Skip to main content
Download PDF

Fentanyl-oxygen anaesthesia for coronary artery surgery: cardiovascular and antidiuretic hormone responses

Canadian Anaesthetists’ Society Journal volume 26, pages 168–172 (1979)Cite this article

Summary

This study demonstrates that larges doses of fentanyl, as the sole anaesthetic with ventilation with oxygen, produces complete anaesthesia and minimal changes in cardiovascular dynamics in patients with coronary artery disease. It also indicates that high dose fentanyl anaesthesia blocks the increases in plasma anti-diuretic hormone and cardiovascular dynamics which are so common with morphine and other anaesthetic techniques during tracheal intubation and surgical stimulation in patients with coronary artery disease. Our findings suggest that fentanyl-oxygen anaesthesia is an attractive technique in patients with coronary artery disease.

Résumé

Dans cette étude portant sur 14 malades opérés pour pontage aortocoronarien, les auteurs ont mesuré la réponse du système cardiovasculaire et de ľhormone antidiurétique à des doses anesthésiques de fentanyl (20-80 ug-kg-1); les observations ont été faites avant et pendant la stimulation chirurgicale et en cours de circulation extracorporelle.

A ces doses de fentanyl, on observe une légère augmentation de la fréquence cardiaque et de la pression artérielle moyenne, mais sans modification du volume systolique, du débit cardiaque et de la résistance vasculaire périphérique. Le taux plasmatique de ľhormone antidiurétique n’est pas modifié de façon significative par le fentanyl, quels qu’en soient la dose, ľincubation, ou le stimulus chirurgical, quelle qu’en soit ľintensité; par contre, on note une augmentation significative de ľADH plasmatique au cours de la circulation extracorporelle.

Cess données montrent que chez le porteur de maladie coronarienne, de fortes doses de fentanyl associées à de ľoxygène pur, produisent une anesthésie complète; on ne note que des effets mineurs sur la dynamique cardiovasculaire et la production ďhormone antidiurétique avant toute stimulation chirurgicale ou pendant celle-ci. Ces données inclinent à penser que la combinaison fentanyl-oxygène apparaît recommandable pour ľanesthésie du malade coronarien.

References

  1. Stanley, T.H. &Webster, L.R. Anesthetic requirements and cardiovascular effects of fentanyl-oxygen and fentanyl-diazepam-oxygen anesthesia in man. Anesth. Analg.57: 411 (1978).

    PubMed  CAS  Google Scholar 

  2. Warner, H.R., Gardner, F.M., &Toronto, A.R. Computer-based monitoring of cardiovascular functions in postoperative patients. Circulation 38 (supple II): 68 (1968).

    Google Scholar 

  3. Philbin, D.M., Wilson, N.B., Sokoloski, J. &Cocgins, C. Radioimmunoassay of antidiuretic hormone during morphine anaesthesia. Canad. Anaesth. Soc. J.23: 290 (1976).

    PubMed  Article  CAS  Google Scholar 

  4. Oyama, T. Anesthetic management of endocrine disease,R. Frey,F. Kern,O. Mayrhofer, Editors, New York, Springer-Verlag, Chap. 4.

  5. Yoshida, Y. Studies on the pathologic physiology of pulmonary hypertension in mitral valve disease: I. The role of the sympathetic nervous system on the increment of pulmonary vascular resistance. Jap. Arc. J.33: 359 (1969).

    CAS  Google Scholar 

  6. Stanley, T.H., Isern-Amaral, J., Lathrop, G.D. Urine norepinephrine excretion in patients undergoing mitral or aortic valve replacement with morphine anesthesia. Anesth. Analg.54: 509 (1975).

    PubMed  Article  CAS  Google Scholar 

  7. Braunwald, E. Control of myocardial oxygen consumption: physiologic and clinical considerations. Am. J. Cardio.27: 416 (1971).

    Article  CAS  Google Scholar 

  8. Kaplan, J.A., Dunbar, R.W., &Jones, E.L. Nitroglycerin infusion during coronary-artery surgery. Anesthesiology45: 14 (1976).

    PubMed  CAS  Google Scholar 

  9. Bland, J.H.L. &Lowenstein, E. Halothaneinduced decreases in experimental myocardial ischemia in the non-failing canine heart. Anesthesiology45: 287 (1976).

    PubMed  CAS  Google Scholar 

  10. Hamilton, W.K. Do let the blood pressure drop and do use myocardial depressants. Anesthesiology45: 273 (1971).

    Article  Google Scholar 

  11. Arens, J.F., Benbow, B.P., &Ochsner, J.L. Morphine anesthesia for aortocoronary artery bypass procedures. Anesth. Analg.51: 901 (1972).

    PubMed  Article  CAS  Google Scholar 

  12. Philbin, D.M. &Coogins, C.H. Plasma vasopressin levels during cardiopulmonary bypass with and without profound haemodilution. Canad. Anaesth. Soc. J.25: 282 (1978).

    PubMed  CAS  Article  Google Scholar 

  13. Stanley, T.H., Gray, N.N., &Bidwai, A.V. The effects of high dose morphine and morphine plus nitrous oxide on urinary output in man. Canad. Anaesth. Soc J.21: 379 (1974).

    PubMed  CAS  Google Scholar 

  14. Lowenstein, E., Hallowell, P., &Levine, F.J. Cardiovascular response to large doses of in-travenous morphine in man. N. Engl. J. Med.281: 1389 (1969).

    PubMed  CAS  Google Scholar 

  15. Lowenstein, E. Morphine “Anesthesia” — A Perspective. Anesthesiology25: 563 (1971).

    Google Scholar 

  16. Philbin, D.M. &Coggins, C.H. Plasma antidiuretic hormone levels in cardiac surgical patients during morphine and halothane anesthesia. Anesthesiology49: 95 (1978).

    PubMed  Article  CAS  Google Scholar 

  17. Stanley, T.H. &Gray, N.H. The effects of high dose morphine on blood and fluid requirements of open-heart operations. Anesthesiology38: 536 (1973).

    PubMed  Article  CAS  Google Scholar 

  18. Stanley, T.H. &Lathrop, G.D. Urinary excretion of morphine during and after valvular and coronary-artery surgery. Anesthesiology46: 166 (1977).

    PubMed  CAS  Article  Google Scholar 

  19. Hill, E.G., Stanley, T.H., Hodges, M.R., Sentker, C.R., &Philbin, D. Failure of enflurane in altering renal responses to acute intracranial pressure increases. Anesth. Analg.57: 200 (1978).

    PubMed  CAS  Google Scholar 

Download references

Author information

Affiliations

  1. From the department of Anesthesiology, The University of Utah College of Medicine, 84132, Salt Lake City, Utah

    Theodore H. Stanley, Daniel M. Philbin & Cecil H. Coggins

  2. Departments of Anaesthesia and Medicine, The Massachusetts General Hospital and the Harvard Medical School, 02114, Boston, Massachusetts

    Theodore H. Stanley, Daniel M. Philbin & Cecil H. Coggins

Authors
  1. Theodore H. Stanley
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Daniel M. Philbin
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Cecil H. Coggins
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Stanley, T.H., Philbin, D.M. & Coggins, C.H. Fentanyl-oxygen anaesthesia for coronary artery surgery: cardiovascular and antidiuretic hormone responses. Canad. Anaesth. Soc. J. 26, 168–172 (1979). https://doi.org/10.1007/BF03006976

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF03006976

Keywords

  • Morphine
  • Fentanyl
  • Arterial Blood Pressure
  • Tracheal Intubation
  • Anaesthetic Technique