Propofol-alfentanil versus fentanyl-midazolam in coronary artery surgery

• Published in: Journal of cardiothoracic and vascular anesthesia Vol. 10; no. 7; pp. 869 - 876
• Main Authors: Collard, E., Delire, V., Mayné, A., Jamart, J., Louagie, Y., Gonzalez, M., Ducart, A., Broka, S., Randour, P., Joucken, K.
• Format: Journal Article
• Language: English
• Published: Philadelphia, PA Elsevier Inc 01.12.1996; Elsevier
• Subjects: Aged; alfentanil; Alfentanil - administration & dosage; Anesthetics, Intravenous - administration & dosage; Anesthetics. Neuromuscular blocking agents; Biological and medical sciences; coronary artery surgery; Coronary Vessels - surgery; early extubation; Female; Fentanyl - administration & dosage; hemodynamics; Hemodynamics - drug effects; Humans; Male; Medical sciences; Midazolam - administration & dosage; Middle Aged; Neuropharmacology; Pharmacology. Drug treatments; propofol; Propofol - administration & dosage; Prospective Studies; early extubation; propofol; alfentanil; hemodynamics; coronary artery surgery; Heart; Human; Intravenous administration; Fentanyl; Cardiovascular disease; General anesthesia; Hypnotic; Opiates; Narcotic analgesic; Coronary heart disease; Recovery; General anesthetic; Surgery; Alfentanil; Benzodiazepine derivatives; Hemodynamics; Midazolam; Propofol; Comparative study
• ISSN: 1053-0770; 1532-8422
• DOI: 10.1016/S1053-0770(96)80048-6

To compare intraoperative hemodynamic profiles and recovery characteristics of propofol-alfentanil with fentanyl-midazolam anesthesia in elective coronary artery surgery. Prospective, randomized study. University hospital. Fifty patients with impaired or good left ventricular function. In group 1, (n = 25) anesthesia was induced with an infusion of propofol, 3 to 4 mg/kg/h, alfentanil, 500 μg, and pancuronium, 0.1 mg/kg, and maintained with propofol, 3 to 6 mg/kg/h (variable rate), and alfentanil infusions, 30 μg/kg/h (fixed rate). Additional boluses of alfentanil, 1 mg, were administered before noxious stimuli; group 2 (n = 25) received a loading dose of fentanyl, 25 μg/kg, midazolam, 1.5 to 3 mg, and pancuronium, 0.1 mg/kg for induction, followed by an infusion of fentanyl, 7 μg/kg/h, for maintenance. Additional boluses of midazolam (1.5 to 3 mg) and fentanyl (250 μg) were administered before noxious stimuli. Cardiovascular parameters at eight intraoperative time points as well as time to extubation, morphine consumption, and pain scores were recorded. Induction of anesthesia was associated in both groups with a small but significant decrease in mean arterial pressure (1: 15 mmHg (15%); 2: 8 mmHg (8%) with significant decreases in cardiac index (1: 8%; 2: 8%) and left ventricular stroke work index (1: 24%; 2: 21%). Throughout surgery, hemodynamic profiles were comparable between groups except after intubation when the MAP was significantly lower in group 1 (75 ± 12 mmHg) than in group 2 (89 ± 17 mmHg). Group 1 required less inotropic support. Extubation was performed faster in group 1 (7.6 h) than in group 2 (18.0 h). Morphine requirements and pain scores were comparable between groups. Propofol-alfentanil anesthesia provides good intraoperative hemodynamics and allows early extubation after coronary artery surgery.