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

Objective: The authors conducted a review of randomized
controlled trials to identify advantages in clinically relevant
outcomes in patients undergoing cardiac surgery with
remifentanil.
Design: Meta-analysis.
Setting: Hospitals.
Participants: A total of 1,473 patients from 16 randomized
trials.
Interventions: None.
Measurements and Main Result: 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. 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%).
Conclusions: Remifentanil reduces cardiac troponin release,
time of mechanical ventilation, and length of hospital
stay in patients undergoing cardiac surgery.