Early extubation and neurologic examination following combined carotid endarterectomy and coronary artery bypass grafting using remifentanil.

Carotid endarterectomy (CEA) and coronary artery bypass grafting (CABG) as a combined procedure is occurring with increasing frequency. CEA-CABG incurs the morbidity of both procedures, and considerations for this procedure include anesthetic techniques that provide hemodynamic stability and prompt emergence from anesthesia. We present, to our knowledge, the first reported use in a combined CEA-CABG of the novel opioid remifentanil as a component of the anesthetic technique to achieve these goals. Remifentanil allows for early neurologic evaluation without sacrificing the hemodynamic stability of traditional, high-dose opioid techniques.