Sevoflurane-fentanyl versus etomidate-fentanyl for anesthetic induction in coronary artery bypass graft surgery patients.
OBJECTIVE
To compare the hemodynamic effects of sevoflurane-fentanyl with etomidate-fentanyl during anesthetic induction in patients with coronary artery disease with good left ventricular function.


METHODS
A prospective randomized trial.


METHODS
University hospital.


METHODS
Twenty patients scheduled for elective coronary artery bypass graft surgery.


METHODS
Patients were allocated randomly to receive either 4% sevoflurane/nitrous oxide 67%/oxygen 33% (sevoflurane group) or etomidate, 0.2 mg/kg, for induction (intravenous group). Both techniques were supplemented by 10 microg/kg of fentanyl and muscle relaxation with pancuronium. Anesthesia was maintained in both groups with 2% sevoflurane/nitrous oxide 67%/oxygen 33%.


RESULTS
Time to loss of consciousness and airway complications during induction were assessed. Hemodynamics were recorded at 1-minute intervals during the induction period up to 5 minutes postintubation. Induction of anesthesia was significantly faster in patients given etomidate compared with patients who received sevoflurane; loss of eyelid reflex was 45 seconds (standard deviation 17 seconds) versus 97 seconds (standard deviation 20 seconds). None of the patients who received sevoflurane had airway complications during the induction period. Both anesthetic induction techniques provided cardiostability with little change in cardiac index (2%). The decrease in mean arterial blood pressure was greater in the patients who received sevoflurane induction (maximal decrease 28% v 14%). The heart rate and filling pressure changes were insignificant.


CONCLUSIONS
Sevoflurane inhalation induction produced minimal changes in cardiac index and no airway complications in patients with coronary artery disease with good left ventricular function. Induction was faster with etomidate, however, and blood pressure remained higher.
Cheong
K F
KF
Department of Anaesthesia, National University Hospital, Singapore, Singapore.
Choy
J M
JM
D000768:Anesthesia, General; D019162:Anesthetics, Combined; D018685:Anesthetics, Inhalation; D018686:Anesthetics, Intravenous; D001026:Coronary Artery Bypass; D005045:Etomidate; D005260:Female; D005283:Fentanyl; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008738:Methyl Ethers; D008875:Middle Aged; D011446:Prospective Studies; D000077149:Sevoflurane
D019162:Anesthetics, Combined; D018685:Anesthetics, Inhalation; D018686:Anesthetics, Intravenous; D008738:Methyl Ethers; D000077149:Sevoflurane; D005283:Fentanyl; D005045:Etomidate