[Fentanyl versus sufentanil basic anesthesia. Hypnotic effect, muscle rigidity and efficacy of competitive muscle relaxants].
As induction agents for cardioanesthesia, sufentanil (S) and fentanyl (F) are usually employed in combination with nondepolarizing muscle relaxants. We investigated potential interactions of these opioids with the relaxant component, paying special regard to the role of muscular rigidity and opioid-induced alterations of hemodynamics. Narcotic anesthesia was induced randomly in 45 coronary artery bypass patients with either F (20 micrograms/kg) or S (4 micrograms/kg). After 6 min, neuromuscular blockade was initiated within each group randomly with either vecuronium (V) or pancuronium (P) (0.01 mg/kg each). During opiate administration, the times for cessation of spontaneous respiration and loss of responsiveness to verbal and tactile stimuli were measured. The degree of opiate-induced muscular rigidity, simultaneous changes in arterial paCO2, cardiac indices (CI) prior to opioid and relaxant administration, onset and recovery from neuromuscular blockade (by electromyographic train-of-four registration), and motor response to laryngoscopy and intubation were recorded. The onset of spontaneous apnea (TK = time to breathing upon command only) and unresponsiveness (TM = time to controlled mask ventilation) was significantly faster with S than with F. Muscular rigidity was moderate in 25% of patients and severe in 35%-40%, during the administration of both narcotics. No significant differences between S and F were observed. During ventilation by face mask, patients with clinically apparent rigidity showed a statistically significant mean increase in paCO2.(ABSTRACT TRUNCATED AT 250 WORDS)
Eberle
B
B
Klinik für Anaesthesiologie der Johannes Gutenberg-Universität Mainz.
Brandt
L
L
Hennes
H J
HJ
el-Gindi
M
M
Ellmauer
S
S
Dick
W
W
D000777:Anesthetics; D002986:Clinical Trials as Topic; D001026:Coronary Artery Bypass; D004347:Drug Interactions; D005260:Female; D005283:Fentanyl / Q000031:analogs & derivatives*; D006801:Humans; D006993:Hypnotics and Sedatives; D008297:Male; D008875:Middle Aged; D009127:Muscle Rigidity / Q000139:chemically induced*; D009469:Neuromuscular Junction / Q000187:drug effects; D003473:Neuromuscular Nondepolarizing Agents / Q000494:pharmacology; D010197:Pancuronium / Q000494:pharmacology; D011897:Random Allocation; D017409:Sufentanil; D014673:Vecuronium Bromide / Q000494:pharmacology
D000777:Anesthetics; D006993:Hypnotics and Sedatives; D003473:Neuromuscular Nondepolarizing Agents; D014673:Vecuronium Bromide; D017409:Sufentanil; D010197:Pancuronium; D005283:Fentanyl
Fentanyl- versus Sufentanil-Basisanaesthesie. Hypnotischer Effekt, Muskelrigidität und Wirksamkeit kompetitiver Muskelrelaxantien.