Remifentanil in Cardiac Surgery: A Meta-analysis of Randomized Controlled Trials

Abstract 

Objective

The authors conducted a review of randomized controlled trials to identify advantages in clinically relevant outcomes in patients undergoing cardiac surgery with remifentanil.

Methods

Meta-analysis. Hospitals. A total of 1,473 patients from 16 randomized trials. PubMed, BioMedCentral, and conference proceedings were searched (updated May 2010) for randomized trials that compared remifentanil with fentanyl or sufentanil in cardiac anesthesia. Four independent reviewers performed data extraction, with divergences resolved by consensus.

Results

Overall analysis showed that the use of remifentanil was associated with a significant reduction in postoperative mechanical ventilation (WMD = −139 min [−244, −32], p for effect = 0.01, p for heterogeneity < 0.001, I2 = 89%); length of hospital stay (WMD = −1.08 days [−1.60, −0.57], p for effect < 0.0001, p for heterogeneity = 0.004, I2 = 71%); and cardiac troponin-I release (WMD = −2.08 ng/mL [−3.93, −0.24], p for effect = 0.03, p for heterogeneity < 0.02, I2 = 74%). No difference was noted in mortality (3/344 [0.87%] in the remifentanil group vs [1.06%] the control group, OR 0.76 [0.17-3.38], p for effect = 0.72, p for heterogeneity = 0.35, I2 = 5%).

Conclusion

Remifentanil reduces cardiac troponin release, time of mechanical ventilation, and length of hospital stay in patients undergoing cardiac surgery.

Journal of Cardiothoracic and Vascular Anesthesia Volume 26, Issue 1 , Pages 110-116, February 2012 (Abstract)