Comparisons of Postoperative BIS Profile and Extubation Time After Valvular Heart Surgery: Remifentanil-based Propofol-supplemented Versus Sevoflurane-sufentanil Balanced Anesthesia Regimen

Backgrounds Since opioid-based anesthesia does not produce dose-dependent myocardial depression, it has been applied for patients undergoing cardiac surgery with myocardial dysfunction.

However, prolonged use of conventional opioids in a large dosage delays patient's postoperative recovery due to their longer half-life and accumulation of their metabolites.

Fast-track cardiac anesthesia which reducing the duration of postoperative mechanical ventilation and length of stay (LOS) in the intensive care unit (ICU) is beneficial not only in reducing ventilator-related complications and medical expense but in improving patient's outcome.

For this purpose, in addition to supplementation of neuraxial blockade, use of short-acing opioid, such as remifentanil, has been advocated for cardiac anesthesia. Remifentanil is an ultra-short acting opioid and provides not only stable hemodynamics, as other opioid does, and but fast recovery, even after prolonged use in a large dosage. In further, recent investigations showed that remifentanil provides preconditioning effect in myocardial ischemia injury during cardiac surgery, as like in the use of volatile anesthetics including sevoflurane.

Remifentanil vs volatile anesthetics In spite of the importance of recovery of cognitive function on whole postoperative clinical features, most investigations have evaluated only the postoperative respiratory profile in determining the speed of postoperative recovery specific to the choice of anesthesia regimen.