title: Intrathecal sufentanil for coronary artery bypass grafting.
abstract: BACKGROUND
  Cardiac surgery patients undergoing coronary artery bypass grafting with cardiopulmonary bypass.
  
  
  OBJECTIVE
  Evaluate the effect of adding intrathecal sufentanil to general anesthesia on hemodynamics.
  
  
  METHODS
  Prospective, randomized, not blinded study, after approval by local ethics in Research Committee.
  
  
  METHODS
  Monocentric study performed at Dante Pazzanese Institute of Cardiology, Sao Paulo, Brazil.
  
  
  METHODS
  40 consenting patients undergoing elective coronary artery bypass, both genders.
  
  
  METHODS
  Chronic kidney disease; emergency procedures; reoperations; contraindication to spinal block; left ventricular ejection fraction less than 40%; body mass index above 32kg/m(2) and use of nitroglycerin.
  
  
  METHODS
  Patients were randomly assigned to receive intrathecal sufentanil 1μg/kg or not. Anesthesia induced and maintained with sevoflurane and continuous infusion of remifentanil.
  
  
  METHODS
  Hemodynamic variables, blood levels of cardiac troponin I, B-type natriuretic peptide, interleukin-6 and tumor necrosis factor alfa during and after surgery.
  
  
  RESULTS
  Patients in sufentanil group required less inotropic support with dopamine when compared to control group (9.5% vs 58%, p=0.001) and less increases in remifentanil doses (62% vs 100%, p=0.004). Hemodynamic data at eight different time points and biochemical data showed no differences between groups.
  
  
  CONCLUSIONS
  Patients receiving intrathecal sufentanil have more hemodynamical stability, as suggested by the reduced inotropic support and fewer adjustments in intravenous opioid doses.
authors.affiliation: Instituto de Cardiologia Dante Pazzanese, Universidade Federal de São Paulo, São Paulo, SP, Brazil. Electronic address: caenigro@uol.com.br.
authors.forename: Caetano
authors.initials: C
authors.lastname: Nigro Neto
authors.affiliation: Universidade Federal de São Paulo, São Paulo, SP, Brazil.
authors.forename: Jose Luiz Gomes
authors.initials: JL
authors.lastname: do Amaral
authors.affiliation: Instituto de Cardiologia Dante Pazzanese, Universidade Federal de São Paulo, São Paulo, SP, Brazil.
authors.forename: Renato
authors.initials: R
authors.lastname: Arnoni
authors.affiliation: Universidade Federal de São Paulo, São Paulo, SP, Brazil.
authors.forename: Maria Angela
authors.initials: MA
authors.lastname: Tardelli
authors.affiliation: Università Vita-Salute San Raffaele, Milano, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Landoni
mesh_terms: D000368:Aged; D000701:Analgesics, Opioid / Q000008:administration & dosage*; D001026:Coronary Artery Bypass / Q000009:adverse effects; D005260:Female; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D007278:Injections, Spinal; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology; D011446:Prospective Studies; D017409:Sufentanil / Q000008:administration & dosage*
chemical_list: D000701:Analgesics, Opioid; D017409:Sufentanil
keywords: Cardiac surgery; Interleukin 6; Spinal anesthesia; Sufentanil