continuous infusion of remifentanil and propofol

Objectives. - Comparison of the length of mechanical ventilation and postoperative complications after coronary surgery in elderly patients anaesthetised with propofol associated with either alfentanil or remifentanil. Study design. - Retrospective study with an historic control group. Patients. - Three hundred thirty-eight consecutive patients (75-year-old or more) undergoing isolated coronary surgery. One hundred and fifty seven patients operated between January 1998 and June 2000 received alfentanil (1 mug/kg/minute) with a manually control infusion of propofol, 181 operated between July 2000 and 2002, remifentanil 0.25 mug/kg/minute with target controlled infusion of propofol (target blood concentration: 1.5 to 2 mug/ml). Methods. - The two groups were compared for preoperative and surgical data. The length of mechanical ventilation, stay in ICU and the main postoperative complications were compared between the two groups. Results. - Length of mechanical ventilation was significantly reduced in the remifentanil group (6 +/- 9 h vs. 13 +/- 63 h : p < 0.0001), 70% of the patients were extubated before the 6th postoperative hours against 53% in the alfentanil group (p = 0.0023). This was not associated with a reduction of stay in ICU or postoperative complications. During surgery, an increased used of vasopressor was observed in the remifentanil Group (40.2% vs 2.4% : p < 0.0001) with a postoperative elevation of blood concentration of CKMb (35.7 +/- 38.2 mug/l, vs. 27.7 +/- 31.9 mug/l, p = 0.02). Conclusion. - Elderly patients undergoing coronary surgery were extubated earlier with remifentanil. However, this had no effect on duration of ICU stay but was associated with an increased used of vasopressor. (C) 2004 Elsevier SAS.