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British Journal of Anaesthesia, 2001, Vol. 87, No. 5 718-726
© 2001 The Board of Management and Trustees of the British Journal of Anaesthesia

Clinical Investigations

Comparative efficacy and safety of remifentanil and fentanyl in ‘fast track’ coronary artery bypass graft surgery: a randomized, double-blind study

T. Möllhoff *,1, L. Herregods2, A. Moerman2, D. Blake3, C. MacAdams4, R. Demeyere5, K. Kirnö6, T. Dybvik7, S. Shaikh8 and the Remifentanil Study Group

1Westfälische Wilhelms-Universität, Münster, Germany. 2Universitaire Ziekenhuis Gent, Ghent University Hospital, Belgium. 3Royal Melbourne Hospital, Melbourne, Australia. 4Foothills Hospital, Calgary, Canada. 5University Hospital Gasthuisberg, Leuven, Belgium. 6Sahlgrenska University Hospital, Göteborg, Sweden. 7Volvat Medical Centre, Oslo, Norway. 8Glaxo Wellcome Research and Development, London, UK*Corresponding author: Abteilung Anästhesie, Intensivmedizin und Schmerztherapie, Marienhospital Aachen, Zeise 4, D-52066 Aachen, Germany

This multi-centre, parallel group, randomized, double-blind study compared the efficacy and safety of high-dose remifentanil administered by continuous infusion with an intermittent bolus fentanyl regimen, when given in combination with propofol for general anaesthesia in 321 patients undergoing elective coronary artery bypass graft surgery. A significantly lower proportion of the patients who received remifentanil had responses to maximal sternal spread (the primary efficacy endpoint) compared with those who received fentanyl (11% vs 52%; P<0.001). More patients who received remifentanil responded to tracheal intubation compared with those who received fentanyl (24% vs 9%; P<0.001). However, fewer patients who received remifentanil responded to sternal skin incision (11% vs 36%; P<0.001) and sternotomy (14% vs 60%; P <0.001). Median time to extubation was longer in the subjects who received remifentanil than for those who received fentanyl (5.1 vs 4.2 h; P=0.006). There were no statistically significant differences between the two groups in the times for transfer from intensive care unit or hospital discharge but time to extubation was significantly longer in the remifentanil group. Overall, the incidence of adverse events was similar but greater in the remifentanil group with respect to shivering (P<0.049) and hypertension (P<0.001). Significantly more drug-related adverse events were reported in the remifentanil group (P=0.016) There were no drug-related adverse cardiac outcomes and no deaths from cardiac causes before hospital discharge in either treatment group.

Br J Anaesth 2001; 87: 718–26


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