Alfentanil and sufentanil in fast-track anesthesia for coronary artery bypass graft surgery.

Objective: To evaluate alfentanil, sufentanil, and the combination of both opioids in patients undergoing cardiac surgery. Design: Prospective, randomized study. Setting: University hospital. Participants: Patients undergoing coronary artery bypass graft (CABG) surgery (n 195), randomly assigned to 3 groups of 65 each. Interventions: Patients in group A received alfentanil, induction (15 g/kg) and maintenance (15 g/kg/hr); patients in group S received sufentanil, induction (1 g/kg) and maintenance (1 g/kg/h); and patients in group AS received alfentanil and sufentanil, induction with alfentanil (15 g/kg) and maintenance with sufentanil (1 g/ kg/hr). Measurements and Main Results: Hemodynamic data showed a reduction of all parameters at induction in the 3 groups (p < 0.05). Cardiac index decreased at induction in all groups (p < 0.05) but increased in groups S and AS toward baseline values at the end of surgery. The intubation time and length of stay in the intensive care unit were less in group AS (2.3 1.2 hours; p < 0.001 and 20 8 hours; p < 0.05), than in groups A (4.2 1.7 hours and 28 13 hours) and S (3.1 1.1 hours; p < 0.05 and 26 12 hours). Length of hospital stay and patients’ outcome were similar in the 3 groups. Conclusion: Although the differences among groups regarding extubation time, intensive care unit length of stay, and some hemodynamic data were statistically significant, the differences were clinically small. All 3 anesthetic protocols were shown to be safe and appropriate for patients undergoing elective coronary artery bypass graft surgery and early postoperative tracheal extubation.