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Canadian Journal of Anesthesia, Vol 33, 475-483, Copyright © 1986 by Canadian Anesthesiologists' Society

Haemodynamic and Plasma Vasopressin Responses During High-Dose Fentanyl or Sufentanil Anaesthesia

A. J. BOULTON MB, CHB FRCPC1, N. WILSON PHD1, K. W. TURNBULL MD FRCPC1, and R. W. YIP MD FRCPC1

1 Department of Anaesthesia and the Department of Physiology (Dr. Wilson), University of British Columbia, Vancouver, British Columbia

Address correspondence to: Dr. K. W. Turnbull, Department of Anaesthesia, Vancouver General Hospital, Room 3200, 910 West 10th Avenue, Vancouver, B.C. V5Z 4E3.

This study compared the haemodynamic and arginine vasopressin responses of patients to fentanyl or sufentanil anaesthesia for coronary artery bypass surgery. Fourteen normotensive patients with normal left ventricular function were studied. Patients were induced with fentanyl (N = 7) 37.5 µg·kg-1 or sufentanil (N =7) 7.5 µg·kg-1 by intravenous infusion over three minutes. Clinically important chest wall rigidity, bradycardia and recall of intraoperative events did not occur. All of the fentanyl patients became hypertensive after induction and five required vasodilator therapy since they did not respond to boluses of fentanyl (12.5 µg·kg-1. Two of these five patients had S-T depression greater than 1 mm. Five patients in the sufentanil group became hypertensive after induction. Four of these patients responded to additional sufentanil (3.75 µg·kg-1) while one required vasodilator therapy for concomitant S-T depression. Sufentanil attenuated the increase of arginine vasopressin during cardiopulmonary bypass. Levels of arginine vasopressin in the fentanyl group were significantly higher than those of the sufentanil group during bypass. Levels of AVP after bypass were higher in the sufentanil group.

The incidence of hypertension was similar in both groups. The hypertension was more easily treated with sufentanil but concomitant vasodilators (nitroglycerine) were required in both patient groups. Neither fentanyl in doses up to 128 ± 8.7 µg·kg-1 nor sufentanil in doses up to 23 ± l.4 µg·kg-1 can be used as sole agents for anaesthesia in adult coronary artery bypass patients with good ventricular function when induction times are three minutes and bolus top-up doses are used.

Key Words: BLOOD PRESSURE: drug effects • ANALGESICS: fentanyl, sufentanil • COMPLICATIONS: hypertension • HORMONES: arginine vasopressin






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Copyright © 1986 by the Canadian Anesthesiologists' Society.