Sufentanil-midazolam anesthesia for coronary artery surgery.
The combination of benzodiazepines and high-dose narcotics has been reported to produce hypotension in patients undergoing coronary artery surgery. This study was performed to evaluate the cardiovascular effects of lower doses of the narcotic sufentanil administered with the benzodiazepine midazolam. Thirty adult patients with good ventricular function undergoing elective coronary revascularization received sufentanil, 2.5 micrograms/kg, and midazolam, 0.1 mg/kg, followed by infusions of sufentanil, 0.7 to 1.5 micrograms/kg/h, and midazolam, 0.07 to 0.15 mg/kg/h. Overall, stable hemodynamics were achieved before and after cardiopulmonary bypass (CPB). Patients who were not receiving preoperative beta-adrenergic blockade (n = 15) had increases from baseline heart rate and rate-pressure product after sternotomy, during aortic dissection, and after CPB that were not clinically significant. Five patients developed hypertension (increases greater than 20% over the baseline value), which was controlled with additional sufentanil or a vasodilator. Hypertension requiring vasodilator therapy did not occur in patients taking beta-adrenergic blockers. Blood pressure decreases exceeding 20% of the baseline value did not occur. Two of 15 patients receiving beta-blockers, versus 3 of 15 not receiving beta-blockers, developed ischemic electrocardiographic changes before CPB (NS); one of these patients without beta-blockade had a postoperative myocardial infarction. The results of this study show that the infusion of low doses of sufentanil with midazolam provides a hemodynamically safe and stable anesthetic for coronary artery surgery and avoids the hypotension seen when a high-dose narcotic is combined with a benzodiazepine.
Tuman
K J
KJ
Department of Anesthesiology, Rush Presbyterian-St. Luke's Medical Center, Chicago, IL 60612.
McCarthy
R J
RJ
el-Ganzouri
A R
AR
Spiess
B D
BD
Ivankovich
A D
AD
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000771:Anesthesia, Intravenous; D000777:Anesthetics / Q000008:administration & dosage / Q000494:pharmacology; D001794:Blood Pressure / Q000187:drug effects; D002302:Cardiac Output / Q000187:drug effects; D001026:Coronary Artery Bypass; D004338:Drug Combinations; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000494:pharmacology; D006339:Heart Rate / Q000187:drug effects; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D006973:Hypertension / Q000503:physiopathology; D008297:Male; D008874:Midazolam / Q000008:administration & dosage / Q000494:pharmacology; D008875:Middle Aged; D009203:Myocardial Infarction / Q000503:physiopathology; D009294:Narcotics / Q000008:administration & dosage / Q000494:pharmacology; D011651:Pulmonary Artery; D013249:Sternum / Q000601:surgery; D017409:Sufentanil; D013908:Thoracotomy
D000319:Adrenergic beta-Antagonists; D000777:Anesthetics; D004338:Drug Combinations; D009294:Narcotics; D017409:Sufentanil; D008874:Midazolam; D005283:Fentanyl