Midazolam and fentanyl continuous infusion anesthesia for cardiac surgery: a comparison of computer-assisted versus manual infusion systems

• HIT Description: Decision support and computerized medication dosing. More info...
  
• Purpose of Study: Assess a comparison of computer-assisted midazolam and fentanyl continuous infusion anesthesia for cardiac surgery.
  
• Years of study: Not Available
  
• Study Design: RCT
  
• Outcomes: Impact on health care effectivness/quality
  

• Settings: Twenty-four patients undergoing coronary artery bypass grafting participated in the study.
• Intervention: Continuous infusions of midazolam and fentanyl by a computer-assisted continuous infusion (CACI) pharmacokinetic model-driven infusion system was compared to a manually controlled infusion (MCI) pump.
• Evaluation Method: Measures of hemodynamic control, plasma concentrations, medication dosages
• Quality of Care and Patient Safety Outcome: Comparable hemodynamic control was achieved in both groups. Mean plasma fentanyl concentrations measured at specific time points were similar between groups. The plasma midazolam level for induction was 196 +/- 139 ng/mL in the CACI group and 300 +/- 128 ng/mL in the MCI group, and the fentanyl level was similar in groups, 6.7 +/- 1.9 ng/mL in CACI and 6.3 +/- 4.6 ng/mL in the MCI group. The drug levels were lower (P or = .05) for midazolam during maintenance of anesthesia and similar for fentanyl during the maintenance of anesthesia. In the MCI group, the average duration of anesthesia was 246.5 +/- 35.0 minutes, with a mean total fentanyl dose of 30.27 +/- 11.14 micrograms/kg. In the CACI group, the average duration of anesthesia was 230.8 +/- 44.1 minutes, with a mean total fentanyl dose of 34.61 +/- 5.40 micrograms/kg (P > 0.05 for comparisons between groups for duration of anesthesia and total fentanyl dose). Mean plasma midazolam concentrations were significantly lower with CACI. Variability in plasma