Abstract
Patients who present for abdominal aortic surgery often have significant atherosclerotic disease which may involve the coronary arteries. Haemodynamic responses occurring during fentanyl (100 μ.g.kg-1 ) oxygen anaesthesia for abdominal aortic surgery were studied in 16 patients. Anaesthesia was induced with fentanyl 100 μ.g.kg-1 with no supplemental doses and metocurine-pancuronium mixture (4:1). In 13 of 16 patients hyperdynamic circulatory responses to surgical stimuli required treatment prior to aortic cross-clamping. Interventions instituted were sodium nitroprusside or nitroglycerin (n = 13), propranolol (n = 4), and diazepam (n = 4). The serum fentanyl concentration at time of response to surgical stimulus was 18.5 ± 5.6 ng.min-1 (range 7–27 ng.min-1; time from induction 71 ± 49 min, n = 9). Eleven of the 16 patients required treatment for postoperative hypertension. Five of the 16 patients developed myocardial ischaemia, defined as ST segment depression greater than O.ImV, at some time during the operative procedure. Unsupplementedfentanyl anaesthesia (100 μg.kg-1) was unable to maintain a hypodynamic circulation in patients having abdominal aortic operations.
Résumé
Les patients se présentant pour chirurgie aortique abdominale présentent souvent une maladie athérosclérotique pouvant atteindre les coronaires. Les réponses hémodynamiques survenant lors de la chirurgie sur l’aorte abdominale et une anesthésie aufentanyl (100 μg.kg-1) — O2 ont été étudiées chez 16 patients. L’anesthésie était induite avec du fentanyl 100 μg.kg-1 sans dose supplémentaire de mélange et métocurinelpancuronium (4:1). Pour 13 des 16patients les réponses hyperdynamiques au stimulus chirurgical ont requis un traitement avant le clampage aortique. Les interventions incluent la nitroprussiate de soude ou nitroglycérine (n = 13), propranolol (n = 4), diazepam (n = 4). La concentration sérique de fentanyl au temps de réaction au stimulus chirurgical était de 18.5 ± 5.6 ng.ml-1 (écart: 7–27 ng.ml-1), le temps à partir de l’induction 71 ± 49 min. (n = 9). Onze des 16 patients ont requis un traitement pour l’hypertension post-opératoire. Cinq des 16 patients ont développé une ischémie myocardique définie comme étant une dépression du segment ST supérieur à 0.1mV, lors de la procédure chirurgicale. L’anesthésie au fentanyl, celle (100 μg.kg-1) était incapable de maintenir un état hypodynamique chez les patients devant subir une chirurgie sur l’aorte abdominale.
Article PDF
Similar content being viewed by others
Avoid common mistakes on your manuscript.
References
Tomatis LA, Fierens EE, Verbrugge GP. Evaluation of surgical risk in peripheral vascular disease by coronary arteriography: a series of 100 cases. Surgery 1972; 71: 429–35.
Attia RR.Murphy JD, Snider M et al. Myocardial ischemia due to infra-renal aortic cross clamping during aortic surgery in patients with severe coronary artery disease. Circulation 1976; 53: 961–5.
Carroll RM, Laravuso RB, Schauble JB. Left ventricular function during aortic surgery. Arch Surg 1976; 111: 740–3.
Silverstein PR, Caldera DL, Cullen DJ, Davison JK, Darling RC, Emerson CW. Avoiding the hemo-dynamic consequences of aortic cross-clamping and unclamping. Anesthesiology 1979; 50: 462–6.
Bovill JG, Sebel PS, Stanley TH. Opioid analgesics in anesthesia with special reference to their use in cardiovascular anesthesia. Anesthesiology 1984; 61: 731–55.
Stahl WR. Scaling of respiratory variables in mammals. J Appl Physiol 1967; 22: 453–60.
Hudson RJ, Thomson IR, Cannon JE, Friesen RM, Meatherall RC. Pharmacokinetics of fentanyl in patients undergoing abdominal aortic surgery, Anesthesiology 1986; 64: 334–8.
Mqffit EA, Barker RA, Sullivan JA, Cousins CL. Myocardial metabolism and haemodynamic responses during high-dose fentanyl anaesthesia for coronary patients. Can Anaesth Soc J 1984; 31: 611–8.
Wynands JE, Wong P, Townsend GE, Sprigge JS, Wkalley DG. Narcotic requirements for intravenous anesthesia. Anesth Analg 1984; 63: 101–5.
Thomson IR, Pulnins CL. Adverse effects of pancuronium during high-dose fentanyl anesthesia for coronary artery bypass grafting. Anesthesiology 1985; 62: 708–13.
Thomson IR, Putnins CL, Friesen RM. Hyperdynamic cardiovascular responses to anesthetic induction with high-dose fentanyl. Anesth Analg 1986; 65: 91–5.
Holley FO. Prolonged respiratory depression in cardiac surgery patients: the contribution of fentanyl. Anesthesiology 1984; 61: A80.
Author information
Authors and Affiliations
Additional information
Supported by a grant from the Manitoba Heart Foundation.
Rights and permissions
About this article
Cite this article
Friesen, R.M., Thomson, I.R., Hudson, R.J. et al. Fentanyl oxygen anaesthesia for abdominal aortic surgery. Can Anaesth Soc J 33, 719–722 (1986). https://doi.org/10.1007/BF03027120
Issue Date:
DOI: https://doi.org/10.1007/BF03027120