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Updated: Aug 7, 2026
05:39
Non-Intubated Video-Assisted Thoracoscopic Surgery
Published on: May 26, 2023
Remifentanil-Based Total Intravenous Anesthesia is Associated with Operating Room Extubation in Heart
Xue-Wen Zhou1, Meng-Jing Yang1, Peng Hao2
1Department of Anesthesia, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.
Summary
Immediate extubation after heart transplantation (IEAHT) is feasible with remifentanil-based total intravenous anesthesia (TIVA). This approach may shorten operating times, but further trials are needed to confirm safety and efficacy.
Area of Science:
- Cardiology
- Anesthesiology
- Transplantation Surgery
Background:
- Immediate extubation after heart transplantation (IEAHT) may improve recovery.
- Factors influencing IEAHT and opioid impact are not well understood.
- This study explores IEAHT in adult heart transplant recipients.
Purpose of the Study:
- To investigate factors associated with immediate extubation in adult heart transplant patients.
- To assess the impact of opioid exposure on IEAHT.
- To examine the feasibility of remifentanil-based total intravenous anesthesia (TIVA) for IEAHT.
Main Methods:
- Retrospective, exploratory case-control study (August 2018-March 2025).
- 8 patients extubated in the operating room (case group) matched 1:3 to 24 patients extubated in the ICU (control group).
- Collected and compared demographic, operative, anesthetic, and outcome data.
Main Results:
- Remifentanil-based TIVA was used in 100% of the case group vs. 25% of the control group (p=0.001).
- Shorter cardiopulmonary bypass (105 vs. 155 min, p=0.004) and operative times (249 vs. 329 min, p=0.012) in the case group.
- No significant differences in total opioid consumption, postoperative complications, or length of stay between groups.
Conclusions:
- Remifentanil-based TIVA was associated with operating room extubation in this exploratory cohort.
- Remifentanil-based TIVA may be feasible for selected heart transplant patients.
- Further prospective randomized trials are required to confirm safety and efficacy.
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