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Comparison of desflurane and fentanyl-based anaesthetic techniques for coronary artery bypass surgery

, : Comparison of desflurane and fentanyl-based anaesthetic techniques for coronary artery bypass surgery. British Journal of Anaesthesia 72(4): 430-438

We have compared, in 51 ASA II and III patients undergoing coronary artery bypass surgery, an inhaled anaesthetic technique based on desflurane, supplemented with low-dose (10 mu-g kg-1) fentanyl, with an i.v. technique using high - dose (50 mu-g kg-1) fentanyl with midazolam for induction. Satisfactory records were available for analysis in 50 patients. There were no differences between groups in operating time, cardiopulmonary bypass time, aortic cross-clamp time or duration of stay in the intensive care unit after surgery. Desflurane maintained mean systemic arterial pressure at the awake level during incision and sternotomy (end-tidal concentrations 3.7% and 4.6%, respectively) but decreased it significantly at all other times. With fentanyl, mean systemic arterial pressure was unchanged from awake values during induction and laryngoscopy but increased significantly at incision and sternotomy by 8% and 12.8%, respectively, to exceed the desflurane group at sternotomy by 20 mm Hg (P lt 0.001). With desflurane, heart rate remained at 60-67 beat min-1 at all times before cardiopulmonary bypass. This was always lower than the fentanyl group by 5-15 beat min-1 and the difference was significant at induction, during skin preparation and before aortic cannulation. In comparison with the desflurane group, cardiac index was significantly greater in the fentanyl group at induction, laryngoscopy and during skin preparation, but was significantly less before aortic cannulation. The need for vasodilator intervention was significantly more common in the fentanyl group before, during and after cardiopulmonary bypass and for beta adrenoceptor block before cardiopulmonary bypass. At the time of sternotomy, 10 patients in the fentanyl group were receiving glyceryl trinitrate compared with one in the desflurane group. There were no deaths during the period in hospital or any cases of awareness under anaesthesia. Desflurane supplemented with low-dose fentanyl produced a controlled haemodynamic state suitable for patients at risk of myocardial ischaemia without recourse to large end-tidal concentrations.


PMID: 8155446

DOI: 10.1093/bja/72.4.430

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