Ventilation time and LOS in ICU and thus fast-track potential is not affected by low or moderate sufentanil administration - a randomized study

Abstract

Background. Progressive cost containment as well as a more efficient use of resources has resulted in a growing interest in fast-track cardiac surgery. Ventilation time and length of stay (LOS) in the ICU are important factors in early patient mobilization and patient turnover. Early extubation is usually considered one of the main steps in fast-track pathways1. The application of fast-track protocols, have demonstrated a shorter postoperative ventilation time and reduced use of resources in cardiac surgery patients. Different protocols have been proposed to achieve this, but the impact of different regimes, drugs and logistics is still debated and the question of effect, applicability, quality and safety is still open. We hypothesized that a protocol with half our standard dose of Sufentanil and double dose of Propofol would reduce ventilation time and LOS in ICU. Methods. Sixty cardiac surgery patients were randomized to “standard” dose sufentanil (bolus 1 mg/kg and propofol 1.8 mg/kg/ h) or “low” dose (bolus 0.5 mg/kg and propofol 3.6 mg/kg/h). Depth of anaesthesia was monitored with BIS, aiming at BIS below 50 during surgery. The primary endpoints were ventilation time and eligible time to discharge from ICU. Secondary outcomes were actual LOS in ICU and quality of recovery. Results. The groups were fully comparable in selected demographics and perioperative parameters. The use of sufentanil and propofol were significantly different between groups. There was no difference in ventilation time (191 vs 204 minutes) or the eligible ICU discharge time (11.3 vs 10.5) between the groups. The propofol infusion was significantly higher (2.76 mg/kg/h) than the stipulated dose (1.8 mg/kg/h) in the “standard” group (P o 0.0001.). Conclusion. Both regimes were useful in keeping the patient on the desired anaesthesia level. Regarding the fast-track potential, we could not demonstrate a faster turnover in patients receiving significantly less opioids during anaesthesia.