Sufentanil is preferable to etomidate during rapid-sequence anesthesia induction for aortocoronary bypass surgery.
To evaluate rapid-sequence anesthetic induction techniques for aortocoronary bypass grafting, 20 patients scheduled for elective surgery were randomly assigned to receive bolus injections of either etomidate, 0.4 mg/kg, intravenously (IV), or sufentanil, 5 micrograms/kg, IV, with succinylcholine, 1 mg/kg, IV. Patients in the two groups had similar demographic characteristics and baseline (preinduction) hemodynamic values. Following induction and intubation, 8 of 9 etomidate patients required a pharmacologic intervention to treat hypertension and tachycardia, whereas only 1 of 11 sufentanil patients required additional treatment (P less than 0.001). Three of 9 etomidate patients had ST segment changes of new myocardial ischemia following induction and intubation; two other etomidate patients developed Q waves on their postoperative electrocardiograms, indicative of a perioperative myocardial infarction. No sufentanil patient demonstrated either ischemia or infarction. It is concluded that sufentanil-succinylcholine provides more stable hemodynamics and fewer ischemic myocardial events than etomidate-succinylcholine in patients undergoing myocardial revascularization surgery.
Butterworth
J F
JF
Department of Anesthesia, Wake Forest University Medical Center, Winston-Salem, NC 27103.
Bean
V E
VE
Royster
R L
RL
D000771:Anesthesia, Intravenous; D000777:Anesthetics / Q000008:administration & dosage; D001794:Blood Pressure / Q000187:drug effects; D001026:Coronary Artery Bypass; D003327:Coronary Disease / Q000209:etiology; D004338:Drug Combinations; D004562:Electrocardiography / Q000187:drug effects; D005045:Etomidate / Q000008:administration & dosage / Q000009:adverse effects; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage / Q000031:analogs & derivatives*; D006801:Humans; D006973:Hypertension / Q000209:etiology; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology; D013390:Succinylcholine / Q000008:administration & dosage; D017409:Sufentanil
D000777:Anesthetics; D004338:Drug Combinations; D017409:Sufentanil; D013390:Succinylcholine; D005283:Fentanyl; D005045:Etomidate