title: Subarachnoid block with low dose of bupivacaine and sufentanil in patients with coronary artery disease.
abstract: BACKGROUND
  Subarachnoid block with local anesthetics and opioids enable efficacious spinal anesthesia because of their synergistic effect and permit the use of low-dose local anesthetics, which results in a stable hemodynamic state. The purpose of this study was to describe the cardiovascular effects of spinal anesthesia with low-dose bupivacaine and sufentanil on patients with coronary artery disease.
  
  
  METHODS
  This study was a double-blind randomized clinical trial. A total of 18 patients who had known coronary artery disease were enrolled. Our subjects underwent spinal block for lower limb surgery with 7.5 mg hyperbaric bupivacaine 0.5% and 5 µg sufentanil. Complications related to anesthesia such as hypotension, bradycardia, vasopressor need, and blood or volume use were recorded.
  
  
  RESULTS
  The average mean arterial pressure decreased 15% in the first 15 min of spinal block in our cases. No patients presented with hypotension and the subjects were without complaints during the spinal anesthesia. All patients remained alert, and no ST segment changes were observed intraoperatively and until 6 h after the operation. Baseline ejection fraction (EF) 40% or less was observed in 10 patients and these subjects were compared with other patients. Systolic and diastolic blood pressures, mean arterial pressure, and heart rate decreased during the first 15 min in response to spinal anesthesia in both groups of patients, but decreased more significantly in patients with EF > 40%.
  
  
  CONCLUSIONS
  We recommend spinal block with low-dose bupivacaine and sufentanil in patients with coronary artery disease and especially in patients with low EF.
authors.affiliation: Assistant Professor, Razi Hospital AND Farabi Hospital, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Mehdi
authors.initials: M
authors.lastname: Sanatkar
authors.affiliation: Assistant Professor, Besat Hospital, Hamedan University of Medical Sciences, Hamedan, Iran.
authors.forename: Afshin
authors.initials: A
authors.lastname: Farhanchi
authors.affiliation: Assistant Professor, Besat Hospital, Hamedan University of Medical Sciences, Hamedan, Iran.
authors.forename: Nahid
authors.initials: N
authors.lastname: Manouchehrian
authors.affiliation: Associate Professor, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Atabak
authors.initials: A
authors.lastname: Najafi
authors.affiliation: Assistant Professor, Razi Hospital AND Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Shahriyar
authors.initials: S
authors.lastname: Haddadi
authors.affiliation: Assistant Professor, Razi Hospital AND Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Javad
authors.initials: J
authors.lastname: Rahmati
authors.affiliation: Assistant Professor, Razi Hospital AND Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Shahrokh
authors.initials: S
authors.lastname: Ghazizadeh
authors.affiliation: Assistant Professor, School of Allied Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Hojjat
authors.initials: H
authors.lastname: Rahmani
authors.affiliation: Deputy of Research, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Jayran
authors.initials: J
authors.lastname: Zebardast
keywords: Bupivacaine; Coronary Artery Disease; Subarachnoid Block