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Canadian Journal of Anesthesia, Vol 30, 370-376, Copyright © 1983 by Canadian Anesthesiologists' Society

Arterial Hypertension Following Coronary Artery Surgery: Influence of the Narcotic Agent used for Anaesthesia

J. F. HARDY MD1, M. BOULANGER MD1, J. G. MAILLÉ MD1, B. PAIEMENT MD1, J. TAILLEFER MD1, P. SAHAB MD1, and M. DELORME MD1

1 Department of Anaesthesia, Montreal Heart Institute and the Department of Anaesthesiology, University of Montreal, Faculty of Medicine, Montreal, Quebec

Address correspondence to: Marcel Boulanger MD, Anaesthesiology Department, Montreal Heart Institute, 5000 Belanger Street East, Montreal, Quebec, Canada H1T 1C8

Mcllvaine et al. reported that morphine anaesthesia (1.5 mg·kg-1) was associated with a lower incidence of postoperative hypertension (3.8 per cent) following coronary artery bypass graft surgery (CABG), compared to 28 per cent when low dosefentanyl (7.5-10 µg·kg-1) and halogenated agents were used for anaesthesia. Since in this earlier study the relative dosage of the narcotics used could not be considered as equivalent we compared the incidence of postoperative hypertension in two groups of 24 patients operated for CABG: one group received morphine 1.5 mg·kg-1 and the other fentanyl50 µg·kg-1 these doses are considered clinically equivalent. In both groups, patients breathed a mixture of nitrous oxide oxygen (3/2). All patients had normal ventricular function. There was not a single case of postoperative hypertension in the morphine group whereas seven cases occurred in the fentanyl group (29 per cent). The incidence of preoperative hypertension was similar in both groups. During the operation, before the extracorporeal circulation, supplementation of anaesthesia to maintain cardiovascular stability was necessary twice as often in the morphine group as in the fentanyl group (40 vs 19). These results show that morphine anaesthesia prevents postoperative hypertension in CABG; clinically equivalent doses of fentanyl do not. However, during surgery, for the period preceding the extracorporeal circulation, fentanyl seems to be preferable to morphine for the coronary patients. This work suggests that a technique combining both narcotics might be advantageous: fentanyl being used before the extracorporeal circulation and morphine during and after, to prevent the postoperative hypertension. It remains to be determined if such a combination would be effective and would not present untoward effects such as delaying recovery, prolonging intubation period and ICU stay.

Key Words: ANAESTHESIA: cardiovascular, ANALGESICS: morphine, fentanyl, COMPLICATIONS: hypertension.






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Copyright © 1983 by the Canadian Anesthesiologists' Society.