Abstract
This study compared the haemodynamic and arginine vasopressin responses of patients to fentanyl or sufentanil anaesthesia for coronary artery bypass surgery. Four-teen normotensive patients with normal left ventricular function were studied. Patients were induced with fentanyl (N = 7) 37.5 μg·kg-1 or sufentanil (N = 7) 7.5 μ·kg-1 by intravenous infusion over three minutes. Clinically important chest wall rigidity, bradycardia and recall of intraoperative events did not occur. All of the fentanyl patients became hypertensive after induction and five required vasodilator therapy since they did not respond to boluses of fentanyl (12.5μg·kg-1). Two of these five patients had S-T depression greater than 1 mm. Five patients in the sufentanil group became hypertensive after induction. Four of these patients responded to additional sufentanil (3.75 μg·kg-1) while one required vasodilator therapy for concomitant S-T depression. Sufentanil attenuated the increase of arginine vasopressin during cardiopulmonary bypass. Levels of arginine vasopressin in the fentanyl group were significantly higher than those of the sufentanil group during bypass. Levels of AVP after bypass were higher in the sufentanil group.
The incidence of hypertension was similar in both groups. The hypertension was more easily treated with sufentanil but concomitant vasodilators (nitroglycerine) were required in both patient groups. Neither fentanyl in doses up to 128 ±8.7 μg·kg-1 nor sufentanil in doses up to 23 ± 1.4 μg·kg-1 can be used as sole agents for anaesthesia in adult coronary artery bypass patients with good ventricular function when induction times are three minutes and bolus top-up doses are used.
Résumé
Cette étude a comparé les réponses hémodynamiques ainsi que l’arginine vasopressin chez les patients ayant recu du fentanyl ou du sufentanil lors d’une chirurgie pour pontage aorto-coronarien. Quatorze patients nor-motendus avec une bonne fonction ventriculaire gauche ont été étudiés. Les patients ont été induits avec du fentanyl (N = 7) 37.5 μg·kg-1 ou du sufentanil (N = 7) 7.5 μg·kg-1 en perfusion intraveineuse pour trois minutes. Ni une rigidite thoracique significative ni une bradycardie ou un rappel des événements per-opératoires n’est survenues. Tous les patients ayant reçu du fentanyl ont présenté une hypertension après l’induction et cinq ont requis une thérapie au vasodilateur car ils n’ont pas répondu au bolus de fentanyl (12.5 μg·kg-1). Deux de ces cinq patients a démontré une dépression significative du segment ST (plus grand que 1 mm). Cinq patients du groupe sufentanil ont présenté une hyperten-sion apres l’induction. Quatre de ces patients ont répon-du à des doses additionnelles de sufentanil (3.75 μg·kg-1) alors qu’un seul a requis une thérapie aux vasodila-teurs suite à une dépression concomitante du segment ST. Le sufentanil a atténué l’augmentation de l’arginine vasopressin lors de la CEC. Les niveaux d’arginine vasopressin pour le groupe fentanyl étaient significativement plus haute que ceux du groupe sufentanil lors de la CEC. Les niveaux de AVP après CEC étaient supérieurs chez les patients du groupe sufentanil.
L’incidence d’hypertension était similaire dans les deux groupes. L’hypertension était plus facilement traitée pour le groupe sufentanil et l’administration concomitante de vasodilateurs (nitroglycerine) etait re-quise dans les deux groupes de patients hypertendus. Ni le fentanyl à des doses de 128 ± 8.7μg·kg-1 ni le sufentanil à des doses de 23 ± 1.4 μgçkg-1 peut être l’agent anes-thesique unique chez les adultes avec une bonne fonction ventriculaire quand le temps d’induction est de trois minutes et des bolus de rajout sont utilises.
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Boulton, A.J., Wilson, N., Turnbull, K.W. et al. Haemodynamic and plasma vasopressin responses during high-dose fentanyl or sufentanil anaesthesia. Can Anaesth Soc J 33, 475–483 (1986). https://doi.org/10.1007/BF03010974
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DOI: https://doi.org/10.1007/BF03010974