Remifentanil-Based Total Intravenous Anesthesia is Associated with Operating Room Extubation in Heart...

Immediate extubation after heart transplantation (IEAHT) may enhance postoperative recovery. However, factors associated with IEAHT and the impact of opioid exposure remain unknown. Building upon our favorable IEAHT experiences in a pediatric patient, we now examine the use of IEAHT in adult patients.

This small, retrospective, exploratory case-control study (August 2018-March 2025) included 8 patients extubated in the operating room (case group) matched 1:3 to 24 patients extubated in the ICU (control group). Demographic data, operative characteristics, anesthetic techniques, and postoperative outcomes were collected and compared between the two groups.

Remifentanil-based TIVA was used more frequently in the case group (8/8, 100% vs. 6/24, 25%; p = 0.001). The case group had shorter cardiopulmonary bypass (median 105 vs. 155 min, p = 0.004) and operative times (249 vs. 329 min, p = 0.012). Among patients receiving remifentanil‑based TIVA, total opioid consumption did not differ between groups (p = 0.852). No significant inter-group differences were observed in postoperative complications or lengths of stay.

In this exploratory cohort, remifentanil-based TIVA was associated with operating room extubation. Remifentanil-based TIVA may be feasible in selected patients, but its safety and efficacy require confirmation in adequately powered prospective randomized trials.