Pure opioid versus opioid-volatile anesthesia for coronary artery bypass graft surgery: a prospective, randomized, double-blind study.
This study was designed to assess, in a prospective, randomized, blinded fashion, the hemodynamic effects of different anesthetics used in the prebypass period during coronary artery bypass grafting (CABG) and the effect on incidence of ischemia. Seventy-five patients were randomly assigned to receive sufentanil increments, isoflurane, or enflurane after a standard premedication and anesthetic induction with sufentanil 5 micrograms/kg. Myocardial ischemia was monitored intraoperatively by the anesthesiologist with electrocardiogram (ECG) leads V5(CB5) and II, and by a Holter monitor of the same leads from which recordings were analyzed postoperatively by a cardiologist. A continuous recording of the blood pressure was analyzed to determine the duration of hypertensive responses. Arterial blood pressure control was best in the patients supplemented with anesthetic vapors; patients receiving beta-adrenergic blockers or those receiving isoflurane were less likely to require treatment for tachycardia. All episodes of myocardial ischemia occurred within 5 min of induction-intubation and were diagnosed more frequently by the anesthesiologist than on the Holter monitor (29% vs 9%), with no difference between groups. There were five perioperative myocardial infarctions with no difference between groups. After anesthetic induction with sufentanil 5 micrograms/kg, isoflurane or enflurane given during CABG provides better hemodynamic control than increments of sufentanil and is associated with a similar incidence of prebypass ischemia and perioperative infarction.
Ramsay
J G
JG
Department of Anesthesia, McGill University, Montreal, Quebec.
DeLima
L G
LG
Wynands
J E
JE
O'Connor
J P
JP
Ralley
F E
FE
Robbins
G R
GR
D001026:Coronary Artery Bypass; D004311:Double-Blind Method; D004737:Enflurane; D005260:Female; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D007530:Isoflurane; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D017409:Sufentanil
D004737:Enflurane; D017409:Sufentanil; D007530:Isoflurane