Time to tracheal extubation after coronary artery surgery with isoflurane, sevoflurane, or target-controlled propofol anesthesia: A prospective, randomized, controlled trial

Abstract

Objectives: To determine if anesthesia with sevoflurane or target-controlled propofol reduced the time to tracheal extubation after coronary artery bypass graft surgery compared with isoflurane anesthesia. Design: A 3-arm (isoflurane, sevoflurane, or propofol), randomized, controlled trial with patients and intensive care staff blinded to the drug allocation. Setting: A single, tertiary referral hospital affiliated with the University of Melbourne. Participants: Three hundred sixty elective coronary artery surgery patients. Interventions: Patients received either isoflurane (control group, 0.5%-2% end-tidal concentration), sevoflurane (1%-4% end-tidal concentration), or target-controlled infusion of propofol (1–8 μg/mL plasma target concentration) as part of a balanced, standardized anesthetic technique including 15 μg/kg of fentanyl. Measurements and main results: The primary outcome was time to tracheal extubation. The median time to tracheal extubation for the propofol group was 10.25 hours (interquartile range [IQR] 8.08–12.75), the sevoflurane group 9.17 hours (IQR 6.25–11.25), and the isoflurane group 7.67 hours (IQR 6.25–9.42). Intraoperatively, the propofol group required less vasopressor ( p = 0.002) and more vasodilator therapy (nitroglycerin p = 0.01, nitroprusside p = 0.002). There was no difference among the groups in time to intensive care unit discharge. Conclusions: The median time to tracheal extubation was significantly longer for the target-controlled propofol group. A significantly greater number in this group required the use of a vasodilator to control intraoperative hypertension.