Improved haemodynamic stability and cerebral tissue oxygenation after induction of anaesthesia with sufentanil compared to remifentanil: a randomised controlled trial

Abstract

Background: Balanced anaesthesia with propofol and remifentanil, compared to sufentanil, often decreases mean arterial pressure (MAP), heart rate (HR) and cardiac index (CI), raising concerns on tissue-oxygenation. This distinct haemodynamic suppression might be attenuated by atropine. This double blinded RCT, investigates if induction with propofol-sufentanil results in higher CI and tissue-oxygenation than with propofol-remifentanil and if atropine has more pronounced beneficial effects on CI and tissue-oxygenation in a remifentanil-based anaesthesia.

Methods: In seventy patients scheduled for coronary bypass grafting (CABG), anaesthesia was induced and maintained with propofol target controlled infusion (TCI) with a target effect-site concentration (Cet) of 2.0 μg ml- 1 and either sufentanil (TCI Cet 0.48 ng ml- 1) or remifentanil (TCI Cet 8 ng ml- 1). If HR dropped below 60 bpm, methylatropine (1 mg) was administered intravenously. Relative changes (∆) in MAP, HR, stroke volume (SV), CI and cerebral (SctO2) and peripheral (SptO2) tissue-oxygenation during induction of anaesthesia and after atropine administration were analysed.

Results: The sufentanil group compared to the remifentanil group showed significantly less decrease in MAP (∆ = - 23 ± 13 vs. -36 ± 13 mmHg), HR (∆ = - 5 ± 7 vs. -10 ± 10 bpm), SV (∆ = - 23 ± 18 vs. -35 ± 19 ml) and CI (∆ = - 0.8 (- 1.5 to - 0.5) vs. -1.5 (- 2.0 to - 1.1) l min- 1 m- 2), while SctO2 (∆ = 9 ± 5 vs. 6 ± 4%) showed more increase with no difference in ∆SptO2 (∆ = 8 ± 7 vs. 8 ± 8%). Atropine caused higher ∆HR (13 (9 to 19) vs. 10 ± 6 bpm) and ∆CI (0.4 ± 0.4 vs. 0.2 ± 0.3 l min- 1 m- 2) in sufentanil vs. remifentanil-based anaesthesia, with no difference in ∆MAP, ∆SV and ∆SctO2 and ∆SptO2.

Conclusion: Induction of anaesthesia with propofol and sufentanil results in improved haemodynamic stability and higher SctO2 compared to propofol and remifentanil in patients having CABG. Administration of atropine might be useful to counteract or prevent the haemodynamic suppression associated with these opioids.

Trial registration: Clinicaltrials.gov on June 7, 2013 (trial ID: NCT01871935 ).

Keywords: Atropine; Haemodynamics; Induction of anaesthesia; Remifentanil; Sufentanil; Tissue oxygenation.

Conflict of interest statement

MMRFS: His research group/department received (over the last 3 years) research grants and consultancy fees from The Medicines Company (Parsippany, NJ, USA), Masimo (Irvine, CA, USA), Fresenius (Bad Homburg, Germany), Dräger (Lübeck, Germany), Paion (Aachen, Germany), Medtronic (Dublin, Ireland). He receives royalties on intellectual property from Demed Medical (Temse, Belgium) and the Ghent University (Gent, Belgium). He is an editorial board member and Director for the British Journal of Anaesthesia and associated editor for Anesthesiology.

TWLS: his research group received research grants and honoraria from Edwards Lifesciences (Irvine, CA, USA) and Masimo Inc. (Irvine, CA, USA) for consulting and lecturing and from Pulsion Medical Systems SE (Feldkirchen, Germany) for lecturing.

The other authors declare no conflicts of interest.

Figures

Fig. 1

CONSORT flow diagram

Fig. 2

Mean values (thick lines) and individual patient data (thin lines) of the investigated haemodynamic variables: mean arterial pressure (MAP), heart rate (HR), stroke volume (SV), cardiac index (CI), cerebral tissue oxygen saturation (SctO2) and peripheral tissue oxygen saturation (SptO2). Red lines represent the sufentanil group and green lines the remifentanil group. Graphs are shown from 1 min before until 6 min after the induction of anaesthesia

Fig. 3

Mean relative changes of the investigated haemodynamic variables during the induction of anaesthesia (from 1 min before until 6 min after). Mean arterial pressure (ΔMAP), heart rate (ΔHR), stroke volume (ΔSV), cardiac index (ΔCI), cerebral tissue oxygen saturation (ΔSctO2) and peripheral tissue oxygen saturation (ΔSptO2)

Fig. 4

Mean values (thick lines) and individual patient data (thin lines) of the investigated haemodynamic variables: mean arterial pressure (MAP), heart rate (HR), stroke volume (SV), cardiac index (CI), cerebral tissue oxygen saturation (SctO2) and peripheral tissue oxygen saturation (SptO2). Red lines represent the sufentanil group and green lines the remifentanil group. Graphs are shown from 1 min before until 4 min after the administration of atropine

Fig. 5

Mean relative changes of the investigated haemodynamic variables during the administration of atropine (from 1 min before until 4 min after). Mean arterial pressure (ΔMAP), heart rate (ΔHR), stroke volume (ΔSV), cardiac index (ΔCI), cerebral tissue oxygen saturation (ΔSctO2) and peripheral tissue oxygen saturation (ΔSptO2)