Effects of the Target-Controlled Infusion of Propofol and Remifentanil on BUN and Creatinine Levels in Patients With Renal Impairment Undergoing Open-Heart Surgeries

Document Type : Original Article

Authors

1 Cardio-Oncology Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran.

2 Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran.

3 Rasool Akarm Hospital, Iran University of Medical Sciences, Tehran, IR Iran.

Abstract

Background: The target-controlled infusion (TCI) system controls the plasma concentration of administered drugs, improves hemodynamic stability, prevents the cumulative effect of drugs, provides faster recovery, and perhaps reduces renal complications. We sought to investigate the effects of the TCI method on blood urea nitrogen (BUN) and creatinine (Cr) levels in patients with renal impairment undergoing open-heart surgeries.
 
Methods: This double-blind clinical trial was performed on 66 patients undergoing cardiac surgeries with preoperative Cr levels of greater than 1.5 mg/dL. The patients were randomly divided into 3 groups. The first group received propofol and remifentanil via the TCI system. The second group received these 3 drugs via the usual dosing (mg/kg) method. The third group received midazolam and fentanyl conventionally (based on the mg/kg method). Postoperative Cr and BUN levels, urine volume, the need for dialysis, and hemodynamic parameters were recorded up to 3 postoperative days. After the exclusion of 10 patients from the study, 56 patients were analyzed.
 
Results: Postoperative BUN and Cr values were significantly lower in the TCI group than in the other groups (P<0.05) There were no significant differences between the 3 groups concerning hemodynamic status. The total dose of anesthetics was significantly lower in the TCI group than in the propofol-remifentanil group (P<0.05). The incidence of postoperative arrhythmias in the TCI group was significantly lower than that in the other 2 groups (P<0.05).
 
Conclusions: In our patients with renal dysfunction, the TCI method reduced post-cardiac surgery BUN and Cr levels, the dose of the anesthetics administered, and the incidence of arrhythmias. (Iranian Heart Journal 2022; 23(3): 97-107)

Keywords

References

  1. Hu C, Horstman DJ, Shafer SL. Variability of target-controlled infusion is less than the variability after bolus injection. Anesthesiology. 2005;102:639–45
  2. Struys M, de Smet TEvers AS, Maze M, Kharasch ED. Principles of drug actions: target-controlled infusions and closed-loop administration. In: Anesthetic Pharmacology: Basic principles and Clinical Practice Cambridge, UK Cambridge University Press 2011 pp:103.
  3. Leslie K, Clavisi O, Hargrove J. Target-controlled infusion versus manually-controlled infusion of propofol for general anaesthesia or sedation in adults. Cochrane Database Syst Rev. 2008:CD006059
  4. Albertin, A., Casati, A., Bergonzi, P., Fano, G., & Torri, G. Effects of Two Target-controlled Concentrations (1 and 3 ng/ml) of Remifentanil on MACBARof Sevoflurane. Anesthesiology: The Journal of the American Society of Anesthesiologists, 2004; 100(2), 255-259.
  5. L. Chen, C.P. Kuo, Y.F. Chen, Y.W. Chen, J.C. Yu, C.H. Lu, et al. Do anesthetic techniques affect operating room efficiency? Comparison of target controlled infusion of propofol and desflurane anesthesia in breast cancer surgery J Med Sci, 2013 33:205-210.
  6. M. Chan, H.C. Horng, S.T. Huang, H.I. Ma, C.S. Wong, C.H. Cherng, et al. Drug cost analysis of three anesthetic regimens in prolonged lumbar spinal surgery J Med Sci, 2009 29:75-80.
  7. H. Lu, J.L. Chen, C.T. Wu, W.J. Liaw, C.C. Yeh, C.H. Cherng, et al. Effect of epidural neuraxial blockade-dependent sedation on the Ramsay sedation scale and the composite auditory evoked potentials index in surgical intensive care patients J Formos Med Assoc, 2010 109:589-595.
  8. F. Lin, Y.S. Huang, C.P. Kuo, D.T. Ju, C.H. Lu, C.H. Cherng, et al. Comparison of A-line autoregressive index and observer assessment of alertness/sedation scale for monitored anesthesia care with target-controlled infusion of propofol in patients undergoing percutaneous vertebroplasty J Neurosurg Anesthesiol, 2011 23:6-11.
  9. F. Lin, D.T. Ju, C.H. Cherng, N.K. Hung, C.C. Yeh, S.M. Chan, et al. Comparison between intraoperative fentanyl and tramadol to improve quality of emergence J Neurosurg Anesthesiol,2012 24:127-132.
  10. Schnider TW, Minto CF, Struys MMRF, Absalom AR. The safety of target-controlled infusions. Anesth Analg. 2016; 122:79–85.
  11. Eikaas, J. Raeder Total intravenous anaesthesia techniques for ambulatory surgery Curr Opin Anaesthesiol, 2009 22:725-729.
  12. Thomson, A. J., Morrison, G., Thomson, E., Beattie, C., Nimmo, A. F., & Glen, J. B Induction of general anaesthesia by effect‐site target‐controlled infusion of propofol: influence of pharmacokinetic model and ke0 value. Anaesthesia, 2014 69(5): 429-435.
  13. Ye, C.Z. Luo, S.A. McCluskey, Q.Y. Pang, T. Zhu Propofol attenuates hepatic ischemia/reperfusion injury in an in vivo rabbit model J Surg Res, 2012 178:e65-e70.
  14. De Castro, V., Godet, G., Mencia, G., Raux, M., & Coriat, P. Target-controlled infusion for remifentanil in vascular patients improves hemodynamics and decreases remifentanil requirement. Anesthesia & Analgesia, 2003 ، 96(1), 33-38.
  15. Tantry, T. P., Muralishankar, B. G., Adappa, K. K., Bhandary, S., Shetty, P., & Shenoy, S. P. Target-controlled infusion (Propofol) versus inhaled anaesthetic (Sevoflurane) in patients undergoing shoulder arthroscopic surgery. Indian journal of anaesthesia, 2013 ، 57(1): 35.
  16. Ji Wook Kim, Joo Duck Kim, Soo Bong Yu, and Sie Jeong Ryu Comparison of hepatic and renal function between inhalation anesthesia with sevoflurane and remifentanil and total intravenous anesthesia with propofol and remifentanil for thyroidectomy Korean J Anesthesiol 2013; 64: 112-116.
  17. El-Attar, A., Al-Safty, A., Abdullah, M., Beltagy, R., Mahmoud, F., & Yasin, K. Effect of target-controlled infusion of Propofol-Fentanyl versus Desflurane in cirrhotic patients undergoing major hepatic resection: 9AP3-2. European Journal of Anaesthesiology (EJA), 2014 ، 31: 147.
  18. Lehmann, A., Boldt, J., Römpert, R., Thaler, E., Kumle, B., & Weisse, U. Target-controlled infusion or manually controlled infusion of propofol in high-risk patients with severely reduced left ventricular function. Journal of cardiothoracic and vascular anesthesia, 2001 ، 15(4): 445-450.
  19. Ziyaeifard M, Alizadehasl A, Aghdaii N, Rahimzadeh P, Masoumi G, Golzari SE, et al. The effect of combined conventional and modified ultrafiltration on mechanical ventilation and hemodynamic changes in congenital heart surgery. J Res Med Sci. 2016; 21:113-5. doi:10.4103/1735-1995.193504.
  20. Aghdaii N, Ziyaeifard M, Faritus SZ, Azarfarin R. Hemodynamic responses to two different anesthesia regimens in compromised left ventricular function patients undergoing coronary artery bypass graft surgery: etomidate-midazolam versus propofol-ketamine. Anesth Pain Med. 2015; 5:e27966. doi:10.5812/aapm.27966v2.
Iranian Heart Journal
Volume 23, Issue 3
July 2022
Pages 97-107

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