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Early extubation after mitral valve surgery: a target-controlled infusion of propofol and low-dose sufentanil
N D'Attellis1, A Nicolas-Robin, S Delayance
1Department of Anesthesiology and Intensive Care, Broussais Hospital, Paris, France.
Objective:
In the current study, the use of a target-controlled infusion of low-dose propofol was combined with a continuous infusion of sufentanil for patients undergoing mitral valve surgery. The purpose of the study was to evaluate the hemodynamic stability, the time to awakening and spontaneous ventilation, and the feasibility in an early extubation setting of a total intravenous anesthetic technique.
Design:
Prospective study.
Setting:
University hospital.
Participants:
Fifteen patients scheduled for elective mitral valve surgery.
Interventions:
Induction of anesthesia consisted of sufentanil (1 microgram/kg), propofol (1 microgram/mL) target plasma concentration achieved over 3 minutes, and atracurium (0.5 mg/kg). The propofol target-controlled infusion was maintained at 1 microgram/mL throughout surgery and stopped at skin closure. A continuous infusion of sufentanil at 1.8 micrograms/kg/hr was started after induction and reduced to 0.9 microgram/kg/hr at the start of cardiopulmonary bypass and stopped at the end of bypass. Atracurium was infused at a rate of 0.5 mg/kg/hr up to sternal closure. No inhalation agents were used.
Measurements And Main Results:
Hemodynamic data were within normal limits. Six patients (40%) responded to verbal commands within 15 minutes postoperatively, 10 (67%) within the first hour, and all patients recovered within 2 hours. Four patients (27%) resumed spontaneous ventilation within the first 15 postoperative minutes. The time to successful spontaneous ventilation was 169 +/- 42 minutes. Spontaneous ventilation was associated with a 21% increase in cardiac index. Total sufentanil dose was 328 +/- 28 micrograms (4.6 +/- 0.2 microgram/kg), whereas total propofol dose was 862 +/- 44 mg (13.1 +/- 1.2 mg/kg). No patient required reintubation.
Conclusion:
The simplicity of the method with only one change in infusion rate is a major advantage. The technique permits predictable recovery and return to spontaneous ventilation in all patients. Its use in patients entering early extubation protocols is appealing for its reproducibility, simplicity, and safety.