Comparison of sufentanil-nitrous oxide anaesthesia with fentanyl-nitrous oxide anaesthesia in geriatric patients undergoing major abdominal surgery.
We have measured haemodynamic changes and plasma concentrations of catecholamines during sufentanil-nitrous oxide and fentanyl-nitrous oxide anaesthesia in a controlled, randomized, double-blind study of 20 geriatric patients (age 65-86 yr) undergoing major abdominal surgery. Fentanyl 7 micrograms kg-1 followed by infusion of 3 micrograms kg-1 h-1 was compared with sufentanil 1 micrograms kg-1 followed by 0.4 micrograms kg-1 h-1. The opioid was supplemented with 60-67% nitrous oxide in oxygen. Haemodynamic changes, plasma concentrations of catecholamines (by high pressure liquid chromatography) and opioids (by radioimmunoassay), and myocardial lactate extraction were measured in the awake state, and at defined times during anaesthesia and surgery. Haemodynamic state was stable during induction and tracheal intubation in both groups, while during stressful operative periods there were increases in mean arterial pressure (17% in the fentanyl group; 11% in the sufentanil group), heart rate (fentanyl 20%, sufentanil 14%) and plasma concentrations of catecholamines (adrenaline: fentanyl 316%, sufentanil 86%; noradrenaline: fentanyl 78%, sufentanil 186%) in both groups. Sufentanil was similar to fentanyl in attenuating the haemodynamic and hormonal responses to surgical stimulation. In two patients in the fentanyl group and three in the sufentanil group, myocardial lactate production was observed temporarily, indicating myocardial ischaemia caused by surgical stress.
Department of Anaesthesiology, University of Göttingen, Germany.
D
D
Kietzmann
R
R
Larsen
J
J
Rathgeber
M
M
Bolte
D
D
Kettler
D000005:Abdomen / Q000601:surgery*; D000368:Aged; D000369:Aged, 80 and over; D000701:Analgesics, Opioid / Q000494:pharmacology*; D000768:Anesthesia, General; D000769:Anesthesia, Inhalation; D004837:Epinephrine / Q000097:blood; D005260:Female; D005283:Fentanyl / Q000031:analogs & derivatives* / Q000097:blood / Q000494:pharmacology*; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D007773:Lactates / Q000097:blood; D008297:Male; D009609:Nitrous Oxide; D009638:Norepinephrine / Q000097:blood; D017409:Sufentanil
D000701:Analgesics, Opioid; D007773:Lactates; D017409:Sufentanil; D009609:Nitrous Oxide; D005283:Fentanyl; D009638:Norepinephrine; D004837:Epinephrine