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

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 (Δ) 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 (Δ =-23 ± 13 vs.-36 ± 13 mmHg), HR (Δ =-5 ± 7 vs.-10 ± 10 bpm), SV (Δ =-23 ± 18 vs.-35 ± 19 ml) and CI (Δ =-0.8 (-1.5 to-0.5) vs.-1.5 (-2.0 to-1.1) l min-1 m-2), while SctO2 (Δ = 9 ± 5 vs. 6 ± 4%) showed more increase with no difference in ΔSptO2 (Δ = 8 ± 7 vs. 8 ± 8%). Atropine caused higher ΔHR (13 (9 to 19) vs. 10 ± 6 bpm) and ΔCI (0.4 ± 0.4 vs. 0.2 ± 0.3 l min-1 m-2) in sufentanil vs. remifentanil-based anaesthesia, with no difference in ΔMAP, ΔSV and ΔSctO2 and ΔSptO2. 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).