Dose-response to anaesthetic induction with sufentanil: haemodynamic and electroencephalographic effects.
OBJECTIVE
To determine the effect of a five-fold variation in sufentanil dose on the haemodynamic and electroencephalo graphic (EEG) response to anaesthetic induction and tracheal intubation.


METHODS
Thirty-four patients undergoing elective coronary artery bypass grafting (CABG) participated in this randomized double-blind study. Patients in Group L (n = 17) received 3 micrograms.kg-1 sufentanil and those in Group H (n = 17) 15 micrograms.kg-1. Premedication was 60 micrograms.kg-1 lorazepam po. Anaesthesia and neuromuscular blockade were induced by infusing sufentanil and 0.15 mg.kg-1 vecuronium i.v. over five minutes. Haemodynamic data and the electroencephalographic (EEG) spectral edge were acquired by computer and compared at Control, Induction and Intubation.


RESULTS
Sufentanil dose did not affect the haemodynamic or EEG response at end-induction. No bradyarrhythmias occurred, and the incidence of hypotension was 12% in both groups. However, during induction apparent electromyographic artifacts and a transiently greater increase in heart rate were observed in Group H. The serum sufentanil concentration at Induction was 6.1 +/- 1.8 ng.ml-1 in Group L and 25.4 +/- 8.8 ng.ml-1 in Group H, and did not correlate with haemodynamic changes. No patient recalled any intraoperative event.


CONCLUSIONS
Increasing sufentanil dose from 3 to 15 micrograms-1 does not influence the ultimate haemodynamic response to induction. Combined with lorazepam premedication, 3 micrograms-1 sufentanil produces near-maximal haemodynamic and EEG effects and is adequate for induction and tracheal intubation of patients undergoing CABG. Sufentanil 15 micrograms.kg-1 is no more efficacious, and causes transient cardiovascular stimulation.
Sareen
J
J
Department of Anesthesia, University of Manitoba, Winnipeg, Canada.
Hudson
R J
RJ
Rosenbloom
M
M
Thomson
I R
IR
D000368:Aged; D018686:Anesthetics, Intravenous / Q000008:administration & dosage* / Q000097:blood / Q000494:pharmacology; D001919:Bradycardia / Q000209:etiology; D001026:Coronary Artery Bypass; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D017558:Elective Surgical Procedures; D004569:Electroencephalography / Q000187:drug effects*; D004576:Electromyography / Q000187:drug effects; D005260:Female; D006339:Heart Rate / Q000187:drug effects; D006439:Hemodynamics / Q000187:drug effects*; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage; D007022:Hypotension / Q000209:etiology; D007442:Intubation, Intratracheal; D008140:Lorazepam / Q000008:administration & dosage; D008297:Male; D008568:Memory / Q000187:drug effects; D008875:Middle Aged; D019148:Neuromuscular Blockade; D003473:Neuromuscular Nondepolarizing Agents / Q000008:administration & dosage; D011229:Preanesthetic Medication; D012815:Signal Processing, Computer-Assisted; D017409:Sufentanil / Q000008:administration & dosage* / Q000097:blood / Q000494:pharmacology; D014673:Vecuronium Bromide / Q000008:administration & dosage
D018686:Anesthetics, Intravenous; D006993:Hypnotics and Sedatives; D003473:Neuromuscular Nondepolarizing Agents; D014673:Vecuronium Bromide; D017409:Sufentanil; D008140:Lorazepam