Ultrashort acting remifentanil is not superior to long-acting sufentanil in preserving cognitive function-a randomized study
| Autor: | Carl-Johan Jakobsen, Anne-Grethe Lorentzen, Pia Katarina Ryhammer, Rajesh R. Bhavsar, Linda Aagaard Rasmussen, Jacob Greisen |
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| Rok vydání: | 2015 |
| Předmět: |
Male
medicine.medical_specialty Sufentanil Remifentanil Neuropsychological Tests law.invention 03 medical and health sciences 0302 clinical medicine Cognition Randomized controlled trial Aortic valve replacement Piperidines 030202 anesthesiology law medicine Humans Pain Management Cardiac Surgical Procedures Coronary Artery Bypass Aged Pain Postoperative business.industry Perioperative medicine.disease Intensive care unit Surgery Cardiac surgery Anesthesiology and Pain Medicine Anesthesia Anesthesia Recovery Period Anesthesia Intravenous Female business Cognition Disorders Postoperative cognitive dysfunction 030217 neurology & neurosurgery Anesthetics Intravenous medicine.drug |
| Zdroj: | Journal of clinical anesthesia. 33 |
| ISSN: | 1873-4529 |
| Popis: | Study objective Postoperative cognitive dysfunction (POCD) is a well-known complication after cardiac surgery and may cause permanent disabilities with severe consequences for quality of life. The objectives of this study were, first, to estimate the frequency of POCD after on-pump cardiac surgery in patients randomized to remifentanil- or sufentanil-based anesthesia and, second, to evaluate the association between POCD and quality of recovery and perioperative hemodynamics, respectively. Design Randomized study. Setting Postoperative cardiac recovery unit, University Hospital. Patients Sixty patients with ischemic heart disease scheduled for elective coronary artery bypass grafting ± aortic valve replacement. Interventions and handling Randomized to either remifentanil or sufentanil anesthesia as basis opioid. Postoperative pain management consisted of morphine in both groups. Measurements Cognitive functioning evaluated preoperatively and on the 1st, 4th, and 30th postoperative day using the cognitive test from the Palo Alto Veterans Affairs Hospital. Perioperative invasive hemodynamics and the quality of recovery was evaluated by means of invasive measurements and an intensive care unit discharge score. Main results No difference between opioids in POCD at any time. A negative correlation was found between preoperative cognitive function and POCD on the first postoperative day ( r =−0.47; P =.0002). The fraction of patients with POCD on the first postoperative day was statistically greater in patients with more than 15minutes of Svo 2 P =.037; χ 2 test). Among patients with postoperative ventilation time exceeding 300minutes, more patients had POCD on postoperative day 4 ( P =.002). Conclusions We could not demonstrate differences in POCD between remifentanil and sufentanil based anaesthesia, but in general, the fraction of patients with POCD seemed smaller than previously reported. We found an association between POCD and both perioperative low Svo 2 and postoperative ventilation time, underlining the importance of perioperative stable hemodynamics and possible fast-track protocols with short ventilation times to attenuate POCD. |
| Databáze: | OpenAIRE |
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