COMPARISON OF REMIFENTANIL AND FENTANYL ANAESTHESIA FOR CABG SURGERY
Abstract
Background. Haemodynamic response to surgical stimulation can cause myocardial ischemia, especially in a patient with coronary artery disease. This paper presents a comparison of the haemodynamic stability during induction of anaesthesia, skin incision and sternotomy for CABG surgery in patients with ischaemic heart disease receiving remifentanil-propofol or fentanyl-propofol anaesthesia.
Methods. 54 patients undergoing elective CABG surgery were studied. Included in this study were patients younger than 75 years, with a score of 2–3 according to NYHA classification, and whose ejection fraction of the left ventricle was more than 40%. For induction of anaesthesia, the patients received propofol 6 mg/kg/h and pancuronium 0.1 mg/kg i. v. The patients were randomly divided in two groups. The R group received remifentanil 0.5 µg/kg/min while the F group received fentanyl 5 µg/kg i. v. Five minutes after the induction of anaesthesia the patients were orotracheally intubated and artificially ventilated with a 50% air and oxygen mixture. After the orotracheal intubation remifentanyl was decreased in the R group to 0.3 µg/kg/min and five minutes before skin incision it was increased to 0.5 µg/kg/min. In the F group the patients received fentanyl 5 µg/kg i. v. Invasively and continuously the mean arterial pressure and heart rate were measured 10 minutes before anaesthesia, during the induction of anaesthesia and 30 minutes after the skin incision. The need for phenylephrine and nitroglycerin was also registered during these period.
Results. No differences were established between the groups with respect to demographic and preoperative data. The incidence of increased mean arterial pressure and the use of nitroglycerine during induction of anaesthesia, skin incision and sternotomy for CABG surgery was statistically significantly higher in the F group than in the R group. The incidence of decreased mean arterial pressure and the use of phenylephrine for regulation of mean arterial pressure was equal in both groups. There were no cases of tachyarryhthmia or bradyarrhythmia in any of the groups. After induction of anaesthesia, the mean arterial pressure and heart rate decreased statistically significantly in both groups as compared to the baseline values. After orotracheal intubation and after skin incision, the mean arterial pressure and heart rate increased statistically significantly in the F group as compared to the R group.
Conclusions. Our study shows more stable haemodynamics after the induction of anaesthesia, skin incision and sternotomy in patients receiving remifentanil-propofol with respect to patients receiving fentanyl-propofol in CABG surgery.
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