Vital capacity inhalation induction with sevoflurane: an alternative to standard intravenous induction for patients undergoing cardiac surgery.
OBJECTIVE
To determine the respiratory and cardiovascular effects of a high concentration vital capacity induction with sevoflurane compared with an intravenous induction with etomidate in patients scheduled for elective coronary artery bypass graft (CABG) surgery.


METHODS
Prospective, randomized, double-blind, controlled clinical trial.


METHODS
Cardiothoracic unit at a university hospital referral center.


METHODS
Twenty-two patients undergoing elective CABG surgery.


METHODS
The study group (group S) received a vital capacity gaseous induction with sevoflurane 8% (n = 12) and the control group (group E) were given etomidate, 0.2 to 0.3 mg/kg (n = 10). Anesthesia was supplemented with fentanyl, 8 microg/kg, and vecuronium, 0.1 mg/kg, in both groups.


RESULTS
The speed of induction of anesthesia was comparable between the groups. There was a significant increase in minute ventilation after induction of anesthesia in both groups. This increase was associated with a small reduction in PaCO2. There were no clinically significant changes in pH and PaO(2). The incidence of breath-holding and the need for an oropharyngeal airway were similar between the groups. Both groups had similar reductions in mean arterial pressure and cardiac output during the study period; however, a downward trend in mean pulmonary artery pressure was noted in group S, whereas in group E it remained unchanged. Absolute plasma epinephrine and norepinephrine values were low during the precardiopulmonary bypass period in both groups.


CONCLUSIONS
The technique of vital capacity inhalation induction with 8% sevoflurane offers a rapid onset of anesthesia, satisfactory airway control, and a good hemodynamic profile. Consideration should be given to the benefits of single-agent anesthesia and lowered pulmonary artery pressure during the precardiopulmonary bypass period. In addition to CABG surgery, this technique could be considered in patients with coronary artery disease undergoing noncardiac surgery, particularly for procedures in which spontaneous ventilation is preferred.
Djaiani
G N
GN
Department of Anesthesiology, Division of Cardiothoracic Anesthesia, Duke University Medical Center, Durham, NC 27710, USA.
Hall
J
J
Pugh
S
S
Peaston
R T
RT
D000368:Aged; D000769:Anesthesia, Inhalation; D000771:Anesthesia, Intravenous; D018685:Anesthetics, Inhalation; D018686:Anesthetics, Intravenous; D001794:Blood Pressure / Q000502:physiology; D002245:Carbon Dioxide / Q000097:blood; D004311:Double-Blind Method; D004837:Epinephrine / Q000097:blood; D005045:Etomidate; D005260:Female; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D008297:Male; D008738:Methyl Ethers; D008875:Middle Aged; D009638:Norepinephrine / Q000097:blood; D011446:Prospective Studies; D012129:Respiratory Function Tests; D000077149:Sevoflurane; D013990:Tidal Volume; D014797:Vital Capacity
D018685:Anesthetics, Inhalation; D018686:Anesthetics, Intravenous; D008738:Methyl Ethers; D002245:Carbon Dioxide; D000077149:Sevoflurane; D009638:Norepinephrine; D004837:Epinephrine; D005045:Etomidate