[Cardiovascular effects of, and catecholamine response to, high dose fentanyl or NLA in patients for valve replacement].
We measured the cardiovascular effect of, and catecholamine and other hormonal responses to, anesthetic doses of fentanyl and original NLA in 25 patients for open heart surgery. The patients were randomly divided into three groups (group N, F30, F75). During induction, in group N; droperidol 0.25 mg.kg-1 and fentanyl 5 micrograms.kg-1, in group F30; fentanyl 30 micrograms.kg-1, and in group F75; fentanyl 75 micrograms.kg-1 were administered intravenously. Additional fentanyl was administered at a rate of 100 to 200 micrograms.h-1. Droperidol 0.25 mg.kg-1 was administered in group N when cardiopulmonary bypass (CPB) was disconnected. Plasma samples were assayed for norepinephrine, epinephrine, ACTH and cortisol before and after induction, during sternotomy, 60 minutes after institution of CPB, after weaning from CPB, and before as well as after extubation. Heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP) and rate pressure product (RPP) were calculated simultaneously at the blood samplings. In all groups, no remarkable change in cardiovascular dynamics was observed. CPB was associated with marked increases in catecholamines, but high dose fentanyl in dose of 75 micrograms.kg-1 was able to suppress epinephrine level more than in group N. In high dose fentanyl group (F30, F75) ACTH was within normal ranges, even during CPB. The results suggest that high dose fentanyl is a complete anesthetic in patients for cardiac surgery. But a large dose of fentanyl causes small decreases in heart rate and arterial blood pressure. Our data indicate that group F30 is an attractive anesthetic technique for patients with valvular disease.
Fujita
R
R
Department of Anesthesiology, Hachiouji Medical Center, Tokyo Medical College.
Usuda
M
M
Tamaki
K
K
Yoshimatsu
N
N
Ikeda
K
K
Isshiki
A
A
D000324:Adrenocorticotropic Hormone / Q000097:blood*; D000771:Anesthesia, Intravenous; D002395:Catecholamines / Q000097:blood*; D005260:Female; D005283:Fentanyl; D006349:Heart Valve Diseases / Q000503:physiopathology / Q000601:surgery; D006350:Heart Valve Prosthesis; D006439:Hemodynamics; D006801:Humans; D006854:Hydrocortisone / Q000097:blood*; D007432:Intraoperative Period; D008297:Male; D008875:Middle Aged; D009458:Neuroleptanalgesia; D011184:Postoperative Period; D013312:Stress, Physiological / Q000097:blood*
D002395:Catecholamines; D000324:Adrenocorticotropic Hormone; D005283:Fentanyl; D006854:Hydrocortisone