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

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.

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.

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).

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.