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Canadian Journal of Anesthesia, Vol 27, 223-229, Copyright © 1980 by Canadian Anesthesiologists' Society

Haemodynamic and Biochemical Variables after Induction of Anaesthesia with Fentanyl and Nitrous Oxide in Patients Undergoing Coronary Artery By-Pass Surgery

O. PRAKASH 1, P. D. VERDOUW 1, J. W. DE JONG 1, S. H. MEIJ 1, S. G. VAN DER BORDEN 1, K. M. DHASMANA 1, and P. R. SAXENA 1

1 Department of Anaesthesia and Cardiovascular Research, Thoraxcentrum, University Hospital and Department of Pharmacology, Erasmus University Rotterdam, P.O. Box 1738, Rotterdam, The Netherlands

Correspondence: O. Prakash, Consultant Anaesthetist, Thoraxcentrum, Erasmus University, P.O. Box 1738, 3000 DR Rotterdam, The Netherlands.

The effects on the haemodynamic and biochemical parameters of three different anaesthetic induction regimes, namely fentanyl (4.1 µg·kg-1 or 15 µg·kg-1) plus 60 percent nitrous oxide with oxygen and fentanyl 15 µg·kg-1 plus 60 per cent nitrogen with oxygen, were studied in patients undergoing coronary artery surgery. Fentanyl 15 µg·kg-1 with nitrous oxide and oxygen produced simultaneous reductions in oxygen uptake, cardiac index and left ventricular stroke work with an unaltered oxygen extraction. Diastolic blood pressure (an index of coronary artery perfusion) was only slightly reduced, and there were no changes in arterial lactate, glucose and free fatty acids. The lower dose of fentanyl (4.1 µg·kg-1) with nitrous oxide produced no haemodynamic changes but decreased the oxygen uptake and extraction. The patients receiving fentanyl 15µg·kg-1 with nitrogen and oxygen showed increases in heart rate, blood pressure, cardiac index and left ventricular stroke work, together with a significant fall in oxygen extraction. Moreover, in the patients who received fentanyl 4.1 µg·kg-1 with nitrous oxide and oxygen and fentanyl 15 µg·kg-1 with nitrogen and oxygen there were significant increases in blood lactate, glucose and free fatty acids, indicating increased sympathetic activity. We conclude that fentanyl 15 µg·kg-1, together with 60 per cent nitrous oxide with oxygen provides a satisfactory haemodynamic and biochemical state during induction of anaesthesia in patients with myocardial function prejudiced by coronary artery insufficiency.






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Copyright © 1980 by the Canadian Anesthesiologists' Society.