Low target sufentanil effect-site concentrations allow early extubation after valve surgery

摘要

Objectives: To test the ability of low sufentanil effect-site concentrations (Ce) to shorten the time to tracheal extubation after valve surgery. Design: A prospective, randomized, blinded, controlled study. Setting: A single university hospital. Participants: Forty-eight patients scheduled for valve surgery under target-controlled propofol infusion. Interventions: After ethical committee approval, patients were allocated randomly to receive sufentanil concentrations of 0.2, 0.3, or 0.4 ng/mL (n = 16 per group) during target-controlled propofol infusion. Measurements and Main Results: Times to spontaneous eye opening, return of spontaneous breathing and extubation; number of changes and cumulative doses of propofol and sufentanil; incidences of light anesthesia and myocardial ischemia; intensive care unit and hospital stays; and costs of propofol, sufentanil, and ventilation were recorded. Compared with the sufentanil 0.4-ng/mL group, 0.2- and 0.3-ng/mL groups had shorter times to eye opening (24.8 min [SD 7.8] and 52.6 min [12.5] v 85.6 min [10.0], respectively), spontaneous breathing (32.7 min [19.9] and 70.1 min [27.2] v 137.5 min [20.8], respectively), and extubation (112.2 min [16.9] and 161.9 min [32.9] v 271.3 min [27.4], respectively; p < 0.001), more frequent changes in propofol concentrations (p < 0.001), higher cumulative propofol doses, lower cumulative sufentanil doses, and 33% to 44% lower total cost (p < 0.001). Incidences of light anesthesia and myocardial ischemia and intensive care unit and hospital stays were similar for all groups. Conclusions: Compared with sufentanil Ce of 0.4 ng/mL, lower concentrations (0.2 and 0.3 ng/mL) promoted faster recovery and shorter times to extubation after valve surgery performed under target-controlled propofol infusion.