Comparison of two anesthetic drugs used in congenital heart surgery

AIM:To evaluate the effect of fast-track anesthesia of sufentanil or remifentanil combined with sevoflurane on the intraoperative hemodynamics and postoperative recovery in congenital cardiac surgery in neonates. METHODS: From February 2011 to March 2012, 132 patients with simple congenital heart disease undergoing open heart surgery (simple ASD or VSD repair) were prospectively selected and randomly divided into the sufentanil group (n=66) and remifentanil group (n=66). Based on midazolam and vecuronium induction, induction and maintenance doses of sufentanil and remifentanil were 1 μg/kg and 2-2.5 μg/(kg·h) in sufentanil group and 2 μg/kg and 0.1-1 μg/(kg·min) in remifentanil group. Both groups inhaled sevoflurane, and the vecuronium maintenance dose was 80-120 μg/(kg·h). Data of heart rate, blood pressure, bispectral index, postoperative awake point and extubation time, postoperative consciousness state and length of stay in ICU were obtained and analyzed. RESULTS: No significant differences were found in gender, age, body weight, types of diseases, ASA classification, operation time and cardiopulmonary bypass (CPB) time between groups. Compared with that during sleep, the heart rate significantly increased (P<0.05) in the two groups at the time of 10-min weaning, sternal suturing, surgery completion and extubation. Mean blood pressure (MAP) decreased (P<0.05) after intubation, 10-min pumping, 5-min rewarming and 10-min weaning. Sufentanil group had a prolonged sober time and extubation time compared with remifentanil group (P<0.01), whereas the agitation incidence in the remifentanil group was higher (P<0.05). CONCLUSION: Fast-track anesthesia of sufentanil or remifentanil combined with sevoflurane for simple congenital heart disease surgery in neonates can effectively inhibit the stress response with stable hemodynamics and provide safe anesthesia for infants with congenital heart disease due to early postoperative extubation.