Hemodynamic effects of a lorazepam-fentanyl anesthetic induction for coronary artery bypass surgery.
Previous anesthetic induction techniques using the combination of a benzodiazepine (midazolam or diazepam) and fentanyl have been reported to produce marked hypotension. In this study, anesthesia was induced with a combination of lorazepam and fentanyl in patients undergoing coronary artery bypass graft surgery. In 10 patients, anesthesia was induced using an exponentially declining continuous infusion of lorazepam equivalent to a total infused dose of 0.1 mg/kg over 15 minutes, which was supplemented at 10 minutes by fentanyl, 75 micrograms/kg, given as an infusion over 5 minutes. In 8 additional patients, anesthesia was induced with an exponentially declining infusion of fentanyl to a total dose of 75 micrograms/kg over 15 minutes, which was supplemented at 10 minutes by lorazepam, 0.1 mg/kg, given as an infusion over 5 minutes. Hemodynamics were recorded during a 20-minute observation period. One patient in each group required treatment for bradycardia during the initial drug infusion (before the second drug was added). Four additional patients in the group receiving lorazepam followed by fentanyl required treatment for bradycardia or hypotension within 10 minutes of the beginning of the fentanyl infusion. When an infusion of lorazepam was added to the fentanyl infusion, hemodynamics remained stable; however, the reverse order produced a high level of bradycardia and hypotension.
Ruff
R
R
Department of Anesthesiology, Duke University Medical Center, Durham, NC 27710.
Reves
J G
JG
D000771:Anesthesia, Intravenous; D001794:Blood Pressure / Q000187:drug effects; D001919:Bradycardia / Q000139:chemically induced; D001026:Coronary Artery Bypass; D004338:Drug Combinations; D004360:Drug Therapy, Computer-Assisted; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage / Q000009:adverse effects / Q000494:pharmacology; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D007260:Infusion Pumps; D008140:Lorazepam / Q000008:administration & dosage / Q000494:pharmacology; D008297:Male; D008875:Middle Aged; D013997:Time Factors; D014655:Vascular Resistance / Q000187:drug effects
D004338:Drug Combinations; D008140:Lorazepam; D005283:Fentanyl