Does choice of anesthetic agent significantly affect outcome after coronary artery surgery?
A prospective study of 1094 consecutive adult patients undergoing coronary revascularization was undertaken to determine the effect of anesthetic technique on outcome. Patients received one of five primary techniques: high-dose fentanyl (greater than 50 micrograms/kg), moderate-dose fentanyl (less than 50 micrograms/kg), sufentanil (3-8 micrograms/kg), diazepam (0.4-1 mg/kg) with ketamine (3-6 mg/kg) or halothane (0.5-2.5% inspired concentration after thiopental induction). Supplemental inhalation anesthesia (enflurane, halothane, or isoflurane) was used in 60% of cases where the primary technique was intravenous based. Patients in the above anesthetic groupings had similar perioperative demographic and risk classifications. The overall incidence of postoperative myocardial infarction, postoperative low cardiac output state, and in-hospital death were 4.1, 5.6, and 3.1%, respectively. There were no significant differences in the incidence of these occurrences or in the incidence of serious pulmonary, renal, or neurologic morbidity or length of ICU stay among primary anesthetic techniques nor among supplemental inhalation agent groups. Multivariate discriminant analysis of this data suggests that a multitude of factors are significantly more important than anesthetic technique as determinants of outcome after coronary artery surgery.
Tuman
K J
KJ
Department of Anesthesiology, Rush-Presbyterian-St. Luke's Medical Center, Chicago, Illinois 60612.
McCarthy
R J
RJ
Spiess
B D
BD
DaValle
M
M
Dabir
R
R
Ivankovich
A D
AD
D000328:Adult; D000368:Aged; D000777:Anesthetics / Q000009:adverse effects*; D003975:Diazepam / Q000009:adverse effects; D004737:Enflurane / Q000009:adverse effects; D005260:Female; D005283:Fentanyl / Q000009:adverse effects / Q000031:analogs & derivatives; D006221:Halothane / Q000009:adverse effects; D006801:Humans; D007530:Isoflurane / Q000009:adverse effects; D007649:Ketamine / Q000008:administration & dosage; D008297:Male; D008875:Middle Aged; D009204:Myocardial Revascularization / Q000401:mortality; D011183:Postoperative Complications; D011379:Prognosis; D017409:Sufentanil
D000777:Anesthetics; D007649:Ketamine; D004737:Enflurane; D017409:Sufentanil; D007530:Isoflurane; D003975:Diazepam; D005283:Fentanyl; D006221:Halothane