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Remifentanil and fentanyl during induction of anesthesia for coronary artery surgery – a comparative hemodynamic study

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Knapik M., Knapik P., Nadziakiewicz P., Saucha W.
Annales Academiae Medicae Silesiensis
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2010
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vol. 64
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issue 3-4
18-25
EN
BACKGROUND Remifentanil is metabolized by non-specifi c esterases and is very shortacting. It is eliminated from all body compartments at the same time. AIM The aim of this study was to compare anesthetic induction with standard dose of etomidate and isofl urane combined either with fi xed rate remifentanil infusion or a single bolus dose of fentanyl. MATERIAL AND METHODS 54 patients (57.0±7.6 years) with stable CAD and EF > 40% scheduled for elective coronary revascularisation were recruited for this prospective, randomized trial. During induction, patients in group I received remifentanil infusion 0,5 mcg/kg/min., while group II received bolus dose 5 mcg/kg fentanyl. After initiation of remifentanil infusion or the injection of fentanyl, 0,2 mg/kg etomidate was given, followed by the injection of 0,1 mg/ kg pancuronium and the administration of 1% isofl urane. Haemodynamic parameters were measured before induction and after tracheal intubation. RESULTS Cardiac index decreased in both groups, heart rate and systemic blood pressure decreased only in remifentanil group, while systemic vascular resistance index increased only in fentanyl group. Heart rate, systemic blood pressure and systemic vascular resistance index after induction were signifi cantly higher in fentanyl group. CONCLUSIONS Remifentanil is more potent than fentanyl in blunting a cardiovascular response to tracheal intubation in patients with coronary artery disease. Low dose of fentanyl, used for the anaesthetic induction, may result in a clinically important increase of systemic vascular resistance.
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