Fentanyl-induced hemodynamic changes after esophagectomy or cardiac surgery.
OBJECTIVE
The goal of this study was to characterize the hemodynamic response to propofol vs propofol with fentanyl when used for sedation after esophagectomy or cardiac surgery.


METHODS
Prospective, randomized, controlled study.


METHODS
University Hospital, Intensive Care Unit.


METHODS
Thirty patients undergoing elective cardiac surgery and 26 patients undergoing esophagectomy were examined.


METHODS
Patients were randomized to receive propofol (0.5 mg/kg bolus over 10 minutes, followed by continuous infusion at 1 mg/kg per hour) with or without fentanyl (2.0 microg/kg per hour) to achieve sedation overnight while in the intensive care unit. Randomization was performed in a double-blind manner.


METHODS
Mean arterial pressure (MAP) was monitored throughout the treatment period, and sedation level was measured. Sedation level was targeted to achieve a Ramsay score of 4.


RESULTS
The number of patients experiencing a greater than 20% drop in baseline MAP was higher in cardiac patients receiving propofol alone (11 of 15 patients, 73%) than in cardiac patients receiving propofol with fentanyl (4 of 15 patients, 27%). Furthermore, the time of optimal sedation was lower in the cardiac patients who received propofol than in cardiac patients who received propofol with fentanyl group (propofol alone, 79%; propofol with fentanyl, 88%). In contrast, there was no difference in the number of esophagectomy patients experiencing a greater than 20% drop in baseline MAP or in the mean time of optimal sedation when comparing the 2 treatment regimens.


CONCLUSIONS
Propofol has a differential effect on hemodynamics and sedation when comparing patients after cardiac surgery and esophagectomy.
Kadoi
Yuji
Y
Department of Anesthesiology, Gunma University Hospital, Maebashi, Gunma 371-8511, Japan. kadoi@med.gunma-u.ac.jp
Hinohara
Hiroshi
H
Kunimoto
Fumio
F
Saito
Shigeru
S
Goto
Fumio
F
D000701:Analgesics, Opioid / Q000494:pharmacology; D018686:Anesthetics, Intravenous / Q000494:pharmacology; D001794:Blood Pressure / Q000187:drug effects; D006348:Cardiac Surgical Procedures; D016292:Procedural Sedation / Q000379:methods; D016629:Esophagectomy; D005260:Female; D005283:Fentanyl / Q000494:pharmacology*; D006439:Hemodynamics / Q000187:drug effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000379:methods; D010149:Postoperative Pain / Q000517:prevention & control*; D015742:Propofol / Q000494:pharmacology*; D011446:Prospective Studies; D013997:Time Factors
D000701:Analgesics, Opioid; D018686:Anesthetics, Intravenous; D005283:Fentanyl; D015742:Propofol