title: A haemodynamic comparison of epidural versus intrathecal sufentanil to supplement general anaesthesia for abdominal aortic surgery.
abstract: The present study was designed to evaluate the influence of epidural sufentanil (ES) and intrathecal sufentanil (IS) on the peri-operative haemodynamic responses during abdominal aortic surgery. Twenty-four ASA Grade II patients without clinical symptoms of coronary artery disease received, randomly, epidural (n = 12) or intrathecal (n = 12) sufentanil combined with light general anaesthesia for elective bifemoral grafting for aorto-iliac occlusive disease. The IS group contained significantly more hypertensive patients than the ES group. This resulted in a significantly higher systolic and mean blood pressure, which remained constant from the start to the end of the study. Following a single bolus injection of 150 micrograms of sufentanil epidurally or intrathecally, there was a significant decrease in heart rate (HR), systolic, mean and diastolic blood pressure, systemic vascular resistance (SVR) and coronary perfusion pressure in both groups. This suggests that IS and ES must be used with caution in patients with cardiovascular disease. The abdominal incision restored the haemodynamic changes produced by sufentanil administration, but these did not exceed pre-sufentanil values. There were no significant changes in filling pressure, cardiac index (CI) and left ventricular work after aortic cross-clamping in the two groups. Revascularization produced significant differences in HR, SVR and CI in both groups in comparison with the pre-declamping period. Notable was the maintenance of systemic blood pressure following revascularization due to preservation of sympathetic activity. It was concluded that both epidural and intrathecal sufentanil produce comparable and stable haemodynamics in this category of patients.
authors.affiliation: Department of Anaesthesiology, Diakonessenhuis, Utrecht, The Netherlands.
authors.forename: P L
authors.initials: PL
authors.lastname: Houweling
authors.forename: T I
authors.initials: TI
authors.lastname: Ionescu
authors.forename: A A
authors.initials: AA
authors.lastname: Hoynck Van Papendrecht
authors.forename: G H
authors.initials: GH
authors.lastname: Schimmel
authors.forename: R
authors.initials: R
authors.lastname: Verkooyen
authors.forename: B
authors.initials: B
authors.lastname: Smalhout
mesh_terms: D000368:Aged; D000768:Anesthesia, General; D001012:Aorta, Abdominal / Q000601:surgery*; D001157:Arterial Occlusive Diseases / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage / Q000031:analogs & derivatives*; D006439:Hemodynamics / Q000187:drug effects* / Q000502:physiology; D006801:Humans; D007083:Iliac Artery / Q000601:surgery*; D007268:Injections, Epidural; D007278:Injections, Spinal; D008297:Male; D008875:Middle Aged; D017409:Sufentanil
chemical_list: D017409:Sufentanil; D005283:Fentanyl