Ultrashort acting remifentanil is not superior to long-acting sufentanil in preserving cognitive function—a randomized study

•Postoperative cognitive dysfunction is equivalent in long-acting sufentanil or ultrashort acting remifentanil.•Short periods of impaired hemodynamics are associated to POCD on the first postoperative day.•Longer postoperative ventilation time is associated with POCD on the fourth postoperative day.•Fast track protocols might attenuate development of POCD.

Study objectivePostoperative cognitive dysfunction (POCD) is a well-known complication after cardiac surgery and may cause permanent disabilities with severe consequences for quality of life. The objectives of this study were, first, to estimate the frequency of POCD after on-pump cardiac surgery in patients randomized to remifentanil- or sufentanil-based anesthesia and, second, to evaluate the association between POCD and quality of recovery and perioperative hemodynamics, respectively.DesignRandomized study.SettingPostoperative cardiac recovery unit, University Hospital.PatientsSixty patients with ischemic heart disease scheduled for elective coronary artery bypass grafting ± aortic valve replacement.Interventions and handlingRandomized to either remifentanil or sufentanil anesthesia as basis opioid. Postoperative pain management consisted of morphine in both groups.MeasurementsCognitive functioning evaluated preoperatively and on the 1st, 4th, and 30th postoperative day using the cognitive test from the Palo Alto Veterans Affairs Hospital. Perioperative invasive hemodynamics and the quality of recovery was evaluated by means of invasive measurements and an intensive care unit discharge score.Main resultsNo difference between opioids in POCD at any time. A negative correlation was found between preoperative cognitive function and POCD on the first postoperative day (r = − 0.47; P = .0002). The fraction of patients with POCD on the first postoperative day was statistically greater in patients with more than 15 minutes of Svo2 < 60 (P = .037; χ2 test). Among patients with postoperative ventilation time exceeding 300 minutes, more patients had POCD on postoperative day 4 (P = .002).ConclusionsWe could not demonstrate differences in POCD between remifentanil and sufentanil based anaesthesia, but in general, the fraction of patients with POCD seemed smaller than previously reported. We found an association between POCD and both perioperative low Svo2 and postoperative ventilation time, underlining the importance of perioperative stable hemodynamics and possible fast-track protocols with short ventilation times to attenuate POCD.