Abstract
Purpose
Due to the progressive aging of the surgical population, the proportion of patients with coronary artery disease (CAD) is likely to increase. The effects of the new inhalational anaesthetic sevoflurane must be determined in patients with known CAD.
Methods
This multicentre, randomized, open-label study compared the haemodynamic and cardiovascular effects of sevoflurane and isoflurane with fentanyl in 284 ASA physical status II–IV patients undergoing elective coronary artery bypass graft (CABG).
Results
Satisfactory records were available in 272 patients, 139 sevoflurane (Group S) and 133 isoflurane (Group I). There were no differences between groups for demographic data except that more patients in Group S were taking preoperative beta-blockers (P = 0.03). The mean end-tidal MAC and MAC · hr requirements between groups were not different (Group S received 0.63 ± 0.02 MAC and 1.00 ± 0.05 MAC · hr while Group I received 0.58 ± 0.02 MAC and 0.92 ± 0.05 MAC · hr P = NS). The preCPB use of intravenous fentanyl was not different between groups. There was a similar decrease in haemodynamic variables in both groups after induction that persisted throughout the preCPB period. The incidence of preCPB myocardial ischaemia, adverse haemodynamic events and use of vasoactive drugs did not differ between groups. The incidence of postoperative myocardial infarction was 2.2% for Group S and Group I was 4.5% (P = NS). There were five postoperative deaths, one of which was attributed to a cardiac cause (Group I).
Conclusion
In patients undergoing elective CABG with low risk factors, either sevoflurane or isoflurane, combined with fentanyl, provided an acceptable preCPB haemodynamic profile and cardiac outcomes.
Résumé
Objectif
A cause du vieillissement de la population chirurgicale, une augmentation proportionnelle de patients souffrant de maladie coronarienne athérosclérotique (MCAS) est à prévoir. Les effets des nouveaux agents volatils anesthésiques, tels le desflurane et le sévoflurane, doivent être déterminés chez les patients ayant une MCAS.
Méthode
Cette étude ouverte, multicentrique, randomisée a comparé les effets hémodynamiques et cardio-vasculaires du sévoflurane et de l’isoflurane en association avec du fentanyl chez 284 patients ASA II–IV subissant une chirurgie de revascularisation myocardique (CABG).
Résultats
Un total de 272 patients évaluables ont servi à l’analyse dont 139 patients sévoflurane (Groupe S) et 133 patients isoflurane (Groupe I), Il n ’y avait pas de différence démographique entre les groupes à l’exception d’une utilisation préopératoire plus grande de bêta-bloqueurs dans le Groupe S (P = 0.03). La moyenne du MAC de fin d’expiration et le MAC·hr pour chacun des groupes étaient similaires (Groupe S a reçu 0.63 ± 0.02 MAC et 1.00 ± 0.05 MAC·hr tandis que le Groupe I a reçu 0.58 ± 0.02 MAC et 0.92 ± 0.05 MAC·hr; P = NS). L’utilisation du fentanyl préCEC était similaire. A la suite de l’induction et durant le maintien de l’anesthésie préCEC, une réduction similaire des paramètres hémodynamiques fut enregistrée. L’incidence d’ischémie myocardique préCEC, d’événements hémodynamiques adverses et l’utilisation d’agents vasoactifs étaient similaires. L’incidence d’infarctus du myocarde pour le Groupe S est de 2.2% et 4.5% pour le Groupe I (P = NS). Il y eut cinq décès postopératoires, dont un était attribué à une cause cardiaque (Groupe I).
Conclusion
Pour des patients à bas risque subissant une CABG, le sévoflurane et l’isoflurane, en association au fentanyl, procurent un profil hémodynamique préCEC et des résultats cardiaques acceptables.
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This study was supported by a grant from Abbott Laboratories, Ltd, Chicago, IL.
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Searle, N.R., Martineau, R.J., Conzen, P. et al. Comparison of sevoflurane/fentanyl and isoflurane/fentanyl during elective coronary artery bypass surgery. Can J Anaesth 43, 890–899 (1996). https://doi.org/10.1007/BF03011801
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DOI: https://doi.org/10.1007/BF03011801