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Canadian Journal of Anesthesia, Vol 31, 368-376, Copyright © 1984 by Canadian Anesthesiologists' Society

Reports of Investigation: The Effect of Population Habits on Side Effects and Narcotic Requirements during High-Dose Fentanyl Anaesthesia

THEODORE H. STANLEY MD1 and SIMON DE LANGE MBBS FFARCS1

1 Department of Anaesthesiology, The University of Utah School of Medicine, Salt Lake City, Utah; and The University of Leiden Hospital, Leiden, The Netherlands

Address correspondence to: Theodore H. Stanley MD, Department of Anesthesiology, The University of Utah School of Medicine, 50 North Medical Drive, Salt Lake City, Utah 84132.

We measured and compared the anaesthetic requirements, incidences of chest wall rigidity and intraoperative hypertension, and time for recovery from anaesthesia after high dose fentanyl-oxygen anaesthesia in patients with and without histories of smoking, alcoholic intake and caffeine consumption who were undergoing coronary artery bypass grafting operations. Patients without a history of smoking and alcohol or caffeine intake required less fentanyl for induction and maintenance of anaesthesia and experienced less chest wall rigidity and hypertension than similar patients who had been chronically exposed to and/or consumed these agents. Pretreatment with more pancuronium (1.5 vs 1.0 mg/70 kg) prior to anaesthetic induction and increased fentanyl (3 x vs 1 x the "sleep" dose) administered after anaesthetic induction but before incision reduced the incidences of chest wall rigidity and intraoperative hypertension in patients with positive histories of exposure to the agents to values similar to patients without histories of exposure. Our findings suggest that population habits may affect the incidence of undesirable side effects during high dose fentanyl anaesthesia but that modifications in anaesthetic technique can minimize or eliminate these problems.

Key Words: ANAESTHESIA: cardiovascular • ANAESTHETICS, INTRAVENOUS: fentanyl • BLOOD PRESSURE: drug effects, hypertension • SURGERY: coronary artery bypass grafting operations






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Copyright © 1984 by the Canadian Anesthesiologists' Society.