Abstract
We measured and compared the anaesthetic requirements, incidences of chest wall rigidity and intraoperative hypertension, and time for recovery from anaesthesia after high dose fentanyl-oxygen anaesthesia in patients with and without histories of smoking, alcoholic intake and caffeine consumption who were undergoing coronary artery bypass grafting operations. Patients without a history of smoking and alcohol or caffeine intake required less fentanyl for induction and maintenance of anaesthesia and experienced less chest wall rigidity and hypertension than similar patients who had been chronically exposed to and/or consumed these agents. Pretreatment with more pancuronium (1.5 vs 1.0 mg/70kg) prior to anaesthetic induction and increased fentanyl (3 × vs l × the “sleep” dose) administered after anaesthetic induction but before incision reduced the incidences of chest wall rigidity and intraoperative hypertension in patients with positive histories of exposure to the agents to values similar to patients without histories of exposure. Our findings suggest that population habits may affect the incidence of undesirable side effects during high dose fentanyl anaesthesia but that modifications in anaesthetic technique can minimize or eliminate these problems.
Résumé
Dans cette étude, nous avons mesuré et comparé les besoins anesthésiques, l’incidence de rigidité de la cage thoracique et d’hypertension per-opératoire et ie temps de recouvrance de l’anesthésie après des hautes doses de fentanyl pour un pontage aorto-coronarien chez des individus avec ou sans histoire de tabagisme, prise d’alcool ou consommation de caféine (groupe témoin). Les patients du groupe témoin nécessitèrent moins de fentanyl pour l’induction et le maintien de l’anesthésie. II y eût également moins de rigidité thoracique et moins d’hypertension per-opératoire chez les patients de ce groupe. Pour les patients du groupe habitué au tabac, à l’alcool et à la caféine un pré-traitement à dose plus élevée de pancuronium (1.5 vs. 1.0mg/70 kg) avant l’induction de l’anesthésie et l’augmentation des doses de fentanyl (3× vs 1 × la dose d’induction) avant l’incision ont ramené l’incidence de rigidité thoracique et d’hypertension per-opératoire au niveau du groupe témoin. Notre étude suggère que certaines habitudes de la population peuvent augmenter les effets indésirables des hautes doses de fentanyl et que la modification de la technique anesthésique peut minimiser ou éliminer ces problèmes.
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Supported in part by Stanley Research Foundation, Salt Lake City, Utah.
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Stanley, T.H., de Lange, S. The effect of population habits on side effects and narcotic requirements during high-dose fentanyl anaesthesia. Can Anaesth Soc J 31, 368–376 (1984). https://doi.org/10.1007/BF03015404
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DOI: https://doi.org/10.1007/BF03015404