Comparison of sevoflurane/fentanyl and isoflurane/fentanyl during elective coronary artery bypass surgery

Norman R. Searle, Raymond J. Martineau, Peter Conzen, A. Al-Hasani, Lynette J Mark, Thomas Ebert, Michael Muzi, Lewis R. Hodgins

Research output: Contribution to journalArticle

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.

Original languageEnglish (US)
Pages (from-to)890-899
Number of pages10
JournalCanadian Journal of Anesthesia
Volume43
Issue number9
DOIs
StatePublished - Sep 1996

Fingerprint

Isoflurane
Fentanyl
Coronary Artery Bypass
Hemodynamics
Coronary Artery Disease
Transplants
Incidence
Myocardial Ischemia
Anesthetics
sevoflurane
Myocardial Infarction
Demography
Pharmaceutical Preparations
Population

Keywords

  • Anaesthesia: cardiac
  • Anaesthetics, Intravenous: fentanyl
  • Anaesthetics, Volatile: isoflurane, sevoflurane
  • haemodynamics
  • Heart: coronary artery disease
  • Holter electrocardiography: pulse rate
  • Monitoring: blood pressure
  • myocardial ischaemia
  • Surgery: coronary artery bypass graft

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

Cite this

Comparison of sevoflurane/fentanyl and isoflurane/fentanyl during elective coronary artery bypass surgery. / Searle, Norman R.; Martineau, Raymond J.; Conzen, Peter; Al-Hasani, A.; Mark, Lynette J; Ebert, Thomas; Muzi, Michael; Hodgins, Lewis R.

In: Canadian Journal of Anesthesia, Vol. 43, No. 9, 09.1996, p. 890-899.

Research output: Contribution to journalArticle

Searle, NR, Martineau, RJ, Conzen, P, Al-Hasani, A, Mark, LJ, Ebert, T, Muzi, M & Hodgins, LR 1996, 'Comparison of sevoflurane/fentanyl and isoflurane/fentanyl during elective coronary artery bypass surgery', Canadian Journal of Anesthesia, vol. 43, no. 9, pp. 890-899. https://doi.org/10.1007/BF03011801
Searle, Norman R. ; Martineau, Raymond J. ; Conzen, Peter ; Al-Hasani, A. ; Mark, Lynette J ; Ebert, Thomas ; Muzi, Michael ; Hodgins, Lewis R. / Comparison of sevoflurane/fentanyl and isoflurane/fentanyl during elective coronary artery bypass surgery. In: Canadian Journal of Anesthesia. 1996 ; Vol. 43, No. 9. pp. 890-899.
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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.",
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AU - Martineau, Raymond J.

AU - Conzen, Peter

AU - Al-Hasani, A.

AU - Mark, Lynette J

AU - Ebert, Thomas

AU - Muzi, Michael

AU - Hodgins, Lewis R.

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AB - 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.

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KW - Holter electrocardiography: pulse rate

KW - Monitoring: blood pressure

KW - myocardial ischaemia

KW - Surgery: coronary artery bypass graft

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