Zapotrzebowanie na remifentanyl w znieczuleniu wziewnym izofluranem podczas rewaskularyzacji naczyń wieńcowych

Małgorzata Knapik¹, Piotr Knapik¹, Paweł Nadziakiewicz¹, Wojciech Saucha¹, Jarosław Borkowski¹, Anna Dyaczyńska-Herman²

Summary
Background. Remifentanil, an ultra-short-acting opioid, is metabolized by non-specific plasma and tissue esterases, and is especially attractive for cardiac procedures because they can be easily divided into stages according to the intensity of nociceptive stimulation. The aim of this prospective study was to assess remifentanil requirement at various stages of coronary artery bypass grafting surgery. Methods. Twenty patients, aged 49-72 yrs and scheduled for CABG, received remifentanil during isoflurane-based anaesthesia at rates adjusted to maintain systolic arterial pressure within ± 20% from baseline values. Mean infusion rates of remifentanil were calculated for every stage. Results. The mean time taken for surgery was 235 ± 34 minutes. The mean infusion rate of remifentanil was 0.22 mcg kg^-1 min^-1 and was significantly higher in the period between skin incision and sternotomy (0.44 ± 0.23 mcg kg^-1 min^-1). The rate of infusion during CPB was significantly lower (0.18 ± 0.06 vs. 0.27 ± 0.08 mcg kg^-1 min^-1, p <0.001). There was no relationship between body temperature and remifentanil dosage. The mean total amount of the drug used during the whole procedure was 5.4 ± 2.0 mg. Conclusions. Remifentanil requirement was highest during the first phase of surgery and gradually decreased during cardiopulmonary bypass. Hypothermia did not influence the analgesic dose of the drug.

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