Comparisons between the Uses of Remifentanil and Fentanyl in Coronary Artery Bypass Graft : A Meta-Analysis of Randomized Controlled Trials

Abstract

Objectives: The objective of this meta-analysis was to evaluate whether remifentanil could reduce postoperative recovery time and improve intraoperative hemodynamic stability in patients undergoing coronary artery bypass graft (CABG). Search methods: We extensively searched randomized controlled trials comparing remifentanil with fentanyl in patients undergoing CABG until May 2015 using the electronic databases such as MEDLINE, CINAHL, EMBASE, CENTRAL of Cochrane Library, Web of Science, and KoreaMed. Selection criteria: We included randomized controlled trials (RCTs) comparing remifentanil with fentanyl for adult patients undergoing CABG. Data collection and analysis: Two review authors independently assessed study quality and extracted the data. Continuous variables were presented as standardized mean differences (SMDs) with 95% confidence intervals (CIs) and dichotomous variables as risk ratios (RRs) with 95% CIs. Assessments for statistical heterogeneity and publication bias, and sensitivity analyses were performed. Results: Our meta-analysis showed that remifentanil was associated with reduced postoperative mechanical ventilation time compared with fentanyl [SMD (95% CI) -0.46 (-0.88, -0.05), P = 0.03, I2 = 91%, n = 1309 in 9 RCTs] but there were no significant differences in the lengths of intensive care unit and hospital stay. Although intraoperative heart rate and cardiac index were comparable between the remifentanil and fentanyl arms, mean blood pressure was significantly lower at tracheal intubation [SMD (95% CI) -0.35 (-0.62, -0.08), P = 0.010, I2 = 61%, n = 709 in 9 RCTs] and at the sternotomy [SMD (95% CI) -0.53 (-0.69, -0.36), P < 0.00001, I2 = 0%, n = 593 in 7 RCTs]. The incidence of postoperative hypotension was also higher in the use of remifentanil [RR (95% CI) 2.25 (1.47, 3.42), P = 0.0002, I2 = 9%, n = 912 in 3 RCTs]. The incidences of postoperative atrial fibrillation, myocardial ischemia, and nausea or vomiting were comparable between the two arms. Conclusions: Our meta-analysis showed that the use of remifentanil decreased postoperative mechanical ventilation time in patients undergoing CABG as compared with fentanyl. However, because the use remifentanil may have a higher risk of lower blood pressure, care should be taken to avoid the inadvertent hypotension during the perioperative period of CABG.